From the use of smartphone Apps, telephone or video appointments, the automation of diagnostic imaging via artificial intelligence, and robot-augmented surgery, digital technologies have the potential to transform the provision of healthcare.
The recently published Topol Review- an independent report commissioned by the government- was focused centrally on this topic, and outlined a bold, ambitious, and optimistic vision of the positive ways in which these technologies have the potential to positively transform the delivery of healthcare in the UK.
However, to make this vision a reality is by no means straightforward, and will involve facing, and overcoming many challenges.
Its successful implementation requires support and investment at both government level, from the Department of Health and Social Care, and at the organizational level, by management in the various healthcare organisations, where the use of these technologies needs to be adopted.
At government level, appropriate levels of funding need to be provided to procure relevant technology, develop a suitable IT infrastructure, and (re)train the workforce with suitable digital skills.
At the level of healthcare organisations, these technologies have to be purchased, work practices transformed, and significant commitments have to be made to investing in the recruitment of new staff, or training of existing staff. As the Topol review predicts that within 20 years 90% of jobs in the NHS will require digital skills, the scale of investment required becomes apparent.
People and tech
The Topol Review advocates such an investment as it emphasises the potentially enormous benefits that can be derived from making it.
These include an increase in the accuracy and speed of diagnostic techniques, a more holistic perspective on care provision through the digital accessibility of patient records, reducing the amount of time clinicians devote to administration, an increased ability for patients to become active in managing their own care, and giving practitioners more time for direct, human-centred patient care.
While the Topol Review is focussed on an increase in the use of digital technologies in the provision of care, the intention is not to replace human care workers with technology. Instead a very human, and people-centred vision of care provision is developed, where digital technologies are used to augment the work of clinicians, and provide the ‘gift of time’, whereby technology is used to provide caregivers more time for direct patient interaction.
The range of digital technologies whose use can be expanded and developed is diverse. These include:
- Telemedicine applications, providing care via digital technology at a distance. Examples include the use of telephone or video appointments with patients, the NHS 111 online/telephone service, the NHS App, and various other more specific Apps. An example of a specific App is the potential to computerise cognitive behavioural therapy (CBT).
- Wearable technologies which allow patients (and clinicians) to actively monitor an increasing range of vital signs.
- Developments in genome sequencing technologies and capabilities which can extend genomic diagnostics of an increasing range of medical conditions, with the potential to improve the diagnosis, and treatment of various genetic conditions.
- The use of smart speakers/voice assistants in the home to support the elderly and those with disabilities and mobility restrictions.
- Automated image recognition using artificial intelligence in the areas of dermatology, radiology, ophthalmology and pathology. For example, trials with the automation of breast cancer screening are currently underway.
- The use of robots in various surgical procedures (robotic tools controlled by clinicians), for rehabilitation via ‘smart’ prostheses, and even the potential use of ‘companion’ robots in care homes.
However, the challenges of bringing this vision to fruition are significant. Firstly, significant levels of leadership and financial investment at government level are necessary, to fully articulate, and champion this vision, and to provide the financial resources necessary to make the vision a reality.
This investment is necessary in both the education and training of healthcare workers with appropriate level of ‘digital literacy’, and specialised knowledge, as well as investing in the creation, and maintenance of a robust, secure IT infrastructure.
The levels of investment in both areas are likely to be significant, as there will be a significant skills gap between the current levels of digital literacy within the NHS workforce, and those required to effectively implement and use the range of new technologies proposed.
Equally, the levels of IT investment are also likely to be significant, given that the NHS’s computers were crippled for days relatively recently by cyber-attacks, and where previous attempts to fully digitise patient records resulted in the ‘biggest IT failure ever’, with the cost of the abandoned system being over £10bn. In a context where the UK government will be dealing with the consequences of Brexit for the foreseeable future, it is unclear whether such levels of financial support and investment will be forthcoming.
At the level of healthcare organisations, Topol talked about the need to develop a ‘culture of learning’ which may not be straightforward to achieve. Thus, the challenges to the effective implementation of Topol’s vision also exists at the level of healthcare organisations.
In a financially constrained environment, these are driven to a significant extent by short term performance targets such as waiting times, hospitals and other healthcare organisations will require to devote time and financial resources to the implementation of various technologies, and also the training of staff.
While some of this training can be provided ‘on the job’, without the need to remove staff from front-line work, undoubtedly, a significant proportion of it will require to take staff away from front line work, in order to attend training courses. If such requirements occur in areas where there are shortages of skilled workers, the capacity of healthcare organisations to free up workers for any necessary training and education may be challenging.
Overall therefore, to make Topol’s ambitious vision a reality, healthcare policy makers within UK government, and management within healthcare organisations will need to be equally bold and ambitious, as without this, Topol’s vision will fail.