How Prepared Were Physicians for the COVID-19 Digital Upswing?

Before the global outbreak of coronavirus, Ipsos conducted a survey with SERMO (a fieldwork partner), looking at how 1,745 doctors from across 21 countries use digital technologies. Findings from the “Digital Doctor 2020” survey show that while a noteworthy proportion of doctors were already starting to adopt digital and connected health, many were hesitant. With the outbreak of COVID-19, this has all changed.

More recent Ipsos data – taken from 311 interviews with healthcare professionals in the US between March 26 and April 2, 2020 – offer an updated perspective from the largest healthcare market in our global study. Although this latest data must be considered directional only due to the base size of the respondents surveyed, it was interesting to note that:

• 80% of the US HCPs surveyed are now taking patient visits using telemedicine

• 62% of the US HCPs surveyed are allowing to receive online or telephone details

• 57% of the US HCPs surveyed consider the e-details to be effective (among 642 e-details the HCPs evaluated). (Note: E-detail was defined as “any non-personal interaction with a pharmaceutical sales representative” in the survey or company, such as a telephone call, videoconference (Skype/FaceTime), online video, etc.”)

Returning to the Digital Doctor 2020 report, although technology had started to be adopted across the globe by primary care physicians, its full potential was yet to be realized. The recent outbreak of COVID-19 has prompted a lot of inexperienced doctors (with many also lacking in confidence) to use online tools and resources, from telehealth (communicating via videoconferencing) and remote patient monitoring to virtual congresses. Whether these changes are likely to remain and become the new “normal” is difficult to predict, but certainly with doctors experiencing these changes we anticipate a longer lasting impact on the way healthcare is delivered and how technology is viewed and embraced by doctors.

Awareness and knowledge of technologies pre-COVID-19

Before COVID-19, there was fairly high awareness of a mix of digital concepts relating to healthcare. However, this did not translate into knowledge. Specifically, in the Digital Doctor 2020 study:

• The top 4 technologies that the doctors surveyed are most aware of include: Telemedicine/Telehealth (97% awareness, 59% know a lot about it), Remote Patient Monitoring (92% awareness, 41% know a lot about it), Artificial Intelligence (AI) (89% awareness, 31% know a lot about it) and Robotics (85% awareness, 28% know a lot about it).

• Technologies that the doctors surveyed are least aware of include: Chatbots (52% awareness, 16% know a lot about it) and Blockchain (44% awareness, 10% know a lot about it).

Source: Ipsos Digital Doctor 2020 study – 1,745 doctors in 21 countries interviewed online, using SERMO, from November 15, 2019 to February 7, 2020 (see “About the Research” for full details).

It seems that although there was a good level of awareness of these technologies, how these technologies apply to healthcare – or simply how they work – was still unknown to many doctors at the time of the Digital Doctor 2020 survey. Now, at a time when so many technologies are being introduced (and advocated) to primary care doctors, it is important to note the level of awareness and knowledge of the various technologies available. Simple explanations, along with clear benefit statements, will be welcomed when there is such a steep learning curve and a lack of awareness. 

The rise of digital and connected health 

The doctors surveyed in our study believe that connected health devices and tools can play a key role in disease and treatment management (83% surveyed agree), a figure which increased by seven percentage points since the last wave of this study (Digital Doctor 2017). Doctors surveyed also agree that connected health devices and tools for patients will form part of treatment plans for certain health conditions in the future (83%). Agreement with this statement increased by six percentage points since Digital Doctor 2017. However, “current usage” of connected health (pre-COVID-19) was not particularly high:

• As shown in Digital Doctor 2020, doctors’ use of connected health is reported at similar levels for personal (34%) and professional (31%) use. Among those who use connected health devices professionally, the main reasons for doing so are: to access information on a disease and how to manage it (57%), and to maintain up-to-date and accurate health records of patients (56%).

• Some doctors surveyed also encourage patients to use these devices, either recommending them a connected health device to monitor their health for self-evaluation (47%) or to review the results over a consultation (46%).

Does connected health equal patient empowerment?

Doctors surveyed in Digital Doctor 2020 recognize a number of benefits that connected health devices offer in relation to their patients having access to their data, creating opportunities for early intervention and having more effective conversations between healthcare professionals (HCPs) and patients: 

• Overall, 86% of doctors surveyed agree that connected health devices provide patients with greater access to their own personal health information. Those doctors surveyed who have also recommended a connected health device to their patients also agree that patients have become more interested in their own health data or have control over their weight, diet and physical activities. However, doctors surveyed have also expressed concerns that this “empowerment” of patients can lead to patients misinterpreting data and potentially risk misdiagnosis. 

Studies have shown that patient empowerment does lead to patient satisfaction.¹ Providing patients with the option to receive more information about their condition and how they can better manage it does not necessarily mean that they will become doctors of themselves. Rather, it gives the opportunity for patients to participate in decisions and ensure they have the knowledge to decide in their treatment plan/management if they wish to.²

• Digital Doctor 2020 shows doctors surveyed agree less with statements about the benefits of connected health in relation to the provision of better clinical outcomes, such as reduction of hospital readmissions (56%), or hospitalizations (55%). 

The benefits and competitive advantage of connected health devices are that they can help healthcare to move from a reactive to a proactive role. Providing patients with the ability to monitor their disease and understand what to do in order to prevent acute reactions means fewer people needing hospitalization or intensive care. Even if the patient is hospitalized, connected health devices will be able to help patients manage their conditions after being discharged from hospital.  

The rise of virtual care/telehealth

Key findings from Digital Doctor 2020 regarding telehealth include: 

• Around half of primary care doctors surveyed had previous experience of telehealth services.

• A majority are aware of telehealth services, but there remains scope for education as to how these services can benefit doctors and how they can be maximized.

• Around two in five doctors surveyed expect telehealth to play a key role in the future.

Telehealth has long been around but has never been widely adopted. Benefits of using telehealth were always centered around reducing health costs, increasing access to care and making both patients’ and doctors’ lives easier. Although this would indeed be the case in reality, in the Digital Doctor 2020 survey only 48% of doctors surveyed globally claim to have ever used telehealth. The more recent survey fielded by Ipsos during COVID-19 (with 311 HCPs from seven specialties in the US) found that 80% of respondents now use telehealth, suggesting a drastic change in doctors’ behavior.

Barriers that countries were facing in terms of adoption of telehealth were regulatory in nature or due to limited technology infrastructure to support secure conversations between patients and doctors. Due to the COVID-19 outbreak, however, things have changed, with new regulations in place in some markets. Specifically, the FDA announced they will not object to any change in claims made by medical devices companies to facilitate the use of telehealth.³ Furthermore, the US federal government has made it easier for patients to get access to their doctors and other caregivers remotely – either via phone calls or video visits.⁴

Pre- COVID-19, Digital Doctor 2020 showed that only around two in five doctors surveyed expected telehealth to play a key role in the future. This is now likely to change. In these times of crisis, it is paramount to adapt to the new realities as quickly as possible to prevent overburden of the healthcare system. It is widely believed that telehealth is now here to stay, as more and more people will experience it daily and doctors begin to realize its benefits and potential.⁵   

The rapid acceleration of digital channels is now happening

Offline sources, such as face-to-face interactions, are the main channels doctors have used for many years. Traditional has reigned supreme over digital for decades, and even in Digital Doctor 2020, doctors’ most used channels (in the past three months from interview) were:

• Discussions with peers (54%), in-person, one-to-one meetings (52%) and in-person events/meetings (48%). 

However, Digital Doctor 2020 shows interaction with digital channels for medical education was already growing pre- COVID-19: 

• Amongst online sources, the main online channels used were: email updates (45%), online study modules (41%), pharmaceutical company websites (39%), online webinars (30%) and remote web access to conference seminars (29%). 

• In most cases, usage of a channel translated into perceived usefulness of this source, but this is not always the case. For instance, receiving email updates – although used frequently – is not considered as useful compared to other sources such as podcasts or online study modules. 

Reflecting on Ipsos’ more recent COVID-19 study results, the US HCPs we surveyed are now allowing online or telephone details via reps (62%) and 38% have simply eliminated seeing reps at all (even though they were seeing reps prior to COVID-19).  Respondents report few recent invitations to e-details; those who had e-details rate them as highly effective (57%).

In summary

In summary, we have found that:

• Awareness of different digital technologies related to healthcare is high – however knowledge is low. 

• Although face-to-face interactions are still preferred, online channels are on the rise and accelerating with COVID-19.

• Benefits of using connected health devices for patient management and treatment are recognized and it is believed that they will play a key role in the future. 

The question remains, why were doctors still reluctant to widely adopt and use these technologies pre- COVID-19? We often talk about the benefits that connected health devices will provide to patients, but less about the benefits that it will offer to doctors specifically. Due to unprecedented changes in recent years, such as the increase in patients with chronic diseases, growing life expectancy and doctor shortages, huge challenges are facing doctors who have very busy and heavy schedules. Value-added solutions, coupled with proper training and supported by new regulations, will accelerate the acceptance and adoption of new technologies. Our latest research over the last few weeks suggests that doctors’ usage of digital solutions has already increased, demonstrating how quickly they can adapt to new realities and respond to a crisis, such as COVID-19. For a long time, digital solutions have often been considered an option; now they have become a necessity.

Reena Sangar is Global Head of Digital & Connected Health, and Matilda Pateraki is Research Manager, both at Ipsos.

References

• https://powerfulpatients.org/2018/05/22/what-does-it-mean-to-be-an-empowered-patient/

• https://www.emerald.com/insight/content/doi/10.1108/TQM-11-2017-0138/full/html

• //www.fda.gov/media/136290/download

• https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak

• https://www.economist.com/open-future/2020/03/31/telemedicine-is-essential-amid-the-covid-19-crisis-and-after-it

About the survey “Ipsos Digital Doctor 2020”

Ipsos MORI interviewed n=1,745 doctors online, using SERMO (fieldwork partner). The survey was carried out across 21 countries with n=200 interviewed in US, n=151 in India, n=150 in China, n=116 in Brazil, n=101 in France, n=100 in UK, n=100 in Italy, n=100 in Spain, n=100 in Germany, n=100 in Canada, n=100 in Japan, n=51 in Belgium, n=51 in Colombia, n=50 in Netherlands, n=50 in Australia, n=50 in South Korea, n=50 in Vietnam, n=35 in Hong Kong, n=30 in Malaysia, n=30 in Indonesia and n=30 in Singapore. All participants were GPs/PCPs with 2-35 years of experience in current role and more than 25 years old. Fieldwork took place between November 15, 2019 to February 7, 2020.

About the survey “Ipsos Health COVID-19”

Ipsos North America interviewed n=311 participants online, only in the US.  All participants were HCPs who spent at least 75% of time in patient care, allowed sales reps in office prior to COVID-19 and participated in at least 1 e-detail in the past two weeks. HCPs included in the sample were: Allergists n=29, Rheumatologists n=24, Neurologists n=50, Psychiatrists n=50, Endocrinologists n=40, PCPs n=50, Dermatologists n=25, Oncologists n=43. E-detail in the study was defined as “any non-personal interaction with a pharmaceutical sales representative or company, such as a telephone call, videoconference (Skype/FaceTime), online video, etc.”. Each HCP assessed up to 3 recent e-details, resulting in 642 e-details being evaluated. Fieldwork took place between March 26, 2020 to April 2, 2020.