COVID-19 and redefined patient expectations: when will healthcare systems catch up? - Part 2
July 8, 2020
In the first blog of this series, I identified how COVID-19 has changed the patient appointment experience. We know that some patients are enjoying significant improvement. COVID-19-driven changes have also redefined patient expectations. This time, I’d like to cover some practical suggestions: the foundation we need for sustained change. A virtual consultation is just one part of the healthcare experience. We have addressed the patient-facing part of the healthcare process—now we need to fix the rest.
Single electronic health record
Interoperability continues to lag. Conversations stall when they stray into clunky old databases with inaccurate or conflicting information. The 6.5 million carers in the UK know the incredibly frustrating experience of dealing with fragmented care. I’m not just talking about complex care needs, either. Many are surprised when they learn it is unlikely their GPs will have access to the details of their hospital care. Patients also have a right to access their own care records. Advances in consumer technology are rarely integrated into clinical information that can meaningfully contribute to treatment.
Care is an ecosystem
Social care is care. Education impacts health outcomes, and socio-economic status impacts life expectancy. According to The Lancet, “health and wellbeing require action beyond the health sector”. The NHS is just one part of the solution—we need funding structures across the NHS and councils that incentivise collaboration. Prevention and intelligent, connected care ambitions can only be realised if national and local bodies cooperate with the voluntary sector, and commercial providers. Appropriate, secure data sharing would enable all parts of the care community to deliver improved, coordinated care.
Patients have a new role
We see patients using home testing kits, engaging with connected devices and accessing e-learning to help them manage their own conditions. Accenture's 2018 Consumer Survey on Digital Health revealed that patients are enthusiastic about using electronic health solutions but, in many cases, it is not part of their care. The narrative of the passive patient is unhelpful and inaccurate. The reality is that often, patients are not enabled to contribute to their own care. There’s even been criticism in the market that organisations swept aside patient involvement in their own COVID-19 care too easily.
Delivering the change
Accenture’s “NewFUTURE for technology” report indicates that, as a result of COVID-19, the healthcare landscape has changed in four key areas: care, society, work and foundation. While there are pockets of progress in all these areas, access remains unequal. Increased clinic waiting lists, the backlog of operations and undetected advancing cancers means the current pressure on the system may not abate when COVID-19 cases are reduced. The response to this reality needs to move from rhetoric to action. Virtual care technology was available before the pandemic—it just wasn’t being used. Health technology for integrated care records, personal health records, connected devices and ways to constructively involve patients in design are here, but they’re also not being used. COVID-19 has changed patients’ expectations for virtual care, it is inevitable they will want the underlying systems to catch up.
A short story of the reality for carers
A simpler way to understand the issue might be to imagine Martin, a 72-year-old who is generally well (on just one prescription for raised blood pressure). He is caring for his wife Betty, who has early dementia. They are just about managing at home, but with no family nearby and a reduced social circle due to the demands of care, the pressure on Martin can be exhausting. One day Martin, who is run down, feels unwell and collapses in the supermarket.
He’s not critical, which means there is a delay at the busy hospital where the ambulance takes him. Stress about leaving Betty uncared for exacerbates his illness—alone at home, she is highly vulnerable. During Martin’s hospital admission Betty deteriorates, elevating her care needs beyond what Martin can manage. Once Martin recovers Betty has, sadly, been moved to a care home. Martin feels like he has failed in his role as carer. After fifty years of marriage, Martin and Betty are heartbroken.
It didn’t have to be this way
Interoperable systems with integrated social care and community services would have resulted in a different outcome. Before Martin started to feel unwell, a connected device could have alerted a care ecosystem that he needed help. His GP could have been notified and short-term respite arranged for Betty. A connected community pharmacy would have ensured his medications were changed, and their daughter who lives abroad could have been virtually involved in their care. Helpful, personalised, digitally delivered care would have supported Martin, given him access to local organisations and enabled the couple to remain in their own home, together. These scenarios play out in the UK every day, and the resulting, fragmented care is ultimately more expensive to deliver than a coordinated caring approach.
A better-integrated (and therefore more human) healthcare system can have a dramatic impact. The changes we have seen through the pandemic may not result in improved outcomes and sustained change without connected care and community systems. Please read our dedicated page for more on how to outmanoeuvre uncertainty in the wake of COVID-19, and feel free to reach out to me if you’d like to discuss anything I’ve said here. I look forward to discussing your thoughts with you.
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