Adoption of remote monitoring will provide essential health advantages
Everyone knows that the way the NHS manages long term condition (LTC) care is unsustainable. The need to establish new models, as laid out in NHS England’s ‘House of Care’ framework, is widely understood. Yet despite the rationale and the consensus, unlocking a solution at the local level remains a huge challenge. This need not be the case.
But first, let’s look at the trend-lines. The number of people with LTCs and multimorbidity continues to grow, placing intolerable pressure on services and pathways.
More than 15mn people in England have at least one LTC, while the number with three or more is forecast to reach 2.9mn this year. The implications are significant. LTC patients already account for 50% of all GP appointments, 70% of all bed days and around 70% of acute and primary care budgets in England. As the population ages, those numbers are only going to increase.
Recent research predicts that, by 2035, 2.5mn (17%) people over the age of 65 will have four or more chronic illnesses. Around two thirds of over 65s – a massive 9.7mn – will have at least two. But the problem is not one for the future – it lives in the here and now. Our ability to establish effective models of LTC care is vital to the sustainable delivery of safe, timely and high-quality care. The question is: how do we do it?
An evidence-based solution is already out there, but it’s important to examine the context in which it sits.
A primary problem: recognising deterioration
Fundamentally, the single biggest priority in the NHS is patient safety. Five years ago, in the wake of the Francis Report and the Berwick Review, a range of policies and measures were put in place to help clinicians recognise and respond to patient deterioration in acute settings. However, these same policies have never been extended into the community. As a result, clinicians in primary and community care are often unable to recognise deteriorating patients before they suffer an emergency exacerbation.
The impact is felt on the front line of care in the form of increased demand for services, greater costs and poor health outcomes. The scenario is particularly common in patients with multimorbidity. The system is not set up to support them.
The problems with current approaches to multimorbidity are manifold. Primarily, chronic diseases are typically managed in isolation via services that are set up to focus on single conditions. Well-coordinated care is the exception not the rule, with pathways often fragmented and thwarted by a lack of informational connectivity.
Alongside this, LTC patients often receive limited support beyond the clinic. In the digital age, increased access to online information theoretically empowers patients to self-manage their conditions more effectively. However, the reality has not yet caught up with the rhetoric.
Services don’t always do enough to educate patients around their disease – expecting them to take greater responsibility for the management of their conditions simply because technology is there to empower them. It’s a passive approach that’s prone to risk.
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Wide variability in online health information, health literacy levels and the understanding of disease invariably leads to poor self-management and, at times, patient deterioration. The latter manifests itself in patients returning to the GP surgery for urgent treatment or presenting at A&E. Many of these emergency exacerbations are entirely avoidable. However, since clinicians have no advance visibility of patient deterioration, they cannot proactively intervene.
The conclusion is clear: current pathways are routinely configured to deliver expensive, reactive models of care. We have to reengineer them.
Regaining control through remote monitoring
The challenges of multimorbidity are familiar to every practice, community trust and acute hospital – many of whom have limited control over the flow of patients into their services. But familiar challenges can have familiar solutions. This is certainly the case with LTC care.
The simple use of mobile technology can, at a stroke, empower patients and clinicians with tools to support the safe, proactive and efficient management of LTCs. Remote monitoring solutions, delivered over intuitive tablet devices, provide a powerful platform for intensive monitoring, education and empowerment of at-risk patients.
These solutions are custom-designed to help patients engage with their health and self-manage their conditions through the daily capture of physiological data and self-reported information about their wellbeing. That data is linked to dynamic care plans and evidence-based algorithms that enable automated triage for healthcare teams when an escalation of care is required.
Crucially, this gives clinicians real-time visibility of physiological trends to help them recognise and respond to deterioration. Moreover, it provides them with an evidence-base that gifts them ‘remote control’ of vulnerable patients, allowing them to intervene proactively rather than wait for a costly emergency exacerbation. This is hugely reassuring for patients and carers, who also feel in greater control of their care.
Adoption of remote monitoring solutions is growing across all settings within the NHS. Evidence shows it’s helping to facilitate earlier discharge, prevent readmission and reduce the risk of future exacerbations through better self-management.
In chronic diseases like COPD, diabetes, heart failure and frailty, CCGs and community trusts are leveraging remote monitoring solutions to engineer more efficient pathways – with improved patient engagement and better self-management helping to alleviate the burden on services and lower the cost of care.
The principles of remote monitoring are strongly aligned with the key components of the ‘House of Care’ model for person-centred, co-ordinated care. The framework highlights the need for services that ‘engage and inform individuals and carers to self-manage’. It also calls for ‘organisational and clinical processes that structure around the needs of patients using the best evidence available’.
Moreover, House of Care underlines the importance of ‘informational continuity’: if HCPs are to provide the right care at the right time, they ultimately need access to the right information. This is undoubtedly true. And its why remote monitoring solutions, which give clinicians unprecedented real-time visibility of their most at-risk patients, must play a key role in future models of LTC care.
Digital health passports - 4 quick facts
As COVID-19 vaccination programmes roll out around the world, policy makers and the private sector are engaged in intense debates over vaccine passports and whether they are the solution to re-opening economies and getting back to “normal”.
With various governments using different systems there is confusion over how universally accepted a digital health passport will be, and whether our private data will remain private. Here is we know about vaccination passports so far.
1. Many countries will require proof of vaccination status
Most international travel has been on pause during the pandemic, with strict quarantine measures in place around the world. For travel to "open up" again, it is likely that vaccine status, COVID-19 status or a combination of the two will be required before you're able to enter another country.
The European Union is behind a “Digital Green Certificate" that would enable people to show they have been vaccinated, had a negative test, or have recovered from the virus in order to travel across its 27 member countries, although MEPs have also said these will not be a precondition to exercise the right to free movement.
The UK is planning to use its existing National Health Service (NHS) track and trace app as a health passport for British people to travel abroad.
There are no plans to implement a nationwide health passport in the US so far, and there is fierce, partisan opposition to the idea; however Hawaii and New York State have launched passport programmes that enable vaccinated people to skip quarantine for inter-state travel.
Health passports are also being contemplated by the hospitality and entertainment industries - for example for entry to live music events and bars. Israel, which has the highest vaccination rate in the world, has launched a "green passport" for people to show at gyms, venues and synagogues, however there have been problems with access and data privacy.
2. They're not conventional passports - they're digital
Calling them "passports" is a bit of a misnomer, as most of the proposed certificates are digital. The CommonPass, for example, saves the user's test results onto their mobile device, along with any other necessary health screening information. The pass then generates a QR code which can be printed or scanned by airline staff to confirm the passenger's health status. It's already being used by major airlines including Lufthansa, United Airlines, and Virgin Atlantic.
In India, the health ministry has said that everyone who has been vaccinated will get a QR code-based electronic certificate.
Additionally China has implemented an app-based health code system that uses travel and medical data to give people a colour-based rating, showing how likely it is that they have COVID-19 and whether they should self-isolate.
3. Numerous tech companies have already created health passports
A number of tech companies big and small have already entered this space, with Microsoft’s CoronaPass, IBM’s Digital Health Pass, VaxAtlas and SafeFun among the many initiatives that have sprung up catering to different audiences - SafeFun is aimed at consumers to be able to socialise, while the SafeAccess app is specifically for workplaces.
This raises issues around standardisation - with so many different types of digital passport available, there will need to be consensus from venues, businesses and airports on how they work and whether they are accepted.
4. There are fraud and privacy concerns
Research by McAfee recently found a growing black market for fake COVID-19 test results and vaccination certificates.
Enforcing vaccine certification via an app would exclude people who do not own a smartphone. It also has the potential to reinforce existing inequalities, for example pregnant women, who are currently ineligible for vaccination in many parts of the world, and would therefore be unable to participate in the same activities as non-pregnant women.
Last but not least, many have raised concerns over data privacy, which is a major cause of the divisions over whether or not to adopt them. Experts have said they fear vaccination information could be linked to other personal data to create a “personal risk score” that could then be subject to abuse.