Digital health is our future: let’s deliver it safely.

The lockdown has forced rapid adoption of digital health techniques - if it's here to stay, let's do it right.

A month ago, I found myself very carefully photographing a very specific part of a family member’s anatomy. No, it wasn’t an art project, or an obscure sex game. A small lesion on a leg was worrying us, and the doctor had requested a more detailed photo than my wife had been able to shoot with her phone.

At first, I was a bit grumpy about it. What a waste of time. But then, I realised, that the photography and email would, between them, take a whole lot less time than a conventional visit to our local surgery. Happily, it turned out to be completely benign, and we could all move on quickly.

And yet, that was something that would have taken weeks waiting for an appointment only a few months ago.

It’s been a consistent theme both here and on What’s NEXT? that the pandemic has accelerated changes that were in progress anyway – and the move towards digital delivery of health care has been one of the clearest examples of that. We’ve had the basic technology to do triage of medical conditions online for at least a decade, but the inherent inertia of the familiar process has led to us all trekking to the local general practitioner to be checked out, just as we’ve been doing for 70 years.

One little virus later, and that trip seems like a nonsensical waste of time.

The rapid evolution of digital health

There’s been plenty of publicity around the struggles the UK has had in launching a track and trace app – but earlier in the pandemic, they managed to turn around a 48 hour tender to deliver text messaging, video consultations and automated triage. We went from a health system based on face-to-face appointments, to one based on remote consultations very nearly overnight. That is a quite remarkable acceleration of change, though it was one born of necessity.

That ethos is spreading fast. I’ve taken a COVID-19 test twice now, both times without talking to a human being before actually going for the test. The COVID-19 symptoms tracker app flagged me for testing twice, and from there the test was quickly and easily booked online. The first time I had to drive for my test, the second it was delivered to me at home.

When you step back and look at the way we used to operate, it makes very little sense. “Hey, let’s get all the sick people together in one place!”. Um, OK.

When doctors interacted with patients face to face because it was the only way to do it, it worked fine. But that hasn’t been the case for a decade, so it’s extremely unlikely we’ll ever go back to a predominantly face-to-face medicine delivery environment in the UK. Not all countries have moved as fast, but where some countries go, others will follow.

Rebuilding our care into a digital health service

If we’re not going back, it’s beholden to us to move forward as intelligently as we can. And there are many serious mistakes we could make in the journey to digital health.

There are at least three distinct elements coming together here:

  • Switch to online consultations where possible – and certainly for triage
  • Greater availability of health sensors and other reporting tools
  • Data security issues

So, what we actually have is a systems design challenge. We're going to conduct a design exercise on existing services, while they’re undergoing the biggest medical challenge of the last few generations.

Blimey.

What can be virtual, will be virtual

One thing that we can be sure of, and thus use as a base assumption, is that whatever can be virtual, will be virtual. For many complaints, we will never physically meet with the doctor. We may not even meet with the pharmacist – medicine delivery services have thrived during the pandemic and, while government-supported schemes are winding down in some places, there’s a useful business opportunity there while we live with the virus, and possibly afterwards.

That, then, helps ease the problem of getting the people who need physical attention back into hospitals – where there’s an understandable nervousness of catching something potentially deadly:

As hospital leaders look to get patients back in, a more sophisticated digital engagement strategy will become mission-critical. Hospitals will need to be able to segment and target patients – starting with those whose procedures were postponed and are most at risk from further delays and assure them that their facilities are now clean and safe for care.

Fewer people in a healthcare setting means less risk. That’s a result.

Now what the online consultation system is in place in many countries – where do we go next? Merely replicating the old, analogue experience is only the first step. How can we move beyond that to create something better? How can we enrich that experience with technology?

Nobody wants a medical data breach

Well, I wear a set of sensors on my wrist. This isn’t a medical device per se, it’s the Apple Watch. But as the watch’s sensor grow more sophisticated, so will the medical data they collect. And that data can be useful to a medical practitioner.

In theory, I’d be able to book an appointment with my doctor, and have her request certain sets of biometric data from my health app based on the displayed symptoms I’ve disclosed. That will allow her to make a better diagnosis, or be more confident that I need to come in for a consultation.

I’d like that. She’d like that. But I’d need to be certain that my data will be protected. The digital health genie is out of its analogue bottle. It is not going back in. So, we need to plan for that – and start the conversations about the security of our health data that we need to have to make this all work.

The exposure notification API jointly agreed between Google and Apple shows us the way here. What we really need – and need soon – is that sort of common, privacy-focused standard for health data collected by our phones and any sensors we have attached to them.

This will deliver two benefits. Firstly, it means that more health care can be delivered digitally, reducing the need for physical attendance, and reducing the risk of a spike in virus infections. And once you have a common platform, you have a target providers can build against.

This is a business opportunity, too. We need to rethink health delivery for the 21st century, in the shadow of a pandemic. We need to create economic opportunities to help restore economies. And government and the private sector will be more willing to fund health initiatives than ever.

Let’s do it.


Photo by National Cancer Institute on Unsplash