Royal Berkshire NHS Foundation Trust

Dr Antoni Chan

Introduction

The uptake of digital health technologies (DHTs) has taken a big step forward during the COVID-19 pandemic. Due to infection control restrictions to meet in person, there have been increased interactions virtually between clinicians and patients as well as between clinicians to clinicians. There is widespread acceptance of the use of DHTs such as virtual clinics, online health assessments, remote monitoring and use of wearables by both patients and clinicians.

Prior to the pandemic, the uptake of DHTs has been slow and piecemeal in healthcare compared to other sectors. The pandemic has disrupted the traditional system of interaction between clinicians and patients which up to recently has been mainly done face-to-face. This disruption has thrown up both challenges as well as opportunities in the field of DHTs.  Turning the barriers to implementation of DHTs into solutions is key to long-term spread and sustainability of the innovation to improve patient care. 

Innovative DHTs can be a double-edged sword in helping the delivery of healthcare, they can also be a hindrance and frustration if not implemented carefully. For this, I believe that the three ‘I’s for innovation are helpful for successful implementation of DHTs.

The three ‘I’s are Integration, Interoperability and Interaction.

" Innovative DHTs can be a double-edged sword in helping the delivery of healthcare, they can also be a hindrance and frustration if not implemented carefully. "

Integration

Electronic healthcare records (EHRs) have been the focal point where data is recorded for medical encounters. This is where important information such as patient demographics, medications, investigations and treatments are recorded. As healthcare is spread across various sectors, there is an increasing need to have integrated healthcare reports. With digital systems in different settings and locations, we need to be able to connect with each other with a smooth transfer of information. The key focus is on data sharing. This would ensure that the patient can travel to different centres or locations and see different specialists without any data being lost. The data also kept up-to-date with each clinical encounter enhancing the subsequent one. With the increasing amount of software and apps being developed it is important that these technologies are linked back to the EHR of the patient. In the longer term, patients will hold their own health records and use them as they navigate healthcare providers.  Software and apps that sit outside the EHRs run the risk of having dropped off in its use if the information it stores sits away from the EHRs. Clinicians can also suffer from login fatigue if numerous software applications or apps need to be opened at the time of the clinical consultation. A single login and sign in allowing access to these software applications that are integrated into the EHR will be important for uptake into clinics.

Interoperability

Increasingly health care is delivered in different settings and often away from hospitals. Clinical teams are now providing care closer to patient homes. In some cases, the care is actually delivered in the patient’s home in an ambulatory fashion. It is therefore key that access to data and medical records can cut across organisations, boundaries and locations. DHTs need to have the ability to work across healthcare providers and location should no longer be a barrier to its use. There needs to be interoperability across different systems and access for clinician-to-clinician interactions. The medical information is shared securely with information governance processes in place to ensure data security.

Interaction

Patients are important partners in the use of DHTs. From new technologies such as remote monitoring, wearables, and inputting data using smartphone technology patients are key to the engagement required for uptake of DHTs. Systems need to be user-friendly where patients can input and also retrieve information. There is a need for a patient portal that is interactive. Patients are able to book appointments, also review investigations and results as well, and share them with health professionals that they encounter. There are times when patients need to access help but they do not necessarily need to go through a long-winded process of trying to arrange an appointment. Clinicians can also communicate with patients using this portal that is secure. This will enhance and improve quality of care in between patient appointments. Data generated will also enable clinicians to understand better the impact of a disease and the treatment on functional factors such as pain, sleep, mood and work. DHTs have the ability to provide a more holistic view of the patient’s condition and improve quality of care.

Summary

As we move forward with the innovation in this area of healthcare, I believe the 3 ‘I’s are going to be crucial for the opportunities to be realised and the barriers to be overcome for successful implementation of DHTs. This will enable spread and sustainability of these DHTs with the aim of improving the patient experience and care. Let’s give 3 ‘ayes’ to DHTs.