By Karen Taylor and Krissie Ferris, Centre for Health Solutions
The COVID-19 pandemic is first and foremost a human tragedy, affecting billions of citizens and millions of healthcare staff across the world. The UK Government’s healthcare response has largely been focussed on helping the NHS’s to manage, as far as possible, the predicted increase in hospital demand. This includes social distancing and lockdowns to minimise the spread of infections; building more hospital capacity; and procuring the diagnostic, personal protection equipment and treatments to deal with those who do become infected. Meanwhile, healthcare providers are having to re-consider how best to meet the needs of patients who fear they may have COVID-19, as well as the many others who require new and ongoing support, advice and treatments, while at the same time reducing the need for face to face consultations. As a result, many providers are rapidly embracing digital technologies to triage, support and, where possible, treat patients remotely and help clinicians work more effectively.
The challenges slowing digital transformation before COVID-19
In our 2019 report, Shaping the future of UK healthcare: Closing the digital gap and our 2020 report, Realising digital-first primary care, we provided a detailed analysis of the research we conducted during February/March 2019, including the views of some 1,500 front-line clinical staff, interviews with 65 key stakeholders and a detailed review of the literature on the current state of digitalisation across the NHS. Overall, the general consensus was that digital transformation in 2019 was ‘slow, expensive and challenging’.
In our report we noted that successive NHS policies had been aimed at getting the basic digital architecture right, improving data sharing and information flows, and adopting technology to deliver more accessible, timely and safe care. Moreover, that the ambition of the January 2019 NHS Long Term Plan is to drive wider adoption of digital technologies. However our research findings showed that there was a growing digital divide between policy ambition and the reality on the front line, with significant variation in:
- the digital maturity of different hospitals
- staff and patients confidence in, and willingness to use, technologies
- the funding available to invest in the IT infrastructure
- the skills and talent needed to implement the much needed digital transformation.
Our reports identified a total of 20 examples of evidence based good practice in using digital technologies to transform service delivery and improve outcomes for patients and staff. However we also noted that use of innovative technologies are only evident in pockets of the NHS. We could not have envisaged then, just how much this unprecedented, and unanticipated COVID-19 crisis, would accelerate the adoption of digital technologies in just a few weeks.
How COVID-19 is accelerating adoption of digital technologies
Already, patient behaviours are adapting to the opportunities presented by technology. For example, more than one million people used NHS 111 online support for assessing COVID-19 symptoms within the first week of the site launching.1 However, this digital transformation presents a number of challenges, such as ensuring equality of access and opportunity, and supporting patients and clinicians to optimise the digital technologies.
Our research identified that if the NHS, its staff and patients are to adopt digital technologies at scale the technologies need to meet the following SMART characteristics (Figure 1).
Figure 1: The SMART characteristics of digital technologies that can help improve adoption at scale
We identified that the two overarching requirements for achieving digital transformation are ‘changing mind-sets’ and ‘liberating the data’. The response to the COVID-19 pandemic is having an impact on both of these requirements.
COVID-19 is changing both patient and staff views of the benefits of digital technology. For example, public facing services, such as the NHS App and NHS Login, have had huge increases in usage, as people turn to technological solutions to deal with COVID-19. Since 24 February, when NHS Digital launched its COVID-19 response, the NHS App, which gives people access to NHS services, such as booking appointments and viewing their medical records, has been downloaded nearly 434,000 times. Prior to 24 February, the total number of downloads stood at 915,500. Requests for repeat prescriptions made through the App have also risen dramatically with more than 100,000 made since 24 February, compared to 236,000 in the year prior to the pandemic.2
NHS England has selected 11 suppliers to extend access to video consultations for primary care across the country aimed at helping the NHS cope with patient demand during the coronavirus outbreak. NHS Digital has also fast-tracked the assurance of video technology currently on the NHS GP IT futures — to try to spread its use.3
Meanwhile funding for digital transformation is no longer concentrated on the most digitally mature trusts. For example, TechForce19, provides funding for new technologies to help the COVID-19 fight. In Scotland, the government has provided £1.8m of Scottish Government funding to accelerate the roll out NHS ‘Near Me’, a video consulting service, to all GP practices and Health Boards as a crucial part of its response to coronavirus.4 The Scottish government is also providing £2.6 million to expand the NHS 24 Mental Health Hub and Breathing Space telephone helpline and web support service, and £1.2 million to provide extra capacity for Computerised Cognitive Behavioural Therapy (CCBT).5
An example of how fast things can change when there is a compelling need is illustrated by the implementation of the digital infrastructure needed for the new 4,000 bed NHS Nightingale temporary hospital at the Excel Centre. The Electronic Health Record provider selected to provide the IT infrastructure, was chosen on its ability to integrate patient data from London hospitals and local GPs. Many of the staff providing care in the temporary hospital already have familiarity with and access to the system, and will not need additional digital training. The required infrastructure has been implemented in a matter of days.6
Remote patient monitoring, which has traditionally proved challenging, has also been fast-tracked in response to the COVID-19 outbreak and shows what can be achieved when patient data is liberated. For example, in Dublin, digital health firm patientMpower has developed a remote monitoring solution for COVID-19 for the Irish Health Service Executive (HSE). Patients with mild to moderate symptoms who are in self-isolation can have their oxygen saturation levels (a key indicator of respiratory distress) monitored through a wireless pulse oximeter device that connects to an app. Patients also use the app to record their level of breathlessness, temperature and other symptoms. More than 50 patients with the virus are already being monitored, with capacity for many more, freeing up hospital space for those with more severe symptoms or underlying conditions.7
The clear evidence of acceleration in the adoption of digital technologies is one of the key positives that we have seen so far in the response to COVID-19. In our report, we concluded that the healthcare of tomorrow will look completely different to today, focused on predictive, preventative, personalised and participatory care. While this vision felt many years away, today it feels more within touching distance. Specifically, the need for social distancing has led primary care to adopt digital triaging as its primary way of working in just three week, with similar responses in outpatients departments. Moreover, the rapid tender process shows how quickly it’s possible to move when there’s a coordinated and determined effort. The key hope now is that once the current crisis has passed, as it will, that the new ways of working and more immediate convenient and safe ways for patients to access services are maintained, improving both the efficiency and cost –effectiveness of service and better health outcomes.