Enabling patient-centred care by maximising digital and AI tools – what works and what could be improved

The common narrative on covid has been that it’s served as an opportunity for the NHS to do things differently; to throw off traditional shackles and live instead by the slogan of a famous US sportswear brand – just do it.

That’s especially the case when it comes to digital transformation. The argument has been that the pandemic has greatly accelerated progress in an area which has long been challenging for the NHS. There has been talk of destroying boundaries which might previously have existed, including those between organisations.

But a recent HSJ roundtable revealed that this ripping up of the rulebook wasn’t the default position everywhere once the pandemic intruded.

“The initial response when covid started to hit was still to retreat to organisations,” said one panellist, head of digital for a sustainability and transformation partnership. “Actually, it was when we started weekly, daily updates as tech digital teams – when we starting working together – that things really got going.”

So, what has that collaboration and progress on digital meant for the ability to deliver patient-centred care? That was the main topic on the agenda for the roundtable, which brought together a range of professionals from a variety of organisation types.

Remote monitoring

One significant development, panellists agreed, was a growth in remote monitoring of patients. “For me it’s a really good example of how technology has accelerated,” reported one speaker, who works for NHSX.

“We can position some really small pieces of technology in patients’ homes – whether that’s a pulse oximeter, a blood pressure monitor – and monitor patients. We can pick up patients deteriorating in a much speedier way than the traditional model of a patient visiting healthcare every three months.”

That is a development helpful not only in a pandemic, but in the context of a long-desired shift to more out of hospital care. Indeed, panellists emphasised that the digital development currently happening must fit into long-term strategies if it is to be truly valuable.

“Covid has presented unprecedented opportunities [to accelerate digitisation]; necessity has been the mother of innovation,” reported a board member of an integrated care trust. “What we have also realised is that, yes, we are responding to an immediate need, but need to keep making sure that what we do today fits our overall strategy and is sustainable for the organisation.”

Doing so is likely to involve re-badging digitisation and changing the people most commonly involved in it. “With a number of my teams, particularly the project managers, they get quite alarmed when I sit down and say that we don’t have any more IT projects – there are no more digital projects in our organisations. They all think they are going to get fired,” explained an NHS chief information officer.

“Of course, that’s not the point. The point is we’ve got lots of change and transformation projects. Everything is bedded in that. If you try and lead [that transformation] from a purely technology-driven perspective, it won’t be accepted. It’s about making sure it’s clinically led.”

A panellist from a vendor to the NHS firmly agreed. “The technology is actually the easy part. It’s the change management and it’s the transformation of the patient journey that’s the hardest part.”

Developing solutions

There now remains the task of ensuring the framework is appropriate for engaging with suppliers as they continue to develop solutions in line with this increase in activity and demand.

This also speaks to another key group of people it was felt is crucial to successful digital transformation: patients. One clinical commissioning group accountable officer reported that a patient survey had revealed positive experiences in engaging with digital approaches. But that was far from telling the whole story.

“Our evidence from complaints, from MPs, from other sources, is that there are significant issues for some patients and members of the community in engaging with these new ways of working. So, I think we have a huge task, in terms of informing, educating but also engaging with people to really understand what is going to be useful for them.”

It was a point reinforced by another speaker, who highlighted that not everyone will be equally well positioned to benefit from a shift to greater use of digital. “It’s all very well doing digitisation and talking about monitoring at home. [But for that to work] first of all, they have got to have a home. They have got to have access to some kind of device – a lot of people don’t have access to a PC, or tablet, or anything like that. So there have to be local solutions for that.”

It was a point which neatly summarised both the benefits of a covid-induced digital acceleration and the possible dangers. “People have talked about riding this wave,” one panellist remarked. “I think the danger with riding waves is you could end up in some very random places and, sometimes, dangerous rip tides.”

The speaker therefore welcomed NHSX’s planned publication of a number of new clinically-led digital pathways that incorporate technology where it can help. “I think having something really detailed, at specialty and service level, saying: ’This service is amenable to this sort of intervention. This isn’t. This is how to do it. This is how not to do it’ [will be helpful].”