Medical Director AZ Sint Lucas Ghent-Belgium

Dr Katrien De Ketelaere

Digital technology in healthcare has evolved rapidly over the last couple of years. Smartphones and wearables can collect loads of health data from patients, creating mobile health (mHealth), increasing the possibilities for home therapy and monitoring. Additionally, digital (business) meetings surely took a leap during the COVID pandemic. In this article, we explore the model of digital consultation in the outpatient setting. A recent paper by Deloitte and MSD in a sample of 98 Belgian hospitals showed that only 15 percent are currently applying digital follow-up for adverse event management for their cancer patients. The Belgian government is reimbursing video consultations starting August 1, 2022. Increasing research on patient satisfaction in digital clinics is being published. A younger population of orthopedic outpatients would prefer video consultation because of commuting and time issues to communicate medical findings, such as x-ray reports or lab values. A small study in a college population being offered telepsychiatry shows patient satisfaction comparable to in-person care and a slight preference for telehealth in the future. Parents of diabetic children being offered video consultation report possibilities for a higher frequency of contact and saving time in combination with a feeling of increased confidence with respect to insulin dosing. Technical issues with internet connections were identified as the main barrier. Digital prescriptions and meeting the same diabetologist in both outpatient and telemedical care were mentioned as important improvements. 

Digital contacts reduce boundaries when seeking medical care. In countries with vast distances to specialized care, telemedicine can be very helpful to improve the quality of healthcare. Patient groups with reduced mobility can benefit from video consultation no matter the distance to their doctor, improving follow-up and therapy compliance with a favorable impact on health outcomes.

A video consultation service is being offered by commercial players like "Mobidoctor" or "Air-dr," but the service is not well known in Belgium, is limited in service, and is usually anonymous, where most patients prefer to connect to well-trusted doctors. 

AXA Partners Benelux developed a platform for virtual video consultations as part of their travel insurance offer, allowing travelers to connect with medical care in Belgium. 

The value creation on the side of the healthcare workers lies in an increased attractivity towards patients, regardless of distance. Another important aspect of the healthcare team is increasing work efficiency, and evidence is growing that digital interventions in medicine have a cost-reducing effect. Costs at the hospital side decrease as digital consultations decrease the need for on-site administrative staff and physical space like waiting rooms, reception desks, and large offices. The patient saves on transportation costs, and digital consultations are less time-consuming. Video consultation will be more attractive to a younger population being raised in the digital era.

“Digital consultations may create a sense of ‘medical insecurity, as doctors and nurses could think their care towards the patient will be less thorough or efficient, therefore increasing concerns about patient satisfaction or even worse, medicolegal consequences.”

Organizing video consultations provokes resistance within the medical force. The satisfaction of healthcare professionals with video consultation is influenced by their own age, technical capabilities, and previous experience. It is good to realize that technology anxiety takes on a critical role next to medical concerns. Digital consultations may create a sense of ‘medical insecurity, as doctors and nurses could think their care towards the patient will be less thorough or efficient, therefore increasing concerns about patient satisfaction or even worse, medicolegal consequences. It is important to be aware of these resistances and concerns and discuss them all before taking off with digital consultations. A kick-off in pilot teams with early adaptors, highly digitally skilled and confident, on both the health workers and patients sides will help to reduce resistance and will be crucial for further success.

The first step in switching to digital clinics should be discussing the opportunities and threats with all stakeholders, including healthcare professionals, patients, and the IT department. Questioning of in-house patient groups should be performed in advance to define the most eligible population for video consulting, both regarding pathology and age. When opportunities are defined, the exact modalities should be discussed, and resistance from healthcare workers and patients should be discussed openly to build trust. The second step in preparation should be to see if all hardware and software are available. Technical issues with internet connections are already mentioned as  the main barrier, so the IT department should be well aware and sufficiently staffed to tackle all problems quickly. Administrative staff should be given clear instructions on which patients to book digitally and which not;  agendas should be organized as digital and physical clinics are preferably not mixed. Doctors and nurses should be trained to perform video consultations, as these differ from physical consultations. Nonverbal communication is different from physical consultations. 

When finally implementing digital clinics, evaluation of the system should be performed on a permanent basis to rapidly identify weaknesses and define further opportunities. This can be achieved through online evaluation tools or recording video consultations with informed consent for evaluation, improvement, and teaching purposes.