The digital revolution of health and care: From the fax machine to Zoom
By Integrated Care Journal-
The Covid-19 pandemic has accelerated the digital transformation of health and care. However, the implementation of this digital transition represents a monumental challenge for the healthcare sector. How can we harness this momentum and continue to deliver digital transformation at pace? Has digitisation really improved patient care on the frontline? What are the opportunities for effective partnerships between healthcare and industry? These are just some of the questions raised at the Public Policy Projects Annual Conference 2020.
Andy Wilkins, Co-Founder of Vision4Health, opened the discussion by highlighting how the pandemic has revealed the strength of frontline staff to rally together against the challenge presented by Covid-19. However, the first wave also exposed how the institutional and siloed nature of health and care hindered coordination at the system level.
Mr Wilkins emphasised that: “We are now at a pivotal moment in the history of healthcare” and must think about how we do health and care differently in the face of our major challenges going forward. On the demand side, the challenge of managing the ongoing pandemic continues while the substantial backlog of other illnesses that ha arisen as a result of the first wave of Covid-19 and underlying rise in chronic disease must also be taken into account. On the supply side, a shift towards integrated care systems and regional population-based health structures will require a different way of thinking about how we organise health resources. With an exponential rise in new medical and technical breakthroughs over the past ten months, the focus now must shift to integrating these new capabilities into our healthcare system for the long-term
Mr Wilkins called for the health and care sectors to ‘embrace new ways of working’ noting, in particular, the cultural resistance to change, overcoming the “internal, self-limiting belief that change at scale was not possible. ” However, the swift adoption of virtual networking, virtual working and virtual consultation during Covid-19 has provided a dramatic example of how quickly change can happen.
The pandemic has also “created a new consciousness about what levels of change become possible when teams come together under a shared purpose” said Mr Wilkins. The cooperation within life sciences and academia on developing covid vaccines and treatments, and the thousands of offers of support from companies to the healthcare system point to huge possibilities for more effective partnerships between the healthcare system and industry. There is much work to be done, “but this energy and momentum for change is something we need to harness as we look forward to the possibilities that arise from the digitisation of healthcare,” he concluded.
Unlocking new capabilities
“It is really important now, to focus on what we are able to do as a system,” emphasised Sarah Wilkinson, Chief Executive of NHS Digital, challenging how providers can take capabilities forward and take advantage of the huge potential to transform care through smarter use of digital and data.
The past nine months have seen the delivery of new digital products and services “at a pace that would have been possible in 2019,” said Ms Wilkinson. During this time NHS digital has delivered the digital infrastructure for Covid testing and the shielded patients' list, rebuilt the 111 systems, built a myriad of new system integrations, new data flows and national scale collaborations. The key learning has been that the NHS already has the ability to deliver successful digital transformation and do it at pace. “The great question,” Ms Wilkinson stressed, “is what was stopping us delivering at the same pace in recent years? How can make sure we don’t fall back but take all this energy forward? ”.
Accord to the NHS Digital Chief Executive, three factors have enabled this period of accelerated digital innovation. Firstly, there has been clarity in the commissioning of digital services. Unlike previous years, where programmes have stalled because the intended outcomes have not been sufficiently clear, the pandemic has necessitated that the system be clearer on its core goals of transformation. Secondly, governance has become more streamlined, with instructions flowing directly from the commissioner to the delivery partner. This has allowed more clarity on where responsibilities and accountabilities lie. Lastly, the pandemic has created an increased risk appetite. The focus has been on delivering capability, even if it slightly imperfect. “When the effect of doing more testing or governance is to delay covid testing for the nation... you know you have to tolerate higher levels of risk”, explained Ms Wilkinson.
Data is also being used very differently in the pandemic. COPI legislation has been used to enable the dissemination of data with far fewer constraints. While this new modus operandi is “an entirely appropriate way to operate during a pandemic,” Ms Wilkinson noted that we, as a system, must work to streamline legislation so that it is more relevant to the 2020 digital environment, including consulting the public on the benefits of using data more extensively.
Digital services on the frontline
The pandemic had rapidly accelerated the deployment of frontline digital services, virtual consultations, remote monitoring and patient self-management. Looking forward, Dr Harpreet Sood, Board Member at Health Education England, asked: “How can we build on this moment? ,” asserting that we must not simply “stick technology onto existing ways of doing things” if we are to ultimately realise the full benefits of digitisation.
With regards to remote patient monitoring, Dr Sood noted that while some benefits have been seen for heart failure patients and those with chronic disease or chronic respiratory conditions, “the evidence remains minimal. ” The impact of the digital transformation on frontline patient care is still largely unclear. Therefore, we must establish that digitisation provides a superior service to existing services before we rush into its implementation, he suggested.
Clinicians need to be equipped with better data infrastructure if they are to properly process the data they are now receiving, summarised Dr Sood “If data remains unstructured and complex then there is a high risk that we will end up missing something that is of critical importance because we don’t have the infrastructure we need in place”.
Stronger partnerships with industry
Bringing an industry view, Rosalind Way, Head of Strategic Partnerships at Novartis UK, discussed the opportunities for greater partnerships with healthcare providers. Improving patient outcomes and the wider population must be at the heart of every partnership, she urged. . In order to deliver the most value and scalability, effective partnerships “must get under the skin of what the priorities and challenges are for the wider health and care system. ”
it is imperative that the right stakeholders are included in preliminary conversations. “If you haven’t got the right people around the table, you may produce a solution or technology that only provides part of the answer,” said Ms Way, additionally noting the importance of considering workforce implications and understanding patient needs.
Considering the benefits of partnerships, Ms Way explained that “industry has the ability to be bold and fail fast in a way the NHS does not. ” The power of industry collaboration is that it can help the healthcare system take risks, while also benefitting from international expertise.
Population health management
The final session’s final speaker Vice President of Global Population Health at Cerner, Dr Justin Whatling, discussed the importance of interoperability and care pathways as “building blocks” to population health management. Although Covid-19 accelerated the need to connect the system and improve information exchanges, more work needs to done on interoperability standards, urged Dr Whatling. The nation cannot afford to have too many proprietary standards as this makes it difficult to connect systems and leaves shared care records in danger of “becoming their own islands,” he warned.
In terms of care pathways, Dr Whatling argued that “digitisation will not create the culture change that is needed”. We must use the tools afforded to us through data and digitisation to remove unwarranted variation in care and population health pathways, rather than simply automating care. Governance models can be changed so that clinical process groups take a data-driven, clinically-led approach in their pathways. Making use of data can drive great efficiencies but will require a “huge culture change around the way we use IT and the value we derive from it. ”
Data intelligence during the pandemic has also allowed for a much more positive population health management approach. For example, local authority and housing data has been used to help pinpoint vulnerable populations and deliver medical and supportive care services. Dr Whatling argued: “this underpins the need to get these data intelligent architectures in place,” adding that more investment is needed if integrated care systems are to fully create these architectures.
Addressing the importance of technical architecture in reducing health inequalities, Dr Whatling urged community partnerships to get better at routinely capturing and integrating social determinants. We must build better service directories so that individuals can be more easily referred across the system. The pandemic continues to squeeze services and pressures are set to get worse over the winter. If the stars have aligned for a digital revolution, the opportunity must not be missed.
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