A new way to manage patients, which involves innovative technology, will be essential to manage a massive health crisis that is likely to disrupt Australia in the near future.
Dr Chantel Thornton, an Australian Specialist Breast Cancer Surgeon and contributor to a recent report, Building a Better Practice Beyond COVID-19, said the health care system is going to “be hit with a tsunami of people with major medical problems that have not been addressed over the last six months… Soon, we’ll see masses of patients panicking because they’ll have undiagnosed tumours that will likely be non-curable, they’ll be panicking as they’ve left it so late, so they will want everything done faster than ever before.” She said practitioners need to find ways to “streamline processes, to give the patient a better experience and reduce wasted hours doing things the outdated pre-pandemic way”.
I believe that technology will be at the forefront of every discussion in the healthcare sector moving forward
The report was prepared on the back of a survey of over 200 practice managers, allied healthcare professionals and specialists in private practice in August 2020. It was conducted by Clinic to Cloud, an Australian developer of cloud practice management software, to identify changes in practice management and patient engagement over the preceding six month period.
PRACTICE STAFF STRESSED
The survey found that time management has become the biggest concern for 43% of healthcare workers over the past six months. This was followed by administrative burden (41%), with 54% seeing an increase in credit card payment processing over the telephone, and 69% seeing an increase in administration, paperwork and document management. This has led to 31% of healthcare workers experiencing an increase in stress and burnout, an issue which was already a significant problem before the pandemic.
Vitreoretinal surgeon and ophthalmologist, Clinical Associate Professor Andrew Chang, who sits on the board of Clinic to Cloud, observed that his clinic staff have been challenged with increased stress and levels of anxiety in managing higher levels of work efficiency to minimise patient interaction, screening patients entering the clinic, pressure to reduce patients in the waiting room and to control patient flow for social distancing. He said additional stresses had come as a result of the need for increased cleaning and hand hygiene practices for each patient, and the increased use of PPE for all staff, patients and carers.
“We clean each instrument down fully between patients and have installed breathshields on slit lamps and laser machines. Ophthalmologists and staff remain at heightened risk of cross-transmission despite infection control measures due to their close proximity to patients when examining them.
“We mandate that all patients and carers wear masks when attending the clinic as well as our staff. We supply masks to those who do not have one and are managing, with difficulty, the supply of PPE.”
However, he said many elderly patients find wearing masks difficult, especially if they have respiratory or cardiovascular disease.
“They are also concerned and anxious about cross-infection. Patients from nursing and retirement homes may be mandated to isolate after having treatment at the clinic, causing further stress associated with their eye care.”
The survey identified that in general, private practices are seeing patients struggling, with 71% of healthcare workers reporting an increase in patient stress and anxiety, 50% reporting an increase in patient appointment confusion and no-shows, and 40% reporting an increase in managing patient expectations.
Clin. Assoc. Prof Chang said in his practice, 30% of patients had cancelled their appointments during the height of the pandemic.
“Over the past few months, patients are returning to have routine eye examinations which we deferred. However, we are following up a significant number of patients who have missed appointments. These include patients who have intravitreal injections for neovascular age-related macular degeneration, diabetic macula oedema and retinal vein occlusion. Some of these patients have lost substantial vision due to recurrent macular exudation.
“I have also noted more patients presenting to the public hospital with advanced retinal detachment and progression with complication of diabetic retinopathy. A concerning number of diabetics have worsening control of their diabetes. They are challenged with changes in their daily routine, exercising less and experiencing issues with their medical care. This is despite telemedicine by general practitioners and medical specialists attempting to address the need.”
Dr Thomas Hong, head of the Clinic to Cloud research, found that 10–20% of clinical trial patients have chosen not to attend appointments due to travelling on public transport, proximity to the clinic (as some travel quite far), and carers being reluctant to bring them in. Sponsors have tried to mitigate this by offering more transportation options (hire cars) and reimbursements, reducing visit frequency and reducing the number of tests at required visits.
The Clinic to Cloud survey found that remote working and telehealth is on the rise across private practices, with 54% working remotely more often now compared to pre-COVID, and 11% working completely virtually. Meanwhile 61% said over a quarter of weekly consults occur via telehealth, and 23% said three quarters or more of weekly consults occur via telehealth. Despite many practices operating remotely, patient expectations surrounding the level of care provided are higher. CEO of Clinic to Cloud, Rafic Habib, said with healthcare workers under pressure to do more with less revenue, it is inevitable that many will buckle under the weight of practice and patient expectations.
“Our results are unfortunately not surprising. The challenges today of balancing quality care versus efficiency of costs and time management are even more prevalent than before the pandemic,” he said.
“Prior to the pandemic, there would be patients in the rooms, in the waiting room, and doctors seeing one patient after another. Now healthcare professionals have to operate in a virtual, ‘contactless’ environment to protect staff and patients.
“At the same time, there’s the pressure to pay salaries, keep up with costs, and try and maintain a certain level of income. And the balance of all that is very challenging. So how do they achieve efficiency and cost savings, yet maintain a thriving practice?”
He said the key to balancing current and ongoing challenges will be using technology to find efficiencies and cost savings in administration, and to empower patients to become more involved in the management of their own health.
“I believe that technology will be at the forefront of every discussion in the healthcare sector moving forward. Practices are asking for more help using technology. They’re looking for efficiencies, to maintain patient engagement and to make their business more profitable and safer, with more decision support and greater protection around them from a technology perspective – to ensure they continue to deliver the highest care possible,” he says.
The survey found that despite stress and an increasing administrative burden, health care practitioners remained optimistic, with 53% looking to invest and grow over the next six months, and only 2% looking to downsize/ cut back. Additionally, 52% were maintaining spend in technology solutions that support virtual and remote clinical and practice management, such as cloud solutions, online payments, telehealth, and mobile apps. Only 5% were cutting back in this area.