15.03.16
Digital health and the productivity challenge
Source: NHE Mar/Apr 16
Simon Jones, former director of long-term conditions and patient choice at NHS Direct, and now commercial director at Inhealthcare, responds to Lord Carter’s latest review of NHS efficiencies.
Digital health and the wider use of technology is the subject of much debate and expectation at all levels of the NHS. Paperless hospitals, interoperable clinical information systems, telemedicine and reformed IT infrastructure are all seen as enablers to the delivery of more effective and more efficient healthcare.
Lord Carter’s recent review (more on p26) highlighted a number of areas where, by being more productive, savings can be made. Examining the use of the NHS workforce, creating consistency around procurement and benchmarking health outputs and outcomes all allow providers to plan their resource use more effectively.
Improving the productivity of interactions
The intention is of course to refine the supply side of healthcare – the bit where treatment is delivered in response to a health ‘need’.
What, then, can we do about the ‘productivity’ of the patient/health professional interaction? If we can maximise both the quality and quantity of available data and develop a balance between patient reported symptoms and scientific evidence, can we get to the optimal treatment point sooner – and if so will this have an impact on resource use down the line?
The quality of the patient/doctor interaction is critical if we are to achieve both an effective outcome and the efficient use of resources. The interaction defines the health problems and identifies the ongoing diagnostic tests and treatments. Sub-optimal outcomes of this interaction may well incur unnecessary costs through delayed diagnosis, ineffective treatment plans and poor outcomes.
In productivity terms, maximising the outcomes of these interactions so patients consume fewer resources whilst realising greater health gain will make a significant contribution to the NHS finance debate.
Some recent studies of out-patient consultations show that around 86% of the diagnosis is based on what the patient reports. This is supplemented by 6% based on the health professional’s findings with the remaining 8% based on technological investigations. This highlights the degree to which the patient is relied upon to create the treatment plan and the use of subsequent resources. This ‘co-production’ of health is particularly true for chronic or long-term conditions. It is also an area where there appears to be the greatest scope for improvement, potentially leading to the greatest savings through improved health and reduced resource use.
What is the role of technology?
There has been a quantum shift in the use of technology by society to maintain and improve health.
The use of the internet as an information source gives 24-hour access to opinion (not always helpful!); wearables support self-monitoring; and in some cases self-management, apps and portals add to the potential to gather health data. Most of these technologies have been sourced independently by patients rather than prescribed as an element of their treatment plan.
Technology also supports the ‘care continuum’ where teams involved in the delivery of care can all record and use the same information efficiently. Electronic patient records, connected to communication channels that collect data, shared amongst the care team creates a collection of healthcare events. The productivity of each event complemented by quality information ensures only necessary resources are used.
Recognising that technology-enabled patients are an essential partner in the production of health means we need to embrace the use of digital solutions across wider areas of healthcare. Creating connected patients through telehealth-type services allows usable data to inform the consultation process and shifts the balance between subjective patient-based reporting, to pre-determined data sets collected by enabled patients who play a central role in their treatment.
The NHS needs to understand that whilst seeing more people quickly may well demonstrate operational efficiency, it does nothing to generate health gain. Looking at the quality of the consultation, recognising that it represents the origin of good care and ‘good health’ will lead to reduced resource use. Using digital health to raise the productivity of the doctor/patient interaction is an essential tool in addressing the wider NHS challenges.
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