LONDON – After years of progressing at snail’s pace, COVID-19 has forced through a rapid adoption of digital tools across the spectrum of health in the U.K., from general practitioner appointments, to hospital referrals, elderly care homes and community nursing.
“At game changing speed” the health and care system, “has gone from one extreme to another,” said Harpreet Sood, a general practitioner in inner city London and board member of Digitalhealth London, where he has been working since 2016 to promote use of digital tools.
“In 2019, 5% of general practices offered digital consultations [this year] it’s gone from 5% to 95%,” Sood said. As a result, clinicians are spending less time on administration and more time on patients. There also have have been changes for administrative staff. “Rather than a lot of people turning up at 8 a.m. looking for an appointment, we can triage them better,” said Sood.
Similarly, Anbananden Soopramanien, group medical director at Renovo Care, which specializes in rehabilitation of patients with spinal cord injuries, said, “Use of technology has been a life saver.”
Discussing his experience on a webinar organized by the King’s Fund, the U.K’s leading health system research foundation, Soopramanien described how he has been working since 2003 to apply what was then called telemedicine, in his practice. “During the pandemic, things moved on quite quickly. Things that were not possible, became possible straight away,” he said.
Tina Marshall, manager at digital health specialist Visiba Care, said during the pandemic the company has enabled 512 health care providers across the U.K. to set up virtual clinics, allowing clinicians who were quarantining to work from home, helping to manage an influx of people with COVID-19 symptoms remotely, following up patients who could not visit a physical health care center, and substituting home visits where the risk of infection was too high. The clinics have all been rolled out while maintaining patient satisfaction, Marshall said.
Michael Oliver, project manager at Livewell Southwest, the largest community and social care organization in the U.K., said while the need for digital consultations was well recognized, it has been difficult to get staff to use them. In the midst of the pandemic, “We’ve done years’ worth of transformation in a number of months,” he said.
Once circumstances forced staff to adopt digital consultations they started to get different ideas for how to apply the technology. “For example, speech and language therapy has gone from none being virtual, to 97% of work being delivered digitally,” Oliver said.
From a user’s perspective, the switch to digital care made it easier to access services, according to patient representative Victoria Halton. She is paralyzed from the shoulders down following a spinal injury, and unable to use her chest muscles. When her annual health review at a spinal unit came up during lockdown, she was naturally unwilling to attend. However, a phone consultation persuaded her she needed an ultrasound scan. Getting the appointment was, “more efficient than usual” Halton told the webinar.
That experience is reflected in the views of 2,400 people with spinal cord injuries in a Facebook group of which Halton is a member. There are only 11 specialist spinal units in the U.K., meaning long journeys to attend physical appointments. Many group members found they preferred virtual consultations to the stress of getting to hospital appointments. “On the whole, they were very positive. It has been easy to get appointments, get treatment and get a quick resolution,” said Halton.
Thomas Coleman, co-founder of digital health company Zendra Health, told BioWorld it was a similar picture in elderly care homes, which started from a particularly low base in terms of technology adoption. “Care homes have definitely seen a big uptake, to solve pain points that were always there,” Coleman said.
In common with the U.S., France, Italy and elsewhere, a large percentage of those dying from COVID-19 infection have been care home residents. Staff in these homes have been working under great duress, with regular visits from health care providers and family and friends not possible, confused residents to attend to, and a swathe of public health guidelines to implement.
“We rapidly rolled out an app for care home staff, covering things like public health messages, [COVID-19] self-screening reminders, and addressing well-being and mental health,” Coleman said. “It’s a virtual arm around the shoulder.”
Zendra works in other aspects of health care, and Coleman believes digital health has reached the tipping point. “Huge strides have been made. Health apps were on the fringe before; now people have got a sense of how useful they are, they won’t give them up,” he said.
However, there are concerns that COVID-19 enforced adoption of digital health will leave problems in its wake. The speed of change from physical to virtual has made it difficult to learn from experience and improve along the way, Sood said. “We thought dermatology would be a good speciality for video consultation. But it turned out to be difficult because cameras weren’t good enough, or there was not enough light. In the end, we got people to email us pictures.”
The key thing that has been missed in the rush is evaluation. “We’ve done in a number of weeks what we expected to do in five years – so we need to pause and evaluate,” said Sood. He believes access and experience of health care services has improved “for a whole host of patients,” but not for everyone.
In addition, Sood thinks the case has not been made that virtual care is as safe. “What you are facing is triage through the telephone or video. You can’t interact or get the verbal cues, so the practice of care changes.” Initially, there was a lower threshold for prescribing, with patients being given antibiotics they may not have needed, for example. “For me, that is a slightly lower standard of care, but with the infrastructure we had, that is how we had to respond,” Sood said.
For Marshall, the heart of the problem is that these tools have been overlaid on existing processes, rather than being used as a trigger for change management. “Digital transformation hasn’t really happened,” she said. “We need to take a step back and see what we can do in the care pathway.”
Sood agreed. “At this point we are just layering things on top of each other. We still need to think about digital transformation,” he said.