The doctor will see you now: online video consultations

In the final of our three-part healthcare series, we take a look at how subscription teleconferencing applications across the world are bringing consultations out of the surgery.

As healthcare delivery continues to face disruption well into 2021, teleconferencing channels will enable the healthcare system to maximise its capacity and patient engagement.

Previously, much of the impetus for establishing telehealth infrastructure was to serve isolated populations, such as the indigenous peoples of Alaska or island dwellers of Vanuatu. Now, GP surgeries, hospitals and mental health services around the world are offering patients personal video consultations. Even lockdown darling Zoom is getting in on the action with a dedicated plan for medical practitioners.

At the onset of the outbreak in China, Ping An Good Doctor, the country’s leading digital health platform, saw registrations grow by 10 times, with Alibaba’s Ali Health and Tencent’s WeDoctor also offering virtual consultations and treatments.

In the UK, digital transformation of healthcare was being driven by NHSX for some time before the COVID pandemic. Providers such as EMIS Health, TPP and Vision Healthcare are providing free tools for practices, while primary care networks can procure videoconferencing software from a pre-approved list of providers under the GP IT Futures Digital Care Services framework.

eConsult remains the most widely used platform for NHS online consultations, accessible to over 26.5 million patients at more than 3,000 GP practices, encouraging “triage and remote closure of minor conditions” according to GOV.UK’s Digital Marketplace. Though they are now far from the only platform available to practitioners; patient communications provider accuRx built and launched its own video conferencing tool over a weekend.

For elderly patients or those requiring shielding for the duration of the pandemic, access to telehealth services is vital; according to Immedicare, one of the UK’s providers of telehealth services to nursing homes, video technologies enable practitioners to assess patients without needing to put themselves at risk. With their teleconferencing software, clinicians can diagnose common complaints, including falls, suspected urinary tract infections, and skin complaints.

In our last report on subscription healthcare, we mentioned Babylon, a Fulham-based practice offering telehealth services augmented by AI-powered medical advice. Last year, Babylon acquired a further $550 million from Saudi Arabia’s sovereign wealth fund, reportedly the largest-ever fundraise for a digital health provider in Europe and the US, and in May 2020, expanded its service to millions of patients in New York.

However, a Panorama investigation in February found the service’s much-vaunted AI triage chatbot to be “significantly less safe” than a GP, not detecting symptoms of common ailments, such as heart attacks. The service suffered further embarrassment in June when a data breach let users access private recordings of other patients’ consultations.

Babylon has attracted a large cohort of young, tech-savvy individuals with fewer complex health problems – thus more profitable patients – sapping them away from their local practices who are then left to deal with older patients with more difficult health problems in the process. This has led to accusations of “destabilising the local health economy” by concentrating the costs of elderly care in other clinics while “deskilling” those responsible for treating Babylon’s healthier patients. Although it could also be argued that this is exactly how technology should be used – streamlining the diagnosis of minor ailments and allowing the specialist practitioners to deal with more complex cases.

Internationally, healthcare companies are looking to expand the reach of their provisions. Teladoc, the US’ first telehealth company, saw virtual consultations nearly double in Q1 of 2020. Its $18.5 billion merger with Livongo, who specialise in chronic care, will create one of the largest digital health companies in the world, already operating in Europe, Asia and South America.

In Sweden, KRY (known internationally as Livi) announced €140 million in funding to expand its influence in Europe and bolster its online appointment provisions. Going hand-in-hand with this is its acquisition of Helsa, one of Sweden’s largest healthcare providers, proving that a physical infrastructure is still crucial to delivering patient care.

In contrast, Italy was blindsided by COVID, and a lack of telehealth infrastructure meant that the country was slow to deploy digital services. Several contributing factors have been cited, including lack of funding for digital health by public health, no integration with patient record systems, as well as regulatory issues.

Telehealth’s benefits lie beyond merely diagnosis of ailments; many clinicians have noted telehealth’s capacity to give an insight into patients’ “social determinants of health,” such as physical environment and financial circumstances, which can reportedly determine 80% of a person’s wellbeing.

Medical professionals have, however, stressed that telehealth is not a replacement for in-person consultations and physical examinations, and with the second wave of COVID gripping many communities, the Royal College of General Practitioners stressed that those needing face-to-face treatment should not avoid seeking it. With COVID however, compromise has to be made to accommodate those in need of medical attention.

Telehealth has the potential to increase access for patients in underserved areas, save time, and even eliminate the need for visits in some cases completely, all at lower costs. A 2018 study by NHS Calderdale Clinical Commissioning Group found that telehealth could slash healthcare costs by £1 billion and cut hospital admissions by up to a third. Conversely, a previous study by the British Medical Journal found telehealth services added 10% onto costs.

A subscription or usage-based telehealth model – paid for either directly by the patient, or free at the point of use and paid for via taxes or health insurance – would lower barriers to access and likely lead to increased use, provided that the necessary infrastructure and support for medical practitioners are in place.