2020 saw a huge increase in the adoption of digital technologies within healthcare – from video-based triage and GP-to-patient consultations in primary care to remote monitoring for shielding and vulnerable patients, as well as those discharged early from hospital. This is unlikely to be a permanent shift, says Dr Noel O'Kelly.
There is no replacement for face-to-face interaction. However, digital has brought attention to the fact that there might be a better way of identifying and prioritising the patients we absolutely need to see. Moreover, it paves the way for long-term change in making healthcare more inclusive.
As far back as 2017, the Government’s digital strategy policy paper outlined plans to “build a stronger, fairer country that works for everyone”. Within the context of the NHS, this means having the infrastructure, connectivity, access, skills and confidence to make healthcare more equitable.
Patients who are more likely to be digitally excluded include the more vulnerable: older people; those in lower income groups; people with disabilities; and those whose first language is not English, amongst others.
These barriers may be challenging, but they are not insurmountable, as the events of 2020 have shown. Indeed, there are many local examples of where digital technologies, designed around the needs and abilities of the patient, have been successfully used to provide continuity of care to these patient cohorts.
traditional ways of connecting to patients are at breaking point
Covid-19 has been a catalyst for extraordinary change: the response proved what can be achieved with the right mindset. It has also shown the value of real-time collaboration between healthcare providers to ensure the right patients are treated at the right time. The concept of working together as a team to look after patients is now firmly established.
But change has, so far, understandably been targeted at the most obviously vulnerable patients. To achieve true digital inclusion, there is still an infrastructure to be built. The priority for 2021 is to address the technology gaps revealed by the Covid-19 NHS response and use that knowledge to achieve a wider adoption of a broad, effective community care model within local health economies.
With the right pathway in place, the opportunity presents itself to move from the current model of reactive care to one where we can start to intervene early and prevent unnecessary exacerbations or avoidable hospital admissions.
Being able to alert a patient with COPD to their local air quality on a daily basis, for example, allows patients and clinicians to make more informed decisions about how to better manage their condition. Having early warning that a vulnerable patient’s health might be deteriorating based on regular vital signs readings similarly allows appropriate intervention, be that through continued care safely at home or to facilitate an early, planned hospital assessment if there are concerning features.
Moreover, this model enables stretched primary care teams to identify and connect with patients who might currently be ‘hidden’ in the system. From the new widower suffering from loneliness, to shielded patients fearful of leaving their homes; or those with social interaction challenges or learning disabilities, by enabling a proactive model of care where we’re not constantly fire-fighting, digital technology can truly make healthcare more inclusive.
With a patient-centric, digital-first approach, the wider health economy will gain from a huge influx of data. Data that can be analysed, using machine learning and artificial intelligence, to help us predict the people who are more at risk, from either physical or psycho-social conditions.
It will enable us to look at trends; to better understand the side effects of medication on specific cohorts of patients. It will provide insight to help us better understand mental health, as well as making it much easier to carry out research and develop therapies. Ultimately, it’s about improving pathways, outcomes, access to medicines and reducing the cost of healthcare.
Amongst the lessons of 2020 is the recognition that traditional ways of connecting to patients are at breaking point. There are more patients with mental health conditions, more with long-term conditions, and more older people with complexity and co-morbidities. This is a system that is struggling to cope with demand, even without the added pressure of a pandemic.
Yet the lessons of 2020 also give hope in the realisation that there is a new and better way of providing care. Digital adoption is only going to increase, but it must be done at the correct scale and in the right way.
The key to digital inclusion is getting the right local stakeholders within a local health economy to work together. It is the cooperation of policymakers, front line clinicians and IT suppliers within a local area that will accelerate digital change and achieve a model of care designed to be truly inclusive.