A whole new Digital world in Medicine…….. Part 1.
Dr. Osman Bhatti of Digital CCIO (Chief Clinical Information Officer) for the East London Health And Care Partnership CCG gives us an insight on how Covid may have changed the way we practice medicine forever.
If there is one thing that clinicians are now talking about as a silver lining from coronavirus, it is that of technological advancement within the NHS.
From a primary care perspective and as a local IT lead in North East London, I’ve been at the forefront of experiencing the challenges we have faced over the last few years in getting technology implemented as a enabler to support our work, to a situation now where we have achieved so much in a matter of months, that previously would have taken at least another 2-3 years.
No more face to face
The way appointments are now booked has dramatically changed. The normal state of visiting your GP practice for a face to face appointment has been transformed in a way that we will never go back to consulting in the same way. At the height of COVID, face to face consultations in primary care had plummeted to <2% and telephone calls had soared in its place. Once we are through lockdown (eventually) we will probably settle to half of all appointments (at least) being done on the phone. Add on to this the fact that all patient contact is now being triaged first before an appointment is given, will ensure that patients will be seen by the right clinician at the right time. The other knock on effect from all of this is that waiting times have dramatically reduced, in part also due to online consultations.
One of the other dramatic technological changes has been around video consultations – who’d have thought we’d be communicating via video to check out a rash or to assess respiration a few months ago. The beauty of how this has been rolled out is that it is very highly clinician led in that a clinician will decide during a telephone call whether a video consultation is required and this in turn has meant that even fewer patients have needed to attend for a face to face consultation.
Along with the ability to have SMS access to patients, patients have also now been able to text back to the practice and have information coded into the clinical system. This has been a revelation in monitoring patients eg suspected of having COVID and has led to a more focused approach to dealing with patients by priority. This along with video consultations have resulted in the tool AccuRx now being used in over 90% of GP practices up and down the country.
Another aspect that has been revolutionised in the way that patients communicate with practices is that there is now 24/7 access to the practice through online consultation tools. They have been (and are still) a challenge to implement, but over the last few weeks we have seen system change that would normally take years to embed in one practice, never mind across the nation. The functionality to allow patients to consult first through an online form that could give appropriate advice or direct appropriately for 999 advice at one end and to pharmacy or social support at the other, can really help support primary care to deal with issues that they are set up to support. Linked to this, the ability for practices to prioritise workload based on this form of communication, has led to response times plummeting to a few hours which is absolutely transformational.
It’s not just the patients that have been staying away from healthcare settings! Primary care specifically has mobilised remote working like never before. The amount of increased investment in remote working has been phenomenal and in part healthcare has contributed to the worldwide shortage of headsets and webcams as well as laptops. There’s been lots of infrastructural change that has had to be mindful of governance with the roll out of VPN tokens to enable connection to the NHS network as well as IT support to provide appropriate software to be installed on PCs and configurations to allow access to restricted websites and functionality such as file access previously only reserved for within the NHS network. This has brought flexible working to the forefront and has also had the knock-on effect of staff being able to offer more flexible time to work from home due to other prior commitments. Tie in the fact that more hours are available to offer from the standard workforce and you can see one of the reasons for why locums are now not in as high demand as they were previously.
Often, it’s the simplest forms of communication that have been transformational. The humble text message has been a fantastic tool that means that we have moved away from requiring a postal letter to be required to send communication to patients and is more readily read than emails are. Add together the savings from printing, envelope stuffing and postage and compare this to the fact that patients can also instantly be sent an SMS that includes documents such as fit notes or clinical letters and you can see the impact it has had.
The NHS App has a functionality that allows appointments to be booked and repeat medication to be ordered without visiting the GP practice. With a self-approval and identification process requiring photo ID, everyone can now download the NHS App and order medication through the app and then collect the medication from a pharmacy of their choice – all without going to or contacting their GP practice directly. Add to this the ability (with practice approval), to view the whole of the GP record, patients now have all their health information from their GP at their fingertips.
We would love to hear you thoughts on what technology you have been utilising since Covid and how you feel this has supported your work or ways it could be improved. Also how do you feel this digital new world will affect our Muslim communities and will this make it easier or harder for ethnic minorities to access healthcare? Please feel free to comment below.
Dr Osman Bhatti is a GP in East London with a specialist interest in IT and is the CCIO (Chief Clinical Information Officer) for the East London Health And Care Partnership that is the STP that covers 7 CCGs across North East London. He also works for HEE as a Programme Director for a London GP VTS and is a presenter for the Red Whale GP Update team. www.DrBhatti.com