Digital healthcare: its high priests and orphans

Citation

Harrop, N. (2015), "Digital healthcare: its high priests and orphans", Clinical Governance: An International Journal, Vol. 20 No. 3. https://doi.org/10.1108/CGIJ-08-2015-0029

Digital healthcare: its high priests and orphans

Article Type: Guest editorial From: Clinical Governance: An International Journal, Volume 20, Issue 3.

The papers in this edition of CGIJ were presented at this summer's King's Fund Digital Healthcare Congress, held in London, UK. They relate to effective patient engagement, the facilitation of mobile working in community care, the avoidance of hospital admissions through better supervision of elderly patients in care homes, the continuous real-time surveillance of performance in mental healthcare, and the economics of digital healthcare interventions.

The development of a mobile “app” to send automatic reminders is intended to help members of the public to comply with health promotion and illness prevention initiatives and is also intended to minimise the waste caused when patients default from attendance at arranged appointments.

The migration of healthcare from secondary to primary healthcare settings depends on dispersal rather than concentration of resources. Dispersal requires healthcare staff to be mobile, visiting patients in their homes instead of bringing them to hospital. The economic benefits of this strategy are measured in terms of convenience to patients and carers and reduction in their time and travel costs. The economic costs to providers and funders include the sacrifice of productive time in exchange for the costs of fuel and travel time. Efficiencies are offered through electronic means to schedule, co-ordinate and control visits and journeys.

Avoidance of hospital admissions is assisted when elderly patients nearing the end of natural life receive a high standard of primary care, well integrated with the contribution of expertise from the secondary care sector. An avoidable cause of worsening health for patients in this group is the inhalation of food debris during feeding. Rapidly declining neurological function is associated with loss of the swallowing reflex and decisions on safe care require expert assessment of swallowing. Expertise too limited to disperse is amplified if it can be brought to bear outside the centre. Telemedicine offers a means to provide important assessments remotely. The technical design of kit and the training of those who apply it at either end of the link are not the only determinants of its success and economic contribution. The capacity to initiate an assessment immediately it is required, and to respond to the findings of an assessment are also key factors. The analysis and design of the social interactions surrounding digital technology applications are just as important as technical analysis and design.

The value and application of telemedicine assessments in care homes are not restricted to patients with impaired swallowing. Applied in a more general way, it promises two principal benefits: pressure on scarce hospital beds can be alleviated and frail, elderly patients can be spared the disruption of their peace and quiet caused by a journey to hospital an avoidable admission. The value of these benefits tends to be assumed and it is right that they should be valued conservatively so that the benefits are not over-stated, out of proportion to the real benefits derived from hospital admission by those who absolutely benefit need it.

It is an over-simplistic policy to promote a binary shift of demand and cost from the secondary to the primary care sector without being specific, first, as to what care needs are to be met and to what standard of effectiveness; second, as to what new monetary and non-monetary costs are to be created then borne by patients and communities. For as long as a meaningful distinction can be said to persist, it makes absolute sense to co-ordinate the contributions of both sectors and, especially, to improve the co-ordination of both existing and novel forms of primary care contribution around the needs of individual patients. The exchange of data through digital communication channels is fundamental but it is also vital to delineate the operational structures and functional relationships to which the digital contribution will be made.

The analogy of the patient's temperature chart is pertinent here. The use of digital resources to generate and organise descriptive data is being superseded by their use to develop integrative information flows. Clinical charts need not wait until the consultant's ward round before being inspected for the messages they contain; they offer patients and staff the opportunity to monitor trends and take therapeutic action before boss comes round to check. As indicators of organisation performance at the level of the individual clinical sub-unit, digital clinical dashboards perform the same function as the patient's observation chart. To operate a clinical unit without this kind of digital resource is like trying to drive a bus without a speedometer, a driving mirror or headlights.

The high priests of the clinical organisation's digital resources, data and information are its information officers. With a growing confidence and sense of mission, they are beginning to emerge from their confinement behind the temple veil, into the congregation of clinicians, managers, board members and patients. Their organisational development will include their integration into this wider community. Understanding statistics and the inner workings of computers and electronic systems, they also need to grasp the anatomy and physiology of the healthcare system: not just at the macro-structural level of its bureaucratic and regulatory organisation but also at the level of interaction between patients, clinical teams, wards, clinics and providers of primary and social care.

Considered as a whole, our international array of health systems contains many opportunities to apply digital technologies if they can be aligned with real needs. Orphan technologies are elaborate solutions to problems perceived by their inventors and proponents within the technology industry, yet they remain homeless and unloved. They are not always relevant or necessary to accomplish the key strategies and goals of an improved healthcare system. The architect's perception of need may not correspond with that of planners, managers, clinicians and patients. The design and successful assimilation of technologies into healthcare depends on a comprehensive elicitation of perspectives and needs. Submitted papers which flagrantly ignored these simple maxims did not survive our selection process.