As featured in Healthcare Global

Michael Niddam, Co-founder and MD of Kamet Ventures, says questions over quality leave the long-term future of telehealth on a knife-edge

Lockdowns have been internationally recognised as a double-edged sword. On the one hand, they have proved to be an effective means of slowing the spread of Covid-19, but on the other they have thrown up numerous complications for a global health industry which has hitherto largely relied on in-person interaction between patients and doctors. 

This is, in part, why telemedicine and telehealth have experienced a boom, as people increasingly turn to the convenience and safety of remote health consultations. 

McKinsey modelling suggests that the US telehealth market could grow from $3 billion pre-Covid to upwards of $250 billion. An oft-cited report by Global Market Insights Inc. predicts that the global figure will be closer to $700 billion by the end of 2026. With news of Amazon’s most recent push into digital health - the launch of an online pharmacy - perhaps these numbers could even continue to rise.

In the UK, astounding statistics show just how rapidly - and completely - the healthcare sector has changed. According to insightful NHS analytics, in March of this year, registrations to the NHS app increased by 111 per cent and the number of repeat prescription requests made online increased by 97 per cent. This paints the same picture we are being told time and again: the appetite for digital solutions is increasing both for patients and on the clinical side.

Fertile ground for digital health innovation

The increased attention and interest in telehealth generated by the pandemic has led to spikes in investment activity and app stores being flooded with new offerings. But typically for a market as nascent as telehealth, question marks have arisen over the quality of the experience and guidance these products deliver. 

This is partly down to distrust. Many of the big players that have established brand recognition so far have encountered significant problems and come under criticism. Many will remember how Babylon Health - an early digital health darling - both chastised a whistleblower for revealing flaws in its AI triage system and suffered a data breach involving confidential patient data earlier this year. 

Furthermore, myriad problems with the NHS Test and Trace app - from design to implementation - have left a sour taste in consumers’ mouths. While truly more of a location device than a telehealth innovation, its NHS branding is deceptive for those dipping their toe into sharing their health data digitally.

Nevertheless, there have been some incredibly important advances in telehealth over the last few months, particularly in medical specialisms most impacted by lockdowns. Oncology has been overwhelmingly affected, both by cancer patients being unable to visit hospitals and by changes to treatment - including the self-administration of oral chemotherapy tablets at home. In these circumstances, offerings such as Careology - which provides cancer teams access to a dashboard charting the vital signs of their patients - can facilitate the types of early interventions that will save lives.

A problematic solution? 

The future of telehealth now sits on a knife-edge. Where, in the past, we have perhaps been too cautious in embracing new ways for people to access healthcare, in our haste to respond to the “new normal”, we now risk being too cavalier in what we allow into the market. 

There are also problems of access, as described by Professor Sonia Johnson of UCL: “Telemedicine doesn’t work for everyone, and there are still major challenges to be addressed for it to be truly effective. The voices of the digitally excluded are especially in danger of not being heard.” 

Concerningly, the ‘digitally excluded’ often overlaps with the most vulnerable in society such as the elderly population who, during the pandemic, are likely to be even more isolated than usual.

Leaders are appearing, such as market-leading Qare in France, which delivers quick and efficient care for those who are time-pressed, have specialist needs, or are geographically distant. However, many of the high-quality telehealth services that are currently available have not yet achieved sufficient traction to stand out obviously from the crowd, and we need to be careful not to allow the default or average standard of telehealth platforms to settle too low. 

The risk is that, if the user experience is unsatisfactory, or if we see a significant number of excess negative clinical outcomes resulting from the use of substandard solutions, adoption of telehealth will slow, regulation will become excessive in overcompensation, a vicious cycle will ensue, and a massive opportunity will be lost. 

However, done well, telehealth does have the potential to resolve a variety of pressing and complex issues within the healthcare system - from simplifying and broadening access, to easing the strain on in-person services. Tackling these challenges strategically would surely result in fairer, more effective and more easily accessible care for all.