Re-imagining health and care services following COVID19
Ijeoma Azodo reports on last year's roundtable discussion on the COVID-19 pandemic led by the FCI
In July 2020, the Faculty led a roundtable discussion on the COVID-19 pandemic with UK health and informatics professionals. Experts from health, social care, dentistry, patient / public representatives and industry came together in this FCI multi-disciplinary, horizon-scanning event.
The session was a moderated discussion around delivering the ambitions of the NHS Long-Term Plan, and key opportunities and challenges drawn from an FCI member survey conducted in anticipation of the event. While squarely within Wave 1 of the pandemic, planning for subsequent waves and tails of the pandemic in order to achieve ‘safe, effective and efficient health care’ enabled by digital and information technology was a primary goal afforded to address the pandemic at pace and scale.
The discussion shared insights on experiences which focused on the role of digital in addressing the themes of increased workload (backlog and rehabilitation) due to COVID, how to maintain the (beneficial) rapid changes in care, staff well-being (stamina, exhaustion, burnout), and data literacy in staff in applying and developing innovation.
This report aggregates the survey results, roundtable discussion, and case studies into 6 recommendations for addressing the disruptions of COVID-19 from a care focused and digitally enabled perspective.
Recommendations and Updates
We are 8 months on from the FCI and Cerner Roundtable engagement ‘Re-imagining health and care services following COVID-19’, and the key recommendations still hold in the face of major positive developments … a host of new vaccines licensed for use through national administration programmes in progress, digitally enabled services like COVID oximetry @home – data and digital services, COVID rehabilitation services, shared via staff stories, and associated educational resources to support healthcare professionals to support patients after COVID. These select examples highlight the report recommendations: ‘Rationalize the infrastructure and promote interoperability’ and ‘Share best practices in an accessible and referenced way’.
As COVID-specific care programmes continue to develop and evolve, the Roundtable experts commented on the importance of clinical safety. Going forward, an informatics-led approach would provide the foundational structure and processes to surface, highlight, and track safety concerns in the implemented technology solution, throughout its conception, and provide an analytical structure for quality and benefits evaluation.
Alongside these developments loom ongoing challenges that threaten to offset these gains … the UK remains within its strictest lockdown and is in the midst of providing care through ‘winter pressures’. The importance of two recommendations, ‘Use informatics to increase capacity’ and ‘Shift from ‘now casting’ to forecasting’, are as important as ever. With an ever-increasing backlog of appointments, procedures and care, and an additional workload related to vaccinations delivery (with apps emerging to support rollout) and administration (such as data collection), innovative uses of digital infrastructure are being applied to prioritization, scheduling and logistics. These principles will also have wide applicability in drawing down on the clinical backlog, identifying people and patients at risk of deterioration and failure to cope.
A key element to success is outlined in the recommendation ‘Upskill and motivate the health and social care workforce in clinical informatics’. At all levels of health and social care, a workforce that understands and can apply digital information into care drives innovative explorations and solutions. The Professional Records Standards Body has recently published a report, Digital health and care and COVID-19, based on a consultation into the role of digital during the first wave of the COVID-19 pandemic, lessons learned and opportunities for the future. There are a variety of programmatic initiatives across the UK to grow digital leadership and embed digital transformation into work and practice(1-5) that have been initiated in the last few years. The Faculty is a key partner and driver of ‘best use of information and information technology’ to improve care. Through its webinars, special interest groups and framework supporting clinical informatics as an embedded standard for care and practice.
The final recommendation, which has seen limited progress since the Roundtable, is ‘Patient and public engagement in all approaches’. The track and trace app was discussed as a case study of opportunities and challenges. Highlighted here was the opportunity to develop solutions with meaningful public engagement, being mindful of widening digital inequalities, which reduce access to already constrained services. The biggest gains are likely to be achieved by focusing on user needs and acceptability, coupled with support and care.
Practical and tactical approaches over the next 18 - 24 months aimed at anchoring developments in digital infrastructure, new service and pathways, and engaging the public are likely to prove the most useful. Innovations using these 3 elements in sync are likely to make the most traction to realise safe and effective gains that consider the wellbeing of people as central in these approaches.
The pandemic has seen the rise of digital health solutions based on public-focused symptom monitoring (such as the ZOE symptom-study app), professional-focused assistance with diagnosis, and enterprise-level operational and clinical infrastructure through solutions for cloud, Big Data, security. These solutions are good examples of developing new digital infrastructure and public / health data to capture, understand, and anticipate emerging health and support needs.
An informatics approach and informatics professionals are critical to connecting people and the technology to make an impact through new and adapted services. The Faculty is keen to learn from member projects, experiences and related innovation. The FEDIP-FCI COVID-19 impact survey has just closed. However, consider completing the FCI COVID19 case study submission form and sharing with your colleagues across the UK.
Ijeoma Azodo, MD, ChM (GenSurg), MPH
NES Digital Service (NDS), Associate Director, Health and Clinical Services Design
Download the FCI report here: Report of roundtable and member survey: Re-imagining health and care services following COVID19
https://topol.hee.nhs.uk/the-topol-review/, as viewed 01 Feb 2021
https://www.hee.nhs.uk/our-work/nhs-digital-academy, as viewed 01 Feb 2021