COVID-19 and beyond: the role of digital healthcare

The relaxation of COVID-19 restrictions may be good news for some but not all. One thing is clear, while we attempt to get back to ‘normal’ there will still be a clear need for digital solutions for patients who cannot – or do not want to – attend the practice in person

Over the last 18 months, the NHS has been fundamentally reshaped. Plans and ideas that were bubbling away in the background for years suddenly received the green light by default. 2020 saw a huge increase in the adoption of digital technologies within modern healthcare economies, and this isn’t expected to slow down throughout 2021. From the adoption of video-based triage and patient consultations, to remote monitoring for shielding and vulnerable patients, as well as those discharged early from hospital – both in their own homes and care home settings, digital technologies have driven wide recognition that there is an alternative way to manage clinical caseloads within a primary setting.

While this is unlikely to be a permanent shift, it is a seismic one. Yes, clinicians will not want to manage their patients by video alone and there is no replacement for face-to-face interaction. But since April 2021, NHS England has required all parts of the health and care system to work together as Integrated Care Systems (ICS), meaning that primary care is set to take a central role in providing joined-up care.¹ Strategic commissioning will focus on population health outcomes, and digital and data will play an increasing role in placing people at the heart of their own care.

From providing educational resources to help empower patients to better manage their own conditions, to identifying and prioritising the patients that absolutely need to be seen and thereby easing the workforce burden faced by healthcare professionals, digital will continue to underpin primary care services well beyond the COVID pandemic. And as we move into the ‘new normal’, with social distancing laws relaxed and the public allowed to make their own decisions about mask wearing, digital healthcare is going to become even more essential. The adoption of digital solutions has shifted the paradigm about the way we will need to provide a proactive and preventative model of care in the future.

NEW MINDSET

Until March 2020, digital innovation was a consumer expectation that was largely unmet in UK healthcare. The old models of delivering care remained at odds with modern needs and possibilities. Patients wanted better ways of accessing healthcare and were increasingly demanding a voice and a choice in decisions about their care.² The technology was there, but the challenge lay in getting innovation out there – and used – more effectively than we had done before.

What COVID-19 did was change innovation at a very local level, rapidly. Making headway during the pandemic relied on local healthcare economies building sensibly on what was already there. In the process, 2020 became the year when local health and care organisations used technology to help existing services work better and more efficiently; applying technological solutions to their current systems and pathways to give patients and clinicians better access to information and education that would enable care to be delivered to vulnerable patients at home.

One of the major areas of technology adoption at a local and regional level has been in remote monitoring for the vulnerable, including the frail and elderly in care homes, patients discharged early from hospital to free up COVID-19 beds, or those in the high risk category with long term conditions such as diabetes, heart failure or COPD.^3,4

By regularly and consistently monitoring these vulnerable patients, this technology allows clinicians to triage their patients and know when to intervene. Extending the concept of care to one akin to a ‘virtual ward’, healthcare professionals get clinical information more quickly than they would do in the traditional setting which allows them to rapidly assess a patient, and better balance risk and time management.

This proactive model, centred around joined-up primary and community care, has allowed for early intervention that has helped keep people out of hospital, increased health system capacity and reduced the risk of cross infection at a time when our collective focus has been on protecting vulnerable patients and the NHS.

IMPROVED COLLABORATION FOR BETTER OUTCOMES

By connecting patients with their clinical teams virtually, patients are given much greater involvement in the management of their health, while healthcare professionals can remotely monitor their vital health information.

As a form of preventive care, remote patient monitoring puts everyday wellness at the forefront of patient care, by providing patients with the necessary tools, from educational resources on their condition, to being aware of positive action they can take to prevent deterioration, and through better understanding of external factors such as air quality.⁵

Indeed, an internal evaluation of work Spirit Digital has conducted with the Leicestershire Partnership NHS Trust following the use of CliniTouch Vie, Spirit Digital’s remote monitoring solution, seems to suggest that patients of all ages are very adaptable to a digital approach, with high patient acceptability demonstrated on patient satisfaction questionnaires and the Family and Friends Test (FFT).

In parallel, the pandemic has also shown the value of real-time collaboration between GP practices and an entire network of healthcare providers to ensure the right patients are treated at the right time. From nurse practitioners and practice pharmacists, to the hospital consultants, care homes, opticians and dentists, the concept of working together as a team is now firmly established.⁶

LOOKING BEYOND COVID

With laws on social distancing and mask wearing eased as of 19 July, it is crucial that we take the learnings from the past year to support general practice staff and the safety of healthcare professionals and the general public alike.

First, we have to ensure healthcare is more digitally inclusive – and that requires infrastructure and education. The priority for 2021 is to address the technology gaps revealed by the COVID-19 NHS response and to use that knowledge to achieve a wider adoption of a broad, effective community care model within local health economies.

As Nicola Haywood-Alexander, Chief Information Officer, NHS Lincolnshire STP, comments: ‘Local health economies have to move from a mindset where we have a portfolio of individual technical projects, to having a strategic, joined-up digital transformation programme that is based upon making healthcare accessible for all; easy to navigate; and centred around the individual needs of a patient – or carer – within their own care setting. This means having a system that isn’t based on the physical location where patients access care, but extending care into a remote, virtual model, empowered by technology.’

The second challenge is around harnessing data. With the increased adoption of digital technology comes data that can be analysed, using machine learning and artificial intelligence, to help us not just identify in real-time those patients who need priority care, but also predict those who are more at risk, from either physical or psycho-social conditions.⁷

These real world data will help clinicians to look at trends, prioritise care, improve COVID-19 treatments, and to better predict another spike in the pandemic or to prevent the collateral effect on long term conditions.⁸

CONCLUSION

Under the most strenuous of circumstances, great strides forward have been made in digitising healthcare and transforming many care pathways from the traditional, reactive model to one focused on prevention and proactive care. But this shouldn’t stop here, especially when the pandemic is far from over, as infection rates continue to soar and winter pressures once again start to loom.⁹

This is a once-in-a-generation opportunity for change. As we look beyond COVID-19, it is imperative that policy makers, clinical leaders and front line staff maintain their grasp on the digital future.

REFERENCES

1. NHS England. Integrated health and care in action. https://www.england.nhs.uk/wp-content/uploads/2019/03/integrated-care-case-study-primary-care.pdf

2. Deloitte Centre for Health Solutions. Connected Health: how digital technology is transforming health and social care. https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-connected-health.pdf

3. Aalam AA, Hood C, Donelan C, et al. Remote patient monitoring for ED discharges in the COVID-19 pandemic. Emergency Med J 2021;38:229-231 https://emj.bmj.com/content/38/3/229

4. NHS England. Remote monitoring to support rapid assessment of vulnerable care home residents. https://www.england.nhs.uk/nursingmidwifery/shared-governance-and-collective-leadership/nursing-covid-19-catalogue-of-change/remote-monitoring-to-support-rapid-assessment-of-vulnerable-care-home-residents/

5. Carlsten C, S Salvi S, Wong GWK, Chung KF. Personal strategies to minimise effects of air pollution on respiratory health: advice for providers, patients and the public. Eur Respir J 2020;55:1902056

6. Care Quality Commission. How providers are working together across systems in response to COVID-19. https://www.cqc.org.uk/publications/major-reports/how-providers-are-working-together-across-systems-response-covid-19

7. Martínez C, Harhan I. Making the right choices: using data-driven technology to transform mental healthcare. Reform July 2019. https://reform.uk/sites/default/files/2019-07/Using%20data-driven%20technology%20to%20transform%20mental%20health%20services.pdf

8. Paubert G. Leveraging Health Data to Support Patient Care. The Health Improvement Network (THIN). European Biopharmaceutical Review. July 2020. https://en.calameo.com/read/006113385393912394987?page=14

9. Stephens M, Davies G. 2021. Covid-19 hospital admissions climb to highest level in four months. The Telegraph (online). 13 July 2021 https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-news-covid-vaccine-passport-certificate-cases-restrictions/