The NHS is facing an unprecedented crisis. The Covid-19 coronavirus pandemic is putting extreme pressure on a health service already stretched to its limits, with staff in both primary and secondary care struggling to cope with demands – and unfortunately it looks like it will only get worse.
This is where technology could make a difference. Using video appointments and consultations – telemedicine – ensuring that best practice, the latest research and data is shared across the NHS, could make it just that little bit easier for staff to do their job.
One NHS secondary care doctor told Computer Weekly that the pandemic has forced NHS staff to think creatively and use different ways of working, and that even those who may previously have been opposed to the introduction of technology can now see the benefits.
“Although the coronavirus pandemic is a terrible thing to happen, it might actually focus our efforts to find ways of providing safe, effective and timely care in a time of crisis, whether that’s through video or phone consultations, using new data, and sharing with colleagues,” said the doctor.
“The NHS was in crisis long before coronavirus, but now it’s really come to light. We’re being asked to provide more with less, so maybe what we’re learning from this will put us in good stead to provide good and effective care in the future.”
Video and phone consultations
In an attempt to stop the spread of coronavirus, as well as deal with the huge increase in people wanting to access their primary care provider, GP practices are advising patients to call, or use online services to access their local surgery. This “triage first model” is aimed at triaging all patients for coronavirus before giving them face-to-face appointments.
NHS Digital’s website states: “Patients should be enabled to get advice and care without attending the practice unless in-person care is clinically required.”
But although phone appointments are great, they won’t cover everything. This is where video appointments are invaluable – not just for patients who may be displaying coronavirus symptoms, but for anyone who needs to be seen by a GP.
Some GPs already have online systems and video consultations in place, but many of those who have the service available have not yet begun to use it. EMIS is one of the biggest GP IT system providers in England, with nearly 4,000 GP practices using its EMIS Web service. In 2017, it launched its Video Consult service, but uptake has been limited.
This echoes throughout GP practices in the UK – suppliers often offer the service, but few GP practices use it. EMIS, which normally charges GPs for the use of video consultations, has now decided to offer it free for the next few months.
London GP Sarah Jarvis, who is also clinical director of Patient Platform, which operates EMIS’s Patient Access, said GP surgeries are not set up “to treat people with coronavirus effectively” and patients are being advised not to visit their GP if they are displaying symptoms.
“That means that if a patient does visit a practice and is found to have coronavirus, the whole practice needs to be closed for deep cleaning,” said Jarvis. “This clearly brings problems for other patients. Most people with coronavirus will have relatively mild symptoms and will not need hospital admission or specific treatment. However, if they are seen in a GP practice, they could pass the infection on to more vulnerable patients.
“As the virus spreads, vulnerable patients will probably need to avoid visiting the GP wherever possible, because of the risk of contracting the virus.”
All this makes video consultation an invaluable tool. It allows people with mild symptoms, but who may have coronavirus, to consult their GP without putting other patients at risk.
Jarvis added: “It also allows vulnerable patients with other medical problems to consult their GP or practice nurse without putting themselves at risk of infection.”
Hospitals full to the brim
In secondary care, hospitals are steadily beginning to cancel outpatient appointments and elective surgery across the board, in order to deal with the unprecedented demand of the coronavirus outbreak. And as the government is putting in place measures for people aged over 70 to self-isolate for what could be months, elderly patients who are due to visit hospital for outpatient appointments are left stranded.
Some, however, are planning to facilitate virtual appointments. At York Teaching Hospital NHS Foundation Trust, the hospital recently piloted a teleconsultation platform from supplier Refero with its diabetes team, which they are now looking to use to help the trust deal with appointment issues arising from the coronavirus pandemic.
Shane Martin, network and systems manager at the trust, told Computer Weekly that the diabetes pilot showed patients benefited by “by avoiding journeys to hospital and allowing staff to see patients’ surroundings, which can be useful, for example in diabetes, reviewing contents of their fridge”.
“Another benefit in the elderly is the reduced need for relatives to take time off to take them to hospital – the presumed hurdle of the elderly does not appear to be an issue,” said Martin.
“We are now looking at working with other teams in the hospital and using Refero’s platform to reduce the need for patients to attend hospital and so reduce the potential for cross-infection with Covid-19. By setting up a video-based communication channel between clinicians and patients, not only will our patients’ needs be met quicker and more efficiently, but more safely by avoiding trips to hospital outpatients.”
In paediatrics, guidance from the Royal College of Paediatrics and Child Health (RCPCH) is calling on hospitals to facilitate video calls with family members, rather than visits to neonatal units, wherever possible, and also said staff should “consider opportunities for remote meetings”. Some hospitals, such as Great Ormond Street Hospital for Children NHS Foudation Trust, is severely limiting visiting, only allowing two adult visitors per day, and is no longer allowing siblings to visit.
Video messaging apps can make a huge difference here. The Royal Hospital for Children in Glasgow is using video messaging through an app from VCreate to ease the burden on families being separated.
Neil Patel, a consultant neonatologist at the hospital, and joint clinical innovation lead for the West of Scotland, told Computer Weekly that separation of critically ill patients and their families is “very distressing” for everyone involved.
“Being able to provide a short, secure and personalised video message for families can make a huge difference,” he said. “In our experience, families feel reassured, informed, and connected to their loved ones and their care team. For staff, it means we can do our best to support and care for families at the most difficult of times.”
Data is key
It is not only video consultations that can help the NHS to provide patient care during a difficult time. It is essential to share timely information and data in order to provide better care, and ensure the virus spreads as little as possible.
At University Hospitals of Morecambe Bay NHS Foundation Trust, which operates from three main hospitals in the region, there is a huge drive to use data to tackle the pandemic.
Rob O’Neill, head of information at the trust, told Computer Weekly that his team now provides operational and clinical support to staff coping with a huge influx of patients. Together with supplier Qlik, the trust has developed an app that tracks patients and staff throughout the hospital, using data.
It identifies, tracks and reports patients who have been tested for coronavirus, along with the result, said O’Neill.
“It tells us their entire journey through the hospital,” he said. “For instance, have they been admitted to the emergency department, then moved onto a ward and what particular location within the ward.
“It then relinks into a clinical app that’s been used in our Covid-19 control room. That’s allowing our infection control teams and clinicians to understand where any patients who have tested positive are located.”
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O’Neill added that it also allows them to perform analytics on which other patients and staff they may have come into contact with while in the hospital. It gives the trust a “view of the journey the patients have taken and what services they interacted with”, he said.
This is simply the immediate response to the pandemic, but O’Neill said that as we move forward, there are also conversations to be had around looking at population health analytics, and that as the disease spreads, there will be a lot of emphasis on prevention and identifying vulnerable cohorts of patients. “Things are moving very quickly,” he added.
The trust is also running some proof-of-concept projects with smaller supplier and Qlik partner DataRobot around automated machine learning.
“The conversation with DataRobot is around whether we can accelerate our ability to use data science and machine learning, in particular, to tackle the Covid-19 outbreak,” said O’Neill.
“What can we do in the immediate term to equip ourselves as a health system to better protect against this type of pandemic, and to get better foresight, identify and predict shifts? Covid-19 isn’t going to go away, so can we get on the front foot by using machine learning modelling to identify what we think is going to happen? And in terms of seasonality, what’s going to be the impact of isolating vulnerable groups next winter?”
The trust is keen to use data, and the evidence for the benefits around it is overwhelming. But in order to get the full benefits, clinical staff need to be on board too. O’Neill said the trust is also running a data literacy drive for clinicial and operational staff to get them on board and feel confident in using data to make clinical decisions. “What’s happening now highlights the importance of that,” he said.
Help from the top
But it’s not just individual trusts and suppliers that are trying to get to grips with the impact of coronavirus through technology. NHS Digital announced today (19 March) that it is rolling out Microsoft Teams to all NHSmail users in the next few days to allow for secure instant messaging, direct audio and video calls between NHS staff, and virtual meeting capabilities.
Ian Phoenix, director of technology at NHS Digital, said that for doctors and NHS staff, “this means that working remotely becomes much easier and more practical”.
The NHS 111 advice service is also seeing extreme demands on its service, both online and through its phone line. NHS Digital CIO Sarah Wilkinson told Computer Weekly earlier this month that it was hoped the online service could relieve pressure on the health service.
“We are not just facing a little more demand,” she said. “It strikes me, looking at the past few weeks, that there is fundamentally new, unprecedented demand from citizens to use digital channels, which avoids the need to use the physical channel.”
NHS Digital has also been working on how to adapt the NHS Pathways algorithms that define the routes taken when patients use the 111 service. The quickly evolving coronavirus outbreak means pathways and call scripts for 111 call-handlers are changing daily.