• Final Mile

Adversity creates opportunity: Improving telemedicine services

The onset of the Covid Pandemic has brought with it multiple new challenges to the health system. Physical distancing, lockdowns and the overburdening of hospitals with Covid patients has made it difficult for other health consultations to continue as earlier. Hospitals, clinics and health centres have become a hot spot for the virus and consultations and other out-patient services are taking a hit because of this. The impacted access to health services can cause immense physical and emotional distress by adding to the overall uncertainty of the situation.

But with this adversity, a new opportunity has emerged in the form of Tele health services. Telehealth has been in the periphery since quite some time but has had tremendous success in the past few months. Multiple new service providers and aggregator platforms have come into this new space in both the developed and developing countries.

Telehealth services have had a lot of advantages through the years and particularly in this period. The salience of the virus being everywhere and the previous association of hospital waiting rooms being full of germs, has led to a quicker acceptance of the technology as the safer bet. Though people may not be completely convinced of it, it is still seen as the less risky method to handle uncertainty.

On the system front, telemedicine reduces the burden on health service providers and infrastructure and allows doctors to consult more people in a day. It is extremely effective for quick reduction of anxiety by providing expert opinions particularly when curtailed access and isolation takes a mental toll on people.

Though it has not been scaled in rural areas, it has the potential of moving the frontline closer home and reducing the burden on the present overburdened frontline workers.

Behavioural challenges faced:

While telemedicine has enormous potential, there are still many behavioural barriers being faced by people which is making it difficult to get people to quickly adapt to it and to sustain the usage once the immediate risk of the pandemic is lowered.

· Stop gap measure: The primary behavioural barrier comes from a core service problem. Telemedicine is only effective for the diseases where a visual inspection can be done. For any further tests or verification, the patient still has to visit the centre. Therefore, for many it is by default only a temporary measure to meet the requirements in the Covid phase and not something which they believe is sustainable in the long run.

· Trust deficit: Virtual contact between the doctor and the patient does not provide that opportunity to establish trust effectively and for many results in a trust deficit. Patients are neither able to trust the expertise of the doctor without the physical interaction nor are they able to seal that doctor-patient relationship effectively. This creates the urge to go back to old behaviours as the trust deficit continues breeding uncertainty rather than resolving it.

· Resistance to Change: For certain populations particularly the elderly, the mental model of consultations requiring physical presence is too difficult to change. The added mistrust of technology with issues of both security and privacy further build that resistance. To provide them with a new mental model of seeking care would be a challenge.

· Not for curative health care seeking: The dominant concept of health in many countries like India is curative where health services and consultations are sought only after experiencing symptoms. Curative health care often requires more in-depth consultations which telemedicine might not always be able to provide. But tele-medicine is more suited for preventive and promotive health care including nutrition support and self-care. But the demand for these services is less due to health care being considered primarily curative in nature.

What could be done?

· Affective and not just effective: While a lot of the focus on the improvement of tele-medicine has been on the effectiveness, there is a need to build focus on the affectiveness. It means that the emotion management and the resulting action tendencies emerging from it need to be factored in while trying to deliberate on improving service delivery. One of the critical ways of doing this is to focus on embedding trust building measures which could establish the relationship between the participants better.

This could be done through various design tweaks, frequency and duration of engagement and even standard interaction styles.

· Driving motivation: One of the big barriers of getting more users to start and sustain the usage of telemedicine is the resistance to new behaviours and new technology. Therefore, using behavioural science to build motivation is a huge opportunity area which needs to be explored. This can be done by multiple methods including incentives, reframing perceived usefulness and improving ease of use.

. Establishing continuity of quality: The perception of inferior quality of services is a barrier that impedes both adoption and sustained usage. The idea that virtual consultations could go wrong or be inaccurate because of the physical distance creates the perception of inferiority. There is a need to reinforce not just the effectiveness of the medium but establish the authority of the doctor and the transferability of their expertise across mediums.

. Reduce psychological distance: A big way in which behavioural science could be used to promote tele-medicine is by reducing the psychological distance in a virtual distance setup. The feeling of distance creates confusion regarding the passing of information and reduces the confidence of people in the medium. Reinforcing trust in technology could be a starting point in addressing this feeling.






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