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Smart Health Care

Progress in health care can often be as prolonged and painful as the ailments we seek to treat. When you consider how far technology has come in the last century alone, it can feel frustrating to be told to “call back at 8.30am” to book a doctor’s appointment when the phone lines open. It’s the year 2020, after all.


My 1990’s self would likely be dumbfounded that we still use telephones as a method of communication at all, let alone relying on such an archaic process for something as important as our health and wellbeing.

A cartoon image of a figure in a lab coat reading medical notes, standing at the forefront. Through an open doorway, another scene shows two people in conversation as part of a medical examination, the patient is seated and the doctor is standing.

There is a major and unavoidable hindrance to progress, though, and one which is likely the giant elephant in the room at any NHS conference, meetings or practice — money, or lack thereof.


With unlimited coffers at their disposal, you could expect the NHS to be rolling out state-of-the-art technology left, right and centre to improve the patient experience, reduce wait times and relieve the significant strain on medical staff. But the reality sits in stark contrast.


With a shoestring budget to abide by, the NHS is often forced to rely on the “safe” options of manual, human-led processes, aging infrastructures and legacy technologies in order to function. Smart technology, by contrast, is risky. It presents an unknown. To adopt a digitised or automated process is effectively placing trust in a machine which could fail at any moment, and put people’s lives in jeopardy.


Frightening, right?


Not really. The reality is we — AKA pretty much every one of us in the developed world — rely on technology already. We monitor our step count, calorie intake and heart rate on our smartphones and wearable devices. Our first port of call is to consult Google when symptoms arise. We share experiences on forums and heed the advice of complete strangers from the other side of the world. Surely it’s better that the technology we rely on is sanctioned and subject to specialist scrutiny? 


But while costs can be extremely prohibitive, there are other factors at play that explain why it’s quicker for your prized pooch to see a Vet than it is for you to see a Doctor, or simpler to order a takeaway than to order a repeat prescription. 


If, like me, you live in the sticks (i.e. not London), it can take an age for the latest innovations to reach your neighbourhood. Think Deliveroo, Uber, Amazon Prime, Virgin Media. Even if such services are available in your area, more often than not your options are limited compared to the big cities. Health care is much the same.


Let’s consider GP Online Services. The NHS UK website lists two options for online services, Evergreen Life and Patient Access — either of which would allow you to book an appointment, view your medical records, download the app, order repeat prescriptions, view test results and communicate with the GP practice. A giant leap for mankind, you might say — but you’d be wrong.


The opening paragraph on the NHS site landing page states:


"Note: GP practices decide which online services they make available to their patients. This means although the sites below offer these services in principle, your practice may not."


A positive move forward for automation, perhaps, but until such online services are readily available to every single patient in the UK (or, indeed, worldwide) then a leap for mankind it is unfortunately not.


The very fact that GP practices can decide which services they enrol with, if any, leaves patients at the mercy of yet another postcode lottery determining the levels of service they receive. 

A cartoon image of two figures in lab coats standing before a large whiteboard with a loading icon. Around them are circular images of various characters alongside smartphones and "email" envelope icons, against a yellow background.

For me, technology is an extraordinary asset which should be embraced and adopted wherever possible. Lack of funding is one thing. Inertia and wilful resistance to beneficial change is something else entirely, especially if you’re making that decision on behalf of thousands of patients within your catchment area.


Part of the problem, I believe, is a lack of understanding around the benefits of adopting smart solutions for health care scenarios, and it’s not hard to see why…  


Deloitte’s 2018 Global Health Care Outlook report succinctly summarises what smart health care should look like:


  • Appropriate treatments are delivered at the appropriate time, in the appropriate place, for the appropriate patient

  • Clinicians use technology to more accurately diagnose and treat illness and deliver care

  • All care delivery stakeholders across the ecosystem effectively and efficiently communicate and use information

  • Patient data is in one, easily accessible place

  • The correct individuals do the correct work (e.g. nurses handle patient care, not administrative tasks)

  • Patients are informed and actively involved in their treatment plan

  • New, cost-effective delivery models bring health care to places and people that don’t have it

  • Efficiency improves; waste declines 


On paper, these points make perfect sense. They centre around accessibility, optimisation and automation for the benefit of staff, patients and businesses. It’s a win-win scenario. 


In practice, however, the implementation of smart health care is riddled with complications and conundrums that even the smartest minds may struggle to surmount. 


This list alone prompts many questions:


  • How do you define what an appropriate treatment is? Do cost implications and availability play a part? Does the patient or practitioner ultimately decide what they deem is appropriate?

  • How can clinicians use technology differently to achieve better outcomes?

  • What are the security risks of storing all patient data together? Who is ultimately responsible for the data?

  • Who decides what roles are appropriate for which team members? Would these role remits be imposed regionally? Nationally? Internationally? 

A cartoon image of a whiteboard emblazoned with the word "DATA" , above which is a pie chart and various other symbols of analysis.

Let’s go back to Deliveroo momentarily. Established out of London in 2013, it now delivers takeaway food in over 200 countries worldwide. That’s remarkable growth for such a young company. Their recipe for success lies with three main components — restaurants and eateries willing to provide food, customers willing to eat said food, and courier-style “riders’ willing to deliver it. Add to that some trendy branding and a strong app UX, and you have a robust and scalable business model. 


Now imagine there are 10 Deliveroo-style companies operating within the same city. They are managed by different staff with different ways of working. Half of the branches are using the latest app and website technology to take orders and organise deliveries. The other half are relying on a landline phone and a handwritten list of what is required and when. What do you think would happen if you asked all 10 branches to collaborate to ensure 1,000 customers received their orders at precisely the same time?


Now instead of 10 branches, imagine there are 10,000 dotted all around the UK and there are millions of customers to serve…


It may sound feasible for a supply-demand model such as Deliveroo to achieve this feat (indeed, they probably do!), but on a scale of simple (1) to devilishly complex (10), the delivery of top-quality, efficient and cost-effective health care hits 11.


The pressure is on for health care. The populace is becoming increasingly accustomed to having the world at their fingertips. We don’t like to wait. Analogue is a thing of the past. It’s a digital-age now, and health care providers are struggling to keep the pace, let alone set it.

Indeed, a service designed to make healthcare easier has purportedly done anything but. In an article from March 2019, Wired describes “the messy, cautionary tale of how Babylon disrupted the NHS.”


According to Wired, at the heart of Babylon’s GP at Hand service is a simple idea:


"Let patients hop on a video call with a GP rather than wait for an in-person appointment. Patients can use the app’s chatbot to talk through their symptoms and consultations with a doctor are free if you make GP at Hand your registered GP practice. Video chats are available 24-hours a day and Babylon says they are usually available within two hours of booking."


Presented with a choice between a quick video chat or spending half of your morning trying to secure a face-to-face consultation, it’s unsurprising that a great number of patients have taken advantage of the structural changes to the NHS that allow people to register at a doctor’s office outside of the area in which they live. The subsequent influx of Babylon sign-ups meant GP at Hand had ten times more patients registered than the practice it took over from.


Wired elaborate: 


"The sheer size of the GP at Hand clinic in Fulham means that the local NHS authority, the Hammersmith & Fulham Clinical Commissioning Group (CCG) is having to pay for the care of scores of new patients, even though the majority of them are based in other parts of London. Documents show the CCG has struggled to cope financially with the strain put on it by Babylon, with other CCGs and NHS England forced to bail it out. Last month, Hammersmith & Fulham warned the cost of the practice would leave it £10 million out of pocket for the current year.


"…The long-term implications are unknown. Now that Babylon can expand to other cities and register more patients it runs the risk of increasing the initial deficit to the NHS by signing up more patients."


It’s likely we are decades away from even coming close to the unprecedented levels of cross-company synergy required to achieve a central base for patient health and wellbeing data.


Likewise, it may be a long wait before robots are reliable enough to replace reception staff or to relinquish nursing staff of admin duties. What we do have now though, are emerging technological advancements that represent the start of something better — online booking systems, prescription deliveries, software for seamlessly scheduling shift work, in-practice digital display screens for keeping patients informed, apps for remote monitoring, online consultations… the list goes on. 


These incremental, evolutionary improvements will surely form the foundations of the smart health care revolution that is to follow — something my 90’s self would again be dumbfounded by, but in the best possible way!


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