The potential for technology to transform patient care for the better was the focus of the Digital Health and Care Conference Wales held in Cardiff on the 7-8 November 2018.
International speakers recognised the possibilities offered by technology, but also the difficulty of implementation and of ensuring that everyone is included in the new world of e-health.
“We are not in it for technology. The goal of digital health is to allow better patient care and to let me do my job better” said Dr Robert Wah, DXC’s Chief Medical Officer and former president of the American Medical Association, opening the meeting.
Dr Wah said that technology provides an opportunity to deliver care in the most appropriate setting, move towards prevention, ensure more effective management of LTCs and support patient empowerment and activation. Digital transformation in the US has come in three major waves.
The first wave was information exchange, followed by the development of electronic patient records. This was underpinned by a billion dollar investment in interoperable systems allowing data from multiple sources to be merged together. The next wave will be the population analysis of data and integrated decision support.
“This is where we can really start to improve health care” asserted Wah. “Technology will be able to deliver better information for better decision making. The right information, at the right time, in the right place.”
But he had a warning. “In healthcare we are behind in cyber security, ransom wear could shut down healthcare companies holding data.”
Looking to the future, Wah envisaged a system where patients would be treated as customers with their data and interaction history held in a giant CRM. AI could be used to suggest the next step for a patient, and a less skilled ‘lower intensity person’ employed to deliver the message.
However, this is a very distant future for the 15% of people in Wales who are not online. Bob Gann, Junction Digital Consulting, described an urgent need to close the digital divide.
The National Survey for Wales 2017-18 found 60% of people aged 75+ and 26% of disabled people are digitally excluded.
Growth in internet access had reached a plateau in the last few years and active intervention was required to connect the elderly, people with disabilities and those with long term conditions who are classed as ‘hard to reach.’
Given these people are likely to have frequent interactions with the healthcare system, Gann questioned whether they really are hard to reach. He argued that digital inclusion is a social determinant of health and urged health boards to sign up for the Digital Inclusion Charter for Wales.
The issues uncovered by his report, Digital Inclusion and Health and Care in Wales, were lack of access, lack of skills and lack of motivation.
The report makes 18 recommendations including greater provision of free wi-fi, providing digital skills training to boost digital literacy, and co-production of resources with patients to ensure they are engaging.
Gann highlighted the Digital Heroes project, where primary school children trained elderly care home residents to use iPads. One man with dementia was able to reconnect with his love of rollercoasters via a virtual reality headset. The result has been transformative – he is no longer prescribed anti-psychotic drugs. Aswell as a reduction in the use of antipsychotic drugs across the home, falls have also been reduced. Calls to the ambulance service have been cut by 28%.
Sophie Randall, Patient Information Forum, echoed Gann’s comments, reiterating the need to ensure the digital divide is closed and that information added to digital channels is high-quality and health literate. Electronic patient records can empower patients to take control of their health, but people need input in their development and to understand how their data will be used, shared and protected. PIF urged delegates to use digital channels to signpost to the high-quality, evidence-based resources developed by national health charities to help facilitate Perfect Patient Information Journeys.
Speaking later in the morning, Cabinet Secretary for Health and Social Services, Vaughan Gething, pledged £3m over three years on projects to reduce digital exclusion in Wales.
“Having the skills and motivation to access digital health services can help people better manage their health conditions, while helping to reduce the burden on under pressure health services.” he said. He pledged support for digital skills training for patients and staff working in the health and social care sectors.
This is important as Wales presses ahead with digital transformation and a joined up electronic health record which will eventually be available to the entire health system and to patients. This system is available now in a beta form in number of areas and is still under development. The smaller population size and fewer health organisations to connect means Wales is confident to be able to move ahead at pace.
Nikki Ellery, Informatics Manager at Abertawe Bro Morgannwg University (ABMU) Health Board, described the benefits of allowing patient access to records. ABMU has been using the Patients Know Best system since July. Patients have access to their medical records including test results, are able to message clinicians with concerns and track their symptoms. The system went live in July 2018 and 102 patients are using the solution with very positive feedback from healthcare professionals and patients. The plan is to roll out to ten specialities by the end of December and to provide support to patients via libraries to increase uptake.
Airedale Digital Health Hub allows people to have medical consultations in their home, via telehealth. Originally designed for use in prisons to avoid the need for prisoners to travel under escort to healthcare appointments, it is now in use in residential care settings and as a palliative care service.
Rachel Binks explained how staff at the hub conduct consultations via video link and are able to assess whether help is needed, or a problem can be managed at home. Calls to the ambulance service from residential care have been avoided. The end of life care service provides 24/7 support to people caring for a person dying at home. As a result, the number of people dying in hospital has fallen.
As Gething pointed out in his brief address to the conference, digital has the potential to transform patient experience but the transformation must include everyone.
Posted on Thursday, 15th November 2018