Many GP’s in Australia underestimate how popular telehealth is with our patients. The HotDoc patient survey found that 55% of patients who had a telehealth appointment in the last two months would prefer a telehealth to in-person GP appointments even when there are no COVID-19 restrictions. In addition, 68% of the same group of patients said they think their last in-person appointment could have been done just as effectively by telehealth.
You can see below what patients think are the most useful types of visits for telehealth (and keep in mind over 95% of telehealth is being delivered on the phone).
Patients rate receiving results by telehealth as their preference but mental health, seeing a new doctor, new problem, sick children and skin checks are not preferred. This would likely correlate fairly well with GP preferences. It would seem reasonable that video would enhance the satisfaction with these types of appointments.
For the month of June, 3.5% of telehealth consults are by video.
The uptake of video is subject to the law of diffusion. You might not be familiar with the law of diffusion, but I am sure you are familiar with terms such as innovators and early adopters.
The law of diffusion says that you must engage the innovators (2.5%) and early adopters (about 13.5%) before a new technology reaches the tipping point and is taken up by the early majority.
That is why marketing targets small markets segments. They are seeking to win over enough early adopters, so that they can transition a product or service into the mass market.
With the take up of video by GPs we have really only engaged the innovators, these are the people that will take up video regardless because the find it intuitive, and they believe it offers a better doctor/patient experience.
The early majority won’t take to video until they know someone who is doing video consultations and the laggards may never try video.
If we are to engage the early adopters what are the issues that video needs to overcome? There is an interesting paper from 2017 that may have some insights. This study aimed to identify the challenges for service providers transitioning from audio to video for the Pregnancy, Birth and Baby (PBB) helpline, which is operated by Healthdirect which us a non-commercial, government funded health information service.
In 2014, the PBB telephone service was expanded to include a real time video conferencing capability (VCC). Video was viewed as offering advantages over the telephone service, such as access to callers’ non-verbal cues and visual information, supporting the establishment of greater rapport and trust with service users.
Overall, providers were quick to identify potential problems with video implementation, and some participants at the PBB struggled to identify any benefits of using video. For example:
Video is “stressing a lot of the staff. There are staff who are trying desperately to avoid it.”
All participants at the BPP believed that uptake of the video service would be poor. Some providers felt that clients may struggle with the new technology, even though up to 90% of Australian own a smart phone. Others highlighted the inability of service providers to multi-task while on a video call in comparison with the telephone, and the extra time needed to connect to the video service.
System design issues were identified, including camera positioning problems, difficulty with the logon protocols, technical issues associated with transferring calls from one provider to another, difficulty with quickly locating decision support tools while on a call, and the absence of effective aural alerts to incoming calls.
The study identified a need for training in ‘video presence’ which would involve discussing the importance of non-verbal communication. Experts recommend that speech be slowed and body language, such as hand gestures, be augmented for effective video counselling (particularly so if the client is using a smaller screen). They suggested that this does not come naturally and should be practised.
The study results were fed back to the service provider and changes were made. This included starting the consultation by audio and then transitioning to video. Another modification was the inclusion of black screens behind service providers, rather than a view of the provider’s workspace, to minimize extraneous information.
In three years after this study was published, what is the percentage of PBB consultations conducted by video? The answer is about 10%, still well short of the tipping point.
Healthdirect also run an afterhours GP helpline, where they have a 15% uptake of video for GP consults, which suggests they are winning over the early adopters. All patients are triaged by a nurse, some will have their problems resolved and then some will go on and have a second call with a GP. Having a person, in this case a nurse, explaining video may be important.
The key learning from healthdirect is that both patients and doctors have significantly higher satisfaction scores when the consultation is with video. The rest of general practice has a long way for go to the tipping point of about 18 – 20%. Webcams are now easier to find (they have been in short supply) and the video software is getting better. But if video is the future it will take time. The future is up to providers.