There is no more critical industry to support us through COVID-19 right now than healthcare. There are doctors, nurses, healthcare practitioners and clinics putting their lives on the line right now to protect us from the swarm and spread of corona throughout the world. While the industry struggles to cope with the tidal wave of patients and staff who have had their healthcare and lives severely impacted, medical misinformation about COVID-19 runs rife online further buoyed by confusing directives given by frantic governments. That’s why it’s more important than ever for clinicians to find new and more effective ways to communicate with patients and staff during this global crisis.
On Friday, the 27th of March, MessageMedia moderated a panel discussion with Head of Channels Anthony Girgis and medical software provider Genie Solutions consultant Dr John Lambert to discuss vital questions affected healthcare right now some of these questions:
- What can clinics (frontline or not) do during this crisis to help each other, their patients and their staff?
- Is telehealth and telemedicine the future of healthcare?
- How can this pandemic change the way healthcare practitioners conduct their services?
- Are these changes a good thing for clinics, doctors and aged care?
Let’s dive in.
[Please note: This recap has been condensed for easier readability.]
New Way Forward for Healthcare: Telehealth, Telemedicine and Personalised Medicine
Q: What are you finding with customers as this crisis has unfolded? What are they asking about from a healthcare perspective?
Anthony Girgis: The traditional ways of communicating through appointments and the like have been ingrained for a number of years now. What we are starting to see through this pandemic is that are clinics using more update-based text notifications such as if someone is experiencing symptoms, they are told not to come into the clinic, and to respect things like social distancing and the well-being of the doctors and others.
There’s also a really big push to drive the telehealth and telemedicine side of things, which has been on the cards for quite a while. This pandemic has really accelerated the process for solution providers, software providers and even individual clinics to look at what they can do to provide telehealth services to their patients, and text-based or SMS messaging is being used to tell people that this is an option now.
There’s also the additional use of messaging services to send links and reminders out for patients to dial into their telehealth appointment in order to have the consultation with doctors and specialists and so forth.
Q: Dr Lambert, as a clinical advisor – what do you think clinics and health practices are facing right now?
Dr. Lambert: It’s a blend of overwhelming information and confusion, and not the information you require when you require it. People are talking to us all the time, but do we understand what is going on? Do we have the information we actually need to conduct our practice or as a patient to get our healthcare in the best way possible for us?
Q: How do you see things changing day to day, week to week with providers out there in the healthcare space?
Dr. Lambert: Healthcare providers are an essential healthcare service. They’re not going to stop functioning by choice anytime soon. However, to think they are not impacted by the lockdown is crazy because staff are affected. Members of their family might be in isolation; they might be caring for other family members or children not being in school may mean they aren’t able to come into work as readily.
“Every practitioner is looking hard at their practice and asking themselves ‘How much of what I do can I do without physically being in the same space at my patients?”
There’s definitely going to be an impact on the team inside the practice, such as the bigger issue of seeing clinicians in the flesh or the difficult logistics in getting personal protective equipment. Not surprisingly, every practitioner is looking hard at their practice and asking themselves ‘How much of what I do can I do without physically being in the same space at my patients?’
Q: Dr. Lambert, have you had much involvement in the telehealth side of things with hospitals, clinics and solution providers?
Dr. Lambert: I had extensive involvement with delivery of healthcare via telehealth during my days as an intensive care specialist. Almost 15 years ago, I was working out in the rural area of Orange, providing a support service to hundreds of GPS and small sites in remote NSW. I’ve been acutely aware of what helps telehealth be a success and what often causes telehealth not to work.
Q: How is telehealth evolving in the industry thanks to COVID?
Dr. Lambert: One of the ‘great’ things about the COVID-19 epidemic is at least we now have a very strong driving force for people to try new things and to do things differently. Many clinicians were already quite happy in their established ways. If you were a busy clinician who’s already got a full booking list, why bother risking that or adding anything to your mental workload by having to deal with telehealth? Interestingly, we were able to deliver telehealth support for the most acute of conditions. I’m an intensive care specialist by training, and during my time we were supporting other clinicians providing healthcare in remote locations to the peak of critically ill patients, and so if you can do that effectively, everything else is theoretically possible.
I guess that is one thing we haven’t heard a lot of discussion about from the media is clinicians helping other clinicians to do their job. For instance, you could argue that specialty care (excluding mental health) has a higher requirement for physically seeing and touching the patient. However, one mode of care that hasn’t been discussed as much, is to have the patient being seen by a GP or another specialist in another location and providing support to that clinician rather than directly to the patient. Telehealth support clinician-to-clinician to support the care of a patient is also a modality we’ll probably see more of once people get their heads around the basics.
Q: What are the first things you’re recommending to clinics and practices do in lockdown?
Dr. Lambert: The key responsibility that clinicians have to give is customised information to their patient groups of interest. We’ve all heard of personalised medicine but it’s not about loading me up with a whole lot of messages that don’t apply to me. I think practitioners with digital practice management solutions are in a great position to craft these messages.
“The key responsibility that clinicians have to give is customised information to their patient groups of interest.”
Cardiologists are a really key group. One of the things going around the net right now is the risk to people who have hypertension. Cardiologists who are managing patients with hypertension, I think they should be isolating those patients in their database and messaging them directly, telling them, ‘Don’t stop taking your ARBS! Don’t stop taking your ACE inhibitors!’ It’s extremely vital that you continue, and the evidence does not say that you should not take those medications.
What about all the long QT patients? Most patients with arrhythmia will go to cardiologists, they should be saying to them for god’s sake please don’t listen to the rubbish on social media about chloroquine, or any of those other medications that prolong QT. You may literally drop dead if you take these meds so don’t take them.
For respiratory clinicians:
You’ve got respiratory clinicians who want to make sure their patients are up to date with their asthma action plans and are taking their preventatives. It’s absolutely imperative that you take your steroidal preventatives because if you aren’t up to date with those, and then you get sick – you’re in twice as much trouble then if you’d be taking them regularly.
Geriatricians should update their patients on how keep safe in isolation. All of their patients are in a high-risk group for COVID. I think they also have an ability to be aware of community support offerings for aged people. Make sure your patients actually know about the existence of these services and help them tap into these resources. Supporting them to access these services if required.
For mental health practitioners:
If I’m a psychiatrist, you don’t want to send a generic message out to all of your patients. You need to be thinking what message do I want to give my anxiety patients? What about my schizophrenics? What about all the various subtleties of mental health? You really want to pick out those patient groups and send targeted messaging in order to help them deal with this issue. Agoraphobics are probably going to love COVID-19 but patients who are scared of being cooped up aren’t going to do so well.
‘The vast majority of your people are not going to be sick with COVID-19, and they need advice on how to stay that way.’
Helping combat rife misinformation and rubbish on social media is a key responsibility for clinicians. I would recommend staying within the domain of your expertise. Focus on, ‘I’m a specialist in X, and I’ve got patients in subgroups A, B and C. What can I add to their understanding of this and help make them safe?’ I think that’s the priority right at the moment. While the vast majority of your people are not going to be sick with COVID-19, and they need advice on how to stay that way.
Q: What would be some key considerations for rural practices and clinicians?
Dr. Lambert: I can tell you that everything a rural-placed practitioner does to remotely deliver their practice using the tools that are now available as a response to COVID will be wonderful for the long-term. Some people are saying that once clinical staff are used to it, this will change the delivery of healthcare forever. I’m not so sure that’s the case universally but in the rural practice, it probably should. If you work out you can actually conduct a 1/3rd of your practice using remote technology, why would you not continue that?
‘If you work out in this epidemic that you can actually conduct a 1/3rd of your practice using remote technology, why would you not continue that?’
Q: MessageMedia is speaking with a lot of customers who are using messaging as a tool to deliver telehealth to their patients. It’s been heavily accelerated by what we’re seeing today across the world. Do you think it’s one of those things whereby it’s been a forced shift from how we used carry out healthcare?
Dr. Lambert: I’m a strong believer in ‘What’s in it for me?’ If people are forced to do this sort of uncomfortable thing, and then they discover that it’s good for them, it’s good for their patients, it’s good for their practice – in fact, their life is better. If they’re finding that it’s really easy to do things remotely, it’s more likely to stick.
You may find that okay, we’ve got ten sessions a week at this practice. Maybe they’ll start thinking that three of those sessions could switch to telehealth rather than face-to-face. If you’ve got a really slick environment, you might be able to interweave telehealth appointments with face-to-face appointments, and that may do some good with your waiting room queue management.
Q: Do you think it will stick – this ‘uberising’ of the healthcare experience?
Dr. Lambert: I do want to talk about waiting rooms. I can assure you, as a doctor, that so much care is about touch. It’s about feeling things and that doesn’t transport very well over the video connection. If I want to look at your big toe over video, it’s much harder and patients don’t know anatomy. There’s a whole lot of reasons why a whole lot of healthcare is never going to be done remotely. Maybe when we have really cool VR headsets for everybody?
What about what you can control which is when they come into your practice? I think the days of full waiting rooms should be thrown out and I hope they never come back after this. The biggest problem with COVID19 is keeping people in a room together, so why do we have waiting rooms? What is the point? Why not manage all of that remotely? Why not have people with dynamic updating lists of what’s happening with the doctor? How delayed they are? Whether they are ready for you or not? Why not get a message three minutes before the doctor has finished their appointment or even as they close off the appointment? By the time that patient leaves the consulting room and goes out to the front desk, the patient could have got out of their car, and come straight in. Then there’s absolutely nobody in the waiting room except for the two patients crossing paths.
I think another thing that will change is people looking at their waiting room designs and seeing if they can spread them out or have multiple sub waiting rooms. It will probably become a trend. On top of that, it will be a great opportunity for us to learn from 200 years of engineering about queueing management. There are better ways of setting up your appointment bookings so that patients don’t wait as long.
‘I do feel that there will be greater use of telehealth where it is appropriate in the practice and that’s going to vary depending on the practice.’
Even if you can’t organise yourself perfectly, you could implement real-time updating for patients so that they know when you’re ready and when they should come in so they’re not sitting around in your waiting room. If you’re in a shopping centre or something, where there are things to do outside the practice but are still close by, why not let the patients do that? I really do hope that better management of wait times will be a permanent feature of benefit from this process. I do feel that there will be greater use of telehealth where it is appropriate in the practice and that’s going to vary depending on the practice.
Q: What do you see are the later impacts from a healthcare point of view on the industry due to the likes of COVID?
Dr. Lambert: I’d like to think from a broader scale it creates a better culture of data sharing and information standardisation. A lot of the challenges we are facing at the moment exist because we just don’t know enough about this bug. There is quite a bit of sharing but pre-stated consent models and approvals for sharing information in pandemic situations should be required.
Even just this little suggestion I’m making about targeted messaging, how many practices have codified their records to allow for targeted messaging? How many have put their diagnoses into their PMS so that they can do this sort of messaging? I suspect not as many as there should be, and this is a great time to start thinking about doing it because now you can see the value. Maybe some practices can start sorting their cohorts by diagnoses so that the doctor’s preference for an appointment is a video consult not a face–to–face.
I think better codification for better communication bracketing and targeting will be one thing I’d like to see long term. A greater collaborative and sharing mentality in the health system would be a wonderful outcome, and there may even be other benefits in terms of working from home. People don’t tend to think about working from home in practices, but I used to sit in a lot of practices and there were people in the practice who didn’t have to physically be there. Whether they were transcriptionists in the background, accountants, practice management specialists who were part–time not full-time. Practice collaboration tools like Microsoft Teams, Slack, Hangouts etc are getting incredibly powerful too.
‘I think better codification for better communication bracketing and targeting will be one thing I’d like to see long term.’
You may find your staff will be happier and will be able to have a more productive team if you take some elements of working from home and allow them to continue after this event. We’re talking the long-term but I’m also thinking the intermediate term, there’s the next 6 – 12 months and we may all be in lockdown apart from the practices. How are we going to deal with that when your staff are supposed to be in lockdown? Do they really have to be in the practice or can you provide tools to allow them to do that?
Q: What is the number one concern you’re hearing from general practices clinics and allied health clinics?
Dr. Lambert: That’s not one I can easily answer. What I would relay is the concern about personal protective equipment (PPE), and the practicalities of managing patients in a waiting room that isn’t designed for social distancing. That’s one of the reasons I’m talking about appointment book management and real-time updating of appointment and waiting room statuses. All PMS vendors and messaging providers can do to help paid practices deal with that challenge would be really helpful.
‘Those are the two issues that I have seen: PPE and the safety and management of staff and patients coming to your practice.’
From the friends I collaborate with who are doctors and allied health professionals, it’s not necessarily the government has not given out a lot of conflicting information. It’s the augmentation or rather the ‘additions’ by mass media, social media, and other purported authorities and that causes great confusion. I think it’s improved now but we had the Australian Medical Association (AMA) contradicting the government at one point. We had a lack of clarity what states were doing what as well as the federal government, so that’s made it really hard and again.
Q: Another big part of our audience today are aged care facilities, what are some of the things as a clinician you would be recommend enacting now in order to protect their residents?
Dr. Lambert: It’s a really hard situation. While I was Chief Clinical Information Officer at NSW Health, I kept raising issue that while we were doing such a great job digitising public hospitals and practises, what were we doing about aged care services? I visited quite a number in South Australia, NZ and the UK recently. It’s tragic.
If you said to them, make sure your aged population have access to methods of communicating with their families if they can’t come and visit, they’re shocked. They haven’t got Wi-Fi, let alone tablet or computers anywhere. People are often relying on 4G or 5G etc. It’s important as a lot of residents are in aged care because they can’t manage themselves. Working out protocols where you can help provide some sort of engagement for people in these places is critical. For many people in aged care homes, the primary thing they’re living for is that connectivity with people.