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Prof. Martin R Cowie
Professor of Cardiology Imperial College London (Royal Brompton Hospital) Chair, Digital Health Committee of the European Society of Cardiology
As I write, COVID-19 is shutting down Europe, with an unprecedented effect on all aspects of daily life. Health and healthcare are being impacted in a seismic way. Undoubtedly, COVID-19 will challenge us all more than any other healthcare issue in living memory.
It is also highlighting the value of digital health technologies. Digital approaches are helping healthcare professionals and the public stay up to date on the spread of the disease; providing better and more rapid public health education; maintaining communication and decision making with our patients and their families; and allowing for better strategic planning.
Long after this pandemic has burnt through our countries, we will be left with enhanced structural changes in the way we work and communicate. These were happening already, but in a rather slow and piecemeal fashion. COVID-19 will accelerate this process and leave us transformed forever.
It is easy to focus on the recent cancellations of many educational events, including the American College of Cardiology meeting in Chicago, the European Heart Rhythm Association congress in Vienna, and the European Association of Preventive Cardiology congress in Malaga. (And there will undoubtedly be more). Digital approaches to communication and education are coming into their own: colleagues are sharing relevant sources and experiences with COVID-19 on social media. Webinars are becoming ever more popular, and great examples can be seen that link Chinese experts to physicians across the world so that we are better prepared for what awaits us. 1,2
Many of us have seen the internet and TV/streaming platforms use their reach to help educate the public about key measures to reduce or slow the spread of COVID-19 , such as washing hands with soap and water for at least 20 seconds, social distancing, and staying away from GP surgeries or hospitals unless absolutely necessary. Infographics and videos are now available to all and will undoubtedly change the way we communicate about health and healthcare in the future. A picture says a thousand words.
Governments working with search engines such as Google can help direct enquiries to reputable websites rather than to #fakenews. We have all seen the spurious claims for “snake-oil” type cures - social media can amplify anyone’s opinion, and as professionals we need to counter these potentially harmful stories, and point towards scientifically robust sources of information, albeit at a time when our knowledge is on a steep learning curve. Transparency and gravitas are needed at a time like this.
Cardiology has a long tradition of remote data collection and consultation, and many randomised trials have tested these approaches, particularly in chronic conditions such as heart failure. Simple remote approaches, such as telephone consultation, are already key to many chronic disease management programmes, but the necessary restriction of movement with COVID-19 will accelerate the transition away from face-to-face contact to more remote video consultation. After the pandemic is under control, it is unlikely we will move back to where we were.
Of course, some contact with patients needs to be face-to-face. Interventional procedures will likely always require the physical presence of human operators and can be lifesaving. This will be challenging during the worst of the pandemic. Looking to the future, remote imaging assisted by artificial intelligence for image collection and interpretation, may also reduce the need for patients to attend distant healthcare facilities – but we are a long way from this at the present time.
The ESC, as a large multi-country professional organisation focused on education, research and advocacy, has been (and will continue to be) massively impacted by COVID-19. As mentioned, many national and international events are being cancelled, postponed or transformed to a virtual-only platform. Education will have to be more interactive, punchier, and more visually attractive. The opportunity to ask/post questions will be essential to preserve a feeling of engagement by the virtual audience. Archiving of material will allow wider access to information, over a longer time span. The income model of professional organisations (and the income generated for others by transport, hotels and entertainment that usually accompanies all human interactions at scale) will have to transform.
The ESC Digital Health Committee, with representation from all ESC Associations, has already been working to move our strategies in a more digital direction, as demonstrated by the ever-larger digital area in the main ESC scientific meetings, and the new ESC Digital Summit each autumn. All of the educational activities of the ESC (and its associations and working groups) are becoming more digitally based and geared for remote access and interaction.
The past decade has seen a much bigger emphasis on “shared” decision making, with more expert patients interacting in a more equal way with their healthcare advisors, including cardiologists. Data can be collected at home, rather than only in a healthcare facility, and decision support can be device-based, app-based, or supported by face-to-face or virtual contact with the healthcare team.
The future is digital, and likely more virtual than has traditionally been the case. Healthcare is no exception. Cardiology has already dipped its toe into these waters, and the COVID-19 pandemic will speed up the process of transformation.
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