Digital technologies shaping healthcare today.
Virtual health needs to be viewed as part of the continuum of care, emphasised Katerina Tarasova, Executive Director of International Accreditation at Accreditation Canada, and attention needs to be paid to patient-centric care. Integrated care is an essential factor when looking at all the components and how the system reacts to new developments in virtual health. Technology as a sector of its own evolves much faster than legal, healthcare or even academia because the private sector drives it. “Faster innovation and solution-finding means that other areas need to play catch-up to roll out healthcare applications. We cannot adopt technological solutions without the right legal structures in place.
We cannot roll these out without the right training. It’s a challenge, but one that our sector can bridge with time and good leadership,” said Professor Najeeb Al-Shorbaji, president of the Middle East and North Africa Association of Health Informatics, speaking At Arab Health’s Public Health Conference. While Richard Wyatt-Haines, founder and director of HCI, highlighted how no technology could be deployed without people – and that they need to be clear about goals set by leadership, with the commitment to making it happen. Only by bringing a group together comprising operation managers, clinicians, and patients – to ensure they are engaged – can all components come together to ensure success.
Digital transformation, discussed Dr Manish Kohli, Senior Advisor at Albright Stonebridge Group, goes beyond virtual care and digital health. The future of healthcare ecosystems will be competitive, and this is where the fundamental building blocks of technology will be recognised. Data centres, servers, and hosting applications will be tools of the past, and cloud systems will gain prominence.
Video: Dr Manish Kohli, Senior Advisor, Albright Stonebridge Group, on digital innovations in healthcare
There are numerous benefits of this; extensive data can be processed through the integration of environments; insights can be delivered immediately to proceed with the appropriate form of care. Microservices, AI and analytics are tools that drive data collected in cloud systems that describe back-end architecture and IoT. IoT’s power is the internet of things enables devices and sensors to leap from the self to the quantified self. All this data funnelled into the healthcare enterprise creates an immense power to create digital twins. This surpasses patient care and addresses processing within the enterprise as well.
For example, picture a scenario where a healthcare facility has a robust infrastructure and AI analytics engine, with prominent data coming seamlessly across the enterprise from other facilities that have patient history. Now health systems can create digital twins of patients, procedures, processes and simulate them to see what the impact is going to be on quality, access, and cost before they implement a solution. Therefore, the risk of attempting a procedure is mitigated, as physicians can plan better using the available tools and technologies. However, he explained that there are challenges. As work environments have moved outside the four walls of every enterprise, cybersecurity is on everybody’s mind.
“Now we are not only in an era of bring your own device but bring your own environments. When working from home, there are vulnerabilities in that home environment, which stops us from thinking about how to shore up the entire ecosystem to protect the data. This is where technologies like blockchain step in,” he explained.
According to Prof Paul Barach, Clinical Professor, Wayne State University School of Medicine, Children’s Hospital of Michigan, while big data is an “incredible way” to understand population health and realise the “Quadruple Aim”, many companies haven’t approached this with the best transparency or engagement with patients and providers. He cautioned that questions remain over how it might work – and whether it might expose patient privacy or bring hospitals “to their knees” through hacking. This can only be adequately examined through a public-private partnership framework that engages ethicists, scientists, and users in a way that supports their wellness journey.
The post-COVID future has three main challenges, according to Catherine Estrampes, President and CEO of EMEA, GE Healthcare:
Some other technology trends that are coming to the fore, according to Prof Dunscombe, include those out of the hospital, where people are self-caring and self-managing in their homes. This is typically where data is being created by sensors or the IoT creates an ecosystem for patient enablement. Another upcoming growth area is the smart routing of clinicians outside of the hospital. This involves smart placement of medical devices in the community and the movement of medicines, which Dunscombe describes as “non-hospital” logistics.
She gave the example of the UK, where this has improved nursing efficiency between 20 and 26 per cent by matching the patient’s needs to the nurse’s skills and routing them efficiently. “The capacity and demand in the community and the smart use of resources is a new horizon that I find exciting. This is backed by smart algorithms and cloud-based processing of capacity and demand. Powerful analytics are providing the optimal way,” she said.
With COVID-19 pushing telemedicine to the forefront, Joint Commission International (JCI) is working towards accrediting these services. Dr Joel A Roos, Vice President of International Accreditation, Quality Improvement and Safety at JCI, said: “It is kind of like the Wild West (in telemedicine) as there are so many different organisations incorporating telemedicine in a variety of methods. However, telemedicine is very effective and is not going away, nor should it.
“It has a tremendous role in bringing access to patients in remote areas, for example, but there needs to be quality standards and methodologies established for telemedicine use. Unfortunately, telemedicine standards do not currently exist. JCI is moving in that direction and will focus upon telemedicine and strive to provide a comprehensive solution.” Telehealth will not solve every problem, but it will provide a solution, said Dr Kohli. Thanks to telehealth, less than even 30 per cent of the care can be offloaded from oversubscribed health systems, clinics, and hospitals and delivered in a remote location.
“All of a sudden, you have a 30 per cent capacity gain, which can be purposed for patients who need it, such as high acuity complex care surgical care patients. Therefore, we can look at democratising access to care. We are starting to look at how we deliver care and create efficiencies in the existing infrastructure. “Pre COVID, the conventional wisdom was that the elderly would be slow to adopt the technology. However, when we look at the data from the pandemic, the elderly have been one of the fastest adopters of telehealth solutions.”
To minimise the risk of viral transmission during the height of the pandemic, most rehabilitation services, for instance, changed all outpatient clinic appointments to telephone appointments unless an examination was essential. In KSA, the rehabilitation team ensured continuity of care through virtual clinics or telemedicine, revealed Shreemathie Somduth, Rehabilitation Nursing Director, Rehabilitation Hospital KFMC. On the other hand, Nirmal Surya, President, Indian Federation of Neurorehabilitation (IFNR), highlighted how teleneurorehabilitation was “unknown” in India before 20 March 2020. Low-cost cellular data services present an opportunity to make teleneurorehabilitation an integral part of follow-up services. At the same time, there exists a need to infiltrate it into an existing government programme.
“We have developed various platforms for telemedicine,” he said. “Several IT companies in India have created platforms where therapists can conduct only audio or video consultations. The payment gateway is linked, and the situation can be reported immediately, and a prescription can be given if certain requirements are met.”
Furthermore, in the UK, shared Prof Dr Nirmal Kumar, the innovation in the delivery of services has been astounding. “We are using more digital technologies such as telemedicine, as part and parcel, not in replacement. However, the doctor-patient relationship has to continue, and we need to examine, for example, the inside of the nose and throat or the ear, in ENT practice. This can’t be done in teleconsultation. Therefore, some parts have to revert to standard patient interaction. But some aspects have improved for the better.”
When it comes to ensuring continuity in accreditation during the pandemic, Dr Roos said that JCI adopted a hybrid approach that sends one person to a healthcare organisation instead of a team and uses technology to expand its teams in other geographies. “We started using technology and methods to perform the survey process without sacrificing rigour, collaboration and integrity.”
The biggest challenge for hospitals has been keeping the focus on quality improvement, he said. “Healthcare workers have been pressed into service to provide care." It has been “all hands-on deck” during the pandemic to keep operations running.
During a mass casualty event in an emergency department, (healthcare workers) are focused on getting things done and maybe doing things differently than if they were during normal operations.”