Hindsight 2020 – Unexpected, yet relevant for global healthcare

By Ian Chuang, Chief Medical Officer, EMEALAAP Health, Elsevier

One year ago, I was collecting my thoughts and sharing my year’s worth of observations and experiences from collaborations across the global healthcare communities (Global Healthcare Opportunities: Perspectives from 2019 and Looking towards 2020). I laid out the areas where I was anticipating continued digital transformation and innovation for healthcare information technology in 2020.  Despite the unanticipated health crisis of 2020, in hindsight, the expectations I set out became more relevant this year and will still be so into the future. The COVID-19 pandemic re-enforced the importance of digital technology for meeting the healthcare needs.

Each health system around the world has its strengths and challenges, rooted in the local realities of the population, economics, infrastructure and politics. The pandemic has redefined the original saying “necessity is the mother of invention” to “crisis is the mother of innovation”. COVID-19 has heightened the issues and challenges that already existed in the healthcare system. At the same time, it has accelerated the pace and extent of digital transformation that had languished on the collective healthcare radars. While some had resistance or hesitation to pivot, the COVID-19 pandemic dispelled those doubts, created the necessity and presented the opportunity to change how we approach healthcare through digital clinical care transformation. This once-in-a-generation crisis has provided many reasons to institute meaningful transformation of health care to better meets the needs of patients and clinicians as the landscape of medicine changes towards a different future. Digital technology is crucial to the future state of improved and equitable healthcare. If we respond to this crisis with more human-centered design thinking to re-engineer healthcare, we have opportunities to pivot to new sustainable changes, as opposed to reactionary, quick technology-centric siloed fixes. And while we proceed with digital transformation, the connection of the new care process to scientific knowledge both logically and functionally is ever more important.

Unique Healthcare Landscape Around the World

Each healthcare ecosystem is unique and at different stages of digitalization. It is this diversity and their different respective responses to the pandemic crisis that will lead to a plethora of innovation. Each system’s response to COVID-19 had its unique opportunities, challenges, and solutions, highlighting the importance of strong leadership to align and coordinate an effective pandemic preparedness response. It has further accelerated investments in hospital infrastructure and necessitated the sharing of trusted and credible information to guide and coordinate care amongst clinicians and the wider population. Based on the crisis priorities, each healthcare ecosystem has embarked on different digital transformation and innovation roadmaps. The resulting innovations, solutions and capabilities are diverse. Sharing the collective learnings can help shape a better prepared and more enabled healthcare system for the future

To highlight this, Elsevier hosted the Future of Healthcare Series, which brought together healthcare practitioners from around the Asia-Pacific and EMEALA region to discuss how hospital systems have pivoted digitally to transform their operation, care, and service models due to the current pandemic. The impact and benefit to patient care during this pandemic has been meaningful.

Moving towards Healthcare Digital Transformation

Health systems serving large populations with limited access to healthcare resources are driving many digital innovations due to sheer necessity as well as highly digital savvy populations. In times of the pandemic, having the right technology infrastructure in place has helped many to quickly respond and adapt to the changing needs for healthcare. To minimize the risk of infection, physical visits to the hospital or doctor’s office were reduced for non-emergency care and elective surgeries were stopped. Various forms of telecommunication opened the door for increasing access and delivering continuity of care virtually. The digital information and interoperability where it existed enabled big data analytics and knowledge discovery, adding to the clinical and operational learnings necessary for health care organizations to adapt to COVID-19.

Televideo and telephonic consultations stepped in to provide alternative means of access and provide telemedical care, and utilization spiked. Healthcare systems are slowly recovering from the initial crisis of the pandemic, with many adapting to the new healthcare realities. While the demand and utility of telemedicine have dropped, it has not fully returned to pre-pandemic baselines in many countries.  The benefits of telemedicine have been demonstrated; however, the sustainability and utility of telemedicine still require work. There are challenges faced when adopting these telemedicine technologies, learned through the initial hands-on experiences (What’s Next for Telehealth in APAC?). A common thread that we have to overcome is how to create a degree of engagement with patients through televideo or telephonic communication that ensures the same standard of care as an in-person visit. Telemedicine must deliver minimally similar, but potentially better quality and safety outcomes, efficiency and value.

Continued practice-based research in this area will better identify logical extensions of care through telemedicine to fully virtual care processes. Clinical decision support (CDS) has started to and will continue to extend beyond the hospital-based information systems to guide clinical decision-making virtually. Some healthcare systems are extending this modality to ensure that virtual care delivered is aligned to evidence and recommended practice guidelines. The pandemic has shown that effective treatment outcomes are in fact possible at a lower cost when done differently. Without being forced to innovate new care models, we would not have this practice-based evidence and insights.

Central to the success of digital healthcare transformation is the availability of quality, interoperable, and standardized data that can be easily accessed by the relevant parties be it clinicians or patients. The wealth of data collected by digital technologies greatly facilitated the discovery and containment of the COVID-19 virus from the initial sentinel warning in 2019. Data collection is extending beyond the medical centric sources such as electronic medical records. There are other relevant data and data sources, whether they be environmental data or travel records.  Prior capabilities, such as self-monitoring apps and image capture are now extensions of the history-taking portion of a doctor’s visit, providing data points to supplement the patient’s medical history. QR codes and Bluetooth capabilities have been invaluable tools in enabling contact tracing of COVID-19 exposures across a population or to confirm the health status of individuals.

I personally participated as a subject in a research study focused on passive continuous peripheral temperature tracking using a commercially available wearable device to determine if COVID-19 illness could be detected in advance of symptom onset. This is one of many innovations solving different aspects of caring for a population during a pandemic. The expansion of technology-enabled capabilities will persist beyond this immediate crisis phase, permeate into other aspects of care, and better prepare the global community for another future infectious pandemic event. Technology must coincide with change management and process re-engineering in order to ensure sustained usability and acceptance by both clinicians and patients/consumers, and to achieve the full potential in terms of outcomes.

Empowering Technology with Knowledge

COVID-19 has been an incredible catalyst for how clinicians access information about a novel illness. The medical library is not the source of real time research knowledge; scheduled continuing medical education (CME) time is not sufficient for physicians to have all relevant information at the bedside. The classic bench to bedside knowledge to practice chasm takes an average of 17 years. With COVID-19, this had to expedite to days or even hours. In this age of information, what a clinician needs to know, and the skills required can change within hours. New information around the treatment of COVID-19 patients had to be continually disseminated and refined to provide optimal care. Thus, there is an urgent need to synthesize research evidence into actionable knowledge that could be shared, discussed, learned, and adopted at the point-of-care. This significantly changed the way clinicians accessed research studies and related knowledge during the crisis.

Elsevier launched the Elsevier Novel Coronavirus Information Hub, and the subsequent Coronavirus Research Hub and COVID-19 Healthcare Hub to remove barriers to the knowledge related to COVID-19. These resources were driven out of necessity, in response to the struggles and challenges faced by the overwhelmed clinicians globally. Clinicians caring for patients at the frontlines are now able to access the latest knowledge, skills, resources, clinical decision support (CDS), and information analytics tools quickly.

Opportunities for the Democratization of Healthcare

In many ways, the COVID-19 pandemic has exacerbated the healthcare issues and inequalities that have existed in different forms across the various health care systems. Different groups of society had disproportionate challenges with their health, medical care and the impact of COVID-19, including mortality. Many issues still must be addressed to ensure fair and equitable access and medical care, independent of age, gender, race, ethnicity, or geography. More precision in treatments that account for the differential health risk and outcomes requires intelligent information technology to deliver knowledge-driven care.

As vaccination and novel treatments are discovered, healthcare systems must remove those unwarranted barriers and variations in care to ensure against systemic and unconscious treatment bias. The health and protection of the entire population require equal evidence-based treatment across all segments of the population. Suboptimal care for any risk group creates an opening for infectious diseases to thrive and propagate, and is ultimately detrimental to society overall.

Democratization of healthcare is not just an ideal, but it is also highly pragmatic and necessary as we are one global community. Beyond making system-level structure and process changes, we need to leverage digital capabilities to guide clinicians against unconscious treatment bias at the point of clinical decision and care. Health care is challenging, and the required knowledge and skills means clinicians struggle to change clinical practice easily and quickly enough. Yet as a knowledge-based profession, with the pace of knowledge growth, evolutionary change in treatment is a must. With the relevant knowledge and evidence-based guidelines provided at the point-of-care, clinicians can make the most relevant treatment decisions tailored to the individual. All of this is possible. COVID-19 forced us to acknowledge the need to apply our learnings and digital technology to evolve health care accordingly, but better and faster.