Much has been written about digital healthcare and it often polarises opinion. The two perspectives below highlight opposing views of an increasingly connected healthcare system.
Perspective 1: Digital healthcare is a bad idea and has no place in the NHS
The last few years have been an onslaught of news and information about digital in healthcare. From online booking, to seeing your medical record, e-prescriptions and online consultations, and sharing data. It’s too much. Digital has its place in home and personal entertainment. Your iPhone is good for phonecalls and text messages, music and games. You can even log your exercise. But it is not a medical device.
Online booking is great, but it penalises those who don’t have internet access. It is ok to make a few appointments available, but the bulk need to be reserved for those phoning or walking in. Access to medical records is a Government inspired nonsense. Patients don’t want or need access to their record, besides the fact, it is your GP’s record, not yours.
Personal health records are a bad idea because health data belongs in the hands of professionals not patients. If patients can interfere with medical data, it will put lives at risk.
Data sharing? Two words: Care (dot) Data. You should be afraid. The Government will sell your medical data to private companies so they can make profits. You data will not be safe. Patients trust their GP to look after their medical data and they are happy with that. Patients do not want anyone else to have access to that data.
The internet is a fantastic invention, it has given us so much access to information and services. But with those benefits have come risks and problems. Fraud, identity theft, phishing attacks, hacking, to name but a few. Medical data is sensitive and should not be exposed to these risks for the vanity of a few fancy apps. The Government wants to use open source software because it is cheaper, but the most popular open source software specifically designed to make computers safer (OpenSSL) was revealing a huge back door for hackers to exploit – and it wasn’t spotted for over two years! Medical systems should not be connected to the internet because it is not safe.
Clinicians train for many years to become proficient at what they do. When you have a problem, they can assess you and make a judgement and ensure that you get the correct medication. They are short on time and the last thing they need is you with your Google diagnosis and your fitness tracking results. Let the doctor do their job and you can keep your data for your own time.
NHS organisations are under financial pressures like never before. They need to save huge amounts of money just to maintain existing levels of care, which are already falling behind demand. You want them to do this and revolutionise who some things work by introducing completely new ways of working? Get real, there is only so much change that can be absorbed at any one time. Maybe come back when the existing crisis is over.
Simply put, reliance on digital and the internet will cost lives and be a disaster.
Perspective 2: Digital healthcare can bring huge benefits to patients and save the NHS
The use of the internet, patient’s own devices and more reliance on patient will introduce new problems to the NHS and to healthcare. Hacking is a real problem and it will affect healthcare, only a fool would suggest otherwise. There are many challenges that the introduction of digital to healthcare will bring. But there are a also a huge number of benefits, benefits that we believe outweigh the problems and make a good case for their inclusion.
The NHS is in trouble. If everything were perfect, there would be no need to suggest making changes. There is a funding crisis, there is a demand crisis, there are individual conditions, such as diabetes, obesity and dementia that present their own crises. When things are not working, you can either do more or less or something or you can do something different. The funding crisis has effectively withdrawn the option to do more of the same. The only viable option is to do something different.
Some patients are not able to be involved in their own healthcare, they are 100% dependent on other. Some are not interested in being involved in their own healthcare – they think that is a job for their doctor. Some patients are interested though and if we can do more to help this group to help themselves, then there will be proportionally more resources to help those who either can’t help themselves or do not want to. Patients are not stupid – many raise families, hold down jobs and pay bills on time. We can trust them to do more.
Online and telephone banking has reduced the need for banks to invest in high street branches and has made banking significantly more convenient for those with online accounts. It has probably made some people think more about what they do with their money as they have direct access to their account – what goes in and what goes out. The NHS cannot copy this model in its entirety – it still needs to provide services to those without internet access, with quality matching, or better than, existing services. For those with internet access, there is a possibility that some will become more involved in their healthcare and become more conscious about what decisions they take that impact their health.
Patients can collect their own data. Smart phones are perfectly good devices on which to collect data. The sophistication of wearables and other connected devices means that so many things can be tracked. Yes, there are concerns about the quality of some of them, but the glacial development pace and expense of existing medical technology is not a practical solution. Quality too late is not better than poor quality on time. Better that we have something that is ‘good enough’ and available now. Is it better that a nurse takes a patient’s blood pressure after they have walked up hill to the surgery or that the patient can simply send the nurse data collect every day for the past 30 days from a wearable device? Which data is likely to be more accurate and useful?
I would not profess to be an expert on how to run a consultation. At the Modality Partnership, they replaced face to face consultations with telephone consultations. The telephone consultation could take place within an hour of a patient requesting an appointment. The telephone consultation might result in the need for a face to face consultation. Rather than have fixed consultation slots of 10 minutes, GPs worked through the call list with an average call time of 3 mins. Only 30% of patients needed face to face follow up consultations. Modality met their previously unmet demand and also found more time to give to high-risk patients who needed more care. Convenience for patients – consultations where you are, when you want them. Efficiency for the practices. All GP surgeries should do this today.
Hotels, groceries, movies and many other things can be booked online. It makes sense. It is more convenient for users and cheaper for companies. Some practices offer this service, though in my experience and anecdotally, it is almost always done badly. Services should be available online and they should be implemented by someone that knows what they are doing. Online services should not replace traditional services, they should complement them. Done well, few resources will be needed to provide the traditional services and the traditional services will improve.
Care.data was a disaster. It was a good idea, excruciatingly badly executed and communicated – the Government failed to help the public understand the purpose of the programme.
Any system has security flaws and those connected to the internet are no different. Whilst it is true to say that transferring data across the internet brings with it new risks, it should be recognised that the current system is not without problems. We have all read about laptops being left on trains, folders of sensitive papers being left in public places, emails sent to groups exposure personal details. Security knowledge within the NHS, as with many industries is variable at best. Whilst concerns around the use of the internet are valid, they are by no means the biggest concern regarding security. Systems can also be too secure – when data is so secure that those who need access cannot get to it, that is still a risk to lives.
I want access to my medical record because it is my record. Furthermore, I want to be in control of who has access to my record. I can understand that my GP should have statutory access. But I should be able to consent to paramedics, hospital nurses and doctors, physiotherapists, psychologists have partial or complete access to my record. It should be my choice – it is after all, my data. A GP should have a statutory right to share my data also, if he or she feels that it is necessary to do so. Consent does not have to be complicated. Do I want my physiotherapist to see medical data about my spine whilst they are treating my back? Yes, please. Do I want them to have access to my sexual health records? No, thank you. It is not hard.
Digital technology and the internet are great tools and can bring enormous benefit to patients and the NHS. Are they the whole solution? No. Are they a key part part of it? Most definitely.
Whilst I can sympathise with many of the issues that clinicians and staff raise about the use of digital technology and the internet, I cannot help but feel that they are misplaced views. In some cases, people have entrenched views that they are not willing or able to question. In other cases, I think the fear of the unknown and fear of being left behind are contributing factors. I think that more needs to be done to educate staff and clinicians about real risks and benefits of digital technology and set them in context against risks and benefits of current service delivery.
It is hard to promote a balanced view that says the internet has not had an overall positive impact for consumers on industries that it has touched. I am convinced that healthcare would likewise benefit.
About the author:
Damien Hampton is the owner of 26 Brains Ltd, a technology and agile delivery consultancy in Buckinghamshire. Damien has significant experience improving the use of technology within the NHS and healthcare generally.