In 2020, the Covid-19 pandemic caused much suffering and loss of life, and with it came reverberating disruption in private and public healthcare sectors across the globe. Moments of great pain and crisis are sadly often the catalyst for accelerating the deployment and development of new and existing innovations, as societies and individuals take risks that we otherwise would not have in order to overcome external threats to our survival. This duality of struggle and hope is as old as history itself and is the engine of how we evolve and innovate. Amidst the vast array of changes in 2020 was an adaptation in the healthcare priorities and the delivery mechanisms within the UK’s healthcare system. With it saw an acceleration of the adoption of new technologies, processes and behaviours that we believe mark a watershed moment in the history of healthcare in the UK. Many of these new approaches to delivering healthcare will pave the way for what we can expect in 2021 and what we can expect over this next decade of accelerating healthcare innovation.
For a good overview of some of these innovations we would recommend reading The King’s Fund long read titled ‘The Digital Revolution: eight technologies that will change health and care’, which recognises examples of digital health solutions that Covid-19 has driven. As an organisation that is continuously trying to support healthcare professionals to manage patients remotely, we listened in 2020 to many examples of healthcare professionals across all sectors and roles being forced to adapt new ways of doing things at a pace and scope that feels very different. Indeed this pace of cage is backed up by the words of Danny Mortimer, Chief Executive of the NHS Confederation who said “Health leaders tell us that the response to the COVID-19 pandemic has seen a digital revolution”.
In short the biggest change we have seen is that many digital health offerings that were previously seen as a ‘nice to have’ are now increasingly being recognised as a ‘need to have’. As we embark on our journey in 2021 we have been reflecting on the acceleration of three important health trends which together mark a revolutionary change in healthcare delivery, and which we believe set the scene for improving outcomes, quality of life and the standard of care for the rest of the decade.
- Remote Healthcare becoming a Need to Have
Virtual healthcare delivery has grown in importance throughout 2020 as it provides a mechanism for individuals to access care without increasing viral transmission. There are various examples of remote healthcare solutions that have been influential in 2020 and here are three insightful examples within disease prevention, primary care and inpatient monitoring.
In primary care, the South West London Health and Social Care partnership have implemented a novel digital solution that provides individuals with personalised care plans that help them to self-manage their type 2 diabetes during the pandemic. The project originated as an NHS Testbeds project and now has 35 practices in the area delivering the personalised care pathway for people with type 2 diabetes. The programme has been possible because of the collaboration between eight different organisations including Year of Care, Oviva, Citizen UK and ourselves. The team have proactively adapted their solution during the pandemic to ensure the offering includes resources that specifically support individuals in black and ethnic minority communities as these individuals are even more isolated.
Across secondary care we have seen the accelerated use of monitoring devices, which have grown in popularity in recent years. Oxhealth’s contact free, vision-based patient and management platform, Oxevision, is an innovative example. The software allows healthcare professionals to detect a change in a patient’s heart or breathing rate and alerts them if the patient has left their bed or fallen. Thus, signalling to clinicians that the individual’s health status has changed which allows for early, potentially life-saving, interventions. Reducing patient clinician contact during the pandemic was important and this provides a proactive solution.
Despite the motivating developments within this sector there remain a multitude of challenges as we move into 2021. For instance, the ongoing Covid-19 pandemic has shifted healthcare priorities away from certain disease verticals, such as management of long-term conditions, to focus on the pandemic response. Primary care facilities have the additional burden of coordinating vaccination programmes which leaves even less time to adopt remote healthcare solutions.
To address these challenges and to maintain the momentum within remote healthcare, it is crucial that healthcare professionals are involved and invested in the process. Any new technology has to be easy for healthcare professionals and patients to use, and the solution needs to mesh into existing and changing clinical workflows. Added to this is the complication that healthcare professionals are tight for time and cannot afford to spend hours learning how to use new software and systems. It all needs to be intuitive to use and to just work. During 2020 we found that including healthcare professionals in our design process and adapting our software and patient facing digital services with their input, enabled us to quickly and effectively respond to their need to manage patients with long term conditions remotely during Covid-19. All our design and development efforts in 2021 will follow suit.
- Deployment of data-driven behavioural science
Behaviour science is an important area within healthcare systems and policy development. The Covid-19 pandemic has catalysed the need to drive and support behaviour change remotely as face-to-face time with clinicians is limited.
Driving behaviour change within populations has formed the foundation for slowing down viral transmission. UK campaigns such as “Hands. Face. Space.” exemplify the dependency that the pandemic response has placed on behaviour change and orders to stay at home have seen dramatic shifts in population behaviours. Susan Michie, a leading academic at UCL in the behaviour science argues that Covid-19 has emphasised the need for behaviour change to be considered as an important element for reducing communicable disease and non-communicable diseases. Her push for more research within these dimensions paves the way for an exciting year in the field.
A particularly interesting dimension of research is the knock-on effect that Covid-19 is having on behaviour change, especially in relation to managing an individual’s health. A study in Italy showed 4% of people have stopped smoking and the number of people sleeping for 9 or more hours a day has increased by nine times. Alternatively, data from the Netherlands Nutrition Centre reported that 7% of people were eating less healthily during the pandemic. These factors are unrelated to the Covid-19 itself but show behaviour changes that may have long-lasting implications for an individuals health. Investigating this further in 2021 offers a wealth of opportunity.
Within UCL’s Behaviour Science and Health department have a range of health focused areas that relate to behaviour change, including obesity. A research study within the department called Ten Top Tips showed that patients who were provided with the weight loss intervention that is based on habit-formation theory lost significantly more weight within three months than the control group. Therefore, demonstrating that behaviour change interventions that are driven by theoretical understandings are effective at helping people to build healthier habits and improve their health.
However, NICE Guidelines on behaviour change recommend that behaviour change interventions need to be tailored to the local community and sensitive to these needs. This reiterates problems that have been presented in conversations with Professor Wendy Willis on the Real World Behaviour Science podcast. Willis comments on the importance of tailoring behaviour change interventions for the population in question. This is supported by the findings from a meta-analysis that was conducted by Seth Noar and colleagues. The findings from this study presented a strong, positive correlation between tailoring behaviour change intervention messages and someone implementing a positive health behaviour change. This demonstrates one of the crucial sensitivities in behaviour science.
The NICE guidelines on multimorbidity and caring for individuals with long-term conditions emphasise the importance of a person-centred approach to care that helps people to manage their conditions outside of the clinical setting. This forms the basis of the work done by Year of Care as they aim to support primary care facilities in implementing a care and support planning system that recognises how facilities that fall outside of the clinical environment are important for people with chronic conditions.
In 2021 we hope to adopt a tailored, personalised approach by working with thousands of people to understand the moments in their lives that make it challenging for themselves and their families to break habits and implement a positive behaviour change. We endeavour to utilise a person-centred approach to care planning that considers external factors that may determine an individual’s ability to uptake a behaviour change, manage their long-term condition and improve their health.
- Artificial Intelligence in Healthcare
The past year has seen multiple breakthroughs in artificial intelligence (AI) in the healthcare sector that prove the value of AI. These range from using AI to provide answers to some of the brain’s best kept secrets. For instance, predicting seizures by using AI to read EEGs and providing early dementia diagnoses. These developments are especially exciting as the brain remains the body’s most mysterious organ so the potential to continue unlocking a huge knowledge base in 2021 has huge potential.
Google’s AI offshoot, Deepmind, made world breaking progress in being able to determine a protein’s 3D shape solely from its amino acid sequence using AlphaFold. The impact of these discoveries will be expansive and range from drug development to environmental sustainability. Professor Andrei Lupas, Director of the Max Planck Institute for Developmental Biology and a CASP assessor stated that “AlphaFold’s astonishingly accurate models have allowed us to solve a protein structure we were stuck on for close to a decade”. The potential for AlphaFold to unleash advances and discoveries in a range of healthcare and research provides a glimmer of hope during an unsettling time.
AI has played an important role in the pandemic response. Algorithms have been used to diagnose Covid patients based on lung scans to drive faster diagnosis and resource allocation. As we move into mass vaccination campaigns the Medicines and Regulatory Healthcare Authority have funded Genpact UK to use AI tools to analyse all reported adverse drug reactions to the Covid-19 vaccine. Using these technologies will mitigate risks surrounding important information about side-effects being missed. Seeing AI solutions adapt to the current global health crisis is inspiring for our work at Healum and exhibits the breadth of possibility within the field.
Despite the traction that AI solutions are gaining within the healthcare space, there remain certain barriers to implementation. For example, it is paramount that AI is used ethically in healthcare and ensures that patient and clinical autonomy are pushed to the forefront. AI solutions that act instead of clinicians run the risk of exacerbating the lack of trust in AI and digital solutions amongst healthcare professionals and patients alike. Patient privacy and data governance needs to remain the headline within this space throughout 2021.
We believe that machine-learning can offer an innovative way to use AI in healthcare whilst maintaining the autonomy of healthcare. At Healum we believe in transparency surrounding patient data use so individuals understand how their data is used within AI research and products.