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Digital health lessons from the NHS

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Despite the recent cyber-attack ransomware attack on the U.K.’s National Health Service, the reliance upon digital data remains vital for the healthcare sector, according to the Head of NHS Digital.

Around the world healthcare facilities are going digital, although the pace varies. This brings with it complications compatibility, patient confidentiality and data security. One of the largest models is with the U.K. National Health service (NHS), which employs over one million people and serves the healthcare needs of the U.K.’s 70 million inhabitants.

The digitalization of health information is coordinated by NHS Digital, which has experienced successes (such as the on-going transition of digital patient records) and failings (the recent ransomware attack, which took services down for several days). There are key learning points for other healthcare institutions.

NHS Digital provides national information, data and IT systems for health and care services. The government backed organization exists to help patients, clinicians, commissioners, analysts and researchers. NHS Digital also acts as an internal NHS IT provider. The organization also produces reports, using big data analytics, drawing upon information collected from what is the biggest health employer in the world.

Examples of recent NHS Digital reports are a survey that highlights need for early intervention for diabetic foot ulcers. Such reports are not only data gathering exercises; they provide analysis, even when this is critical of the health provider. For example, the diabetic report concludes that the “basic framework for effective prevention and management of diabetic foot disease in England and Wales is often missing.”

A second example is with a statistical release published by NHS Digital which makes available the most recent data relating to patients with learning disabilities and/or autistic spectrum disorder receiving inpatient care commissioned by the NHS in England. A third example of digital health analysis is about ‘Improving Access to Psychological Therapies (IAPT)’, which looks at activity, waiting times, and patient outcomes such as recovery.

Daniel Ray who is in charge of NHS Digital and the NHS Digital cyber security team has provide an illuminating interview to Pharma File about the importance of digital information for healthcare services. Outlining the work of the agency, Daniel Ray explains that NHS Digital controls the “architecture and infrastructure designed to enable the NHS to operate.”

This includes a system called Spine (IT infrastructure system for health and social care in England) and N3 (which is the national broadband network for the English NHS, made up of 12,000 miles of fiber optic cables). An interesting statistic about Spine is that it handles some 2,000 messages per second.

The key challenges for growing health provision is with the ever growing volume of data, especially with the demand for making more “data available faster and more efficiently.” The requests for data are not only made within the NHS but also from pharmaceutical organizations. Outside organizations need to make applications to NHS Digital. This needs to be carefully evaluated.

To make the data sharing process faster, NHS Digital is implementing new business intelligence tools to allow people to better interact with the data. This will include the ability to remotely data access data.

The biggest risks to data arise from cyberattacks and here the NHS was hit during 2017 by the WannaCry ransomware global incident. Hospitals and GP surgeries in England and Scotland were among at least 16 health service organizations hit by a “ransomware” attack; some of the reasons were due to the use of Windows XP systems and a lack of security updates. This has led to a review of cybersecurity across the health service. NHS Digital has created what’s called the Data Security Centre to support staff and the services they support.

As to the future, Ray concludes “NHS Digital is the conduit for data security advice, guidance and intelligence for the nation’s health and care system. We are working with partners across health and care to build patients’ confidence that we protect and safeguard their data and that it is only ever used for the benefit of health and care.”

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How will decisions made by healthcare organizations now impact the future?

Digital healthcare care is a “new normal.” What’s needed to keep it going? According to an HBR roundtable, stronger support infrastructure and increased investment in digital health.

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With the world in the early stages of COVID-19 vaccine deployment, it’s important to look even further ahead — specifically, how we can keep the momentum going on the digital transformation of healthcare. 

A recent roundtable discussion of CIOs from leading health systems, hosted by Harvard Business Review, concluded there are three main areas of focus for this new digital health frontier: Virtual care, setting, and the patient experience.

“Care providers must understand the ramifications for their digital health function and agenda — and how information technology can address the challenges and opportunities of their ‘new normal,’” wrote a team of experts for HBR, including: John Glaser (executive in residence, Harvard Medical School), J. Marc Overhage, MD (Chief Medical Information Officer, Anthem, Inc.), Janet Guptill (CEO, Scottsdale Institute), Chuck Appleby (Director of Publications & Communications, Scottsdale Institute), and Donald Trigg (President, Cerner).

The first focus — virtual care — comes into play simply because of the numbers, and how quickly solutions had to be implemented. The panel of experts cites one McKinsey study that shows physicians and healthcare professionals are seeing 50 to 175 times more patients by telehealth. As a result, they explain, “health systems must construct a sturdy, permanent bridge that includes organizational, financial, and clinical structures and processes.”

The second focus is on setting, more specifically on patient care being delivered in the most appropriate setting. One example they give is the increasing discussion around chronic care management from the patient’s home, via telehealth or virtual doctor visits.

The final focus relates to patient experience, and how to make digital health align with the quality and efficiency they’ve come to know from other services like Amazon or Uber. According to the roundtable, it comes down to ease-of-use. 

“To meet these expectations, health systems will need to double down on their ‘digital front door’ efforts,” they explain, “enabling patients to handle routine interactions such as scheduling an appointment, paying a bill, finding a doctor, renewing a medication, finding answers to health questions, and navigating the health system itself.”

The opportunity is there to create an even better ‘new normal’ than previous healthcare systems, the roundtable concluded. 

“Covid-19 has forced health care leaders and clinicians to move faster, work smarter, and take a more focused approach to decision-making than ever before.”

Want to read the whole analysis? Head to HBR.

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“Digitization is not a panacea for everything”

Biocon founder Kiran Mazumdar-Shaw on the COVID-19 response, and why Asian companies need to understand, not just embrace digital innovation.

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As founder and chair of global biopharmaceuticals company Biocon, Kiran Mazumdar-Shaw is on a mission to make healthcare affordable to all.

Under her leadership, Biocon’s mission is to “reduce disparities in access to safe, high-quality medicines, as well as address the gaps in scientific research to find solutions to impact a billion lives.”

Recently, Mazumdar-Shaw sat down for a video conference interview with McKinsey’s Sathya Prathipati and Joydeep Sengupta, senior partners out of the company’s Mumbai and Singapore offices (respectively). 

Here are some key quotes from their interview, where they discussed digital transformation in the COVID-19 response, and digitization:

The difference between Western and Asian organizations:

“While Western companies focus on value capture, Asian companies have tended to be really focused on scale, size, and market share… We have not really focused on innovation to capture value, whereas the Western model is to capture a big piece of the value share with innovation and IP [intellectual property] and to outsource whatever you need in terms of vertical integration.”

How digital transformation accelerated because of COVID-19:

“COVID-19 is a true inflection point. In India, e-pharmacies are becoming a reality, and we see a lot of opportunities to use technology in daily life. We need to leverage and build on that. There was so much resistance to e-pharmacies, but this is a new opportunity. Biocon… started digitizing everything six or seven months before COVID and were able to finish before the pandemic. It’s given us a lot of benefits and showed the huge transformative potential of digital technologies.”

Approaches to digitization:

“Digitization is not a panacea for everything… Yes, the digital world has the potential to accelerate transformation, but you need to understand exactly what digital can do to get the benefits. In our business, data analytics can help us make decisions with lower risks. We just hired a CIO whose whole mandate is to look at our digital infrastructure and see how we can future-proof ourselves. We are thinking about this very carefully, not just a cut-and-paste. That’s why I would rather bring in people from the digital world—from the tech industry—instead of the pharmaceutical industry. We want them to transform old mindsets.”

Read the full interview transcript here.

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After this year, what will healthcare look like in 2021 (and beyond)?

Experts share their opinions on what digital health will look like after a transformation-heavy 2020.

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It’s flat-out impossible to discuss healthcare right now without addressing its digitization, telehealth, and the many ways the sector has leveraged technology to improve everything from systems and workflow to patient outcomes — all in the face of COVID-19.

“There’s no going back on telehealth,” writes Ashwini M. Zenooz, MD — Chief Medical Officer and General Manager for Healthcare and Life Sciences at Salesforce — in Harvard Business Review

Dr. Zenooz does provide a warning, however. She explains that we have to make sure “providers are not only on-board with digital transformation but also see their experience of care enhanced in the process.” She outlines three considerations and requirements:

  • Telehealth adoption “will be more likely to succeed if it is “pulled” into organizations and workflows by providers rather than “pushed” on them by leadership.”
  • Human-centered design is key. Tools like AI, machine learning, and voice technologies will be doing the heavy lifting with respect to the “documentation burden.”
  • “Care coordination, enabled by seamless data sharing, is therefore as important to the provider experience as it is to care quality and outcomes.”

What innovators are saying

And the momentum is there for continued transformation into next year, according to Becker’s Hospital Review. The publication interviewed nine healthcare innovation leaders to get their 2021 predictions.

What are they saying?

Both Jeff Semenchuk (chief innovation officer for Blue Shield of California) and Muthu Krishnan, PhD (chief digital transformation officer of IKS Health) said that digital health solutions will help doctors and patients manage disease-specific care for things like chronic conditions or pregnancy. 

Mohan Nair (senior VP and chief innovation officer of Cambia Health Solutions) raises one critical area of care that we’ve mentioned before: mental health.

“The COVID-19 pandemic and mental health crisis will collide and demand attention. This will enable and force us to face our isolation but recognize our interconnected humanity, our compassion, and our empathy for others. Digital technologies, like telehealth, digital therapeutics and artificial intelligence/machine learning, are all candidates to catalyze a new world with a common cause.”

Nicole Cable, chief experience officer of InnovaCare Health predicts that both millennials and seniors will keep embracing telehealth. Cable emphasizes, however, that tech companies will need to create tools that can help address the care of chronic and complex conditions of aging populations. 

To read more expert predictions, visit Becker’s Hospital Review

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