Has COVID-19 sparked digital transformation in healthcare?
The rapid onset of a global pandemic has led to swift and often remarkable deployments of new technologies in healthcare. We ask four leading voices whether an industry historically resistant to transformation might now be able to find its digital feet
Eight years ago, emergency-room physician Dr Michael Brooks became so disturbed by the dangerous anachronisms of the hospital in which he worked that he decided to do something about it.
“I saw some pretty shocking things, mistakes being made, largely because people had lost bits of information or data wasn’t available. Most of my life as a doctor has been spent collaborating on paper, and that is still the case in the majority of hospitals in the world today,” he tells Tech For Good.
Dr Brooks began spending just one week a month in the emergency room, using the rest of his time to champion a cause he felt was critical to the welfare of the patients he served. He founded PatientSource — a novel electronic medical record (EMR) system — and set about creating a tool he says doctors and nurses desperately needed: A digital patient records solution designed by them, for them.
It was an effort, along with repeated high-profile attempts at all levels of government over the last decade, to wrestle a recalcitrant and hugely complicated NHS system into the 21st century. However, while technical progress has been made in some areas — especially on a regional level by astute and collaborative trust CIOs — truly holistic digital transformation remains a more distant ambition. Eight years later, PatientSource counts most of its clients in countries outside of the UK.
“It culminated, for me, when a patient had a stroke because of a lost piece of paper,” recalls Dr Brooks, underlining the mission-critical importance of digitalisation. He’s keen to stress that the risks to patients of a stubbornly analogue system remain prevalent today.
As recently as two years ago, an emergency department in which he worked still relied on fax machines to process patients in need of time-critical interventions. It could take 20 minutes to transmit ECG results to a regional cardiologist in order to blue-light a heart-attack patient onwards for life-saving treatment.
“I could have scanned it and emailed it within a minute. That’s 19 minutes of heart muscle that’s dying in that patient because of our technology.”
The hospital no longer relies on fax machines, he says, but even achieving that milestone was a struggle. “They’re not doing that now because I put a flatbed scanner in the department. It took me nine bloody months to get the organisation to agree to it, and they only did it because I threatened to go to Argos, buy one, and hack the computer to make it happen. They knew I had the skills for that.
“There’s a real cost to not innovating.”
Dr Brooks’ frontline experiences illustrate well the challenges faced at all levels of healthcare governance in terms of digitalisation, and not just in the
UK. National and even regional healthcare systems are necessarily enormous bureaucracies, populated by huge numbers of long-standing staff using intractably entrenched tools and work practices. They are overwhelmingly concerned with the sanctity of patient data and are fearful of the disruptive impact of change against their duty of care to patients. Moreover, they are almost always making investment decisions from the wrong end of a negative balance sheet.
But the devastating sweep of the COVID-19 pandemic around the world, while applying unprecedented levels of stress to these systems, has perhaps revealed an adaptability and openness to technological change that was hitherto hard to see.
“There’s probably three areas where we’ve seen pretty dramatic progress,” says Dr Brooks. “Number one, above everything else, is videoconferencing. Another area that we’ve seen progress is the tracking of cases. And then there’s VPNs.”
All three factors have been enhancements forced by necessity. Similar to organisations of all types, healthcare systems have needed to rapidly transform their infrastructures to allow very large numbers of people, including patients, to interact with institutions remotely. In the short-term, doing so has meant a crisis hasn’t become a calamity. In the longer-term, it could finally mark the beginning of something transformative.
NEW BEGINNINGS
Andrew Raynes is CIO of The Royal Papworth Hospital in Cambridge, the UK’s leading heart and lung hospital and the country’s largest cardiothoracic transplant centre. It is home to some of the world’s most renowned surgeons and already boasts a history of innovation; it was the site of the world’s first triple transplant in 1986. It was where Professor Stephen Hawking received his care (his family donated his ventilator to the hospital at the beginning of the coronavirus outbreak), and it is also one of the country’s newest, having been rebuilt on a new site just over a year ago.
Raynes’ speaks to Tech For Good in the midst of the UK’s coronavirus outbreak, in between appointments to oversee the installation of handheld and ceiling-mounted RFID scanners intended to track vital hospital assets around the estate in real time. His hospital, like all others, is responding to the sudden demands of COVID-19.
“The virus has given organisations a stark realisation on the value of communications in particular, and a focus on how important technology is in helping with that,” he says. “We have accelerated our digital strategy at least three to six months in that sense. That’s in terms of infrastructure, equipping and mobilising.”
Raynes outlines how the hospital quickly expanded its bandwidth to accommodate a suddenly connected and distributed workforce. It upgraded from a 100Mb line to a 500Mb “five-lane motorway”, while simultaneously splitting out its WiFi provision to enable both staff and patients much faster access to its network. Some of that was separated out for VPN, too.
But perhaps the greatest challenge was the need to physically equip a newly dispersed workforce with the devices they needed.
“Every organisation in the country was after the same thing. Quite honestly, it was just trying to find a seller that hadn’t already sold out. Some organisations were queuing up outside shops trying to buy stock — and that smacks of crisis. So all your infrastructure was strained, all at once, with the rest of the country.”
Once the workforce was connected and equipped, the next challenge became upskilling staff to use unfamiliar tools. Centrally, the NHS provided licences wholesale for software such as Microsoft Teams and Cisco Webex, which Raynes says has been “fantastic”, albeit representing a looming cost burden for the future.
“For us, technology is about making people as efficient and safe in the hospital as they can be. Now everyone in the hospital has got a bigger picture of what is needed to help them function as efficiently as they can in a crisis situation.
“Things will never be the same. A bar has been set that has accelerated the adoption of new technology.”
One opportunity Raynes spies is the ability for a world-leading surgical institution such as The Royal Papworth to leverage its enhanced connectivity to broadcast its expertise to the rest of the world.
“Exporting the capabilities of that high-end surgery into other countries… that’s quite an exciting opportunity. Covid has accelerated that capability through the very nature of virtual consultation — the Microsoft Teams and Webex type scenarios which provide a platform to do that.”
BARRIERS
While a newly connected and enabled healthcare workforce has been key to meeting the immediate challenge of a global pandemic, maintaining and building on that digital progress is another thing altogether. That may be particularly true in the event of seemingly inevitable post-pandemic budgetary pressures.
Dr Brooks, for one, is cautious: “We’ve had rapid digitalisation because we’ve been forced to. Adversity has allowed us to innovate. But I think we will largely revert to form.
“A lot of the processes, procedures and regulations that have stood in the way have been given a temporary bypass. But those barriers are still there. As the force of change of the covid pandemic passes, the licence to bypass those barriers is going to disappear.”
Among the systemic barriers Dr Brooks cites are rigid hierarchies of decision making, exclusionary tendering processes that bar entry to smaller innovators, and burdensome, often overlapping regulatory processes.
Another long-time healthcare innovator, Dr Bernard Algayres, agrees. His perspective is informed by providing technology solutions to healthcare institutions for the last 20 years, including in leadership roles at Carestream and as general manager of GE Healthcare’s enterprise imaging division.
Dr Algayres is now Managing Director at Smart Reporting, a fast-growing German software company aiming to revolutionise the efficiency and sophistication of medical reporting in radiology and pathology contexts. Today, up to 99% of formal reporting in those areas remains free text — inefficient, error-prone and difficult to store, analyse and reproduce.
“Healthcare is very conservative — it is still struggling with some of the basics that other segments resolved a long time ago, such as simply transferring patient data over the internet. Your bank started transferring your account through the network 30 years ago,” he says.
“Being able to work remotely, virtually and digitally, in healthcare will require that patient data is more easily accessible from different locations, and that does not exist today.”
He is, however, optimistic that green shoots are beginning to appear.
He refers to examples in the NHS where regional trusts are forming data-sharing consortia to tackle the problem. Similarly, at The Royal Papworth, Raynes led a successful pre-covid effort to build a bi-directional interface between the EMR systems of The Royal Papworth and neighbouring Cambridge University Hospitals. It made headlines since it was the first time in the UK that anyone had managed to integrate systems from giant American platform providers DXC and Epic, otherwise fierce competitors in the EMR space.
And the world is not without examples of healthcare systems that have largely overcome the data sharing roadblock and provide impressive role models to which others can aspire.
“Finland,” says Dr Brooks, without hesitation.
“Finland, Estonia and the Nordic countries,” says Dr Algayres. “I have always been told: look at what those Nordic countries do, because sooner or later it will come down to the rest of Europe. They were the first ones to really digitalise primary care, digitalise imaging, to create regional networks. They’re more open and less conservative than other countries.”
While methods for comparing the relative quality of countries’ healthcare systems vary, Finland and its neighbours are used to holding all the top spots in most world rankings. Kari Klossner heads up Business Finland’s Smart Life programme, which represents the country’s dynamic healthcare industry on behalf of his government’s trade and investment arm.
“Close to 80% of healthcare in Finland is provided publicly, while the rest is operated and funded by private healthcare providers and insurers. For both public and private players, COVID-19 has meant it has become even more important to secure access to healthcare systems remotely. We have seen up to a tenfold increase in use of remote appointments and other telehealth services during this COVID spring.”
Finland is already well ahead of the curve in providing a portfolio of digital health services, collectively called Kanta Services. The country systematically introduced electronic prescriptions 10 years ago, and that will soon be supplemented by a national medications list to provide patients with key information about their treatments.
A national patient data repository, accessible by both clinicians and patients, went live seven years ago. That has more recently been complemented by infrastructure to share imaging, a similar repository for social care data, and a system through which patients can add their own data to the record via a range of different apps.
This holistic investment in digital healthcare has led to a return in the form of a vibrant healthcare technology ecosystem in Finland, which Klossner is proud to represent internationally.
“With the increase in demand, and by being already well positioned in these markets, many Finnish companies have been able to develop a leading position internationally. We fully expect time- and place-independent access to health services to become the ‘new normal’ in the post-COVID world for many applications in the health and wellbeing services space.
“I think now we will see a real focus on wearable devices, such as intelligent rings and bracelets. While their main function has traditionally been monitoring health and wellbeing, they can now also assist in self-diagnosis, measuring weak signals that can be an indication of infection.
“Moreover, the use of machine learning algorithms provides additional insight into the data logged by wearable devices. Finland is also a leader in this field with a number of companies developing advanced AI algorithms. The use of wearables is not limited to temperature measurements. Several Finnish companies are world leaders in monitoring heart rates to deliver real insight, too.”
Examples of the export of Finnish healthcare expertise include Oura, a smart, connected ring, alongside wearable offerings from the likes of Suunto and Polar. Meanwhile, Ninchat and VideoVisit are secure communications platforms that facilitate remote consultations. The latter was recently awarded funding by the UK’s NHSX innovation arm as it sought ways to support vulnerable people during the coronavirus lockdown.
So despite problematic barriers, countries like Finland prove what is possible with clear-eyed policy and consistent, long-term effort.
“The things that I’ve seen that have come across my desk in terms of innovation over the last eight years. I’ve seen some amazing things,” say Dr Brooks.
“However, I’ve also seen the vast majority never see the light day because of these systemic barriers. Priority one — knock these barriers down. Suddenly you’ll see a rate of innovation similar to when you’ve got a global pandemic shifting stuff.
“We now know we can do it.”
