Telehealth is seeing a significant rise as a result of COVID-19, and has been accepted as a cost effective and safe tool for healthcare workers at risk of exposure. There is no single agreed legal definition in the United Kingdom, regulators in various jurisdictions apply different definitions. In broad terms, telehealth encompasses any healthcare service provided remotely, typically through information and communication technology.
The UK health secretary Matt Hancock has advised NHS GP’s see patients virtually by default, causing an increase from 25 to 71% in virtual appointments. NHSx has developed the digital technology assessment criteria in an attempt to create a screening tool to assess the quality and safety of digital solutions offered by companies, but there are as of yet no clear defined regulations or guidelines in place to guide physiotherapy practitioners through the field of telehealth.
Risk vs benefit?
The benefits of telehealth are multiple – it is convenient and comfortable for patients, allowing them to be seen outside of potentially scary clinical settings in a hospital (surrounded by other sick or infectious people). It is less hassle for patients with mobility problems and those in rural areas and requires fewer resources to run (after making upgrades to IT systems which, to be fair, can be very costly). With its lower travel rates it is sustainable and good for the environment, and allow for practitioners to collaborate via shared electronic patient records, digital imagery and files. Emergency department staff can also utilise video-link with trauma specialists for instant access to life saving competency, and other speciality providers can provide ‘tele assistance’ to health care staff through supervision, guidance, virtual diagnosis and treatment support.
More research is required into the risks and potential harms of telehealth. The most obvious being security and privacy risks for patients. Hospitals and clinics are prime targets for cyberattacks as they hold astounding amount of private health information (PHI). PHI can be used to extort and discriminate against patients if in the wrong hands. At present, UK laws and regulations do not specifically address telehealth.
There is a potential risk not being discussed at the moment related to the efficacy of telehealth assessments and red flags, as well as the accuracy of diagnosis. Some popular physiotherapy resources online have brought forward some updated information on red flags and online assessments as educational tools – however I have yet to read any published research on the prevalence of red flags since the recent boom of telehealth. This includes quantitative data such as close calls, missed flags, practitioner competency as well as more qualitative data such as patient satisfaction data - whether or not the patients feel comfortable, safe and if they felt the session went well. This latter data cannot be collected over the phone or during the session, as patients are unlikely to be completely honest with a practitioner they did not enjoy the session with for fear of reprisal or a reluctance to enter into conflict.
Crisis brings creativity ?
The pandemic has forced health workers to think creatively and develop innovative solutions to combat the risk of transmission through physical contact. Therefore, with the rise of virtualised providers has come a rise of virtual physiotherapy as well – often marketed as assessment and rehabilitation advice from the comfort of your own home. These services offer secure video calls, personalised rehab, feedback and progress tracking – a service that has traditionally been reserved for personal trainers working with clients towards fitness goals.
Kaia Health is an example – initially created for back pain, they are now a market leader in digital therapeutics across the globe with 450 000 users. It has recently introduced management of COPD and continues to look for innovative areas to expand into, such as a case review services, triage algorithms and interoperability across healthcare providers networks, in addition to coverage for all peripheral joints. Their business grew over 600% following the pandemic, and over 60 million people worldwide now have access to their services.
Physiotherapy is well placed to offer health and wellbeing services, in addition to assessment of injury and rehabilitation. The UK telehealth market is anticipated to rise at double digit of over 10% from 2020 to 2025 partly due to increased geriatric population and increased healthcare costs.
There are some considerations and precautions to take but this may be a good time for entrepreneurs interested in starting a small business to get involved in a booming market of virtual health.