Suzanne Waite - Health Policy Partnership

Suzanne Wait

Ready, set, go: are our health systems ready to fully integrate digital health?

17 August 2022

The COVID-19 pandemic has been the catalyst for massive digital innovation in healthcare. But how can we ensure that health systems are adapted to integrate the available technology for maximum benefit?

The term ‘digital-first’ has crept into health policy jargon in recent years, accelerated by the COVID-19 pandemic. For the first time, health services made virtual consultations and services integral to the way they engaged with patients, and health system leaders around the world have advanced ambitious digital health strategies.

But what does this term really mean? Digital health is best seen as a complement to traditional health encounters. I don’t think even the biggest proponents of digitalisation are suggesting digital health entirely replace traditional human interactions. The risks of doing so would be immense – as Matt Hickey said during the recent HPP webinar on digital health, ‘no machine or app will be able to detect the fear in a person’s eyes’.
 

Moving to healthcare 4.0

The vision of a connected, digitally enhanced health system has been described as ‘healthcare 4.0’. Its benefits have been well documented; the question is whether our health systems, and the policy frameworks that govern them, are ‘ready’ for its full, sustainable integration.
 

Bringing the person into person-centred care

Data can be a powerful enabler of person-centred, proactive and efficient care. The collection of patient-reported outcome measures (PROMS) data has long been advocated to get a better understanding of the impact of a given intervention. Digital technologies now enable real-time monitoring of such data, even after the patient has left the hospital or clinic, and can feed this information back to clinical teams. This seamless exchange of information and ongoing visibility for clinicians on how well their patients are doing allows them to proactively address any issues that may warrant attention. This has been termed patient-initiated follow-up.

Digital technologies now enable real-time monitoring of data, even after the patient has left the hospital or clinic, and can feed this information back to clinical teams.

 

One of the most transformative abilities of digital health, however, is its predictive ability. As was discussed during the webinar, the question asked of every patient as they enter the doctor’s office is: ‘How are you?’ But really, what is more appropriate to ask is: ‘How have you been? How are you now? And what is the difference?’

Collection of data through wearables and digital apps before a physician–patient encounter would provide the doctor with a wealth of information, allowing them to understand the person in front of them beyond the 10 minutes allowed in the consultation. In the words attributed to Hippocrates, ‘It is more important to know what sort of person has a disease than to know what sort of disease a person has.’
 

The bigger picture: digital health as an enabler of better, more equitable care

Defining ‘better’ may seem contentious, but six key aims for healthcare defined over 20 years ago remain equally relevant today. Healthcare should be: safe, effective, patient-centred, timely, efficient and equitable. Rising socioeconomic inequalities have been a long-standing concern, but political and societal awareness of them has been heightened by the pandemic. Digital health can, in many ways, help improve access to care for those who may have previously faced barriers. In mental health, for example, digital platforms are well accepted by adolescents and young adults who may hesitate to seek care in person.

But there is the possibility that increasing need to rely on digital tools in healthcare may exacerbate existing inequalities. It is sobering to remember that fewer than one in five people aged 65 and over owns a smartphone, and people who already face socioeconomic deprivation are most likely to be digitally excluded.

 

Digital health can empower individuals to better understand their own health, by receiving more tailored information and digesting it in their own time, rather than within the (often stressful) confines of their clinical appointments.

 

Embracing change – a cultural shift for all

An important component of readiness is culture. At its full potential, digital health can provide an incredibly rich array of information which can help healthcare providers and researchers better understand the populations they serve. But openness to embedding this information into clinical decision-making (by healthcare professionals) and performance assessment (by health system leaders, payers and policymakers) may require education, time and a cultural shift away from ‘measuring what is measurable’.

Digital health can empower individuals to better understand their own health, by receiving more tailored information and digesting it in their own time, rather than within the (often stressful) confines of their clinical appointments. Undoubtedly, having this ability will be empowering for many – but the cultural shift it represents from the traditional, paternalistic model of care and doctor–patient communication should not be taken for granted.
 

System preparedness for healthcare 4.0

The transformation of our health systems to fully accommodate digital health is invariably a gradual one. ‘Digital readiness’ is not achieved as a one-off. As with the integration of any innovation into mainstream care, there will be ‘low-hanging fruit’, ‘quick wins’ and slower-burns – and systems will adapt over time. And through this transformation, we must always focus on the most important lens through which success should be measured: that of the person receiving care.

 

This blog was inspired by insights from an HPP webinar, A digital-first health service: are we there yet? The webinar, first in a new series, is available to view on our website.

 

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.
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