The digital 
healthcare experience

Here’s what a day in the life of digital health could look like in England: “I have a heart condition and diabetes; I am 65 years old and can manage on my own. I have a few devices and sensors in my home to enable me to better monitor my condition and my day-to-day activities. I have an intuitive app that tracks my exercise and diet, and another device that checks my blood pressure and oxygen levels. Today I receive an alert on my smartphone from one of these devices telling me that the latest readings indicate that I should contact my GP. I click on the link in the alert which triggers a secure chat session with my GP’s practice nurse. The nurse checks with my GP and we agree that I should be referred to a consultant.
    
I can book a consultant’s appointment as easily as booking a flight or a hotel. My GP sends me an electronic referral ‘ticket’ (much like a boarding card) that I use to book an outpatient appointment of my choosing using the new E-Referrals system. But first I seek other patients’ opinions of the hospital consultant, not from the hospital website but from a trusted independent healthcare review – a ‘Tripadvisor’ for hospitals. My work commitment is not too high at present so I volunteer to go on the E-Referrals “standby” list to be called at short notice if there is a cancellation at any clinic within a 25 mile radius of my home or a 10 mile radius of where I work.

Online health records
I manage my own health record online and I can give consent to healthcare providers of my choosing to access the parts of my record 
that are relevant, and exclude those parts I want to keep private. I review the notes that my GP has recently added and then enable access for the hospital consultant at the hospital where I have an appointment.
    
My GP gets an alert to say that my appointment has been made and that the consultant wishes to speak with my GP first. My GP clicks on the Skype link and is connected to the consultant. They discuss my case, jointly review my online record.

I need some diagnostic tests performed. I consult my Health Services app (similar to Yelp) to locate the nearest pathology lab, checking first their average waiting time before booking an appointment with the press of a button. At the pathology lab, my blood is taken and as soon as the test results are available I get an alert from the My Health app on my smartphone that informs me that everything is normal. It advises me that my cholesterol level is a little too high so I should watch my diet. Hmm...”

What's the real experience?
Instead of this scenario, we have the following patient experience in England.

A colleague of mine recently had to see a GP to have her knee checked. She called the GP, got lucky, there was a slot free next week. Last time she had to wait four months. She even received a text reminder a few days before. 
    
At the GP practice she underwent a paper based consultation; the GP filled out a piece of paper, and said he would post this to the Physiotherapists. The Physiotherapists would then review and post a letter to my colleague asking when she could meet for an appointment. My colleague would then have to post a reply and wait for a response. When she asked what the timescale would
likely be for this, the GP looked at her and smiled. He didn’t know.
    
This fairly straightforward transactional process is dealt with online, in seconds, in the rest of our country today. In the NHS it can take months. Is that not odd? If you think about it, the NHS deals with over 1 million patients every 36 hours, and over 250 million interactions a year. Is a paper and postage system that can take months the most effective way of providing care today?
    
In any other industry that volume of interaction would be ripe for digital transformation, and it has. The insurance industry, the travel industry, the banking industry, and the retail industry have all successfully embraced digital services with millions of interactions taking place online every day.

Is there the demand?
If we look at the demand for digital health, we can’t blame a lack of interest for our failure of not having a digital health service today. A recent survey of 7,000 patients and 1,400 GPs show there is a strong demand for digital health services.
    
We want digital health because we are digital everywhere else. Over 80 per cent of us are regularly online interacting and transacting on a daily basis. Moving to digital health, starting with the straight forward transactions, wouldn’t be as difficult as we might think from a user perspective.
    
But if the demand for digital health is not a strong enough reason on its own for digital health, we need to explore what else will and can drive it.

Efficiency and cost? The NHS has to make efficiency savings of £20bn from its £110bn+ budget between 2011-2016 to meet the gap between demand and supply. After 2016 we are likely to see another round of £30bn efficiency savings to be met as demand continues to grow, outstripping the supply and funds available to the health system.
    
A visit to the GP cost £36 and a visit to the A&E cost between £59-117. In total we visit a GP or the A&E over 200 million times a year. It has been reported that over 51 million of these are unnecessary, such as 40,000 GP visits a year for dandruff. If 51 million visits can be avoided we can save anything from £1.8bn to £6bn. A digital service, such as finding information about dandruff on NHS Choices cost 13p a visit.

Substantial Savings
It is unlikely we will succeed in avoiding 51 million visits by turning on a digital solution today, but over time as user volume goes up we can, and the savings will be made. Taking into account growing demand for health services, this sounds like a very effective way of optimising resources in the NHS. If you look at online banking, it has only taken us a few years to get over 50 per cent of the population to manage their bank account online.

Tim Kelsey, National Director for Patients and Information at NHS England believes the new integrated customer service platform can save the NHS more than £1 billion by encouraging patients to get involved in online self-care.
    
Is quality and effectiveness a driver? Digital health allows data and information to be captured, stored and used electronically. The benefit of having data electronically is that it drives up quality – no more illegible hand written notes, or lost notes. The data can be easily accessible wherever the patient and carer are using modern technologies such as tablets and smart phones over a wi-fi or 3G (soon 4G) network.
    
Using digital solutions enables care to be joined up. Information that was previously inaccessible because they were stored in deep, locked silos can now be accessed by those who need it when they need it. Patients can be at the centre, in control, the information following them, and carers join up around the patient collaboratively through digital channels.

The digital data created will be more effectively used by commissioners and providers to optimise care delivery by analysing, measuring, predicting and planning.
    
Hospitals can get a real time view of how they are performing by monitoring activities taking place, seeing where blockages are, where spare capacity can be utilised and so on.
    
Similarly if we manage to reduce avoidable interactions, professionals will have more time to provide care for those who need it the most; our rapidly growing population of long term conditions patients who currently account for 70 per cent of the NHS cost. If we can provide better care for them we may be able to avoid future costly hospital admissions and a better life for those patients.

How do we do digital?
The technology that allows for the NHS to become digital is available today. And NHS England has just announced an initial fund of £260m to make this a reality. That’s the upside. 

The downside is that the current NHS information technology architecture is restricting the innovation and scaling of these solutions to professionals and patients.
    
In Intellect’s The NHS Information Evolution report, we outline what we need to do to get there; from a business and collaboration perspective to the technical architecture we need to put in place. These are not radical proposals but do require sideways thinking and a new imaginative approach to how we use information in the NHS.

Further information
www.intellectuk.org