Digitisation is Transforming Physical Therapy
In 2019 you were happily seeing and talking to clients face-to-face in your clinic or gym – the analogue approach. I am quite fond of analogue – touch is another form of communication. As a manual therapist, it gives me some information, but more importantly, it connects me to the client. I do not want to give that up. However, times are changing and just like every other industry, value creation is occurring online, and I may need to accept that touch is a luxury that healthcare and clients will not pay for unless we can show results. As an evidence-based profession, we are meant to be reimbursed for what is shown to work. Evidence requires before and after objective measurement. The research tends to lean towards exercise prescription and advice as to the cornerstones of effective physiotherapy and training. Digital Health solutions inside of Telehealth teleconferencing platforms are perfect for objective measurement, exercise prescription and giving advice. The temporary social distancing imposed by the COVID-19 virus could be forcing us into a digital transformation that benefits clients, practitioners and payers.
It is time to frog leap from analogue to digital
Like in every other industry, health and fitness organisations need to consider how value creation and organisation design are affected by digitisation. This comes along with the opportunities and challenges that digitisation presents – especially now when clients of clinics, members of gyms, players in sports teams, and residents of care homes are told to avoid physical contact, and new routines are necessary. It is a unique opportunity to frog leap from analogue to digital consultations, with payers on board, and with the sense of urgency required to make the transition. For researchers and physiotherapy associations, it is also a unique opportunity to A/B-test the value created using status quo analogue versus modern digital health and fitness.
The digi-physical consultation
It is time to rethink the importance of an entirely physical visit, and possibly our self-importance as practitioners. We need to realise the benefits of the digi-physical consultation. There is no doubt that people like to meet physically. However, it comes at a cost – travel costs and time away from work for the client, and personnel costs and overheads for the provider. Digital can perform many tasks better – routines like measurement, surveys, analysis and monitoring. Digital can also empower the client, enabling self-efficacy, convenience and flexibility. Once upon a time in another essential industry, banks closed all their tellers and forced us to use ATMs and online banking – now, no-one wants to go to the bank anymore. This created value for the banks and the customers, despite the initial resistance, to change. Healthcare is experiencing the same inertia, and with physiotherapists currently reporting a 50% reduction in client visits, we inevitably need to embrace the idea of moving away from the treatment bench and going online.
The technology is already available
In 2020, health workers can see and talk to clients online, and there are many technical options from which to choose. Some are general teleconferencing systems, such as Zoom (USA) or WebEx (USA), and others are very specific, such as Physitrack (GBR), Physiotec (USA) and Neorehab (AUS) for physiotherapy, and Kry (SWE)/Livi (GBR) for doctors. In addition to video conferencing, they enable online prescription of exercise and medication, respectively.
The choice of a general or specific teleconferencing channel is essential, as it needs to be user-friendly as well as compliant with data protection rules. The early adopters who cleverly used Facetime, Messenger, WhatsApp and Skype to send exercise programs and chat about symptoms need to reconsider their communication strategies. A secure teleconferencing system is a hygiene factor.
Content enables payment for your expertise, not just your time
Now that health providers are using teleconferencing, they are also demanding digital health solutions to improve efficiency and to add meaningful content to their calls.
Subjective assessments are now performed by chatbots, with immediate access and immediate feedback. Clients are interacting with Babylon Health (GBR) or Doctrin (SWE) before they talk to the doctor, and Phio by EQL (GBR) or Healo (SWE) before meeting the physiotherapist. Clinical research has been using remote surveys to assess people for years – it is inexpensive, convenient and removes interviewer bias.
Objective assessments are also going digital. Clients measure themselves, where it suits them - at home, in pharmacies and at gyms. Blood pressure and blood saturation using Omron (USA), as well as height and weight at a SISU health station (AUS), body composition using Tanita (JAP), and even blood values by Werlabs (SWE) are all available outside of the clinic. Only the regulators, reimbursement systems and clinicians themselves stand in the way of progress – the technology has been ready for years, as have the clients, but who gets paid what is still under discussion. Showing value though objective outcomes is the only way to get paid for results, and the perfect opportunity to get out of an archaic fee-per-hour model.
Online medical imaging reporting via teleconferencing with patients and between colleagues is common practise. An MRI, X-ray and ultrasound can reveal structural problems inside of the body. However, they say nothing about function. Observation of movement and balance in activities of daily living is fundamental to many health services and poorly served by a webcam. Hence, physical therapy, personal training and coaching still rely heavily on a physical visit to capture, evaluate and communicate function. It is known that webcam images and recorded 2D video are not adequate for clinical use. A new breed of affordable 3D motion capture services for assessment and intervention has evolved over the past ten years, and they are reinventing the way we see and analyse movement in the clinic and remotely. Our very own Qinematic (SWE) software is recording and measuring human movement in 3D in clinics, gyms, clubs and workplaces all around the world.
In 2021, we will stop saying digital health - It will be digital by default
Connecting online is now just the norm – Facetime with loved ones and on-demand TV is enjoyed daily. We benefit from more personalisation than ever. Digitisation can help physiotherapy and fitness bring a new level of personalisation to both clients and health providers. We now have the opportunity to pave a path to much-needed precision medicine, predictive analytics, and outcomes-based reimbursement.
Remember - Content is King! Putting more Digital Health solutions like Qinematic inside of Telehealth services will add untold value to health and fitness payers, consumers and providers.
A personal message
Like most physical therapists and fitness instructors, my passion is for human movement. I share the mantra that ‘Exercise is medicine’ and believe that it should be prescribed following individual analysis and structured clinical reasoning, with the support of technology. That is how award-winning Qinematic came into existence, along with the help of international expertise in human movement, rehabilitation, computer science and artificial intelligence. In retrospect, I can see that we were before our time in 2012. But today, we are more relevant than ever.
Changing the status quo is not easy. Some years ago, I heard that a successful digital solution needs to be ten times faster and ten times cheaper than the status quo. Compared to our big brother mocap solutions like Vicon (UK) and Qualisys (SWE), we have achieved that. It takes just 5 minutes for a client to perform an automated 3D scan. Unlike an expensive movement lab or an MRI, there are no particular facility or personnel requirements. Without delay, artificial intelligence analyses the movements and reports the measurements online to the client and the provider. Most importantly, it is simple to use and affordable for clinics and gyms of all sizes.
Glenn Bilby
Physiotherapist, Human Movement Scientist
Founding CEO of Qinematic
Connect on LinkedIn or email me: glenn.bilby@qinematic.com