Improving patient experience with technology: Wolters Kluwer
Shara Cohen, Vice President of Customer Experience at Clinical Effectiveness, Wolters Kluwer, Health tells Healthcare Global about telehealth and improving the patient experience.
Wolters Kluwer Health provides tech solutions for clinicians, healthcare providers, researchers, and patients. The company was founded in the Netherlands over 180 years ago, and today operates globally, providing information and solutions to healthcare organisations all over the world.
These include tools like Emmi, multimedia programs available in the US that help patients take an active part in their health, for instance helping to understand a diabetes diagnosis, and information on Covid-19.
Another example is UpToDate, a solution for clinicians that provides evidence and recommendations to help answer complex medical questions; it's currently used by 2 million healthcare providers worldwide.
Working in customer experience, Cohen explains that her role is all about how technology can improve healthcare. "I've spent the last couple of decades talking to people in hospitals and health systems of all sizes and across the world, listening to what their challenges are and thinking about ways in which we can help. There's a common theme every day where I get to think about new puzzles that healthcare organisations face, and hear about what they need to do the amazing work of caring for people."
One of the greatest healthcare challenges of recent times is of course Covid-19, which in many ways has transformed a healthcare sector that was already undergoing drastic changes. "The speed of change has been relentless for our customers" Cohen explains. "They've dealt with a shift to value-based care, the emergence of electronic records, the constant development of regulatory frameworks, it goes on.
"But that was nothing compared to the last nine months. The pandemic upended everything and care teams had to treat patients with a condition and symptoms they were totally unfamiliar with, under conditions that were terribly challenging in terms of volume and uncertainty.
"For our part, we were trying to support customers as best we could. The information that we provide throughout the day was critical to frontline workers, so our customer experience team was working to make sure it was available as organisations propped up field hospitals that needed access in new ways, or physicians were called out of retirement or into new specialties they weren't used to practicing. UpToDate provided them with the information they needed."
Additionally, Wolters Kluwer made their Covid-19 resources available for free to clinicians around the world. "We did a ton of work to make sure that as physicians were struggling to keep up, a contract wouldn't stand in the way of good patient care."
As the pandemic continues, healthcare organisations are evaluating how coronavirus has changed the way they work. Virtual care is perhaps the best example, as hospitals and clinics need to provide safe care for people with chronic and mental health conditions, pregnancies and other care needs.
While telemedicine already existed, adoption had so far been slow. "Some organisations and some countries were really ahead of others in their adoption of telehealth" Cohen says. "So when the pandemic hit, some were six steps ahead and didn't have to implement the technology, they just had to better leverage it. Most big institutions were already down the path, they simply needed to handle the volume. Others had to handle the influx of patients, while implementing new technologies.”
"What is interesting now is that we're seeing the next step in maturity of using these technologies. In those early stages, particularly for organisations that were not as prepared ahead of time, they were using Microsoft Teams as a way of interacting with patients. That's ok as an early adopter solution, but platforms like Teams and Zoom are going to evolve and create better interfaces that take into account medical records, or what the patient is seeing."
A challenge that the rise in telehealth has thrown up is digital literacy. Cohen says there can be a lack of comfort on both sides, but solutions like Emmi provide an opportunity to help patients engage with their own care digitally, coaching users through the experience.
"Once we get past that initial hesitation, there's a tremendous opportunity to create a better experience. We've all been in care experiences where it's the patient and the physician, they have a screen in front of them with the medical record and while they're talking, they are documenting and their eyes are on the screen. Even the most fantastic clinicians with the best bedside manner will swivel between the patient and the computer, and that de-personalises the interaction.”
"If we can work with platforms to improve the interface for the physician, then all of a sudden that computer is not a distraction for eye contact, so they can type things while they're talking and the patient won't feel like the doctor isn't directly interacting with them. There are ways in which we can think about the experience and improve those interactions for both sides."
Cohen believes that virtual healthcare is here to stay. "Telehealth already existed, but what the pandemic did was force payment models to appropriately reimburse for virtual services. It forced patients to adapt because they wouldn't get care otherwise. It essentially directed a mass of the population to the availability of telehealth.”
"Consumers have always had an expectation for how they interact with healthcare providers, but it wasn't really available before. Telehealth can also help address health inequities and access to care. Now that we've made progress on regulatory and payment models, the promise of addressing these healthcare needs is exciting."
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.