From time immemorial, an invariable feature of the interaction between patient and doctor is that it has taken place in person, either in the GP surgery or hospital.
That is suddenly changing. The global pandemic COVID-19 presents a unique challenge to health systems around the world and will necessitate the adoption of innovative virtual care solutions.
Ingrained patient and clinical behaviours, entrenched stakeholder interests and a complex regulatory framework have made it difficult to operationalise and scale new technology-enabled approaches.
However, recent events will bring about a paradigm shift to distribute increasing volumes of healthcare interventions away from the hospital and towards the home and community. While COVID-19 will likely be the catalyst there are good reasons why this should happen in any case.
Healthcare is arguably one of the sectors with most to benefit from digital transformation. Digital health sits at the confluence of a number of developments that are with us now:
- New virtual care platforms are capable of supporting an ecosystem of virtual care solutions that can provide care teams with rich knowledge of a patient from afar and on a continuous basis.
- Wearable devices, sensors and digital services can monitor health information remotely, engaging patients and carers, and enabling better self-management. The sophistication of these devices is increasing and adoption across age groups is growing.
- Artificial intelligence can convert these data streams into actionable insight, prioritising patients that require an intervention to prevent a distressing and expensive hospital admission.
This technology can and is being used to address major healthcare challenges such as reducing emergency hospital re-admission rates from patients with long-term conditions and helping meet outpatient waiting-time targets.
An NHS Greater Glasgow & Clyde service for remote management of COPD patients (patients with chronic lung disease) is an example of a virtual care model in action today with the aim of reducing hospital re-admission rates.
Moreover, while virtual care can offer effective care delivery – and for patients on immunosuppressant therapies this is currently the safest way to manage these patients – they can also enhance clinical productivity. Adoption of video consultations and asynchronous virtual clinics are examples of how outpatient care can be virtualised.
Outpatient appointments across the UK account for 85 per cent of all hospital activity (excluding A&E) and in Scotland return outpatient appointments account for 55 per cent of all consultant-led outpatient activity and 85 per cent of nurse-led clinics in Scotland.
Evidence suggests that virtual outpatient models can deliver greater patient throughput for the same level of resources and meet patients’ expectations around convenience and flexibility. Greater adoption of these services would free up clinical teams to help meet rising demand and reduce outpatient waiting times.
Yet, it’s worth noting that healthcare is a sector with unique characteristics that make it harder to deliver the kind of disruption and transformation we’ve witnessed in other industry sectors over the past few years.
Medical Device Regulations on software as a medical device are absolutely necessary to ensure what is delivered does not jeopardise patient safety. This involves companies implementing quality management systems and achieving relevant certification. But while regulation is necessary, it has undoubtedly slowed down the introduction of reimagined services, which in turn makes it harder – and more expensive – to operationalise at scale.
In addition to regulation, in most scenarios we cannot achieve full automation of a healthcare interaction end to end. For the next few years – at least – there will always be a healthcare professional involved in reviewing information that’s been provided by a patient, and that individual will also be involved in follow-up actions. So, it will take time for the full efficiencies of digital services to be realised.
Last but not least, after regulation and automation is the question of the digital divide. The health service must be free at the point of need for all, not just the digitally literate. As such we need to be mindful that some patients cannot transact in this way.
Nevertheless, the digital divide is narrowing in Scotland. Recent stats from Ofcom for Scotland showed that ownership of smartwatches and wearable technology has jumped from five per cent to 25 per cent just in the past two years. Seventy-six per cent of people in Scotland now own a smartphone. Even in the lower socio-economic categories, 68 per cent of people have smartphones, and this continues to rise year on year.
Sixty per cent of 65-74 year olds in Scotland now have a smart phone and 75 per cent have a home internet connection. To put this in context, 90 per cent have a landline phone.
Looking further to the future, technologies such as connected sensors, devices and AI will change how healthcare is delivered. A recent study by the American Journal of Preventative Medicine found that clinical care, the primary focus of healthcare, accounts for around 15 per cent of overall health outcomes while health behaviours, social status and genetics account for the other 85 per cent. In the near future patients will generate far more data about their health and wellbeing than is gathered by clinical care. The challenge for the healthcare sector is how to harness this data to deliver better healthcare and health outcomes for all.
Paul McGinness is Director of Storm ID, a digital consultancy working primarily in the health sector