In March 2023, Dan Morris (Partner and Digital Health Co-Lead) and Louise Brennan (Solicitor, Commercial and Infrastructure) attended the Digital Health Rewired Exhibition and Conference in London. The event comprised thought-provoking panel sessions, debates and pitches. We reflect below on the important themes that ran across the sessions and our conversations with key industry players and thought leaders in the digital health world.
Virtual Wards - “there is no place like home”
NHS England describe virtual wards as allowing patients to get the care they need at home safely and conveniently, rather than being in hospital. In a virtual ward, support can include remote monitoring using apps, technology platforms, wearables and medical devices. Support may also involve face-to-face care from multi-disciplinary teams based in the community.
Virtual wards extend the reach of clinical staff, liberating time and allowing patients to benefit from the comforts and familiarity of home care. We often hear about potential risks associated with the adoption of technology in the virtual ward model, but such risks need to be balanced against the undoubted risks associated with inpatient care: infection, muscle wastage, pressure sores and general deconditioning. As well as helping to relieve capacity, virtual wards can go some way to assuaging the anxiety that an in-patient hospital visit is a bit like a “lobster trap”, very difficult to get out of unharmed.
But there remain concerns about ensuring that wide scale deployment of technology happens only where there is a proper evidence base for its use and that patients are not subject to digital exclusion. Access to virtual wards could be perceived as only for the digital literate, leading to inequality in the health service. On the other hand, studies have found that we underestimate how much patients embrace technology and that assumptions are often made about how “tech savvy” certain patient populations may be.
Guidance from the centre about the expectations and safety components for virtual wards will go some way to assist with the deployment of virtual wards at scale and at pace.
Innovation in imaging - “don’t let perfect be the enemy of good”
There are great strides being made in clinical imaging, including AI innovations as well as the regional imaging and pathology networks developing across the UK. Improvements in the integration of systems truly supporting the patient pathway are innovations to be commended.
There are continual concerns with cybersecurity in a single centralised system solution, the continued risks of working in silos and lack of funding for pilots. But we are reminded that we should not let “perfect be the enemy of good” and that incremental changes can push forward good practice in clinical imaging.
The patient’s voice is key to improvements. Innovators and clinicians should not lose sight of the need to listen to patients and to learn from findings where patient safety and outcomes have gone wrong.
Integrated care via EPRS and shared care records – “is there a single version of truth?”
For true integration, it is often said that an EPRS and a rich shared care record is an absolute prerequisite. 80% of the room during the Rewired Big Debate agreed that integrated care is impossible without EPRS and Shared Care Records.
There are still important points to consider about integrated patient record systems, since there is no silver bullet. Interoperability remains a pervasive concern. An EPRS or shared care record cannot account for all findings from the third sector, local government, dentists or opticians. Further, an EPRS and shared care record could lead to information overload in the incidence of an emergency admission. Nevertheless, with true cultural change and a move from NHS bodies becoming collaborators rather than competitors, we have the resources to improve patient experience and outcomes through harnessing the power of EPRS and shared care records. Funding and investment for transformation in the area of records is fundamental to change in this area and true integration.
Inequalities in health - “design with the end user in mind”
The COVID-19 pandemic highlighted the inequalities being faced by marginal and deprived communities in the UK and across the world. However, the pandemic also managed to kick-start initiatives in the digital health world, further upskilling patients and clinicians to a new way of working. Remote monitoring solutions allow for patient empowerment and a quality of life change where a smart phone and an app may be the only infrastructure that is required to monitor some illnesses. To forge a “tech” component within the NHS, it is clear that co-creation and co-development is key to build the trust in the technical solutions created for better patient outcomes. Notwithstanding the concerns about digital exclusion, there is evidence that digital solutions can actually lead to better health inclusion, with the use of video calls and remote monitoring allowing improved accessibility. There is evidence of higher patient satisfaction with these innovations. Clinicians and start-ups can work collaboratively and achieve a lot with a user-centre approach to create the solutions for digital health transformation.
#Rewired23 was a useful reminder about how digital health and care solutions can achieve true service transformation; however, this is not done by technology alone. Real change management and a cultural shift is required to take all stakeholders along on this journey. Patient trust in digital solutions is key to real world uptake, as well as greater awareness, accessibility and governance in so that change can be made at scale and at pace.
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