A repeated meme emerging from the COVID crisis has been that of massive acceleration of digital transformation across multiple business sectors, with talk of three/four/five - exaggerate as applicable! - years worth of work being achieved in a matter of weeks as the pandemic forced quick decisions and eliminated endless cycles of executive dithering.
Whether that can be applied to the COVID frontline - the health and social care sector - is a moot point. Digital transformation in the health market has been a notoriously spotty business. In some countries, encouraging progress has been made on digital healthcare delivery; in others, passing round increasingly battered folders full of paper-clipped medical records remains an all-too-common reality.
The success or otherwise of digital transformation in the health sector was one of the subjects under discussion in a recent debate hosted by trade association techUK, with participants contemplating whether the crisis conditions of COVID had assisted in adoption of digital best practice - and if so, how could the benefits of this be retained once the pandemic emergency finally passes.
Charles Alessi is Chief Clinical Officer at the Healthcare Information and Management Systems Society (HIMSS), a not-for-profit organization with a mission to reform global health ecosystems through the power of data and technology. He was, perhaps understandably given the remit of his organization, optimistic in his assessment:
I think we're at the dawn of a new age. We've heard this many times before. For the last 20 years we've been talking up the value of digital transformation, of having a single version of the truth and having interoperability or having all the bits we need to ensure we deliver a modern, consistent personalized health and care system to people. To a large degree we've over-promised and under-delivered. I'm talking globally...Suddenly everything's changed and everything's changed because we've been forced into actually adopting systems, which really we could have adopted some time ago. But this time, to a degree, there's no choice but to introduce them.
For her part, Sarah Deeny, Assistant Director of Analytics at independent charity The Health Foundation, can also see progress tied to the current crisis:
What I think is been really interesting about the past few months is that the pandemic has exposed where we weren't strong and had started to invest already, and then also those areas where we were weaker. So if you look at the contrast between the rapid rollout of digital primary care services across the UK now, with vastly more people being able to access their primary care services via digital or even just on the phone, with what is happening in perhaps in the public health system and even the social care sector...I think it does reflect that where there had been previous investment, particularly in the acute sector, we were able to ramp up pretty quickly, like digital trials that allow us to really quickly get information on new treatments for COVID, which I think a few years ago we probably wouldn't have been able to do. What I hope is that we can look at those advancements and think, "Why didn't we make those happen in the areas that were weaker?'.
There is positivity to be found, agreed Albin Forslund, Head of Customer Operations at digital health platform provider Visiba Care:
There are a lot of constraints and a lot of challenges when going through any type of policy change. One problem here that we've known for such a long time what type of change we have to do and what type of technology we should implement. We've seen it in the long term plan and we've seen that it's ongoing, but still hasn't really started. Then suddenly we end up in a situation where we have to adopt a lot of technology at a very rapid pace in the same time period as, more or less, we have to adjust all types of work. So, to try to implement the solution has been a huge challenge during a time of massive change in other areas. What we can really see is that [everyone] had a much greater way of adapting in this crisis and we have been able to adopt these technologies much quicker and at a faster pace.
Mind the gap
All that being so, the trick now is to ensure that progress made is maintained. But if the transition to a more digital model of healthcare delivery is set, a long-term concern raises its ugly head - that of digital inclusion. Or more accurately, digital exclusion. A problem that’s always been thrown back in the faces of digital health evangelists when they extol the virtues of online healthcare, is how to ensure that everyone in society is able to participate? While COVID has forced people not to trot along to their local doctor’s surgery for every ache and pain, is that a long term shift in behavior or will a face-to-fact chat with the nurse still be the preferred choice of most?
The Health Foundation’s Deeny points to the (bad) example set by legislators in the UK who rejected the idea of operating via a digital Parliament in favor of getting back to Westminster and sitting on the benches in the House of Commons in person as a warning sign:
I suppose I sometimes think everybody will want to go back to the old ways of doing things because that's what they're used to, while I would hope that where things work for patients and work for clinicians, they will stick. I worry a little bit that an awful lot of people did an awful lot of things on goodwill, because they needed to at the time, and that if they don't have adequate support to make them sustainable and to bring them into the normal workflows, that we'll lose some of the good practice. So that might be around fantastic work on digital outpatient appointments, for example. OK, how do you make that stick and actually make it sustainable for both clinicians and patients and work out who does it work for and then who doesn't work for? It might be working for everybody at the moment and that might have been fine when you're in an emergency situation, but over the next weeks, months and years, we need to really understand who does need face-to-face and who's fine with having a bit of a phone call or a video chat?
Keeping in mind the needs of patients as human beings is going to be critical, agreed HIMSS’s Alessi:
I really worry when I hear discussions going in the direction of instead of face-to-face we move to digital modalities, because we inevitably set up barricades - which have been there for the last 20 years, we've just forgotten about them over the last four months! - around digital transformation in general. The approach we need to adopt is digital technologies, digital modalities, that are an integral part of the delivery of health care, but they are there as well as, not instead of.
Trained, skilled, people-facing healthcare professionals are still needed in a digital world, he said:
What you do need a trained person for is that dialogue, that human face-to-face contact, that is caring - sorry, it's a very old fashioned word!. That warmth, that compassion, all the things we think are quite important, a lot of these are best delivered face-to-face and will be for some appreciable time. So, [let’s] really use what time we have and concentrate on things like behaviour modification which are really important, which can be delivered really quite effectively face-to-face, even though we're making some advances digitally. I think the narrative is very important and it's really up to us to make sure we pull that narrative together and that we talk around this as being complementary because we'll scare everybody if we're not careful.
All the research we've done show there are two big issues here. One is the digital infrastructure, in other words the availability of broadband and available technology. But it's mainly around the language, the design and everything else. This myth around the age barrier to digital inclusion is just that - a myth. There will always be the digital orphans in life, of course there will be, and one needs to manage everybody, but designing things properly actually fixes these problems.
Deeny agreed, arguing:
Some of the answer to this inclusion question, I wonder whether it's about not just in the tech, making sure that people have access to the technology that they need, but it's also in the designing of the services. So when you're designing the service from scratch, are you actually designing with the people in mind who you think are going to need to use it? And don't make the mistake of thinking that if 90% of people can use it, it's good enough. Actually in healthcare, we have to say, who really needs to use this service? Maybe that's the one person for whom a laptop or an iPad is not the best way to go and you have to design that person in mind.
There are potential ‘workaround’ solutions to the challenge of digital ‘orphans’, suggested Alex Eavis, CEO of Dovetail Lab, developer of a data sharing platform to pioneer better information sharing in healthcare:
Proxy access is one potential route. We notice a lot of access through dependents or children using phones on behalf of their parents or grandparents. Whether there's a public way of doing that - you know, libraries and organisations that are working on digital inclusion - but there needs to be a mechanism where everybody is included so there's always a fall back. That goes back to the omni-channel route. If you're happier to pick up the phone and that's your preferred method of communication, you should be allowed to do that and there should be a mechanism for you to do that. But we've probably got things to learn from other parts of government, central government, and lessons to be learned from from their digitalization which is some way ahead of healthcare.
Long term learning
Taking away long-term learnings from the short-term crisis response is critical, agreed Forslund:
What I want to see and what I hope will happen is that we don't forget about this time after the pandemic. We can really build upon this and move tomorrow towards a more digital-first mindset, where we actually see digital pathways as a critical part of healthcare, and then find a way of sharing that expertise and knowledge that we've had in different areas within the NHS and in other parts of the health sector, so we can actually build on this and start implementing it efficiently.
Or as Alessi concisely summed up:
The big issue for all of us is really to ensure that the gains we've made over the last few weeks are not forgotten.
Digital healthcare delivery has been a long-standing theme in governments around the world, to greater or lesser effect. In the UK, the ghost of the multi-billion pound nightmare that was Tony Blair’s techno-folly - the NHS National IT Programme - casts a long shadow. And the recent inability of the so-called ‘app-happy’ Health Secretary Matt Hancock to make a Track and Trace mobile app work will have done nothing to inspire confidence in the digital future of health sector IT!
But the techUK panelists are correct in their view that progress has been made in a lot of areas, typically with less fanfare and fewer political photo-opps attached to them. That said, there’s still a long, long way to go. The lessons of the past few months are valuable, but they need to be accompanied by a lot of post-pandemic work to make them stick.