I veckans blogg lyfter Tiago Cravo Oliveira Hashigushi från OECD vikten av att vi på allvar funderar över hur vi kan upprätthålla det som pandemi fört med sig vad det gäller den snabba utvecklingen av digitala lösningar. Det finns en risk att vi går tillbaka till hur det var innan och det vore ett slöseri att inte ta vara på de snabba framsteg som nu skett. Tiago lyfter fram problem såsom till exempel ersättningssystem, IT-infrastruktur och kulturella eller organisatoriska hinder som måste lösas för att digitaliseringen ska användas i större utsträckning och skapa möjligheter för säkrare och bättre vård även efter pandemitider. Läs gärna också rapporten från OECD och se seminariet från Hälsodalen där Tiago pratar mer om dessa frågor!
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The COVID-19 telemedicine boom provides clues for policy makers seeking to mainstream its use
Tiago Cravo Oliveira Hashiguchi, OECD
Just before the COVID-19 pandemic, in January, the OECD published a report looking at how policy makers were responding to growing demand for telemedicine services, the impact that these services were having on health care systems and patients, and the barriers and enablers to wider use
Prior to COVID-19, use of telemedicine was limited as a share of total health care activity, despite growing interest in, and increasing use of, such services. In light of COVID-19, interest in telemedicine has skyrocketed, and for good reason.
Telemedicine has clear benefits in the context of a respiratory pandemic. For example, people with mild symptoms can consult from their homes, thus avoiding potentially infecting themselves or others – especially much needed health workers and essential workers who cannot telework. Furthermore, physical capacity in health care units is reserved for critical cases and people with serious health conditions unrelated to the outbreak.
Even before the pandemic, telemedicine was already being used across the OECD to deliver health care in a wide range of specialties (e.g. neurology, psychiatry), for numerous conditions (e.g. stroke, COPD) and through varied means (e.g., remote monitoring, store and forward, real-time videoconsultations). While this broad heterogeneity in contexts and applications does pose challenges to evaluation, a growing body of evidence suggested that health care can be both safely and effectively delivered via telemedicine.
While a majority of OECD countries allowed at least some form of telemedicine before COVID-19, for the most part providers and patients wanting to use telemedicine faced regulatory uncertainty, patchy financing and reimbursement, and vague governance mechanisms.
This sluggish context changed when many OECD countries went into lockdown to contain the spread of the virus, and policy makers moved quickly to bring down existing barriers to the use of telemedicine, from creating new reimbursement fees, to relaxing requirements for continuity of care, to publicly promoting its use. Policies that had taken years to negotiate and discuss were now being implemented in a number of days and weeks. Naturally, the number of teleconsultations exploded.
We have seen astounding progress in recent months, but some barriers to wider use of telemedicine, like access to broadband, will be difficult to tackle in the short-term, highlighting the need to strengthen health care provision in rural and low-resource settings. Other structural barriers include gaps in digital health literacy and insufficient interoperability. These barriers require longer term policies and investments.
It is still too early to tell whether COVID-19 will be a paradigm shift for telemedicine (and perhaps for a digital transformation in health more broadly) or simply a temporary boom. What is clear is that the pandemic has led many patients and providers to adopt and use telemedicine services. This collective experimentation is a unique opportunity for countries – and communities – to learn whether, how and for what purpose telemedicine could be used after the pandemic is over.
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Tiago Oliveira Hashiguchi is a Health Policy Analyst at the Directorate for Employment, Labour and Social Affairs of the Organisation for Economic Co-operation and Development (OECD) in Paris, France. His work at the OECD Health Division seeks to identify best practices and inform evidence-based policies in various areas, including the digital transformation in health. Before joining the OECD, Tiago held research positions in London at Imperial Business Analytics with KPMG, and in Seattle at the Institute for Health Metrics and Evaluation (IHME). He has a PhD in Health Management from Imperial College London and an MSc in Biomedical Engineering from the Technical University of Lisb