The moment has arrived for healthcare technology to deliver on its hyperbole.
Emerging from the rubble of the Covid-19 pandemic, hard-pressed NHS leaders are working to cut waiting lists and expand capacity in the face of rising demand.
At the same time NHS budgets are being cut amidst challenging economic conditions and a national productivity crisis.
Not only is technology essential to supporting the Covid Recovery Plan, but it is powering healthcare into an exciting new era of effectiveness, efficiency and productivity.
One of the most significant obstacles hospitals face is a ward at full capacity.
Healthcare providers want to treat as many patients as they can, but full wards place a brake on patient throughput.
Patients staying too long on wards expose themselves to risks from cross-infection and, in some cases, institutionalisation, leading to sub-optimal health outcomes as well as preventing the admission of incoming patients.
This is a problem as old as the hospital itself; can technology solve it?
Hospitals want to clear their wards.
At the same time most patients would rather be at home, surrounded by family, friends and pets, with better food and greater comfort, cleanliness and privacy than a crowded hospital can offer.
There is often talk of a lack of beds, but there is no bed shortage when we include the millions of beds in our own homes.
Were patients able to be safely and effectively treated at home, space in wards would be freed up, whilst patient recovery times could speed up.
With the rise of internet-connected smart devices, such a scenario is becoming increasingly viable.
Indeed the US ‘big box’ retailer Best Buy predicts that 30 per cent of hospital care will soon be delivered in the home, backing this prediction by creating a new business unit to deliver and service home medical devices for American hospitals.
It is generally unwise to draw a straight line across the Atlantic when it comes to health services, but in this case the principles of hospital-at-home seem applicable to the British situation.
The Healthcare IoT Revolution
Internet of Things (IoT) devices offer the prospect of delivering high-quality care to patients beyond hospital walls.
The developing capabilities of modern IoT devices mean that patients can be equipped with simple, non-intrusive medical devices when they are discharged from hospital into a ‘Virtual Ward’.
These devices allow a patient’s progress to be tracked by a hospital’s ‘Command Centre’, where clinicians and algorithms dynamically determine the needed amongst the patient cohort.
First-generation, community-based Virtual Wards emerged during the Covid era, when initiatives such as London’s ‘Covid at Home’ played a key role in easing the burden on over-stretched hospitals.
These community-based Virtual Wards, which necessarily had to be stood up quickly in difficult circumstances, rely on patients to file manual reports of their medical readings at set intervals.
Not only do they place an unrealistic burden of competence on patients; they also lack the feedback mechanisms and automated failsafes to enable more serious conditions, such as post-operative recovery, to be managed safely in the home.
Consequently first-generation Virtual Ward take-up has plateaued and even declined, in spite of government edicts that each Integrated Care System (ICS) of approximately a million people, should provide a 500-bed Virtual Ward delivering two weeks’ worth of treatment.
Martin Taylor
ICS bosses are puzzled: they think they have implemented Virtual Wards, but find that their hospital clinicians are not committing patients to them.
Some feel that the Virtual Ward concept has failed.
The answer may lie in the advent of the Acute Virtual Ward.
Unlike its community-based predecessor, the Acute Virtual Ward sees hospital-grade continuous monitoring medical devices, such as chest patches, linked to Wi-Fi and mobile data networks, delivering a constant stream of IoT signals that feed into a hospital’s Command Centre.
Building on processes that allow energy utilities to monitor power consumption precisely via millions of connected smart meters, Acute Virtual Wards combine medical IoT with cloud-based orchestration technology, the latter providing a system of action that overlays a hospital’s systems of record.
Staffed by hospital clinicians and other professionals, Command Centres provide a communication and data backbone not just for the Acute Virtual Ward but for the whole of an ICS’s diverse infrastructure.
That infrastructure is spread across primary, secondary and community care facilities plus mental and social providers, all using different platforms that do not traditionally play well together, let alone produce the kind of consistent data needed for Artificial Intelligence modelling.
Dedicated teams of clinicians in the Command Centres are directed to the cases that require most attention, with the technology segmenting and stratifying the constant streams of patient data.
The resultant 360-degree view of the patient makes remote care as safe as it is comfortable.
The quality of data generated means clinicians can achieve a never-before-seen understanding of patient needs, but crucially without increasing workloads.
Meanwhile hospital Electronic Patient Record systems or GP IT systems are updated automatically with periodic summaries of patients’ conditions.
This combination of automation and process management enables Command Centre clinicians to manage large patient populations with unheralded efficiency.
Rather than filling in forms, a clinician supervising an Acute Virtual Ward is freed to operate at the top of their licence.
Connected devices and Command Centres could just change the rules of a very old game.
A New Virtual Reality
Virtual Wards are still in their infancy. Even so, their potential is clearly enormous.
Meanwhile other virtual concepts, such as virtual waiting rooms that manage demand into Emergency Departments and Primary Care, or technology that delivers remote pre-operative assessments and post-operative follow-up consultations, are either emerging or already being applied.
Ultimately, virtual environments will improve patient experiences, and help to manage demand at scale for the NHS.
To fully realise the potential of virtualisation, providers must focus on implementing the right technology strategy – not just optimise their siloes – to connect and simplify experiences for patients and clinicians alike.
