Emerging Smarter: Rethinking Healthcare in a time of COVID-19

Emerging Smarter: Rethinking Healthcare in a time of COVID-19

Emerging Smarter: Rethinking Healthcare in a time of COVID-19

Emerging Smarter: Rethinking Healthcare in a time of COVID-19

About the author:

Mark Davies,
Chief Medical Officer, IBM and Watson Health, Europe, Middle East and Africa

IBM would like to thank the industry subject matter experts and leaders for their contributions throughout this paper.

An opportunity to reset and rethink

An opportunity to reset and rethink

An opportunity to reset and rethink

An opportunity to reset and rethink

A watershed moment for the NHS

A watershed moment for the NHS

2 min read

Accelerating digital transformation

Accelerating digital transformation

Accelerating digital transformation

Accelerating digital transformation

Building the digital capabilities required for long-term change

Building the digital capabilities required for long-term change

3 min read

The three steps to recovery

The three steps to recovery

The three steps to recovery

The three steps to recovery

Re-establishing services and establishing a more sustainable system

Re-establishing services and establishing a more sustainable system

4 min read

The next normal

The next normal

The next normal

The next normal

A break from traditional healthcare models

A break from traditional healthcare models

3 min read

Making healthcare personal

Making healthcare personal

Making healthcare personal

Making healthcare personal

Targeted delivery based on individual or population needs

Targeted delivery based on individual or population needs

2 min read

A new era of participation

A new era of participation

A new era of participation

A new era of participation

Taking control of our own health

Taking control of our own health

2 min read

Integrating health and care

Integrating health and care

Integrating health and care

Integrating health and care

Breaking down barriers to incentivise better health

Breaking down barriers to incentivise better health

3 min read

Realising the potential of data

Realising the potential of data

Realising the potential of data

Realising the potential of data

Creating an agile, learning health system

Creating an agile, learning health system

3 min read

A vision for healthcare in the future

A vision for healthcare in the future

A vision for healthcare in the future

A vision for healthcare in the future

Implementing a bold new model of care in the UK

Implementing a bold new model of care in the UK

2 min read

Emerging Smarter: Rethinking Healthcare in a time of COVID-19

01

2 min read

An opportunity to reset and rethink

A healthcare professional using PPE washes hands during COVID-19

The COVID-19 crisis has created a watershed moment for the NHS, demanding a reappraisal of how essential services are delivered to the public.

This pandemic is the most disruptive event healthcare organisations globally have ever faced, and in the UK, especially challenging when the NHS was already navigating the need to transform in the face of global trends such as an increase in older patients, capacity issues around skilled workforce, and rising costs. Responding to these challenges is among the top priorities in both the NHS’s Five Year Forward View and Long Term Plan.

Even prior to COVID-19 the NHS recognised a pressing need to rethink healthcare using user-centred design principles, based on populations, not organisations. With the advent of the pandemic that pressing need has become an operational imperative. Digital capability has been and will continue to be a key part of transformation, but will only work when aligned with reforms in other key enablers such as financial flow, workforce planning and regulation.

“We need NHSE, PHE and other major national bodies to work with us to provide a really clear vision for what the future of healthcare might look like in a world in which the digital possibilities are huge. This must be done without reference to the constraints of current infrastructure and the weak historical track record of transformation programs in health and care, both of which simply must be overcome.”

Sarah Wilkinson,
Chief Executive
NHS Digital

“We need NHSE, PHE and other major national bodies to work with us to provide a really clear vision for what the future of healthcare might look like in a world in which the digital possibilities are huge. This must be done without reference to the constraints of current infrastructure and the weak historical track record of transformation programs in health and care, both of which simply must be overcome.”

- Sarah Wilkinson, Chief Executive, NHS Digital

Many industries have already made the shift to enabling collaboration and innovation through more agile models of delivery by embracing technologies like artificial intelligence (AI), internet of things (IoT) and/or flexible and secure forms of (multi) cloud storage. Health, on the other hand, until now has introduced new technologies with the objective of improving existing pathways and service delivery models. There is now an opportunity to reimagine healthcare, driving true transformation enabled by digital capabilities. This is about design-driven technology, not technology-driven design.

Discover AI technologies to help you work safe, work smart, and guard the health, safety and productivity of your people in a changing workplace.
Learn more.

02

3 min read

Accelerating digital transformation

A clinician works on his laptop

Digital transformation in healthcare is difficult. It is one of the most highly regulated sectors in the world, and its safety-critical nature makes it understandably risk-averse. Innovation also requires some space to thrive and authority to make change happen. With NHS services typically running at or over-capacity, the service rarely has the headspace to create and explore new approaches.

The response to COVID-19 has shown that it does not have to be this way. In the midst of a deadly pandemic, aligned incentives allowed the NHS to pivot and respond at pace, despite the myriad challenges it was facing.

We have seen general practice transition to mainly virtual consultations in a matter of weeks, and hospitals are looking to make digital outpatients the rule rather than the exception. We have seen the system, almost overnight, enable remote working of its non-clinical workforce. And several health systems in the UK and internationally have adopted ‘virtual assistant’ technology to improve access to authoritative advice about COVID-19 to both staff and the general public.

The NHS has managed in that short time to build the digital capabilities and capacity required to deliver these changes. The speed of this is an incredible achievement when you consider that, pre-COVID, it would have taken several years to create the support for such a transition. These innovations have been used to stabilise capacity at a time of crisis. We are now shifting to longer-term plans as we rebuild NHS performance and establish resilience for further possible pressures on the system.

“If you’d said at the start of the year that there is a cohort of patients that no longer need to come in to see us and will use remote monitoring systems, the response would have been that it was interesting but not a priority. But now we are doing it and seeing the results so we now have the impetus to expand this to more patient cohorts such as those with certain long term conditions.”

Dr Axel Heitmueller,
Managing Director,
Imperial College Health Partners

“If you’d said at the start of the year that there is a cohort of patients that no longer need to come in to see us and will use remote monitoring systems, the response would have been that it was interesting but not a priority. But now we are doing it and seeing the results so we now have the impetus to expand this to more patient cohorts such as those with certain long term conditions.”

“Every day, our goal has been to progress as fast as possible in delivery of critical COVID-related products and services. Removing, or working round, historical obstacles such as bureaucratic approval processes, was an imperative. Consultation had to be both fast and effective. Procurement had to be streamlined. In many ways, COVID-19 has been a catalyst by taking some of those obstacles away for us.” 

Sarah Wilkinson,
Chief Executive
NHS Digital

“Every day, our goal has been to progress as fast as possible in delivery of critical COVID-related products and services. Removing, or working round, historical obstacles such as bureaucratic approval processes, was an imperative. Consultation had to be both fast and effective. Procurement had to be streamlined. In many ways, COVID-19 has been a catalyst by taking some of those obstacles away for us.” 

UK Government and IBM sign public cloud agreement to accelerate innovation across public sector. Collaboration intended to enable government to design new cloud-based citizen services.
Read the story.

03

4 min read

The three steps to recovery

New online poll results

The steps to re-establish services in the NHS can be seen as three inter-related stages. The first is to understand the nature and severity of the backlog. We need to understand where people are on their care journey either in pre-primary care, in primary care, or on a secondary care waiting list. We need to understand COVID-19 and non-COVID-19 related morbidity and mortality, and measure the patient experience associated with this.

The next stage is to design recovery plans for each of these cohorts based on risk models, balancing risk of infection, local capacity and urgency of treatment. Addressing this backlog requires creative models for mobilising resources, leveraging expertise and insights across teams, and using a combination of short-term and turnaround approaches, and more long-term solutions.

There are well-established processes that have shown to deliver fast responses in similar situations. These include user-centred design methodologies and ‘garage’ style sessions that bring strategy, design and technology together to accelerate the solving of an identified problem or need.

The emotional and mental wellbeing of all healthcare staff must also be considered. Many will have just been through one of the most challenging times of their professional lives. We need to ensure we take the time to measure that impact and provide support in an environment that makes talking about such stresses part of our next normal.

The third and final phase of the recovery plan is a more sustainable long-term model which embeds some of these new ways of working.

We will have to plan and prepare for the possibility of further waves or rebounds, and given the uncertainty of a vaccine in the short term, we will need to entertain the possibility of running COVID-19 services alongside usual services almost as a new speciality. We will also have to consider the impact of COVID-19 on the broader public health challenges, domestic violence, at-risk children, mental health and substance misuse in the broader population. It is an uncomfortable truth that this virus could make health inequalities worse in the UK.1 The societal and economic impacts of the pandemic will sadly be a major detriment to public health for some time.

“Looking towards next winter, the big question is capacity, and how we run COVID-19 and non-COVID-19 services concurrently. The main challenge here is the workforce and we have to be really careful that we support staff appropriately – people are already working at the limits of what’s possible and safe. We’re looking at significant backlog and we won’t be able to work on it all immediately. We will need real honesty from government to help manage public expectations about what is possible in this new world.”

Rory Deighton,
Regional Lead North West,
NHS Confederation

“Looking towards next winter, the big question is capacity, and how we run COVID-19 and non-COVID-19 services concurrently. The main challenge here is the workforce and we have to be really careful that we support staff appropriately – people are already working at the limits of what’s possible and safe. We’re looking at significant backlog and we won’t be able to work on it all immediately. We will need real honesty from government to help manage public expectations about what is possible in this new world.”

Helping healthcare cope with crises.
COVID-19 has lead to a change in behaviour, evidenced by much less busy emergency department waiting rooms. Read about the impact on healthcare and potential approaches to re-thinking the model of care. Read the blog.

Vaccines manufacturing in response to COVID-19
Matthew Duchars, CEO of the UK Vaccines Manufacturing and Innovation Centre (VMIC), discusses how project scope was rapidly expanded and significantly accelerated due to the pandemic, and the additional challenges around execution of a virtual VMIC facility. Register to view on-demand.

References:

1 Public Health England, (2020). Disparities in the Risks and Outcomes from COVID-19. [online] Available at

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892085/disparities_review.pdf

04

2 min read

The next normal

A person does a virtual consultation at home on their computer

During the pandemic, virtual consultations have been highly effective at safeguarding doctors and their patients while social distancing rules are in place. But in reality, this is still the face-to-face GP appointment via a different route. Where is the new digital functionality? Or integration with wider systems? Is this still just using digital capability to improve what we currently do, and limiting the opportunity for real transformation?

Consider banking for a moment. Did the industry transform customer experiences by providing video access to bank managers? No. It did so by introducing entirely new customer-facing apps, changing the relationship between account holders and their bank, and giving them far greater control over their finances. Healthcare has a similar opportunity to think in broader terms about service transformation. Rather than just digitising existing processes and adopting the latest solutions we need to be able to reimagine service design and delivery.

It is essential the NHS holds onto the recent agile, can-do approach to service modernisation. This starts with assessing which changes worked best during the pandemic and should be augmented as we transition to the next normal. Healthcare leaders must take care to ensure their adoption of digital technologies represents real transformation, improvement - and equity.

“In the coming months and years we must ensure that we build the next generation of health and care technology against a radically more ambitious service design for health and care delivery which is informed by the potential of digital and data.”

Sarah Wilkinson,
Chief Executive,
NHS Digital

“In the coming months and years we must ensure that we build the next generation of health and care technology against a radically more ambitious service design for health and care delivery which is informed by the potential of digital and data.”

Sarah Wilkinson,
Chief Executive,
NHS Digital

The NHS’s primary objective is pretty straightforward: improve patient outcomes, increase overall wellbeing of the population, and do so in a financially sustainable way. The NHS’s Long-Term Plan is clear: to move away from traditional healthcare models to an approach more focused on wellbeing, prevention, and early diagnosis. We are moving to a model of healthcare that is characterised by being more personal, more participative, more integrated and, ultimately, more digital.

05

2 min read

Making healthcare personal

A healthcare professional in PPE speaks to a young patient during COVID-19

“Only 10-15% of health outcomes are influenced by quality of healthcare services; the rest is influenced by housing, diet, education, transport etc.”

Prof Kiran Patel,
Chief Medical Officer and Consultant Cardiologist,
University Hospitals Coventry and Warwickshire NHS Trust

The shift to more personalised care is not just a design ideal, it is an economic necessity. More targeted delivery based on individual needs is more efficient and creates less waste in the system. This is true both on the individual level and at the level of cohort or segments of the population with common needs.1 Using a population health management approach we have an opportunity to understand ‘value’ in more detail.

This emerging approach is designed to measure needs, cost, outcomes and experience to create a real-time understanding of the impact of care in order to improve outcomes, promote wellbeing and reduce health inequalities across an entire population. At the other end of the spectrum is the advent of personalised precision medicine, where the understanding of disease can be individualised to a person’s genome and phenotype, and in effect all diseases may become rare diseases.2

“We are working to the goal of being able to deliver care which is highly customised to the specific needs of each patient but obviously in ways that are economically viable. Genomic profiling shows that every patient is highly unique: there are almost infinite levels of diversity in our population. Advanced data analytics enables us to use our big NHS data stores to compare each unique individual to a population of unique individuals to identify non-obvious patterns and correlations and yield insights that enable customised care.”

Sarah Wilkinson,
Chief Executive,
NHS Digital

“We are working to the goal of being able to deliver care which is highly customised to the specific needs of each patient but obviously in ways that are economically viable. Genomic profiling shows that every patient is highly unique: there are almost infinite levels of diversity in our population. Advanced data analytics enables us to use our big NHS data stores to compare each unique individual to a population of unique individuals to identify non-obvious patterns and correlations and yield insights that enable customised care.”

Sarah Wilkinson,
Chief Executive,
NHS Digital

References:

1 Lynn, J., Straube, B. M., Bell, K. M., Jencks, S. F., & Kambic, R. T. (2007). Using population segmentation to provide better health care for all: the "Bridges to Health" model. The Milbank quarterly, 85(2), 185–212.

https://doi.org/10.1111/j.1468-0009.2007.00483.x

2 Ginsburg, G. S., & Phillips, K. A. (2018). Precision Medicine: From Science To Value. Health affairs (Project Hope), 37(5), 694–701.

https://doi.org/10.1377/hlthaff.2017.1624

06

2 min read

A new era of participation

A personal device is used to monitor health outside the hospital

One of the societal shifts we have seen during the COVID-19 pandemic is an increased emphasis placed on participation and personal responsibility in keeping both ourselves and those in our communities well. This trend is likely to continue with care delivered in a more virtual way for many conditions, and innovations like ‘direct-to-consumer’ diagnostics becoming more widespread. The proliferation of apps and devices enabling people to take more control of their own health and the health of those they care for will help redefine the social contract between individuals, the community and the NHS. Rather than being passive recipients of care, citizens are becoming equal partners and indeed a critical part of the ‘workforce’.

Interestingly, this more participative model of health is also true at the community level as demonstrated by the remarkable public sign-up to the GoodSAM app and local volunteer groups to support the vulnerable in our communities during the pandemic. We have an opportunity, through primary care networks and community asset development projects, to tap into the large numbers of people who would like to volunteer and help build the essential social capital that is so important in tackling the wider determinants of health for the volunteers and the communities they serve.1 Tapping into the design insight and personal goals of individuals and the community is likely to improve the experience of care. At a community level, there is a real opportunity to harness the wisdom of the crowd to help design and reconfigure services.

“Before the crisis, the relationship with local communities could be described as being transactional. We delivered services, and patients consumed them. COVID-19 changed this and we established a new social contract where we have worked in partnership to tackle the disease and keep families safe. We provided expertise care and medical skill, and people gave up some freedoms to keep communities safe. There is an important idea here we should explore.”

Rory Deighton,
Regional Lead North West,
NHS Confederation

“Before the crisis, the relationship with local communities could be described as being transactional. We delivered services, and patients consumed them. COVID-19 changed this and we established a new social contract where we have worked in partnership to tackle the disease and keep families safe. We provided expertise care and medical skill, and people gave up some freedoms to keep communities safe. There is an important idea here we should explore.”

Rory Deighton,
Regional Lead North West,
NHS Confederation

Medical devices are vital but vulnerable.
Legacy devices in hospitals are often unprotected from vulnerabilities and hacking, yet they can hold sensitive, personal and life sustaining data. Find out about emerging technologies for security. Read the report.

Loneliness in the face of COVID-19.
Self-isolation and social distancing can further exacerbate loneliness. Find out how technology can complement face-to-face solutions to help combat loneliness with interaction and inclusion. Read the report.

References:

1 Public Health England, (2019). Wellbeing and mental health: Applying All Our Health. [online] Available at:

https://www.gov.uk/government/publications/wellbeing-in-mental-health-applying-all-our-health/wellbeing-in-mental-health-applying-all-our-health#professional-resources-and-tools
[Accessed July 2020]

07

3 min read

Integrating health and care

A woman helps a family member with their mask during COVID-19

“There are no good reasons why we can’t explore the opportunity to deliver a 24/7 integrated care model, optimised through real-time data insights. If we can develop these capabilities, we will improve population health management and incentivise better health.”

Prof Kiran Patel,
Chief Medical Officer and Consultant Cardiologist,
University Hospitals Coventry and Warwickshire NHS Trust

The long talked about concept of integration between and within health and social care is a key component of a reinvented model for care. This has proved difficult to achieve, in part due to the significant structural barriers that exist between and within the systems.1 COVID-19 may now represent an extinction event for siloed thinking. It has made apparent that we will be unable to re-establish our public services without a combined, and therefore integrated, effort not only across health and social care but also with non-statutory and broader public services.

Achieving this relies on finding better ways to marry centralised supervision with devolved care delivery, and enabling wholescale adoption of population health management. Naturally, this is easier said than done. Even in the same regions, healthcare entities can be incredibly disparate.

All this cannot be achieved without proper transformation. If we can unlock the existing wealth of data within the system it will provide an opportunity to drive improvement by providing meaningful, actionable insights. Rather than attempting to run healthcare in the dark, this is about playing our part in a smarter kind of healthcare, one where the lights are switched on and we have visibility of the inputs and impact on an individual level.  

“If you want to solve problems, you can’t do that with a top-down approach. Local solutions to local problems are required. We need to get to a devolved structure with local decision making for specific problems. London is very different to Sunderland and the NHS needs to reflect that.”

Dr Axel Heitmueller,
Managing Director,
Imperial College Health Partners

User-centred design for social services
Read how the Scottish Government established a new agency to help meet the needs of citizens in receiving their social security benefits, building a modern, secured and flexible platform designed together with the people of Scotland.
Read the blog.

References:

1 Baxter, S., Johnson, M., Chambers, D. et al. (2018). The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 18, 350.

https://doi.org/10.1186/s12913-018-3161-3

08

3 min read

Realising the potential of data

A clinician uses a mobile device

At present, the NHS is data rich but information poor due to a long-standing lack of linking data for an individual to guide their care. Instead of following and informing the patient journey from start to finish, data is often fragmented and trapped within the part of the organisation that generated it. Moreover, data is typically used in a highly transactional manner, maintaining a managerial system instead of driving incremental improvements.

By optimising its use of data, the NHS has an opportunity to create an agile, learning health system, capable of tangible improvements every day. At a technical level, fixing this issue requires a shift in system design, as well as the adoption of open standards and more open technical architectures that support interoperability and co-operation. We must also ensure we do this safely and securely. Maintaining the confidence and trust of patients and staff is key to continuing the digital healthcare shift that COVID-19 has accelerated. By building our systems and services securely by design, baking privacy, transparency and confidentiality into a model worthy of public trust and support, we can drive real change in both citizen behaviour and the system itself.

“Data has often been seen as an IT issue rather than a clinical one and because of this has served the needs of back office functions rather than care givers. GDPR has brought it up the agenda, but there is still more work to do so that patients can see the real benefits it can bring.”

Natalie Banner,
‘Understanding Patient Data’ Lead,
Wellcome Trust.

“Data has often been seen as an IT issue rather than a clinical one and because of this has served the needs of back office functions rather than care givers. GDPR has brought it up the agenda, but there is still more work to do so that patients can see the real benefits it can bring.”

Natalie Banner,
‘Understanding Patient Data’ Lead,
Wellcome Trust.

The COVID-19 outbreak has helped by breaking down many of the data barriers that existed between organisations. Evidence of the first medicine to reduce deaths from COVID-19 has been generated by the RECOVERY trial, the largest trial in the world, run across the NHS. Researchers demonstrated that dexamethasone can reduce death of patients on ventilators by a third, and those on oxygen by a fifth. This trial was possible because a consortium of NHS Digital, IBM, Oxford University and Microsoft were able to collate multiple data sources, integrated by NHS DigiTrials, to rapidly identify results. This hopefully heralds a new age of real-world evaluation and the mainstreaming of research into health delivery.

All these developments will require substantive involvement from the general public, particularly when it comes to the appropriate use of data. That includes ethics and transparency around who has access to that data, as well as the continued safety and integrity of that data upon which clinicians and critical services rely.

“You can’t have a conversation on data without coming back to trust. Everything else we do is dependent on that; it’s beyond critical.”

Sarah Wilkinson,
Chief Executive, NHS Digital

“You can’t have a conversation on data without coming back to trust. Everything else we do is dependent on that; it’s beyond critical.”

Sarah Wilkinson,
Chief Executive, NHS Digital

Using real-world data to build a learning healthcare system
With more diverse real-world data, life sciences companies recognise the value of using the right data framework, asking the right questions and engaging expertise.
Read the blog.

09

2 min read

Conclusion: A vision for healthcare in the future

a healthcare professional smiles

“The response to NHS around COVID-19 has been incredible. This presents a real opportunity to reset the relationship and reconnect the public and healthcare to create a lasting legacy from this moment in time.”

Dr Axel Heitmueller,
Managing Director,
Imperial College Health Partners

“The response to NHS around COVID-19 has been incredible. This presents a real opportunity to reset the relationship and reconnect the public and healthcare to create a lasting legacy from this moment in time.”

Dr Axel Heitmueller,
MD, Imperial College Health Partners

With support for the NHS at an all-time high, now is the perfect moment to introduce a bold new vision for health and care in the UK’s future. We have been presented with a unique opportunity to rethink and reimagine health and care, guided by the insights drawn from data, for a significant shift towards a model of care that stops trying to provide a one-size-fits-all service for the nation, and instead delivers services according to need.

Delivering on the promise of personal, participative, integrated health and care can deliver this vision, making way for an enhanced – and ultimately smarter – National Health Service to emerge, for patients, the community, and staff alike.

Access the pdf version of this paper here.

IBM offers a unique combination of advanced technology solutions designed to help drive impactful change, services to digitally transform organisations, and the support of an experienced partner.

Contact us