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What Can We Do Today To Integrate Health and Social Care Using Digital Technology?

A report from the ESC Digital Summit 2019
5 and 6 October 2019, Tallinn, Estonia

Chairperson: Panos Vardas.

Speakers: Lis Neubeck, Jacob Sorensen.

Roundtable experts: Folkert Asselbergs, Paul Cummins, Donna Fitzsimons, Itzhak Gabizon, Hein Heidbuchel, Hugo Katus, Nicholas Linker, Paul McGreavy, Kyungmoo Ryu, Emma Svennberg, Luka Vugrac.



Around 40% of adults over the age of 80 currently use social care, most of which is provided by third sector and charitable organisations. Integration of health and social care therefore requires incorporating a variety of different systems. To do that, data must be mobile. A significant challenge is that information is not standardised. In addition, health and social care IT systems may not link up; even health systems alone often do not link up. Technology is moving so rapidly that it must be able to slot in and out of care systems to ensure they are future-proofed.

The workforce can be an enabler or a barrier to adoption of digital technologies. Some staff do not trust new technologies, even keeping fax machines as reliable technology. Others have had poor experiences: if it takes longer to perform a task digitally there will be little enthusiasm for it. Fearing the pace of change is an issue for some staff, who may be unprepared to engage with technology.

Digital technology is incorporated into everyday clinical practice at Aarhus University Hospital in Denmark. To take one example, many patients heart attack symptoms use the 1-1-2 app to call the emergency services and relay their location. The AED (Heart starter) app allows bystanders to call 112, pinpoints the nearest automated external defibrillator (AED), and gives cardiopulmonary resuscitation (CPR) instructions.

In the ambulance, a digital ECG is transmitted wirelessly to a cardiologist who decides if the patient should go directly to an invasive hospital. The hospital tracks the location of all ambulances and estimates arrival time. Electronic patient charts include test results, medication, vital signs, and imaging files – doctors review these with patients, who can also view the information on their smartphone. Cybersecurity is one concern – so far there have been no serious breaches. Contingency plans are needed in case the network breaks down.

Discussion points

How can we improve data transfer within and between health and social care?

  • Patients should be at the centre – owning and controlling their data and sharing it with health and social care providers by dynamic consent.
  • Patient consent for data sharing is not required for entry into some databases but is needed by some systems and may be denied.
  • A unique identifier for each citizen has the potential to link data from health and social care.
  • Countries and hospitals vary widely in their adoption of electronic health records which is a barrier to data sharing.
  • Reimbursement authorities have a key role in enabling continuous care for patients regardless of where they are in the health or social care systems. For example, keeping a telerehabilitation contract live when a patient transfers from hospital to their GP.
  • Payers need to take a long-term view on investment in digital technologies.
  • Platforms should be agnostic to the device or other technology they use so the application program interface (API) can be interpreted differently. This could be a requirement for reimbursement to avoid vendor lock-in.
  • Nomenclature and coding vary across countries. There is a role for the ESC to define standard phenotypes.

How can we bridge the digital divide?

  • There is a digital divide in health and social care based on age, social class, ethnicity, and geography (between and within countries). This leads to poor uptake of available digital solutions such as personal records and digital GPs.
  • Many patients do not have an email address, which is needed for some digital systems. Of those who do, a proportion prefer to communicate by WhatsApp.
  • We should not assume that the older generation do not want to use technology. Many of them do if given the appropriate chance and support.
  • Social care is a neglected part of cardiac care, with little assistance after discharge for rehabilitation. Digital solutions can improve access to rehabilitation (saving travel time, for example) and provide support for patients and their families.
  • Could connected patient communities support integration of health and social care systems? For some patients, yes, but older people may still require face-to-face communication.
  • Education and ease of use are central to patient uptake. Solutions need to meet user needs.
  • No solution will be right for 100% of the population but 90% is enough. Traditional interaction can continue for those who need it. Some may want a hybrid model including digital and face-to-face interaction.

How we can we engage the workforce?

  • Adoption is an issue: Croatia has a digital programme but only 20% of GPs use it. Of those who use it, just 5% of their patients use it.
  • We need to prepare the workforce for the digital integration of health and social care. Some are resistant to the idea of change. Physicians become exhausted from data overload.
  • Digital solutions provide the opportunity to reorganise care with greater involvement from nurses and technicians – for example with telemonitoring of devices. We need to train staff and clarify their responsibilities. Teamwork saves doctor time and delivers better medicine.

Will the human touch be lost?

  • Electronic medical charts save time but instead of spending it with patients we use it to feed data into different databases. We spend even more time in front of the computer.
  • Patients increasingly have multiple conditions and need to discuss their options. They want to look a professional in the eye and get a human response, rather than a machine learned response, about the impact on their quality of life. Can digital technology help us do that?
  • Patients sometimes prefer talking to avatars instead of doctors because they feel less intimidated and still get information.
  • Digitalisation can increase the human touch because patients become partners in the care pathway. They have access to their data, come with questions, and stimulate interaction. In addition, digitalisation leads to improved coding and structured care, which benefits even those who fall outside the digital divide.

Conclusion

An ageing population puts more demands on health and social care, while at the same time some countries have recruitment difficulties. Digital technology is needed to link up systems and provide seamless care for citizens, who should be at centre as owners and controllers of their own data. Interoperability within and between health and social care systems remains challenging. Efforts are needed to ensure that the sections society which engage less with digital technologies do not get left behind. The workforce has a key role to play in making digital technologies a success.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.