Virtual health – services continue to grow

Video Enabled Healthcare a robust evaluation

Highlights from 2020 National Patient-Clinician survey on Video Enabled Healthcare

Due to the unprecedented challenges of the COVID-19 pandemic, there was an accelerated need for access to safe, distant healthcare and advice nationally. Patients and healthcare professionals rose to this challenge by adapting and adopting new ways to access healthcare in record time.

Video Enabled Care (VEC) quickly unfolded across health services in Ireland. A robust and systematic evaluation of this rapid introduction of VEC was undertaken between October and December 2020.

Quantitative and qualitative data were collected from 719 healthcare professionals (HCPs) and 696 patients. The HSE National Service Plan highlights, as a priority action, to ‘involve patients in the design and evaluation of new models of care, clinical services and initiatives’.

ENHANCED EXPERIENCE

• Over 80% of patients found their experience to be as good as or better than face-to-face appointments • 93% of patients commented that VEC o ered benefits over and above in-person consultations. Qualitative data showed that benefits included improvements in their comfort and well-being and in their ability to self-manage their condition • 49% of HCPs reported that VEC resulted in unanticipated benefits.

Qualitative data showed video consultations allowed for increased access to care, facilitated improvements in the delivery of care and empowered patients and carers to take a more active role in their care “It was warm and comfortable at home which is helpful when you’re in pain.” - Patient “I was able to take notes which I normally wouldn’t do during a face to face conversation. This has helped me to have a future game plan clearer in my head. So I think generally very benefi cial.” - Patient “Parents developing skills in implementing therapy themselves within home environment. For some cases it was easier to obtain a language sample when child in home environment.” - HCP “I can access families who normally have di culty coming to the clinic. For parent only appointments, it fi ts into their working schedule when done remotely so they don’t need to take time o work to attend.” - HCP

Involve patients in the design and evaluation of new models of care, clinical services and initiatives -Priority Action- National Service Plan (NSP) 2021 ‘The plan has prioritised delivery technology platforms to enable the healthcare system to keep people well at home whilst also providing pathways to access care when needed’ - eHealth and ICT Capital Plan - aligned strongly with the HSE Corporate Plan, the 2021 Winter Plan, and Sláintecare

EFFICIENT HEALTHCARE

• 95% of patients reported that they were likely to recommend to a friend or colleague • 29% of HCPs reported that VEC enabled them to increase the number of appointments they could offer • 32% of HCPs reported that ‘Do Not Attend’

Rates were reduced and some commented on the increased flexibility around appointment times

“More efficient use of time; enables worker to work from home and more flexibility regarding appointment times as can offer early morning or late evening.” - HCP “Increased attendance due to not having to travel.” - HCP “Increase uptake to OPD (Outpatient department) reviews and convenience for parents and children.” – HCP

Retaining and maintaining some of the innovation which were implemented as part of the COVID responses will be a key enabler of timely service provision - Strategic Context, National Service Plan (NSP) 2021

Dr Aoife Lane and Vanessa Clarke, Nursing and Midwifery Planning and Development, Prinicpal Investigators

CONNECTIVITY

• 40% HCPs and 34% of patients reported that at times they experienced technical difficulties which were largely related to connectivity • 66% of patients did not experience difficulty with technical issues • Those living in the country or rural areas were 10% more likely to report having technical problems than those living in a town or city “Sometimes it is difficult to communicate on the video because of network.” - Patient “Video lagged/slow in image and sound at times and was distracting.” - HCP “Connectivity issues for staff and for service users in rural areas.” -

HCP

“You are supported to live well and you feel connected with your community” - HSE Corporate Plan 2021, ‘HSE vision’

ALLOWS FOR EFFECTIVE COMMUNICATION

• 91% felt that they were able to communicate everything they wanted to their HCP “The sessions were more structured than face-to-face appointments usually are, with built-in time for giving feedback which sometimes gets overlooked in real life.” - Patient ‘Patients seemed much more relaxed and at ease during video consultations in their own homes compared to attending in clinic. Frequently they asked more questions than usually asked in clinic and overall have been very positive about the experience.” - HCP

Focusing on patient experience and outcomes will also be a key priority for 2021 with key actions to address the multiple aspects of patient experience including transparency, openness, the use of data and patient safety - Strategic Context - National Service Plan (NSP) 2021

VEC MOVING INTO THE FUTURE

NEXT STEPS

Our lifestyles are changing, altering our healthcare needs. New developments in technology and practice are opening up new opportunities to transform care delivery - Sláintecare action plan 2019

CURRENT STATUS

The HSE has introduced a range of measures to improve connectivity. The National Broadband Plan is committed to removing the existing digital divide between urban and rural communities and increasing availability of high speed broadband to households nationwide. Measures are in place to increase usage of VEC by older persons either residing at home or in residential care settings

FUTURE STEPS

Identify a clear process for determining appropriateness in accordance with preference, clinical need, connectivity, outcome, social inclusion/exclusion factors. In response to survey, improve access for both HCPs and patients Explore the need for administration support to match VEC requirements. Phase 2 - National Patient-clinician survey to support the ongoing improvements of VEC

We need your help to continue to develop the evidence base for VEC in Ireland, please tell us: • Your story • How you use VEC • Your learning Email: virtualhealth@hse.ie

*The publication of the final report is pending where this piece reflects highlights of interest rather than a summary of the complete report **The survey was developed by the Nursing and Midwifery Telehealth Advisory Group in conjunction with healthcare professionals and patients

ENGAGEMENT BARRIERS

• 18.2% of healthcare professionals commented that both staff and patients experienced barriers to engaging in VEC which included; lack of digital skills, limited access to technology and not feeling competent in engaging with VEC “My clients do not all have mobile phones, phones are out of date, unable to use internet facility on phone.” - HCP “Clients with no access to IT were excluded, as were those with poor IT ability. Clients with health literacy issues struggled even more.” - HCP “This was a brilliant service, thank you. However, my dad would not have been able to operate the online consultation on his own but I was able to do it for him so it wasn’t a problem.” - family of

patient

The delivery of high quality, safe, effective and accessible services is a priority for our healthcare system - Clinical, Quality and Patient Safety - National Service Plan (NSP) 2021

CLINICAL APPROPRIATENESS

Although VEC allowed for continuity of care during the pandemic, some healthcare professionals raised concerns regarding its suitability for all consultations

“It was fantastic to have an opportunity and keep the exercises going with my son as he was starting to fall behind” - Patient “Unable to feel the injury, range of movement or muscle strength has been a drawback most definitely”- HCP

You can access the right care, at the right time and in the right place and you feel empowered, listened to and safe - HSE Corporate Plan 2021- ‘HSE vision’