A Roadmap For Digital Health

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Why is digitalisation in healthcare inevitable? What solutions does it offer? An interview with Dr Charles Alessi, Chief Clinical Officer at HIMSS.

Executive summary

Why is digital transformation inevitable?

  • The ageing population and multimorbidity = “overheating health and care”
  • Movement from volume to value – moving to population-based capitated systems
  • Prevention becomes more critical – and care is being delivered from a variety of places by a variety of people – we need a single version of the truth
  • Insights essential – hence the importance of EMRs and agreed taxonomy and analytics – as well as assessing progress via maturity models

What are the opportunities?

  • Digital transformation is not merely a transcription of a medical record – it is an opportunity to re-imagine care for people
  • Patients have become consumers, and digital transformation makes a more customised and personalised approach possible
  • Digital transformation enables the use of Artificial Intelligence to automate and gain insights to improve care
  • Precision medicine starts to become possible for the mainstream, not the exception
  • Precision health becomes the new personalised, predictive public health

Challenges for physicians (and the reasons for burnout):

  • Behaviour modification in non-communicable diseases
  • Filling the treatment and administrative gaps
  • Managing clinical risks rather than excluding it – which is inherent to success in emerging value-based systems
  • Delivering consistent quality care in different geographic locations
  • The democratisation of care and managing shared decision making
  • Managing the complexity of multimorbidity & patient expectations
  • Accurate and consistent contemporaneous record-keeping

Changed nature of the physician/patient relationship:

  • Value-based systems drive the management of risk not only its exclusion
  • From didactic approaches around giving information to a longitudinal relationship accompanying the person (no longer the patient) in NCDs
  • Physician selection and training still mainly 20th century
  • Seeing the value of behaviour modification training for physicians and care workers
  • Consent – starting to embrace dynamic rather than blanket consent

How will we handle this transition?

  • The “ask” around transitioning from the traditional to the 2020 model is enormous
  • The development of the primary care home in the traditional model still rudimentary where it is operational
  • Governance and process and metrics, let alone financial flows, around the Integrated Practice Units (IPU) still not able to be articulated coherently
  • All ageing and multimorbidity and the urgency for other additive solutions increases
  • The workforce is ageing at exactly the same rate – although if transition succeeds, potentially requirement may decrease
  • Effortless adoption of clinical decision support in mainstream practise is still not widespread
  • Delaying the expression of symptomatology from NCDs and in cases development of the disease is the rational next step and can only be achieved via a precision health approach

Precision health is achievable by:

  • The use of personal data, appropriately safeguarded, to change the conversation we are having with individuals – business to consumer approach
  • Driving personalised engagement at scale, using technology to direct people to advice and interventions that are relevant to individual requirements
  • Anticipate and communicate risks in a way that invokes an action, directing people to screening, health checks, social prescribing etc.
  • Add a new perspective to population datasets with granular personal information
  • Employing real-time feedback and continuous improvement of what works.

What solutions does digitalisation offer?

  • Better support of our workforce – from digital immersion classes to phased and sensible EMR deployments where the clinical flow is at least as necessary as “closing the gaps” and ensuring the claim mechanisms remain central
  • Clinical decision support – embedded within EMRs to better assist health workers supported by AI to reduce the number of keystrokes + emergence of voice
  • Training – in behavioural modification techniques and enabling empowered consultations
  • Exploiting digital transformation as a “clinical extender”

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