Why is telephone specifically being excluded from discussions about telehealth? Despite being reassured that telephones (i.e., audio-only, landlines) are indeed “absolutely a key telehealth tool” by staff of NZ Telehealth, telephone is excluded from the definition of telehealth on the website.
Today, I learned that indeed, key leaders in the telehealth space believe audio-only delivers less quality care than video. This really concerns me for the following reasons:
Equity in all spheres requires embracing diversity because we are all diverse. This applies to technology. Just as paper-based communication is not going to disappear despite the digital age, telephone communication is not going to disappear . . it has stood the test of time, as has the printing press (unlike technologies like CDs, tape recorders, etc.).
Telephones are an important technology, and will be especially important for socially disadvantaged groups for the many reasons audio-only consults dwarfed video-consults during the Covid-19 lock-down here in NZ and in the UK: familiarity, access to video-enabled devices (both patient and provider), IT capacity to activate video software, access (geographic + cost) to data, patient privacy, etc.
The only groups who can determine what technology is equitable, are those who experience systemic disadvantage. Equitable technology cannot be determined by those with systemic advantage (e.g., the majority of us on this digital health forum).
There is no body of evidence (e.g., meta-analysis, large trials, etc.) that demonstrates video consults are better quality than audio-only. Please point me to any rigorous RCT to show me otherwise. Eventually, I hope we will have the RCTs to guide our practice for when highest quality outcomes are achieved via in-person vs audio-only vs video as we finally embrace telehealth (INCLUDING audio-only) as a tool of healthcare. Like all our tools, we need robust evidence to guide how we use these tools. Outcome measure must include PROMs (patient-reported-outcome-measures).
I am perturbed that digital health leaders are advocating a singular technology, that is higher-cost for patients and the health sector; has no rigorous evidence to guide decision-making; and, currently has no robust legislative protections for us as individual citizens. Conflicts of interest abound, as the IT vendor sector aggressively expands into health. This is abundantly clear in the US, and I’m increasingly worried about this journey here in NZ.
Hi Emily, thanks for the comments and email to NZTLG and sorry for the tardy response!! From our point of view we definitely do not exclude phone calls, email or texts these are very valuable TH tools.
However what we do need is choice and by in large the majority of the increase in Covid TH has been by phone. Text I agree really needs to come and I am confident it will once the issues of closing a conversation, funding and recalling/saving information is sorted. In fact I predict that will be the next new bright thing.
The response we had from the wider community is that video was required to be supported and fast. Arguably telephone is much easier, folk jumped on it quick and if we do not enable video clinicians may stay there. Thus the focus on video.
In terms of equity the NZTLG equity panel has morphed into something super and we hope there will be great news on that group going forward.
We have plenty of working groups and would love to get others more involved. Would you be interested in joining our primary and integrated care group???
I should also add that in our smart health work (including going to Walaa AMA festivals and our OPC) video was preferred and that is the overwhelming feedback from our Waikato patients. Personally I don’t think it is about ‘better’ but about patient (and clinician) choice
Agree The next step is to have evidence to help inform us all when their may be quality considerations when offering these choices.
Agree video needs to be enabled, but not at the expense of diverting scare resources away from other priorities. To know how to prioritise, we do need to be lead by an equity approach until we have roboust evidence to guide us. Look forward to learning more about the NZTLG equity panel
I concur 100%
During lock down I only used the phone. Pretty much all patients have one and know how to use it for voice and TXTing pictures. mucking around with video works well with ZOOM where all members have the tech but if one could imagine a busy clinic having a HCP move from room to room in my experience would need a tech going from room to room in-front of the HCP to be sure the tech was set up and working and the cost does not offset the usefulness in my opinion. I guess some will call me a Luddite and want me excluded from discourse for my opinion but there needs to be shown there is significant gain here. has anyone else had the tech up and running well previously but failed to get into a ZOOM meeting despite this and resorting to a PC which you discover has no mike or camera and finally joining the meeting late on their third try with the cellphone.
I think that’s a good example of why we must make it easy, easy isn’t always best for patients though and overwhelmingly the mrsssfe from patients is that they want the option to video conference and ‘see the whites of the eyes’ of the clinician.
Is this a published finding? I agree patients likely prefer in-person, but video and in-person are different. Video means clinician is ‘seeing’ into a space that is normally private for the patient. Their home and the clinician’s room are different places. For safety reasons, a patient may need a telehealth consultation in a place that’s not appropriate for video (e.g., toilet), as this is only place patient can have privacy. There is also the clinician-perspective that needs to be understood. I don’t think it’s about being a luddite . . it’s about recognising that video IS NOT in-person. It is part of a suite of telehealth telecommunications, that also includes telephone.
I totally agree video-consults require an increased capacity. However, this needs to be evidence and equity- based, not industry-driven. How we increase this capacity is important . . and, it may be about enhancing telephone telehealth first, to understand the quality considerations, then introducing video as a supplement.
Regarding phone consults. I had the fortune or otherwise to engage with our own system as a patient during lockdown. I has 2 telephone consults and I was impressed with the clarity I came away with. And following this, the expediency of tests and then feedback on outcomes and next steps.
I was surprised to find that I felt considerably clearer about the conversations than when face to face.
It has me pondering on the impact of the distractions in face to face, and possibly video consults. Of course this is only relevant when a physical examination isn’t required.
With selective triaging for a first stop consult, and as a follow up consult, phone could be highly effective at ensuring people are consulted with in a safe timeframe.
Phone is extremely convenient – I was in a supermarket car park for the first consult - and is without technology fails or the added logistics of car parking and venue finding
Thanks Emily. That was a fantastic post. It does appear that, for many, telehealth equal video consulting. Video consulting is actually quite hard to due to clunky software solutions, provider resistance and currently no widespread usage of video interactions in general. I agree that telephone work is something that is already very comfortable for all of us and less likely to lead to inequalities related to bandwidth, data credit, device ownership and process changes.
In New Zealand the Health Care Home practices have embedded telephone based brief clinical triage which works very well by telephone and provides a new way of accessing care, in my view 100% telehealth. We also use patient portals for personal care planning, advanced care planning and day-to-day interactions for patients with their own records and their general practice care teams- this is also telehealth.
In my view none of the work I do is “virtual”. Maybe it’s not in-person face to face but it’s 100% real with different strengths, whether it’s brief triage, video/phone consults or portal work. Many of these modes are types of telehealth which can increase equity if travel and cost issues reduce for patients. Video consulting will find it’s place but is a tiny subset of what should be viewed as telehealth
Telehealth clinician patient interaction can occur accross multiple platforms, these include written interaction (text/email etc) audio, static images and video.
Accross htis smorgasbord of options clinicians and patients will have their preferences. A third factor is clinical requirement.
Leaving the most common form of telecommunication from the smorgasbord is wrong.
To use all modes of telehealth, especially video, fast broadband internet services are required. Telehealth can be delivered across landlines, over text messages, and with even intermittent access to the internet.
Is it worth introducing concept of asynchronous vs synchronous telehealth?
telephone - can discuss audio-only + text messages
patient portals
Suggestion: Video consultations are the most commone type of telemedicine in New Zealand for . . . . (ideally, site a reference) Given the addition of visual information, in real-time, that is afforded by video technology, efforts of NZ telehealth are focused on ensuring access to video telemedicine is equitable for all New Zealanders.
Personally, I think efforts should be equally, if not more, focussed on improving access to and quality (e.g., read-write functionality; based around patient goals and patient-centered care plans; etc.) of patient portals as this is the game changer, in my opinion
This is a great read and interesting discussion. I have noticed that for the CM evaluation of Telehealth during COVID-19 and for one I’m currently working on through CCDHB, the most commonly used medium by far was the telephone. For me, I thought this to be a little disappointing that we won’t have a lot of information about how well video did or didn’t work, but I quite like your perspective here and it may be useful to have these evaluations which are almost entirely about PROM and PREM for “traditional telephone as a delivery method for healthcare”.
There is a patient based research survey being developed with input from NZTLG primary care group of clinical informaticians which is exploring the patient experience of digital consult @i.hunter is leading this work. Inga based on this thread and topic maybe the telephone questions in survey remain a significant contributor
Kia ora @grahame.jelley . . .yes, wiki’s can be edited directly but the reason I posted as a quote is that the quoted bit is directly for the existing website: https://www.telehealth.org.nz/telehealth-forum/what-is-telehealth/
My thinking is that people select relevant wording → select quote feature → suggest edits/modifications. Otherwise, may be difficult to tell what’s original vs what’s a suggestion. Ultimately, these are ideas that NZ telehealth may or may not consider . . . so, thought it would be easier for them to identify suggestions as individual posts??
So, look forward to other ideas/suggestions and easy enough to start new wiki, if that’s best approach.
Another thought: Perhaps ‘digital health’ should be distinguished from ‘telehealth’. Upon reflection, what NZ Telehealth is advocating for is increased ‘digital health’ access . . . which, indeed, is an important area to focus efforts. The discussions above reflect that the digital component of telehealth has a long way to go. I still think non-digital telehealth will always have it’s place, but thinking about digital health as a sub-section of telehealth is helpful to me.
The next step is to have evidence to help inform us all when their may be quality considerations when offering these choices.
→ suggest edits/modifications. Otherwise, may be difficult to tell what’s original vs what’s a suggestion. Ultimately, these are ideas that NZ telehealth may or may not consider . . . so, thought it would be easier for them to identify suggestions as individual posts??