The United Kingdom is a pretty good place to get sick. For citizens and taxpayers, healthcare is free at the point of delivery and for the most part, the treatment is as good as you’ll get anywhere in the world.
But as a report out this week highlights, healthcare professionals are under increased stress in the wake of the Covid-19 crisis. According to the House of Commons Select Committee on Health, NHS workers are exhausted, over-stretched, and frankly, burnt out. That’s partly down to the stresses of coping with two waves of the viral infection – and a third may be on the way – but staff shortages were a problem long before the virus took hold
Looking ahead, even if the worst of the crisis is over, hard-pressed staff have a mountain to climb in terms of catching up with delayed operations and appointments. Meanwhile, the day-to-day work of hospitals and general practice continues.
So the question arises – as it does in most healthcare systems – in the face of backlogs, how do you get the most out of healthcare staff without subjecting them additional pressures at a time when a great many already think too much is being asked of them.
All of which brings us to the plethora of technology startups that have come into their own during the Covid crisis, many of them web, phone, and video consultation and triage solutions. They have flourished in a period when social distancing put limits on contact between doctors, nurses, and other practitioners and their patients. But with the immediate crisis now over, will remote consultation providers have an ongoing role to pay, or will demand for their services drop as normality reasserts itself?
Medium Term Stress
In the short to medium term, at least, it looks as if the strains on healthcare will generate continued demand for labor-saving software tools. Indeed, that appears to be Health Service policy. In May, the NHS recommended that general practitioners should triage patients by phone and/or video before seeing them.
Not surprisingly, this has been welcomed by health tech companies working in the field. Reacting to the recommendation, Piotr Orzechowski, CEO and Founder of Nursing, said “The NHS guidance to reduce the number of in-person visits via initial video and phone consultations is a positive step in improving patient care and should be followed by healthcare providers across the world. Reducing the number of people in the waiting room who needn’t be there allows doctors and nurses to focus on those who are in need of urgent attention and decreases the associated costs for all involved.”
Dr. Murray Ellender, CEO, and founder of online consultation and triage solution provider, eConsult agrees that a corner has been turned. “The health system will not go back to the old ways,” he says. “The days when doctors saw every patient at the surgery are over. It’s just not sustainable. We are moving to a needs-based system.”
As Ellender sees it, the system under which patients – regardless of how trivial or serious their ailment happen to be – gets a five or ten-minute consultation does not represent a good use of time. By using technology to identify patients who do not need to see a doctor in person, GPs can prioritize those who need more attention. “There are people who really need longer – say 20 minutes,” he says.
This need to prioritize according to need goes some way to explaining why companies such as Health Hero and Babylon Health have been growing rapidly. The same is true of eConsult, which has just acquired SMS and video platform QDoctor.
But there is a certain amount of controversy. The Royal College of GPs has expressed concern about pre-screening and patient groups are also said to be concerned. Perhaps the biggest worry is that in the absence of a face-to-face consultation, something may be missed. For instance, a patient may turn up with an injured foot and mention weight loss (a red flag) in passing. Indeed, maybe the doctor notices the weight loss when compared to previous visits. This could be missed in a remote consultation.
Ellender argues that the way around this is to create smart systems. For instance, eConsult takes an initial questionnaire approach. The questions, which depend on the reported problem, are based on the accumulated knowledge of doctors. He cites the example of one patient whose life was saved because one of the questions – relating to headaches – flagged an imminent brain hemorrhage. “The algorithm for our questions is authored by GPs,” he says.
Mention of the “A” word points the way ahead. Dr.Ellender says artificial intelligence will play an increasing role in improving removed triage.
Piotr Orzechowski agrees. “AI symptom checking can be incorporated into primary healthcare, handling symptom checking and triage to accurately identify when it’s most appropriate for a patient to see a doctor, visit the ER or administer self-care.”
Will the patents buy in? Well, the number of remote consultations is rising. Dr. Ellender. To date, the company has facilitated 14.5 million. The key to adoption is to move the first contact between patients and doctors online, he says – rather than assuming they will pick up the phone and attempt to book an appointment. Once a patient is online, a tech-based triage process is a logical next step.
All this is a long way from the family doctor of my youth and many will miss face-to-face contact. On the other hand, consulting a doctor via website, video or app is undoubtedly convenient. That convenience if coupled with patient confidence is likely to be a driver of uptake. The question is, does all this represent the future or just a point in time.