Digitally-enabled care is increasingly recognised as fundamental to the future of the NHS. There’s no doubt that progress is being made, but increasing pressures mean we need to move fast.
There are digital solutions available to aid many of the day-to-day problems we face in health and social care – so how do we accelerate take-up while maintaining confidence in the quality and safety of patient care?
Understandably, change is often met with some resistance – whether that’s lack of time to understand and embrace new ways of working, concern about impact on quality of care, or even uncertainty about how it will impact our own role. But with the post-COVID backlog impacting an already over stretched service, we have to find ways of working smarter.
An important component of this is allowing computers to do what they do best so that experienced clinicians can spend more time treating patients. Embracing Artificial Intelligence (AI) to support care is a key enabler, but the obvious fear is that AI will miss something or negatively impact existing roles.
Currently, NHS England is piloting capsule endoscopy which allows patients to swallow a camera that transmits images as it passes through the digestive system. Although not included in the current trial, Artificial Intelligence can be used to view those pictures – hundreds of thousands of them – and identify images showing cancers or their precursor polyps. Statistics show that some cancers and precancerous polyps are missed by human operators with the standard endoscopy process – ranging from 6% to as high as 27% for small adenomas (less than 5mm) , compared to, for example, Laiz and colleagues showing that the AI detection rate could be higher than 90%. But AI can’t direct decisions or build crucial relationships with patients that impact every aspect of their care. Effective use of AI is about using the most effective solution to large scale, repetitive tasks, freeing up time for experienced consultants to treat more patients, more quickly. But we need to bridge the confidence gap.
This is where shared learning is so crucial – learning from others, both within the UK and overseas, will reduce duplication, limit unnecessary reinvention, and build a body of evidence to support new ways of working. That doesn’t mean we’re looking for one size fits all solutions – but we need to facilitate discussions among clinical and non-clinical staff, as well as industry, to knit together common themes and apply relevant learning to our own organisations. If not, we limit the reach of potentially great innovations.
For example, NHS Arden & GEM CSU has been working with Leicester Clinical Commissioning Group (CCG) on a European Space Agency-funded project to help patients and carers manage COPD by using satellite weather and air quality data to work out the safest times and places to exercise. The project has demonstrated cost savings by helping patients manage their conditions and reducing hospital admissions. This is a successful approach that has been shaped with one CCG but has the potential to work elsewhere with the right knowledge sharing.
Clinical forums are a great way to bring specialists together to air opportunities and challenges and build confidence based on feedback from individuals with similar skills and experience. We’ve also seen progress emerge from applying a ‘living laboratory’ approach to problem solving, for example, bringing together ICS partners and industry representatives to co-create solutions based on user needs. This helps to minimise silo decision-making, where technology solutions are brought in to fix an immediate problem without first considering a solution that could service a broader range of needs.
Working with regulators early on in the development process also helps to understand pathway requirements and certification criteria so that these can be built in.
Joining the dots
Making the most of digitally enabled assisted living and tools for self-monitoring is key to delivering preventative care at home and in the community, for which connectivity is crucial.
With reliable and universal connectivity in place, we can do more to tackle digital inclusion barriers by giving people access to technology they can use without digital skills, such as devices a resident can talk to or request help if they’re unwell, but that can also remind them to take medication. As we’ve seen with the use of innovations such as the Teki-Hub remote diagnostics system, a reliable combination of satellite and Wi-Fi technology is already enabling GP consultations and diagnostic tests to take place in remote rural locations as well as COVID-restricted care homes.
Inevitably, these systems don’t fit neatly into NHS and social care structures – it’s not unusual for the organisation purchasing a solution to be different from the organisation benefiting from it which can get in the way of progress. Not only that, progressing some of these initiatives means NHS bodies taking a more active role in developing reliable connectivity such as 5G and satellite solutions.
This is where Integrated Care Systems could play a pivotal role. Instead of considering how a future hospital can take advantage of technology, an ICS can look at place-wide challenges, beyond organisational barriers, and consider solutions that will deliver most benefit to the local population overall. Acting as a system should help to break down any existing barriers and identify priority initiatives that will support digitally enabled care at scale.
There is no doubt that digital health, from simple to sophisticated, is key to managing the growing burden on the NHS. The challenge for us all it to work closely together to fast track our learning, build confidence in new ways of working, and adopt approaches that enable even better care for our patient populations.
This article was written for National Health Executive and you can read the original version in their September/October 2021 issue here.