Post-Covid-19 Questions: Where Is The Balance Of Virtual Vs. In-Person?

13 May 2020

Zayna Khayat, PhD, Future Strategist at SE Health

Our legacy infrastructure, protocols, and capabilities were put to work overnight to accelerate the adoption of virtual channels. Many of the ways we did this were band aid solutions and workarounds that are simply not sustainable. Now that we realize that we will need to work this way for at least 18 months of "crisis." No one is talking enough about the investment that it will take to sustain these channels as a viable alternative to in person. Sustaining needs investment (cash, time) to rebase underlying systems, processes, etc. which almost no one in healthcare has right now given volume has declined across the board in nearly every sector.

Figuring out the balance of virtual vs. in-person given a new complicating factor of social loss of "touch."  As an isolated care exchange, it might make sense for a given encounter to be virtual. Still, as a whole, we lost a lot of in-person touch through this pandemic response, and we do not have a view of how much we need to overcompensate to physical to overcome that.

Can we use this new channel, which is so much more patient-centred, to shift the focus on "what matters to you?" instead of dealing "what's the matter clinically or physically?".  When you are invited into the patient's home, there is a lot more context available to deliver value from a care exchange. I just did a virtual visit for my son and a specialist to discuss suspected asthma. She got to see how we are at home in our native environment, how he behaves with mom and dad, what the home looks like, what the siblings are doing, how we live. She would have never seen that if we were in her clinical office.

Dr. Sam Shah, Digital Health Tech Advisor, Clinical Director at the Ivory Clinic

The post-COVID-19 era is likely to result in new needs for citizens, carers, and the health workforce. The relationship between State and citizen has been altered once again, and challenges in relation to data privacy will need to be rapidly addressed. Equally, we are reliant on trials for drug development, which will require a novel approach using digital tools to support patients beyond COVID-19.

Telehealth has been expanding rapidly during COVID-19, but this form of digitization will also place new demands on the health system. As clinicians opt for new ways of working, it may mean that working in traditional settings is less attractive, and a two-tier health system may emerge.

We need to shift the focus to "what matters to you?" from "what's the matter clinically or physically?

COVID-19 has increased the interest in telemedicine and devices that consumers can use to manage their own conditions. This has been an ongoing aim of many health systems, but what COVID-19 has demonstrated is that the infrastructure hasn't been in place to support these devices, which now needs rapid investment. The fragility of legacy EHR's was exposed during the COVID-19 crisis, and a future health system that is ready for the next COVID or anything similar needs to start tackling these legacy products and systems, many of which still rely on manual workarounds. Communication between clinicians at scale has been a feature of COVID-19 collaboration beyond borders locally and internationally. During COVID-19, we have relaxed many of the usual privacy and sharing rules. However, it's unlikely clinicians will go back to previous channels, so policymakers will need to do much more to support clinical communication.

Bart de Witte, Founder of the HIPPO AI Foundation and Digital Health Academy

I witnessed some potential domains that need a joint effort to keep momentum: the global community connected in incredible ways. Open data projects, open-source ventilators, open-source 3D printing, open access for papers – all the initiatives showed that when we have a joint enemy, we can collaborate, and we consolidate to reach a collective goal.

In a post-COVID-19 crisis, we need to define joint visions that keep us collaborating. Technology has shown that the world is hyper-connected. We see the evil parts, where people unite to create alternative truths, but we can see the power of positive connections. We saw the weakness of the current system and policies. They are not in line with the present digital world. We need to reorganize them, so our communities become more resilient and agile. Federal and local governments need to restructure and connect more with civil movements and create trust through more transparency. There is so much we learned, and so much opportunity for change. Something I do hope will happen prior to the end of COVID-19.