Lockdown and Digital Health: Leadership Insights and Innovation from the Frontline

The Coronavirus pandemic has shaken countries across the globe and has become the trigger to mobilise resources to cope with the virus. Digital technology is one of the resources that have been leveraged upon to transform healthcare.

Whilst first reported in December 2019, COVID-19 hit the UK in March 2020. For five months the virus has been directly affecting people’s health and indirectly influencing social and professional life, due to the introduction of unprecedented preventive safety measures, including social distancing and lockdown. Those impacts have stimulated the public health workforce and the government to reshape healthcare systems and practices in an effort to protect uninfected people, reduce the speed of contamination and increase the effectiveness of the treatment of those infected.

Given that, the July 2020 Digital Thursday was aimed at exploring the role of digital innovation in managing healthcare delivery and mitigating the implications of the pandemic. The event was joined by Joanne Luther, a Health Sector operations consultant, who specialises in the transformation of emergency care services. The second speaker was Richard Böckel, Managing Director at Myo (www.myo-care.com). The company partners care providers across the UK, US, Germany and Switzerland in developing a fully-integrated digital care system where we prioritise the human – rather than medical – moments in care. Joanne and Richard provided their insights in relation to three areas of discussion, namely, a) the pandemic as an impetus for digitalisation of healthcare, b) the application of digital technologies during lockdown and c) the future transformation of social care. 

Pandemic as the tipping point for adopting digital innovation

Facing COVID-19: The readiness of the UK healthcare system for the COVID-19 challenge should be considered by taking two key aspects into account. Firstly,  preventive measures. the NHS had a policy and plan in place, such as the ones developed for an annual influenza outbreak. The system was ready to face the virus outbreak, though not COVID-19, creating uncertainty in terms of the potential magnitude of the impact and treatment approaches, especially at the beginning of the pandemic. The novel disease challenged the healthcare delivery system, as regional hospitals received different pieces of information on a daily basis, causing delays and inefficiency.  The NHS was not fully ready for such a unique event and could not have been fully prepared, even if it had tried to.

Secondly, from the innovation perspective, good progress has been made in developing digitally-enabled care for the last several years. For example, over 70 apps have been developed for citizens and professionals. The Electronic Prescription Service (EPS) has been installed in 93% of England’s practices, which has improved the patient experience and made the system more efficient (see more https://www.longtermplan.nhs.uk/online-version/chapter-5-digitally-enabled-care-will-go-mainstream-across-the-nhs/). However, the full potential of available digital technologies has not been fully exploited yet.

As per the insight provided by Richard Böckel into social care, only 25-30% of the sector is digitalised so far, although the digitalisation is skill skewed towards core tasks like documentation through digital care planning tools. However, the pressure of COVID-19 has become the driver for rapid digitalisation. Such a crisis as we are in right now is the chance to switch to more effective and efficient processes using innovative solutions.`

The barriers to the digitalisation of social care: Culture, judgement (perception), infrastructure, finances, regulations, technological barriers and coordination between technological and medical spheres are the factors that had been slowing down the digitalisation of social care before the pandemic.

Culture is the ability of care homes to accept behaviour change and see the need for digitalisation. Resistance to change was partly rooted in the perception that technology would cause a problem. Instead of pre-empting the potential issues, organisations rather need to start using technologies and learn how to tackle problems. Inadequate technology infrastructure can also be a barrier to digitalisation, considering that some localities may not have broadband, or households may not have required digital devices to connect to the health system virtually.

A financial barrier is the degree to which organisations can afford digitalisation (e.g. access to grants and investments). Although the government allocates grants, the procurement of digital solutions typically comprises the smallest part of investments.  A regulatory barrier results from a different perception of digitalisation outcomes by the Care Quality Commission and other healthcare organisations. Therefore, the transformation of healthcare should be supported at an institutional level.

For example, the Netherlands and Germany have implemented reforms enabling these countries to improve the social care system through a range of novel approaches (for more information: https://www.kingsfund.org.uk/sites/default/files/media/commission-background-paper-social-care-health-system-other-countries.pdf). A technological barrier refers to the difficulty of developing a system fitting multiple purposes and units in healthcare organisations. The difficulty of coordinating technical and medical organisations is rooted in the complexity of procurement processes and the lack of unifying language enabling medical workers and digital providers to understand the needs and requirements for technological solutions.

Not going out – Digital lifelines for the shielded & vulnerable

Social care during lockdown: After the pandemic outbreak, emergency centres have seen a surge of people suffering from huge anxieties due to lockdown. For that reason, the NHS designed a new virtual reality (VR) therapy service to help patients overcome anxious social avoidance. VR solutions had also been used by the NHS before the pandemic for treating the fear of heights. Against the backdrop of social isolation and the shortage of medical specialist availability, digital technologies have also been helpful in replacing physical practice, with remote working and telecommunication consultation alternatives.

As General Practitioners stopped seeing patients face-to-face to mitigate the spread of the virus, patients first have a telephone call with GPs to discuss the symptoms remotely. With the development of mobile applications (e.g. www.babylonhealth.com), it is possible to make an appointment with NHS clinicians with one tap. Practitioners would take essential patient observations (blood pressure, temperature etc.) and provide consultation over the phone.

There are a few other alternative solutions such as telepresence (www.healthcareitnews.com/news/making-case-telepresence), which allows patients to converse with GPs remotely. The technology is based on the combination of HD video and audio, enabling barrier-free communication among patients and specialists irrespective of distance. Similar solutions are available for care homes, where observations can be taken and sent digitally to a GP.

Challenges with the use of digital technologies: Although telepresence and other digital solutions are helpful alternatives, given the social distancing measures and the shortage of medical staff incurred by the pandemic, the solutions can also bring difficulties.

The first challenge is the technical one, reflecting the difficulty in integrating and processing prescriptions. Some intricacies of using technology in practice have not been fully addressed yet, which hinders its wide adoption by the healthcare system. Second, the total adoption of digital solutions entails the risk of leaving some digitally excluded segments of the society without a good quality care service. People can be deprived of access to digital technologies due to poor infrastructure (access to wi-fi), knowledge gaps (lack of understanding of how to use technology) or financial costs. These challenges can have a massive impact, especially on older people. Third, digital solutions cannot fully substitute for physical visits to doctors, due to symptoms that are difficult to gather digitally – e.g. the symptoms that are not visible and can be observed after a profound physical examination.

How might we transform the future of social care?

Although COVID-19 has been the stimulus to intensify digital transformation in the healthcare sector, the challenge is to keep on working on that transformation once the crisis has passed. The improvement of the healthcare reputation and service quality are among the priority areas where digital technologies can be applied.

Healthcare reputation improvement: There has been mostly a negative bias towards social care in terms of the image of health care providers and the workforce. Average annual employee turnover is very high, which undermines the reputation of social care organisations. As Richard Böckel suggests, high turnover could be partly due to the lack of transparency in the care process. Digital technologies, by contrast, can be used to open up lines of communicating, allowing caregivers to experience appreciation for their talents by showcasing the tireless work they go through on a daily basis. That can help build trust in carers and social care organisations in general.

Service quality improvement: With social care systems stepping on the path of digitalisation, there are a lot of opportunities in the digital sector that can be embraced to improve the service quality of social care. There is a need to tackle the systemic complexity. For example, the simplification of the procurement system will enable the digitalisation to be more effective. Also, there are numerous care home suppliers (e.g. www.carehome.co.uk), software solutions providing case management IT systems for children’s and adult social care (e.g. www.liquidlogic.co.uk), virtual and augmented reality solutions that can find wide application in the treatment of physical and psychological disorders. There are good prospects for many more digital solutions to be implemented in the future, given that the NHS is open to collaborations and exploring new ideas through the NHS Improvement Hub (https://improvement.nhs.uk/improvement-hub/).

Conclusions

  • The Covid-19 pandemic has created one of the biggest challenges to and opportunities for adoption of digital innovations in UK Health and Social Care.
  • The severity and speed of the Covid-19 first wave has accelerated adoption of health digital technologies exponentially faster than ever before.
  • The main barriers to adoption of digital innovation in health and social care include: lack of understanding of how digitalisation can benefit health care providers and patients; uneven access to the right devices and connectivity in different healthcare settings, including in the community; cumbersome central health procurement processes; inability of patients and clinicians to complete full diagnosis or interaction via virtual means.
  • The opportunities from future digitalisation are more personalised and immediate care for those who seek it, perhaps without having to visit a health facility; equalisation across the social care sector. Learning from international proven practices and advancements; wider and faster adoption of other digital technologies as a result of greater community and provider experience as a result of the pandemic changes in health care provision.

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