The slow march towards implementing the National Health Insurance (NHI) scheme continues and is now in Phase 2, which runs from this year until 2028. The Board of Healthcare Funders and the Western Cape provincial government are challenging how the NHI Act was passed in the Constitutional Court, arguing that there wasn’t enough public participation. The court heard argument in May and has yet to announce its judgment. Meanwhile, the health department continues to work on the national Health Patient Registration System.
But in a country with a dual healthcare system – a well-resourced private sector serving a minority of the population and an underfunded and overwhelmed public healthcare system serving the majority – the successful delivery of universal healthcare is sure to be a challenge. According to the government’s National Digital Health Strategy, digital health technologies provide opportunities to transform the way health services are provided and how people engage with those services. While telemedicine is not explicitly positioned as a key component of the NHI, this model can help deliver healthcare more efficiently and equitably, particularly in underserved and rural areas.
Telemedicine will only succeed at scale if it’s built to be affordable, flexible, and inclusive across South Africa’s diverse patient population.
Minette Barkhuysen, Mediclinic Southern Africa
Pippa Yeats is the co-founder and CCO at Turn.io, a local company that helps organisations build and manage large-scale services on WhatsApp. One of its big plays is in the telemedicine space, where it makes text, voice and video consultations available to patients within the app.
Yeats says she’s lost count of how many times she’s seen companies spend hundreds of thousands of rands building applications that see little adoption. Meanwhile, WhatsApp use is ubiquitous, and the platform is well suited to telemedicine.
This ease of use also helps healthcare providers minimise no-shows. Not only do missed appointments waste time and create gaps in appointment schedules, but they also mean lost revenue. “When patients can confirm that they're coming on the day or can easily reschedule without having to call a receptionist, it’s a game-changer. This convenience factor has helped some of the telehealth providers we work with reduce missed appointments by between 10% and 25%,” she says.
The average lower-income consumer only has enough space on their phone to download a small handful of apps, which is why asking these people to download another app, and one that has a very niche use case, is doomed to fail, she says. There is also a learning curve involved in downloading and using a new app, which can be a major stumbling block when you’re serving the elderly or people with limited digital literacy.
When patients can confirm that they're coming on the day or can easily reschedule without having to call a receptionist, it’s a game-changer.
Pippa Yeats, Turn.io
Minette Barkhuysen, GM for ICT Business Systems at Mediclinic Southern Africa, believes that to improve adoption, telemedicine platforms must be designed to adapt to the user’s context rather than expecting the user to adapt to the technology. Telemedicine will only succeed at scale if it’s built to be affordable, flexible, and inclusive across South Africa’s diverse patient population, she says.
The pandemic was a baptism of fire for telemedicine. Almost overnight, global healthcare systems were forced to find other ways to treat patients while limiting face-to-face contact. Once a niche service, telehealth became an essential tool for screening, monitoring and treating patients remotely.
WHY BABYLON FELL
When Babylon Health partnered with the UK's National Health Service in 2017, the promise was revolutionary. One of the software’s big selling points was an AI-powered symptom checker that asked questions about symptoms before recommending the most appropriate course of action. But it wasn’t long before this AI functionality was challenged. While Babylon claimed that the tool was comparable to, if not better than, human doctors, clinicians expressed concerns that the symptom checker had, in some cases, missed serious conditions or failed to escalate patients displaying potential warning signs. Ultimately, the business and the partnership failed. Experts largely attributed this failure to a mismatch between the fast-paced culture of tech startups and the more measured, considered approach required in healthcare, where a mistake could cost someone their life.
Today, the use cases for telemedicine are less broad, and are well-suited to follow-up care, such as monitoring chronic conditions, getting a new script, adjusting medication and checking on a patient's recovery. The Health Professions Council of South Africa also recommends a practitioner establish a professional relationship with their patient before telehealth services can be considered.
Telehealth is also well-suited to scenarios where a physical examination isn’t necessary or for quick patient triage. If a healthcare provider can assess a patient’s symptoms, they can determine whether a face-to-face consultation is necessary. For patients in remote communities, virtual consultations prevent people from wasting time and money travelling to their nearest clinic when they don’t need to. The goal is not to replace doctors and nurses or to circumvent traditional healthcare, but to provide the most efficient and effective care in each situation.
Telemedicine is not a product, it’s a tool, says Saul Kornik, founder and former CEO of Healthforce, a clinic management and telemedicine software business that Dis-Chem acquired in 2021. “When a patient is sick, the job to be done is to make that patient feel cared for. There are certain situations when this tool is applicable based on the job to be done, and there are times when it's not,” he says. Patients feel reassured when they can sit in front of a doctor, who takes out the stethoscope and thermometer and physically examines them. “But the truth is that what actually makes the patient feel cared for and calm is the theatre behind the medicine. It’s the doctor asking questions and reassuring the mother that her sick child will be okay. When a mother has a child who is deathly ill, she doesn’t want to phone the doctor. She wants to visit a clinic and have a doctor or nurse do a physical assessment to figure out what’s wrong.”
Kornick says Healthforce was created to provide healthcare at the lowest cost. Why should a doctor or a specialist take a patient’s blood pressure test or do an ultrasound when this could easily be done by a nurse, he asks.
Healthforce’s software functioned as a practice management system, with an electronic medical record and decision-support tool that nurses used to treat patients. When the nurse couldn't reach a diagnosis, they used the software to contact a telemedicine doctor via video call. This doctor had access to the patient notes and then worked with the nurse to conclude the consultation and provide a prescription or referral letter. “About 80% to 90% of the time, the nurse could solve the patient's problem without having to call the doctor at all,” says Kornick, and in cases when a doctor was needed, the nurse had done the bulk of the consultation, taking up less of the doctor's time and, thus, costing less money.
“If you just develop a substandard piece of software or slap a screen onto an app, and think that you’re providing care, you’re not,” he says. “In the same way that feeling cared for and heard by a doctor will make a patient come back, if the user experience on a telehealth platform isn’t good, it’s not going to succeed or get repeat customers. When something doesn’t work, we’re quick to abandon it entirely. But if someone has to spend 15 minutes setting up the tool, this doesn’t mean that telemedicine as a piece of functionality within the healthcare system is bad; it just means that particular tool is badly designed.”
* Article first published on www.itweb.co.za
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