While eHealth comprises more than e-consultations (text, video, and telephone), this is the eHealth solution that comes first to mind for many. This is indeed the solution where we observed the most rapid adoption during the pandemic, much thanks to legislators and authorities around the world introducing new guidelines or legislation allowing for new or improved reimbursement for e-consultations. This, combined with desires to limit in-person interactions across society, caused the number of remote consultations to skyrocket. In Norway, as in most other countries, remote consultations historically accounted for a very small percentage of general practitioner consultations – fewer than 5% of all consultations the week of March 2, 2021. However, only two weeks later, e-consultations accounted for the majority despite the total number of consultations changing only slightly.2 The proportion of e-consultations have since dropped, but one is hard pressed to think we will ever go back to the way it was, the convenience factor, especially for patients, is just too great.
While e-consultations may have been the most visible solution, others, some still emerging, may prove to be more transformational, enhancing access to care, improving quality, helping to bend the cost curve in healthcare – and, yes, prove valuable amid a pandemic. The World Health Organization’s “Rapid hospital checklist” for the COVID-19 pandemic3 includes 12 components. While none call out eHealth specifically, at least three are meaningfully addressed by eHealth solutions, namely “Surge capacity”, “Rapid Identification and Diagnosis”, and “Infection prevention and control”. One example is tele-ICU. A tele-ICU allows a trained intensive care physician to remotely monitor patients from a different floor, building, or even from halfway across the globe. The physician has access to the same patient monitor data a physician in the patient’s room has, plus real-time video. In many countries, physicians with an intensive care specialization are in short supply. As a result, non-specialty trained physicians are left to cover shifts in intensive care units, especially in smaller hospitals, potentially affecting the quality of care. A tele-ICU allows experienced, specialty trained physicians to support lesser trained colleagues 24/7, providing hospitals and their patients with access to intensive care expertise even in the absence of on-site intensive care physicians. Beyond this it may allow for much needed surge capacity. A hospital’s limitations in surge events are often not related to a lack of space, hospital beds, or even equipment, but rather availability of trained staff. A tele-ICU solution may allow for additional beds to be designated ICU beds on wards or in hospitals where intensive care physician staff is a limiting factor. Beyond this, tele-ICUs may allow for more rapid identification of patient deterioration and in turn fewer adverse events given the involvement of more experienced experts in the assessment. The latter potentially supported by embedded early warning score data may further help pre-empt patient deterioration and avert more serious adverse events.