Overcoming culture and economics to drive telehealth forward

A recent report on Management in Practice highlighted the challenge facing any organisation seeking to encourage the adoption of telehealth solutions. Telehealth solutions are being developed to serve all parts of the healthcare environment, including:

• data-gathering for public health research, both for the development of health policy and for the design of healthcare interventions
• primary care solutions include services and applications that support the diagnosis of medical conditions, and the provision of treatment by medical staff
• applications for the enhancement of emergency care
• the management of long-term conditions supporting the provision of care for patients in their own homes
• information and self-help applications promoting wellness, and encouraging individuals to improve their own health
• whole system improvement: some telehealth services and applications have an impact on the complete healthcare system.

[Source: Innovation Observatory and Cambridge University – report on mHealth applications, for China Mobile 2011] Nonetheless there is significant inertia restricting the adoption of services. Projects fall down at a variety of stages, for technical, financial, organisational, cultural, and political reasons. Innovation Observatory has been working with companies active in the health sector for a number of years – with a great many of our engagements associated with driving change through the health service. We have worked with organisations seeking to induce behavioural change, striving to increase participation, and trying to find new ways of doing things. We have noticed a number of consistent themes that technology providers absolutely must understand if they want to drive telehealth initiatives from the experimental into the mainstream:

1. Don’t underestimate the clinicians. They are a powerful group in any country. They are highly educated, and highly autonomous in thinking. They don’t typically like being told what to do – as they consider themselves perfectly capable of making a sound judgement (as indeed they are). They will expect to see rigorous evidence about the clinical benefits of a telehealth solution before they will be persuaded to change their behaviour en masse. They will also need to be persuaded of the reliability of a telehealth solution before they will put their trust in it. Doctors don’t want to recommend solutions that might fail and put patient health at risk. This means telehealth providers must invest significant resources in communicating to the health professionals that will be recommending / using their solutions on an ongoing basis – marketing through the health organisations themselves may not be sufficient.
2. Don’t forget the power of economic incentives. That is not to suggest clinicians should be paid to implement telehealth solutions – although in the case cited in the Management in Practice article it is proving a crucial driver of behavioural change. But in many countries where doctors and hospitals and clinics are privately run, and even in publicly funded services where incentives and bonuses are linked to clinical behaviour , there may be economic disincentives to implement telehealth solutions. Telehealth providers need to understand what these may be and demonstrate a clear return on investment from their solutions. Just because a telehealth solution is good for a patient does not always mean it will be offered by a health provider.
3. Learn from those that have been before. There have been a great many trials of telehealth solutions around the world. Many of them have been small scale, but collectively they are delivering a great body of evidence, and a wealth of experience about the challenges of implementation that could be used by those planning new trials and initiatives.
4. Telehealth providers can’t do it alone. Unless they are going to sell directly to end users (and a number of business models have emerged that involve doing just that) technology companies need the support and cooperation of a wide range of players – they need champions (clinical, financial, political, and technological advocates) to promote their technologies at all levels within the health institutions they want to use their technologies.
5. Make sure you understand the perspectives, and liaise extensively, with all potential stakeholders. Having them all on board can make a significant difference. Aside from clinicians, and other staff in the healthcare industry, other important stakeholder groups include policy makers, budget holders, welfare-focused lobby groups, consumer groups, charities, insurance companies, drugs manufacturers and technology companies.
6. The technology must be integrated properly into the end-to-end care pathway; systems must be redesigned to ensure that the technology is used where it is appropriate, that it is used appropriately, and that all stakeholders are persuaded to integrate the technology into the care of their patients. Moreover, processes must be in place to ensure the technology continues to be used appropriately…so that it becomes embedded.
7. Place a strong emphasis on understanding a patient’s experience of using the technology. Make sure the patient experience is positive, documented, and shared. Perception that patients won’t like the technology, or won’t use it (or the fact they don’t like it and won’t use it) will prove a big inhibitor of adoption. Patient support systems must also be in place – so even the least technology savvy can use the telehealth solutions available.

Preparing the groundwork with a business plan that reflects these findings, which is underpinned by detailed discussions with key stakeholders, and with an engagement plan informed by those discussions, will give telehealth providers a much better chance of selling their solutions into the marketplace. If you would like to know more about how Innovation Observatory can support technology providers with that groundwork, email us at enquiries@innovationobservatory.com. Simon Sherrington, Founder, Innovation Observatory sms@innovationobservatory.com