During the challenging days of the COVID-19 pandemic, it is sometimes hard to try and find the positive elements. About 90% of the world’s children are not in school (1.3 billion), many workers are working from home and our colleagues in the health and care sector and other essential workers continue to put themselves at risk to deliver critical services. But as Plato said, ‘necessity is the mother of invention,’ in this case, disruption is the acceleration of change.
As we look back on 2020 from a point in the future, we will recognise that it was a turning point in not only how health care was delivered, but just as importantly, how citizens interacted with the health care systems.
As citizens around the world have moved into lockdown with limited movement, vast swathes have become reliant on technology for maintaining social connectedness or even obtaining essential supplies such as food or medicine. Products with names that had limited awareness have become household lifelines, such as Zoom®, Teams®, Uber eats® and the plethora of other communication and delivery services.
The doctor-led approach of health care in most countries has been swept away in a stroke. Patients who previously considered the only way of receiving health care was by contacting their doctor, meeting them face-to-face, explaining their symptoms, being examined and ultimately getting diagnosed and treated have, in a few short weeks, found other mechanisms to receive care. Patients have found themselves interacting via apps, online tools and video conferences, in many cases, with a more responsive approach.
Clinicians themselves who have held out doggedly for a more hands-on approach to care, saying, “That could never go virtual, it wouldn’t work in my specialty,” have practically overnight been transformed to remote working, with only minor numbers of patients being seen in person, and even then, those were after much of the investigation had already been done.
Throughout the entire process, the availability of data and the ease of collation and collaboration have been central to how health services have continued to function and evolve. The mobility of patients, often in serious condition and their treatment in ‘non-conventional’ settings, has meant that the ability to access details of a patient’s medical history rapidly, identifying co-morbidities, has been essential as has been seen in the UK NHS Nightingale Hospital. The ability to rapidly aggregate, normalise and interrogate data has allowed data scientists to start to understand what treatments work and what the best pathways of care are for patients.
Without the ability to aggregate data in a meaningful way across populations to identify those cohorts of citizens and patients most at risk, be that the elderly or those with underlying health conditions, rapidly and accurately, that ability requires not only a platform designed by those who understand health care and health care data but additionally near real-time data. This, in turn, requires standardised or at least standardisable data from a plethora of different sources; where organisations already had such population health platforms in place, managing their epidemics of non-communicable diseases, such as diabetes, their ability to respond to identifying at-risk populations was significantly enhanced.
The genie is well and truly out of the bottle and many innovations can’t and shouldn’t be returned to the bottle. That is not to say that things built and implemented in haste cannot and should not be improved, but health care will never be the same again.
The respect that patients have for the health care systems around the globe, and the understanding of what it means to have a health care system truly under pressure, will allow health systems to build on that goodwill to improve their services in ways that pre-COVID would not have been possible, at least not in a rapid timescale or the extent that will be possible now.
As we move into a post-COVID world, there will be significantly different interactions between patients and clinical teams, such as patient entering their personal data directly rather than relying on clinical staff to be transcriptionists; initial remote screening of patients to identify the best clinical team and route of access rather than relying on the default appointment; different approaches to delivering that consultation via telemedicine, telephone care, computer suggested screening prior to consultation; and direct referral and management by care teams without the need for the doctor’s intervention.
For those health care providers with technology in place and true delivery partners that can be responsive, there will be even more drive to get their technology to the latest standards to allow rapid sharing of innovation and data, as has been seen in the pandemic of those who were either not on a technological base or were on older technology having a disadvantage when it came to taking advances developed in a timely fashion.
If COVID-19 has taught the world one thing, it’s that humans are fragile and no health system can be maintained to have the idle capacity to step up to delivering care in a situation such as COVID-19. Instead, it relies on the whole population to do its duty to support the health systems, to help themselves where possible and to utilise health care appropriately. Health care has changed forever. It cannot be taken for granted, it will change and it will change for the better.
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