July 8, 2022
The history of our health system began a new chapter on Friday last week. The team at Spritely is delighted and relieved that equity of access to healthcare will be a key priority. It’s also great to see an emphasis on data and digital enabling more people to get the care they need in their homes.
These two pillars don’t always align though.
We can create new models of care using data and digital but in doing so we can exclude some of the people we’re trying to help. Not everyone has experience with technology. Not everyone has access to devices and connectivity. So, unless we’re careful, there is a risk many people won’t have access to innovative and convenient new services designed to help them and inequity may be increased.
The key to mitigating this risk is removing barriers. As a company, Spritely has focused its efforts on removing barriers for telemonitoring. Telemonitoring uses data and digital to remotely manage treatment plans for patients in their own home (at scale). The benefits of telemonitoring for patients and the health system are well known, but the success of telemonitoring services depends on people being able to access them.
The reality is that many people who could benefit from telemonitoring are, for many reasons, unable to participate in telemonitoring programs. Those people shouldn’t be excluded due to their circumstances. Instead they could benefit from a low-cost equity of access solution they can easily use.
Our experience shows that doing three things eliminates barriers to telemonitoring and creates near universal equity of access to life changing services enabled by data and digital.
Providing a pre-provisioned tablet, which is fully managed by the healthcare provider removes the need for patients to have their own smart device. Pre-provisioning it with a sim card and the relevant application means that patients don’t need to unbox it and set it up. They don’t need WiFi, email or even an app store account. Any one of these requirements can be a major barrier.
To achieve this in practice you need a platform that can quickly provision tablets at scale. Otherwise, you’re faced with setting up hundreds of iPads. Anyone who has ever bought, opened, and set up a new tablet of any kind knows how long and frustrating the process is. Whose iCloud or email account will be used during the set-up process? Whose name will the app store account be in? It’s impossible to make it work at scale without pre-provisioned enterprise software like Spritely.
Even if you did Just give someone a tablet with an app on it, it hardly ever works. Your telemonitoring app is just one among many pre-installed apps, making it hard to locate and launch. Even when the app is located and launched it can be hard to login and frequent updates to the operating system sometimes cause compatibility issues. All this contributes to a poor experience and low adoption.
The best thing to do in our experience is lock the telemonitoring app into kiosk mode so it is always on and there is no ability to end up on the desktop, lost in the settings, or on apps like You Tube and Facebook, which present their own risks. Keep the navigation simple so people don’t get frustrated finding their way around. Make sure patients can operate the video calling with a single tap. It’s not great receiving a link that forces you to click through a multi-step process of consents and updates only to find that you still struggle to turn on the camera. Ensure medical devices can be connected without Bluetooth pairing. Needing to pair and constantly re-pair devices is another major barrier to adoption of telemonitoring services.
Help patients to become more engaged in their treatment. The system should be able to support health literacy initiatives by displaying content in any language. Helpful videos can improve knowledge for patients and their family members. Ensure the system can be linked through to family so they can participate in programs of care when appropriate. Encouragement from whanau can help patients stick to treatment plans and achieve their health goals.
As the health sector develops new digitally enabled models of care, and more people get the care they need in their homes and local communities, we need to make sure we don’t exclude people who struggle to engage with technology.
The fully managed device service I have outlined isn’t for everyone. For most people, telemonitoring can be managed using a device they already own. But that’s not true for everyone. Clinicians should be able to deliver the same high quality of service over digital to anyone who needs it. If we want to ensure low-cost equity of access, then a fully managed device service must be part of the mix. Then everyone can benefit from these new services, regardless of their circumstances.