Technology-delivered remote healthcare has been held in the waiting room. But like so much in technology in 2020, Coronavirus led to a sudden and rapid adoption of remote healthcare provision. Has the pandemic triggered a tipping point? Will remote care become the norm? Or is there still the need for a deeper diagnosis before the operation takes place?
“We were not ready in our heads for this as a sector, but now we have been pushed into making that step,” Stefaan Kinderkens, Group Chief Digital and Information Officer at Mediq, a Dutch healthcare provider told me in a MindFuel debate on safeguarding a business during a crisis. Across the Atlantic CIO Cindy Fedell agrees: “There is definitely an increase in remote care technology. In an effort to support patients not needing to come into the hospital during COVID-19, clinicians have supplied patients with at-home kit, for example, lung function and heart monitoring. I believe this uptake will continue.” Fedell has recently become Regional Chief Information Officer at Northwestern Ontario Hospitals in her native Canada. Across the world healthcare services rapidly adopted remote healthcare technology in order to keep patients safe and protected from the global pandemic. Not only were remote care technologies adopted, but, in common with the wider business community, healthcare organisations took on a course of cloud computing and communications technologies to ensure the smooth operations of their hospitals.
“The public has been there for some time, and it has taken a systemic change like this virus to bring about the cultural change within organisations,” says Nick Hopkinson, CIO for NHS Devon STP of how patients have been keen to adopt new ways of being cared for. “We have seen a significant shift in primary care to non face-to-face services,” he adds. Spaniard Senai Jimenez, Head of IT programmes and projects at Kings College Hospital, London agrees with Hopkinson: “I think we will see more and more remote care, but tipping point? That point had already happened, but post-Covid we will see a review and refinement of the services.
“Covid will not let you say that you are not very techie. Everyone has become more IT literate,” she says of the internal cultural adoption that took place during the first global lockdown. “Remote care adoption is growing across Europe and the USA,” says Kenny Bloxham, MD of Healthcare Communications, a patient messaging services provider to 360 hospitals in the UK.
“I believe we have had a watershed moment where more people have truly realised the value of technology to patient care, and more importantly that it’s not as hard as it had otherwise seemed,” says Fedell.
But the CIO has well-founded reservations: “For this watershed moment to be a tipping point, we must also have got past the notion that technology is unaffordable, and that the longer-term investment in technology, to enable care, should come ahead of shorter-term investment to address immediate pressures on health care services like staffing. I believe we have not passed this point.”
Patient centric
Not only does the adoption of remote care face perception hurdles in terms of budgeting, Bloxham and others believe a plethora of technologies and standards is an obstacle to the success of remote care. “There is still a lot of work to be done on what platforms bring about the best results for patients.”
Hopkinson in Devon, UK sees this as a great opportunity for the sector to reflect. “The pandemic has enabled people to think where does this go next? Remote care will be a huge opportunity for areas like social care and care homes, as healthcare services will be better connected, which in turn means better-informed decisions can be made.” He adds that consumer devices will drive up the increased monitoring and remote led care.
Jimenez adds that appointment follow-ups delivered remotely will be beneficial not only to healthcare providers, but also to the patient.
The challenge for healthcare providers embracing technology-led remote care is the digital divide that exists in many societies. “We must not leave anybody behind, because there are still a lot of patients that are not digitally enabled, so a healthcare provider has to have a joined-up workflow for all types of patient,” Bloxham says.
In Ireland, the UK and other markets, Chief Clinical Information Officers (CCIO) have played an important role in ensuring every element of care is considered: “CCIOs are becoming more integral to health service discussions and are vital in responding to the pandemic as they understand clinical care, and act as a bridge with digital services,” Fedell says.
Data injection
Dan Streetman, CEO of Tibco, a data technology services provider, says organisations like Norton Healthcare in the USA are a typical example of how data is being used to improve resource management in healthcare and monitoring patients, both in the hospital and remotely as part of a Coronavirus response.
“The new technology for at-home diagnostics and monitoring will definitely yield data that can be then used to improve treatment,” adds Fedell. “Some of the technology that is now widely used, for example, video conferencing with patients, produces metadata and data in image format. This data format is useful and could offer a significant opportunity to be used in new ways.”
Kinderkens in the Netherlands has data concerns though: “I have no view of what they are doing on their devices, and they are working with patient data,” he says of the dangers of the shift to home working, which he supports, but is aiming to deliver better governance on. The sudden shift in ways of working has been great for rapid adoption, but CIOs not only drive technology adoption, they are also responsible for data governance and pandemic or not, standards must be respected.
Healthcare keeps its patients healthy, not only through the valiant effort of its clinicians, but also the back office teams that keep wards clean, drugs ordered, staff paid and of course the technology working. The pandemic witnessed these teams leave the hospital campus and operate the healthcare providers from homes, and as a result, quickly adopt the same cloud and collaboration technologies as the enterprise world.
“It has worked really well,” says Hopkinson. “Meetings are shorter and more productive, and we have seen benefits.”
“There was a huge uptake in licensing for VPN, teleconferencing and work-sharing tools like Microsoft Teams,” Fedell adds. “However, there is also a downside to this, as a number of organisations felt very pressured and deployed first, and now need to do the usual assessment processes. This reverse process means a few things - they have less bargaining power with suppliers, a few suppliers may end up with a larger market share then perhaps otherwise, and it will be difficult to change suppliers if their assessment shows another supplier is preferred.”
Savings healthcare
The cost of delivering care, the world over, is a political hot potato. Health research body The Kings Fund reported that when the UK’s Labour Party created the National Health Service in 1948, it consumed 3.4% of gross domestic product (GDP), yet despite improvements in technology and care, today the cost has doubled. So clinical and technological improvements are not counteracting a rise in population.
So can increased use of technology-led remote care help healthcare organisations reduce their spend, but increase the provision of medical services?
“We are only just starting to see the scale of remote care begin to increase, but it is important to consider how we sustain that change, lead the behaviour change for both clinicians and patients, as we need to make sure it leads to the right behaviour,” Bloxham says. He also says a key part to this will be gathering patient feedback. Hopkinson adds: “We can redesign services and the approach to healthcare, and that means we can deal with the challenge of continued demand. I believe this will unleash the next generation of healthcare thinking.”
Fedell agrees with Hopkinson and adds that the debate has some real nuance: “I am not an advocate of thinking of the contribution of digital to health care as a means to reduce cost. The value of digital, first and foremost, is to enhance patient safety, quality of care and more recently to improve patient’s experience with healthcare. Improving patient outcomes will save lives - does that mean the cost of care will reduce? Improving outcomes often means more efficient diagnostics and treatment, which saves clinician and administrative time, the cost of inpatient stays and other costs like drugs. However, the demand on the health service is always increasing, and so savings tend to only mitigate demand.”