Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response

Abstract

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response. Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems. Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response. Conclusion: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

“…Basu et al [ 27 ] have sought to capture the different perspectives of the International Medical Informatics Association Telehealth Working Group, to broadly explore the role of telehealth in 10 different countries during the pandemic. The authors present 6 themes which align broadly with our Scottish case study, namely, strategic (policy decisions and legal changes); operational (increasing capacity and delivery by building skills and resources at pace and scale); regulatory (including pandemic-related unofficial workarounds with unregulated products); changes in attitudes and uptake; public engagement; and training and education.…”

“…A weak system is highly vulnerable to such shocks but a resilient one that is able to adapt can sometimes use the shock as an impetus to innovation and thereby become better able to weather the next shock [ 68 ]. The litmus test for Scotland is perhaps not the impressive expansion of video consulting during the pandemic under emergency measures (unregulated telehealth) but the extent to which the positive elements of this expansion will be retained and mainstreamed once such measures are rolled back (regulated telehealth) [ 27 ]. It is to Scotland’s credit that both its technological and human infrastructure were sufficiently resilient to respond in ways that could often be routinized within the existing system.…”

“…During the first wave of the pandemic, most countries saw a rapid reduction in face-to-face medical consultations and an increase in remote ones in both primary and secondary care [ 3 , 24 ]. Such shifts were part of a system-wide response in what has been termed the world’s first “digital pandemic,” which included technologies to support outbreak monitoring and management, triaging and severity assessment, ordering and documentation, secure messaging, real-time data analytics, fast-track research trials, global knowledge sharing, and living systematic reviews [ 25 - 27 ]. But as Gkeredakis et al [ 28 ] (p2) have observed, while the pandemic provided fertile soil for rapid growth of new technologies, “the shifts in digital technology use to cope with the COVID-19 crisis are fast-paced, dramatic and not well understood,” and successful embedding and use of novel solutions is “contingent upon the openness, distributedness, recombinability, re-programmability, and accessibility of digital technologies”.…”

Telemedicine supported strengthening of primary care in WHO South East Asia region: lessons from the COVID-19 pandemic experiences

“…7 While comprehensive evaluation of telemedicine in the SEA region has not been systematically undertaken, the recent experience from use of telemedicine during the pandemic and emerging evidence suggest that telemedicine might be a way forward to build strong, resilient primary care systems. 8 Lack of flexibility and resources have become barriers for primary care systems to adapt to the changing patterns of diseases globally. 9 Chronic diseases account for almost 60% of all deaths and 43% of the global burden of disease.…”

Keeping it going: the importance of delivering interprofessional education during the COVID-19 pandemic

“…In a pandemic situation, stay-at-home orders and 'bubble' recommendations, 44,45 particularly for more at-risk populations, mean students cannot always physically visit people. Abrupt alert-level changes resulted in overnight cancellation of home visits and switching to phone or Zoom visits challenged students.…”