It could be one of the few good news stories of the pandemic.

As lockdowns across Europe kept millions at home, doctor’s appointments moved online; e-prescriptions became a necessity; and patients turned to digital self-management of their long-term health conditions.

While the coronavirus pandemic forced many industries to grind to an abrupt halt, digital health care is booming.

Take KRY, a digital health care company operating in several European countries including Sweden, the U.K, and France. It saw a 128 percent increase in appointments between February 1 and May 18, and a 139 percent year-on-year growth in registrations for its app.

“We’ve had five or 10 years of change in a very short time,” Johannes Schildt, the company’s CEO and co-founder, told POLITICO. He described the change as “dramatic.”

It’s not just doctors talking to patients. In the U.K., over 90,000 remote meetings between National Health Service (NHS) staff are taking place every day, following the introduction of Microsoft Teams in March.

“The last two months has seen a digital revolution in the NHS, which has brought in widespread virtual consultations, more electronic prescriptions and sharing records like never before,” said NHS Confederation’s Layla McCay.

But these changes also come with a cost: Experts warn they could exacerbate health care inequalities if policymakers don’t enact structural changes to how health care is provided.

Slow adoption

While digital health care may be on a winning streak, its tools haven’t appeared overnight.

For years, proponents of virtual consultations, health apps and the sharing of health care records have pushed for health systems to embrace these new technologies. But the coronavirus has been a “sledgehammer” forcing change in the sector, said Schildt.

Theodoros Arvanitis, director of the Institute of Digital Healthcare at the University of Warwick, told POLITICO that long-expected changes in digital health didn’t happen until the sector was faced with the “immediate need” necessitated by the virus.

“The health care sector is always risk averse,” explained Arvanitis. “But maybe the unfortunate consequence of the pandemic [is that] it has brought us to face this issue.”

In Spain, Vicent Moncho Mas, IT director at Denia Marina Salud Hospital, told Healthcare in Europe that there’s “always resistance to change.”

“Patients had never been asked what they wanted and physicians hadn’t had the opportunity to try these services,” he said. “Now they have.”

A case in point: The U.K.’s National Health Service has been attempting to reform its digital services since 2002. But a report published on May 15 (but prepared before the pandemic) by the National Audit Office found that the track record for digital transformation has been poor, with key targets being missed.

The European Commission’s European Semester review found similar issues across Europe. The Commission said on May 19 that the pandemic “brought to the fore the untapped potential for the deployment and use of e-health services.”

It zeroed in on France and Croatia as requiring investments in e-health, while Germany, the Czech Republic, Poland and the Netherlands need to focus on the deployment of these tools.

Postcode lottery

In Europe, a patient’s location often determines the level of access to quality health care. For example, the U.K., Sweden, Italy, Spain and Belgium all have variations of decentralized management, where local authorities or regions are responsible for at least some health care.

“Health care, by tradition, is very localized. That’s usually how reimbursement models [work] and all of the infrastructure is built upon that,” said KRY’s Schildt, adding that digital health care offers the possibility of doing things differently by equalizing access.

At the same time, he argues, if digital health care is pushed into the narrow confines by which traditional care is structured, it will just exacerbate existing inequalities.

For example, he points to the fact that only three million people in the U.K. are able to access KRY’s LIVI service, which offers digital GP consultation.

“Why can’t everyone access the service?” he asked. “There’s no reason, really. It’s just that health care by tradition is [managed through] care commissioning groups.”

It’s the same case with Babylon Health’s GP at Hand, which is only available in several catchment areas in the U.K.

Mas, of Denia Marina Salud Hospital, said that the disjointed nature of regionalized health care has been made evident by the pandemic.

“People understand that things have to change and that we need a centralized initiative,” he said.

There’s also the age-old issue of access. Barriers such as cost or limited infrastructure mean that not everyone can access these services, said Arvanitis.

This is what Donna Walsh, executive director of the European Federation of Neurological Associations, is also worried about.

Speaking during a POLITICO event on Wednesday, Walsh said that contrary to assumptions, the internet isn’t everywhere. “There are lots of places across the EU where connectivity just isn’t there,” she said.

Compounding this are digital literacy issues, she noted, with questions around whether all patients and doctors can use this technology.

“Lots of work needs to be done to look at this almost as a pilot and think: What worked well, what didn’t work well, what parts we want to keep and what parts we want to throw away,” she said.

A January working paper from the Organization for Economic Co-operation and Development (OECD) found that patients most likely to benefit from digital technologies like tele-medicine are also those who are most likely to face difficulties in accessing and using it.

It’s not just about access to the internet, but also demographic and socio-economic differences: The report cites data indicating that those who are younger, wealthier or have a higher level of education are all significantly more likely to access the internet for health information.

But if done correctly, the wider use of digital health care, particularly remote consulting, could in fact lead to better access to health care in areas with limited access, such as middle and lower income countries, argued Arvanitis.

This is the same conclusion that the Information Technology and Innovation Foundation (ITIF) came to in its May 26 report. The U.S. think tank found that digital health technologies could help lower and middle income countries in particular “overcome traditional barriers to better health care, especially staffing and other physical resource constraints.”

“While health data and digital technologies are not a silver bullet to COVID-19 and other health issues, they will be crucial to improving overall health outcomes in countries around the world,” ITIF stated.

Keeping up with the KRYs

What the NHS Confederation is worried about is that the drive for change may fizzle out after the pandemic.

“The universal cry from hospitals, community and mental health services and GP practices is that we must not return to where we were before COVID-19,” said McCay.

This is the impetus behind the organization’s new campaign calling for an NHS Reset, which aims to maintain and build on progress made in many areas of the health service during the pandemic.

Schildt said that while there will naturally be an increase in physical consultations post-coronavirus, the change necessitated by the pandemic will have “long-lasting effects.”

From his experience, “once you start to adopt digital services … it will be the natural entry point of health care.”

Arvanitis is similarly optimistic: “We’re going to see a change in the model of our health care system.”

Additional reporting from Sarah Wheaton. 

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