In no time at all, coronavirus (aka SARS-CoV-2) has turned our lives upside down. It’s too early to fully assess the long-term effects on the economy and how we live together, but we can start to examine how our health system has coped with the virus and identify areas for improvement. We’ve been giving a lot of thought to how and where digitalisation might be able to help out, both during the immediate crisis and longer term.
Medical opinion is that SARS-CoV-2, like the flu, is likely to become endemic in Europe. This means that, rather than being a one-off visitation, it will become a permanent fixture, destined to return at regular intervals. We therefore have to assume and prepare for the eventuality that pathogens such as SARS-CoV-2 will continue to have a major impact on our everyday lives.
In a viral pandemic, all eyes turn to the healthcare system. The crisis we are facing confirms something first identified by the German Federal Ministry for Economic Affairs and Energy back in 2018 – when it comes to digitalisation, healthcare is very much in the rearguard. The reasons for this are varied, but high regulatory hurdles are probably one of the most significant.
But digitalisation could make a significant contribution to a more efficient healthcare system, both during the current pandemic and, even more so, in future crises. We want to take a closer look at various facets of the healthcare system in the light of the ongoing pandemic, and to outline potential routes to a better, more digital future. In this first part, we look at GP practices, outpatient care, hospitals and inpatient care. In part 2, we look at medical device manufacturers, laboratories, diagnostics and the pharmaceutical industry.
GP practices and outpatient care
During a pandemic, it becomes impossible to provide care for patients suffering from ‘normal’ conditions in their GP practice. Though it is possible to resolve some emergencies over the phone, this means managing without a number of important diagnostic tools. It is likely that this will lead to delays in treatment, ultimately resulting in extra costs to the healthcare system. In our view, primary care is therefore the area where digital solutions can exert the greatest effect.
The quick fix – better data protection for doctor-patient video consultations
Doctor-patient video consultations are an inexpensive, rapidly implementable solution. Many doctors have already started using video portals to allow them to make at least some kind of visual assessment of their patients. However, this still leaves them unable to undertake key examinations such as measuring blood pressure and pulse rate or listening to breath sounds. But the doctor is at least able to gain some kind of impression of how the patient looks and in some cases may be able to initiate treatment. Medical associations in Switzerland have already responded by lifted rules limiting the use of video consultations. Unfortunately, many practices aren’t yet equipped with the technology required, with many computers lacking cameras or video calling software.
Consultations between patients and doctors usually involve the exchange of confidential information. This means that standard video calling portals like Skype and Zoom can only be used if the patient has first received written notification that the call may not comply with data protection legislation and has given their consent to go ahead with the call on that basis. One alternative is certified, free video services offered by companies such as Health Info Net AG (HIN). Standard portals are, however, perfectly OK for online training.
The medium-term solution – integration with billing systems
In the medium term, video consultations which use speech recognition to automatically produce a written record of the content of the consultation look set to take the place of many visits to the doctor. These consultations will of course be protected by strong security and use advanced encryption. Automatically linking the record produced with billing systems will deliver further productivity benefits, and not just during a crisis. This will leave doctors with more time for tackling key treatment issues.
In addition, many newer diagnostic devices are equipped with technologies to enable data to be transferred to a smartphone or the internet. Despite an abundance of connectivity options, integration of such devices into existing IT infrastructure is not well advanced. In our view, this would be a promising point of attack. Integrating device data into electronic patient records could significantly decrease paperwork.
The long-term plan – AI solutions to reduce the workload
During the coronavirus outbreak, many specialists have had to close their practices due to a simple lack of demand. As a result, many general practices have had to deal with cases that they would normally have referred to hospitals or specialists. In this situation, gaps in knowledge or experience could be filled by artificial intelligence-based health applications. These apps are designed to support doctors with their work, not to replace them. They therefore represent a type of augmented intelligence. Another promising idea is to use a chat bot to take the initial medical history. Some of the approaches taken to date look very promising, and are already demonstrating that AI solutions can significantly improve the efficiency of frontline health systems. The sticking point here, however, is whether doctors and the public are ready to accept such solutions.
Hospitals and inpatient care
Hospitals are pinch points during a pandemic. If hospitalisation rates exceed a country’s intensive care capacity, disaster ensues. Many of the measures initiated during the coronavirus epidemic have been directed towards a single goal – stopping hospitals from being overwhelmed. If it were possible to utilise hospital capacity more efficiently and to manage hospitals more flexibly, it would be possible to deploy much less drastic virus-containment measures.
The quick fix – using tablets to record advance healthcare directives
Educating and informing patients and relatives takes up a lot of time, especially where there are language barriers. It should, however, be possible to use an app to answer many key questions. Simple, automated translation and the ability for hospitals to add specific content themselves would be very useful. Many patients will not have made an advance healthcare directive or may have left it at home.
With relatives not allowed into hospitals during a pandemic, older people in particular often find this issue somewhat overwhelming. In such cases, an app installed on a tablet that helps answer key questions using age-appropriate blocks of information and videos could prove highly useful. The app could also email the text of the directive to the patient’s relatives for checking. An electronic extract of the directive containing key instructions would be shared with the hospital to be filed in the hospital information system. Using modern low-code platforms such as Mendix (owned by Siemens), apps like this can be created quickly and with a minimum of effort.
The medium-term solution – digital checklists and communication systems
Entering and leaving isolation wards, often implemented as negative pressure rooms, is time-consuming for staff. Any materials needed have to be passed through an air lock and cleaned. If you forget something, you have to go through the whole process again. Staff often hand write notes whilst on the isolation ward, but are then unable to take them outside. Digital checklists and digitised communication solutions are an efficient means of bypassing the physical limitations imposed by isolation wards.
As the number of people admitted to hospital as a result of coronavirus reached its peak, it was evident that staff deployment planning in hospitals was pushed to the very limit. Digital staff planning tools employing paradigms from the agile world, such as Kanban and Scrum, could offer a potential solution. As a short-term fix, standard tools currently used to manage software maintenance tickets could be reconfigured for hospital use.
The long-term plan – onboarding apps and robotic systems
In a pandemic, admitting people to hospital is a key process step. Triaging patients requires large numbers of staff who need to have undergone some basic medical training. As a result, these staff are not available to deliver medical care within the hospital. Onboarding apps, already used in other industries, could significantly boost triage efficiency. This would involve staff being guided through the triage process by a software system. The data collected could then be automatically forwarded to the hospital system. Some caution is required, however. Since any such software solution would affect treatment pathways, and as errors could be potentially life-endangering for patients, they would need to be developed with due regard to applicable medical standards. Developing this kind of assistive system is therefore going to take some time.
Patients admitted to intensive care units with COVID-19 have faced longer than average hospital stays. This has been a big challenge for nursing staff, as these patients require 24 hour care and need to be turned at regular intervals, a process that can require 4–5 people. Ventilation in a prone position is particular challenging. It should be possible to develop technical aids and assistance systems to support nursing staff with this task. Safe cooperative robotic systems are already in widespread use in other industries. Our experience shows that, in addition to regulatory requirements, the needs of nursing staff – the users – are critical when developing such systems.
Interested? We would be very happy to discuss the opportunities and available options with you.
You are interested in topics like Agile Systems Development, Data Driven Solutions, New Digital Business Models or Decentralized Technologies? Activate our roundtable alert and we will notify you when we are planning the next (virtual) roundtable on one of these topics.