In the wake of the demise of HotDoc’s Telehealth on Demand, what can we (re)learn about how to implement change? Let go of the status quo, for a start.
In mid-July, HotDoc announced the immediate suspension of its Telehealth on Demand pilot. Telehealth on Demand offered patients the option of booking a telehealth appointment with an alternative, probably unknown-to-them GP, in case their usual GP was unavailable.
The pilot’s end came after a slew of criticism by HotDoc’s clients – general practitioners – for whom the initiative represented an offensive attempt at fee undercutting, undermining continuity and quality of care, and doing so with no consultation.
HotDoc’s CEO Ben Hurst issued a “mea culpa” and pulled the pilot. Indeed, a platform provider siphoning off clients’ “customers” to competitors is eyebrow-raising business practice and it should have been foreseeable that GPs would be upset.
Presumably, however, HotDoc is genuine when they say the pilot came about for different, more wholesome reasons. Their real aim, according to recent communications, was to provide patients with improved access to care in a system where workforce shortages mean long waits for appointments for many Australians.
HotDoc is the platform of choice for my GP. Today I checked when her next available appointment is. It’s in 10 days. A long but common wait time in my neck of the woods.
How would I feel about the option to book a telehealth appointment with someone else? I probably wouldn’t have taken it because I value my GP’s understanding of my medical history, and I am selective about my healthcare providers. But who knows? Under certain circumstances, having the option would be welcome.
Is care by a qualified professional – even one we don’t have a relationship with – superior to delayed care?
It depends on the circumstances and individual needs. It should be the patient who decides.
In any case, if we had a truly connected healthcare system, many of our concerns about care continuity would be moot. Your health information would travel through the system with you, and everyone who needed access to it would have it.
In a world where access to primary care is increasingly compromised either because of appointment unavailability, distance or cost, how we view continuity of care will need to change.
Our willingness to change as a sector has already been tested. Unfortunately, we are conservative and protectionist a lot of the time. When it comes to system design, health holds onto the status quo more ardently than many other sectors.
Although there is no excusing HotDoc’s lack of consultation, is it possible they circumvented it because they viewed the rejection of the pilot as a foregone conclusion?
When the Scope of Practice Review was published, proposing the removal of unnecessary obstacles to professionals’ ability to practice at the top of their scope, it was met with alarm and resistance in some quarters.
By way of reminder, the review proposed the removal of systemic barriers the costs of which outweighed the benefits. For example, the need for a physiotherapy patient to go back to their GP to get a referral to an orthopaedic surgeon – an action the system should entrust to a qualified physio. Doing away with this would save the GP from administrative burden, the patient from the cost and wait for a low-value appointment, and it would capitalise on the skill and expertise of the physio.
The rationale behind the resistance is that these “barriers” ensure centralisation of health information and a higher degree of quality control. Without centralisation of health information, we risk fragmenting care and losing track of what matters for each patient. This outcome should indeed be avoided. But how we do it matters.
Related
Patients are poorly served if the principle of centralisation requires them to go through unnecessary obstacles and longer wait times to get the care they need. Instead, it should be facilitated by connected systems that share information among clinicians who need it, in ways that fit intuitively into their workflows.
At the centre of this model of information centralisation is the patient themselves.
So, what have we (re)learned from the Telehealth on Demand saga?
You need social licence to implement innovations that affect your stakeholders. Good consultation – in which both parties are culturally and philosophically committed to finding solutions – is necessary.
In so many ways (though not all) health is resistant to change. Those on the receiving end of new ideas and models of care should keep an open mind. Our system needs to evolve with a changing world, and the status quo won’t cut it for much longer. The first principle in considering whether an innovation has merit should be patient benefit.
Business continuity in primary care is a real and legitimate concern. Without thriving primary care businesses, we won’t have primary care. Innovators need to be conscious and respectful of these realities in solution design (particularly if those in question are their paying clients).
Would Telehealth on Demand have succeeded with better consultation, in which both parties recognised the root of the issue and the merit in finding a solution? Could changes in how the service was presented to patients, or how it was priced, have made it viable? Was a happy middle – in which GPs’ interests and accessibility to care were both supported – achievable?
The most important question is: are patients better or worse off?
Anja Nikolic is CEO of the Australasian Institute of Digital Health.