Background
2020 caught the world and healthcare providers by surprise. It has been more than 100 years since the world has faced a pandemic impacting every country. Technology and healthcare have changed significantly since the 1900’s and the Covid-19 virus has forced us to review how we provide healthcare and protect our communities.
We were not prepared for this catastrophic event. The ability for people to easily travel by air meant the virus could rapidly move to all corners of the earth and extensive use of social media to provide instantaneous information meant everyone had a different opinion of how to address this deadly disease, as well as whether the virus was actually real and life threatening. Many people across the world opted to believe personal opinions rather than scientific evidence.
Different healthcare systems had to identify medical care response and processes to address the immediate clinical needs at their doorstep. Without a doubt, healthcare professionals stepped in and stepped up to meet this challenge. Simultaneously, it seemed like the rest of healthcare was shut down and patients had to figure out on their own, where and how to seek care, or how to manage their conditions differently.
Introduction
What is the future – will healthcare be the same again?
The pandemic has significantly affected our communities. To try and control the pandemic the focus of healthcare has been on protecting our society, but at what cost? Healthcare budgets are limited and by diverting funding to address the pandemic meant a reduction in funding for other clinical activities. “Locking down” populations increased mental health anxieties which resulted in the escalation of the suicide rates amongst our young. The cancelling of elective surgery and screening processes caused a surge in the rates of cancer and saw an increase in disabilities amongst our older populations. It is our healthcare professionals that have had to deal with these issues. This rapidly led to stress and burnout for these individuals.
What is the Future?
The pandemic has forced changes in both care delivery and in the development and implementation of technology to support patient care. Hopefully the future will not be the same and the importance of mental health for patients, the community and our staff is something that needs to remain current and be addressed. We need to use data, e-health and patient applications to focus on addressing the clinical and mental health issues that are dormant in our communities but need to be addressed.
Technology
Healthcare technology, both systems and equipment, have been rapidly developing over the last twenty years. However, their international rollout and acceptance has been limited by a number of factors including costs, acceptance, and legal authorities. Prior to the pandemic the following technologies had been developed and were being piloted/implemented in limited geographical areas. Each country had placed different constraints on the use of these technologies. This all changed with governments attempting to address the requirements for patient care during a pandemic. It has been one of the few advantages of the pandemic as Governments were forced to review legal and financial constraints such as payments, insurance, and pharmaceutical requirements.
- Tele/Video Conferencing
Teleconferencing had been in place in several countries prior to the pandemic, mainly to address patients located in remote areas. However, there were constraints in place that limited the use of telemedicine. In the USA it had limited use due to insurance payment issues, whilst in Asia the limits included the inability to order drugs or make a definitive diagnosis. In the UAE there was limited uptake or interest with only 100-patients per month pre-covid accessing the system. In all countries there was limited use of telemedicine if vital sign monitoring was required.
2020 resulted in both healthcare and Governments working together to address these constraints to keep both patients and healthcare providers safe. Having 500+ patients in an outpatient clinic does not allow for social distancing, and patients with a diagnosis of Covid-19 isolating at home cannot attend hospitals or clinics for routine checks.
Suddenly Tele/Video Conferencing became the answer.
Laws were changed/modified to allow for this form of consultation. The issues of payments and insurance coverage were also addressed (helped by online payment systems developed for shopping!). Numbers of consultations went from 100 per month pre-covid, to over 10,000 per month during the pandemic. The development of home monitoring devices also allowed patients to be reviewed in the safety of their own home. Devices such as vital sign monitoring, ECG, respiratory and glucose monitoring, and even fetal heart monitoring, became affordable and available. These devices were also connected remotely to the patient’s medical record which allowed their healthcare professionals to monitor their progress.
Communication tools were also implemented, and patients were provided with SMS messages via their smartphones to deliver results, updates, and appointment times.
- Electronic Medical Records (EMR)
The EMR electronic system which automates and records processes in the medical field is designed to improve clinical outcomes/reduce medical error. The purpose is to improve organizational outcomes, deliver societal benefits, provide data warehousing and to engage the community.
Covid-19 identified the need to streamline our access to clinical and research data more efficiently and collaboratively to address this global health crisis. Everyone was forced to produce information on the number of patients, the number of beds and the number of staff available. This was a nightmare as unless the data comes from a single source of truth it meant conflicting information was provided every time.
Because of the panic and emotive situation everyone was requested to provide this data but often were asked slightly different questions resulting in different results, confusion, and frustrations. Some of the data was provided from the EMR and sometimes the information was provided manually. This led, in all countries, to differing statistics and therefore resulted in the community having a lack of confidence in their governments and healthcare providers and supported the ignorant information circulated on social media.
The pandemic placed significant focus on EMRs to respond to modifications required to address the changing clinical requirements. Informatics staff were requested to change documentation rapidly, including assessments, navigators, summaries, tip sheets and severity outbreak dashboards. There was also an emphasis on tracing and public health requisites. The implementation of universal health cards and national data warehouses were fast tracked to ensure effective, comprehensive, and holistic health care provision.
- Artificial Intelligence (AI)/Predictive Analytics
Artificial intelligence enables health care providers to shift from “crystal ball gazing” to accurately predict the future outcomes. It uses the ability of computers to think like humans but use problem solving and pattern recognition to rapidly review huge amounts of data. Subsets of AI include machine learning and predictive analytics. In health care this has led to diagnosis and reviews to predict deteriorating patients more accurately such as sepsis, chest x-rays for tuberculosis and, during the pandemic, to identify modelling of outbreaks. The effective future of healthcare will be dependent on the use of these technologies to predict and assist in healthcare management and planning.
The use of device technology is an essential component for health care providers to track this data. End user devices such as smart phones and tablets allow both health care providers and patients to record and rapidly retrieve clinical data.
- Models of Care
Models of care during this pandemic have changed. The focus has been on implementing care models that can be changed rapidly without increasing the documentation and time health care professionals spend on non-direct care.
Historically a major complaint from health care providers has been the amount of time spent on documentation and non-direct care activities. There must be a balance between safe patient care and health care professional’s communication. The pandemic has highlighted the need for contactless care. This has included home monitoring, home based vital signs monitoring, as well as patient/provider communications supplemented with information delivered by SMS, patient portals that allow for both patients and health care providers instant access to clinical information as well as delivery of videos etc. for education.
Mental health has been a significant factor in ensuring well being for all members of society. This pandemic has identified that it is not only patients with an exiting mental health problem that are struggling. Everyone has faced times over the last two years when their mental health has suffered. Models of care have been developed/introduced to routinely check and identify anxiety/depression/suicidal thoughts for all presenting problems. This pandemic has hopefully taught us that we all need to feel secure and supported. It is essential that this becomes a core component of future health care.
Conclusion
Will healthcare be the same again? I hope not. I hope we have learned from the health care response to this pandemic. Public health has historically taken a backseat in Health and this pandemic has demonstrated just how important protecting our populations from disease can be if individual’s health care data can be monitored and tracked. Even though some of the responses were negative and misinformed, hopefully we have learnt how technology can assist in the provision of health care for the benefit of our community.
Staff have had to multi-task, moving outside their comfort zone and do “other” work. Seventy three percent of nurses have identified that the pandemic has significantly changed their work. Will this continue? Many registered health care professionals have been brought out of retirement to cover pandemic activities. The future question will be, who will cover the expected staff shortages of the future as many health care professionals are so overwhelmed and stressed that they have indicated they will be leaving their profession.
It has been a wake-up call for governments and health care providers to recognize that the focus and centre of health care is the patient, and not the health care providers’ or politicians’ careers.
The advances in health care technologies have focused on rapid responses to clinical demands. We need to recognize, encourage, and continue these changes. These changes include using technology to allow patients to remain at home yet still be effectively monitored.
Using AI and predictive analytics to identify deterioration in patients, as well as implementation and supporting universal health cards and data warehousing to allow both patients and health care professionals to track the wellbeing of individuals anywhere in the world, is an ideal solution.
Covid-19 has identified the need to streamline our access to clinical information and data more efficiently and collaboratively to address health care delivery and any global health crisis likely in the future.
Knowledge and frontline care are evolving rapidly, and we need to be able to react and respond faster in the future. We need to learn and remember the issues from this pandemic!
About the Author
Associate Professor Jane Griffiths
Jane has over 30 years’ experience in health care at rural, district, Teaching Hospital, area, and international Levels. Based in the United Arab Emirates for 14-years until recently, she was Chief Nursing Information Officer at the Dubai Health Authority (5-years) and, for 7-years prior to that, the Director of Nursing at Rashid Hospital in Dubai.
Her clinical experience and qualifications are in Operating Theatre Techniques and Management and her academic qualifications include a Diploma in Nursing Studies, Nursing Administration and her Masters in Health Planning. In the UAE Jane chaired the UAE Nursing and Midwifery Council Scientific Committees for Research and Excellence and participated in several UAE Boards and Councils. She also has extensive academic experience in teaching and research at Universities in Australia, Ireland, and USA with over 25 scientific publications.
She has an adjunct appointment with the University of Western Sydney, is an honorary fellow of the University of Technology (Sydney), past President and Honorary Treasurer of the College of Nursing, a previous member of the Nurses and Midwives Registration Board, a coordinating surveyor with the Australian Council on Healthcare Standards, a member of Sigma Theta Tau International, a fellow of the Australian College of Nursing and a member of The Australian College of Operating Room Nurses.
Jane regularly lectures at the College of Nursing, Universities, and other venues both nationally and internationally on Financial Management, Quality and Benchmarking, Information Technology and Disaster Planning.