Turning COVID-19 catastrophe into an opportunity

The way COVID-19 started, and is now spiralling out of control in many parts of the world, has shown how fragile our connected world is. The bad news is that another NEW pandemic may come sooner or later. What the world cannot afford is starting from scratch when the next pandemic comes, as it did with COVID-19.

But, there is good news too. COVID-19 forced us to rethink the way we live, work and play. Over the next few weeks I will highlight:

  1. Step changes that COVID-19 has brought already, and how we can build on them.
  2. What structural changes we, in the UK, and the rest of the world, need to do to respond better and faster when the next pandemic comes.
  3. How those structural changes can be delivered.

Dr Kais Al-Timimi, @DatamationUK

Cambridge, 11th August 2020: Responsiveness to future care challenges – care model

COVID-19 damage is a wakeup call that healthcare IT infrastructures worldwide are not resilient to big shocks. But the signs were there already when growing and aging populations made healthcare unsustainable.

The solution to both problems is not more money or resources, but a radical rethink of how care is delivered. The current care model is to treat citizens when they become ill or have injury. This model led to the proliferation ‘point solutions’ to support primary, secondary, social care, medical research and public health. The result is that patient records are fragmented over plethora of disjointed systems. In such an environment not only joined-up health and social care not possible, but the damage that new pandemics can inflict can as catastrophic, as COVID-19.

Point solutions (GP system, hospital system, etc) are, by definition, designed to solve a pre-defined, and therefore known problem. Therefore they are out of date the day they enter service. So the challenge is how to build solutions to unknown and unexpected problems, such as COVID-19.

To answer this question let’s step back and ask what is the purpose of healthcare? Is it to be reactive and treat citizens when they become ill or have an injury, or be proactive in keeping them healthy in the first place? Clinicians and care professionals aim for the latter while current solution providers are focused on the former. This is why clinical and care best practices are advancing at such a fast rate, while solution providers are falling behind and not delivering the tools to support clinicians and care professionals.

Put another way, clinicians and care professionals cannot predict how the care will be delivered in 6 months, never mind 5, 10 or 20 years time. But they do know that any data they create in the course of delivering care today will still be relevant for the care of their patients for the rest of their lives. Therefore, to solve tomorrow’s problem (whatever that may be), patients’ medical records must be made readily usable at any future time. That is, making the unknown and unexpected a ‘known unknown’!

Next post will focus on how viewing care from this perspective will help accelerate adoption of new digital and other technologies and help give clinicians and care professionals the tools they really need to be even more innovative and effective.

10th August 2020: Resilience and responsiveness to future pandemics

Anyone who listens to daily news bulletins would think that testing and tracing is the silver bullet that will magic away pandemics. If it was, many countries would have avoided national lockdowns.

Testing and tracing, like most other tools being used to fight COVID-19 is a “fire fighting tool”, i.e. it is reactive. As such it is always going to be behind the curve. Whether it is based on an app or a manual system, it is being started from scratch. And this is too slow no matter how innovative it is and much money and resources are ploughed into it.

Much was said about COVID-19 being a novel virus. Does that mean we have to accept national lockdowns as inevitable when the next pandemic comes? Certainly not! National lockdowns were enforced in most countries for the simple reason that COVID-19 infections were doubling every 2-3 days when the best available data was two-week old aggregated survey data. That is, by the time those fighting the virus have the data, the number of infections have multiplied by 16 times.</>

Oxford University researchers have a programme called Disease X, with the aim of being better prepared for the next pandemic. However, the issue has not been lack of innovation on the science front, as has been demonstrated by the phenomenal progress on finding new treatments and vaccines for COVID-19. No it is much more mundane – data.

To illustrate the point, early in the pandemic, those who had flu-like symptoms were advised to self-isolate. So here is a situation where high proportion of cases went unreported and those that were, have potentially left ‘foot-prints’ of unconnected data in primary care and/or secondary and social care as well as NHS-111. In short, an opportunity was missed not only to collect valuable data that would have speeded up the learning process, but also what data was captured in the disjointed healthcare systems was of little use to public health researchers even if it was readily accessible to them.

What this means is that if there was an infrastructure where this data was collected as part of citizens’ day-to-day care, then those in charge of fighting the virus would have had dynamic, real-time picture of ‘suspected’ infections, symptoms, rates and means of transmission, etc. This data would have been very valuable even before the genetic code and testing kits became available.

How this been collected? Through patient feedback and engagement mentioned in the last post. More on how this can be implemented in future posts.

Cambridge 4th August 2020: Patient engagement.

One of the early positive step changes that COVID-19 brought is that most GP consultations are now conducted by phone or online. But, this is only the tip of the iceberg in what can be done to enhance patient engagement, and through it, quality of care. If patients can provide online feedback it will save GP time, and in COVID times, capture quality data about it.

Currently, when a patient sees the GP, the GP may prescribe new / modified medication treatment. Unless the patient seeks a follow-up consultation, the GP will have no idea what the outcome of what was prescribed in the first consultation was. Online patient feedback will rectify this and save many follow-up consultations.

Feedback is a powerful tool to improve customer services that has been successfully applied in retail and many other sectors. In healthcare, it can lead to improvement of the quality of care and empowering patients to be proactive in their own care.

Furthermore, subject to the appropriate consent protocols, this information can be valuable for research and fighting future pandemics. More on these in future posts.