In practice, the use of video technology may be as simple as two clinicians discussing a case via Skype or as complex as bespoke video technology linking GP practice teams with care homes, such as is happening in Staffordshire.
Increasingly, there is a need to explore the use of readily available platforms such as Skype or FaceTime, which offer the potential for interacting directly with patients. This could be as part of a self-monitoring programme or an asthma review consultation.
Virtual consultations are increasing
Several large consulting firms have forecast that virtual physician visits will soon be the norm in the USA. Deloitte has reported that as many as one in six doctor ‘visits’ are already virtual.
Care at a distance or ‘in absentia’ care has been running for years in different manifestations; but as technology develops the challenge is to radically change the way health services are delivered.
As pressure builds from the bottom up, the system itself will be under pressure to meet the new ‘digital native’ patient who wants to email and Skype the nurse as well as monitor their own health through wearable technology.
According to a report from Tractica in the USA, the extent of telehealth video consultations across the globe is increasing. Starting from a base of 19.7m consultations in 2014, Tractica forecasted that the market will expand to 158m sessions performed annually by 2020.
This presents the UK health and social care systems with a challenge. Can we deliver this form of service delivery? Might patient or service user safety be at risk if video consultations are substituted for face-to-face care? Is the increased efficiency and productivity expected from Skype or video consultations worth the effort?
Benefits of video consulting
In many situations, the use of video technology offers benefits as an alternative to traditional face-to-face support including the following:
The use of video can be a great option for patients where travel is difficult. It can be particularly beneficial for those in isolated communities where public transport access is limited or where travel to large cities may be a daunting prospect. A good example could be a weight management clinic with a high number of young mums on the register where childcare is an issue for them so Skype or FaceTime could help connect them to a health professional from their home.
Besides doctor-to-patient communication, video conferencing allows hospitals to create networks to provide each other with support. By easily sharing their expertise outside their own organisations, medical or nurse specialists can offer incredible value to health or social care colleagues.
Reducing the spread of infections
Remote consultations can eliminate the possible transmission of infectious diseases between patients and medical staff. This is particularly an issue where spread of flu or MRSA is a concern.
A remote consultation via video link will not only relieve the pressure of the patient visiting the health practitioner, which can be daunting for some, but also ensures that those with phobias do seek medical help if required.
The use of video consultations can also be linked to self-monitoring equipment to ensure that patients or service users are using the equipment properly to take their readings.
Risks and barriers
The downsides of using video technology include the cost of the equipment and training for staff. A ‘train the trainer’ approach will encourage adoption by cascading learning throughout the organisation.
Virtual consultations may also lead to decreased interaction with the health practitioner, so forward planning is required to determine the types of intervention where remote consultations will be used. This is also important to ensure that remote consultations don’t become another additional pressure on the organisation.
For video consulting to work effectively and become embedded within day-to-day practice, it has to show that it is saving time and reducing pressure and the cost of health or social care usage as well as improving the quality of services. This will allow clear business cases to be developed to roll out its use.
There is a school of thought that suggests virtual consultations can lead to overprescribing as the health practitioner errs on the side of caution. The set- ting of clear parameters for clinical protocols from the outset can address this.
A key barrier to adoption will be internal cultures within an organisation. Concerns about security will often be at the top of the list.
When developing a case for use of video consultation, it is important to acknowledge that most interventions carry a risk. The use of postal services, telephone consultations and email are not without risk either. The key is about managing the risk at a level that your organisation feels comfortable with.