2020 saw a huge increase in the adoption of digital technologies within modern healthcare economies. From the adoption of video-based triage and GP-to-patient consultations within primary care, to remote monitoring for shielding and vulnerable patients, as well as those discharged early from hospital – both within their own homes and a care home setting, digital technologies have driven wide recognition that there is an alternative way to manage clinical caseloads.
This is unlikely to be a permanent shift. Clinicians will – understandably – not want to manage their patients by video alone and there is no replacement for the face-to-face interaction within the privacy of a GP surgery. However, as Dr. Noel O’Kelly, Spirit Digital, outlines, 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.
What do we mean by digital inclusion?
As far back as 2017, the government’s digital strategy policy paper[i] 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 – amongst both those providing services and those receiving them – to make healthcare more equitable.
Indeed, as NHS Digital states, patients who are more likely to be digitally excluded include those who are amongst the more vulnerable: older people; those in lower income groups; people with disabilities; and those whose first language is not English, amongst others.
These are barriers that may be challenging to overcome, 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.
From the virtual education programme for type 2 diabetes patients being delivered in not only English, but also in Gujarati, Hindi and Urdu; to care home residents receiving virtual ‘ward rounds’; patients with long-term conditions such as COPD, heart failure and asthma gaining access to digital Cardiopulmonary Rehabilitation services; and the remote monitoring of symptomatic COVID-19 patients post-discharge from hospital – these are all examples where patients and clinical & care teams have embraced digital technology to reconfigure traditional patient pathways.
So where are we today?
COVID-19 has been a catalyst for extraordinary change: the response proved what can be achieved with the right mindset and commitment. It 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 the nurse practitioners and pharmacists that play a key role within practices, to the hospital consultants, care homes, opticians and dentists, the concept of working together as a team to look after patients – and how patients themselves can also contribute positively to their own care – 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 to use that knowledge to achieve a wider adoption of a broad, effective community care model within local health economies.
From reactive to preventative
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 on 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.
What are the opportunities for tomorrow?
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 is an increase in patients with mental health conditions, an increase in the number of those with long-term conditions, an increase in older people with complexity and co-morbidities, and people are living for longer. 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. Hope from the realisation that there is a new and better way of providing care. The trajectory for digital adoption is only going to increase. But it must be done at the correct scale and in the right way.
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.