NETSCOUT’s Darren Anstee on the rapid rise in demand for telemedicine services during the COVID-19 pandemic.
Telemedicine services were initially introduced to solve the difficulties of providing expert medical care to people in communities where that expertise might not otherwise be available. Accessing medical specialists, or even GPs in some cases has been a challenge for some time.
Telemedicine sought to fill the gap, making medical care more universal by changing the way in which we access resources. When COVID-19 hit, and lockdowns began to be announced, the slowly growing telemedicine industry suddenly became the only way of interacting with medical professionals for many people across the world.
Telemedicine services have seen a rapid increase in demand. In some cases, the use and volume of telehealth applications quadrupled within a very short space of time. Indeed, when speaking to the New York Times in April, a general practitioner in the UK said, “We’re basically witnessing 10 years of change in one week.”
Adoption and use of telemedicine services in the UK had previously been slow due to privacy restrictions and reluctance from patients to turn to technology rather than traditional face-to-face consultations. So, when the pandemic hit, use skyrocketed as government restrictions were loosened and many patients and service providers had no other option.
As you’d expect with such rapid change, the dramatic increase in the use of telemedicine services placed strain on the technology and revealed its weaknesses, mostly related to performance bottlenecks. These bottlenecks were not apparent at a time of lower demand and may not have even come to light with slower growth.
Performance is of course vitally important; a patient needs to be able to easily log in to the application and have a seamless call with a medical professional where both participants can hear and, if required, see each other. If these functions do not work, then telehealth services will not be effective, patients will lose confidence, and people will not receive the treatment they require.
When telemedicine usage started to ramp up due to lockdown some providers were more prepared than others. For example, hospitals and healthcare clinics with well-established telehealth systems were able to provide a virtual alternative to in-person care without too much preparation. But, even in these cases, the dramatic increase in demand sometimes caused performance issues.
Usually, when visiting the doctor, the patient would arrive, sign in, wait for their name to be called, have a face-to-face consultation with the doctor, explain their problem, and be given a diagnosis along with necessary treatment options.
The patient may have to wait a while beyond their booked appointment slot if it is a particularly busy day, but they would know that they were in the right place. With telehealth services, a lot of these steps can be streamlined to remove waiting time and make more efficient use of medical experts’ time.
A patient should be able to book an appointment slot, sign-in at the given time and be ready to go, all without having to leave home.
However, for a change such as this to be successful patient experience must be consistently good to build confidence in this new way of doing things. If the patient cannot sign-in due to application problems, or performance bottlenecks, then they miss their session and are not able to get the diagnosis and treatment they need.
The same is also true if the quality of the audio/video interaction is poor, given that many patients may not be regular users of online audio/video communications (and its foibles). At a time when in-person appointments are either not possible or very risky, the performance of telemedicine services has never been more important.
The key to ensuring the success of telehealth services is being able to get on top of any performance issues as soon as possible, ideally via leading indicators that show an issue is building before a patient sees the problem, and being able to triage a problem quickly to get to root-cause when it occurs.
In one case study, a hospital adopted a two-part strategy to solve their performance issues. This is an approach that other medical centres could replicate. The first step involved performing scheduled tests for their telehealth application service’s website. Doing so allowed the IT team to quickly pinpoint early signs of performance of application problems in their dashboard. This more proactive approach allowed the team to identify sporadic errors that were occurring.
Having discovered the errors, the next step was to understand what they meant and their cause so that they could be addressed and prevented from reoccurring. The IT team returned to their dashboard view to analyse what was happening, looking at the utilisation of their website.
This revealed that there was no problem with the connectivity but rather that the compute capacity was too limited to be able to cope with the exponential increase in demand for the application. By having the relevant information at their fingertips, the IT team at this hospital could get to the root-cause quickly and was able to rapidly coordinate with their vendors to add several additional servers, quickly resolving the problem.
The coronavirus pandemic has only served to speed up the adoption of telehealth technology. Virtual appointments are appealing, responsible, and viable for anyone needing an initial medical consultation or a meeting with specialist that might not otherwise be possible. The pandemic has tested many of these applications and they are here to stay, so it is important that we put the right monitoring in place to identify any issues as early as possible – prevention is better than cure.
Darren Anstee is the chief technology officer for security at NETSCOUT.
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