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Virtual interactions can ease NHS pressures, says expert

NHS bodies should be bolder in using technology to address the increasing cost and time pressures they are under, a digital health expert has said.12 Nov 2018

Louise Fullwood of Pinsent Masons, the law firm behind Out-Law.com, said the NHS lags behind many other industries in persevering with old-fashioned processes and has an opportunity to use technology "to increase efficiency, productivity and deliver better patient service".

Fullwood said a new report published by the Royal College of Physicians (RCP), which highlighted the potential of technology to change how outpatient services are delivered, was welcome. She urged health bodies in the UK to look to the US for inspiration for how health care services can be performed digitally at scale.

Kaiser Permanente, one of the biggest US health care providers, had 131 million virtual interactions with patients in 2017. This represented 59% of all its patient interactions last year. The company lets patients schedule appointments digitally, access lab results remotely, use their mobile devices to obtain repeat prescriptions and also have online appointments with doctors, according to the report.

"As an example of what is possible in the NHS, we can think about the way booking a holiday has changed in recent years," Fullwood said.

"Previously it was only possible to book a holiday through a high street travel agents during set opening hours that may not always suit, where people would wait in a queue, get called to a desk, and an agent would select options for you on a screen you could not see before you would make a choice, go home and eventually some tickets and information would arrive through the post. Today, we have the ease and speed of booking a trip online – the NHS could be doing this but is still following the old 'show up and wait' model," she said.

In its report, the RCP called for "a person-centred approach" to outpatient care. It said that approach should replace the current 'one-size-fits-all' model of specialist opinion, diagnosis and monitoring and would recognise that people have "varying health needs, personal pressures and abilities to self-care or manage".

Its vision included plans to better utilise technology to enable remote monitoring of patients and allow them to access clinicians via telephone or video-link appointments instead of always through "face-to-face consultations".

The RCP said that because some patients "may not be willing to engage with digital technologies", they should be "offered alongside traditional services".

The RCP said patients and clinicians should both be involved at the "design stage" of digital health projects to help ensure the new tools are "more effective, problem-focused and usable", and further highlighted the need for "technical support" for some digital health solutions, such as videoconferencing.

The report also highlighted the importance of ensuring patient data confidentiality, and recommended that only clinicians with "legitimate relationships" with patients should have access to those patients' data, and that access controls should not be "simply based on role".

"There is good evidence that new technologies will support innovation in outpatient services," the RCP said. "But making good use of technology requires careful thought and planning. It is as much about changing clinical practice and professional culture as procuring high-quality, tested products."

Fullwood said: "Although there are some limitations on virtual interactions – and various UK regulators have warned against inappropriate use, such as the prescribing of certain drugs without appropriate interaction with patients – when properly managed, there is a huge potential for increasing use of remote monitoring and use of telephone, online and video calling to provide a better service to patients, make life easier for primary health care providers and increase NHS efficiency and productivity."