DrDoctor Spotlight 24 March 2020 An NHS for the 21st century Technology can deliver better health outcomes, improve patient satisfaction and save money. Shutterstock/ElenaBSL Sign UpGet the New Statesman's Morning Call email. Sign-up Ever read the papers and wonder why stories about the NHS always involve budgets going up or down, but rarely discuss efficiency? Increasing efficiency in the NHS sounds like it will cost members of the public more money, but in reality, it can be delivered through increased patient engagement.This is enabled by technology and means better quality of care with better outcomes that ultimately results in a positive impact on hospital finances. Digital transformation is the lifeline to ensuring the NHS remains sustainable and able to cope with the growing demands of our ageing population. However, often the focus of technology is too small in scale and starts from the wrong place in the digital value chain. Patient engagement refers to all the parts of healthcare that someone can do for themselves, outside of the clinical setting, when enabled by technology. These include managing appointments, tracking symptoms, correspondence (letters or test results), two-way communication (chat, video consultations), care plans and repeat prescriptions. These transactions are all important parts of the digital value chain, and when patients are encouraged to engage with their health provider online, they feel much more in control of their own health journey. Experts say that 50 per cent of the people born today will live to 100. It is clear that healthcare is fundamentally facing an enormous supply and demand problem. We simply can’t keep depleting precious NHS resources the way we have been. The way to fix the problem is by shifting the onus of care to the patient (in a positive way). Today, the world revolves around data and technology. We use our smartphones to navigate through life, work and relationships. We are instantly connected across the globe and have access to limitless information with the simple click of a finger. Healthcare needs to follow this same channel shift, allowing people to look after themselves and to gain an awareness of their own healthcare and health data. We should no longer be told what to do by the health system, we should expect to be partners when it comes to our own health. This means being able to pick the format and frequency of interactions you have along your healthcare journey. Eric Topol put this brilliantly when he said that the patient is the “single most unused person in healthcare”. To enable true patient engagement, technology needs to allow people to take control of their health by engaging with them properly from the moment they enter the healthcare system to the moment they leave, hopefully with a good outcome. The ultimate goal is to break the place and time relationship between patients and healthcare. What that means is that we stop relying on huge buildings to provide care and start employing data to support its provision. When you are fully engaged as a patient, you can sit at home with your smartphone while being supported by a huge amount of data. Doctors could also work from home, and be the best at what they do because we only need them when we really need them. They no longer need to sit in a hospital treating countless routine cases This also means we can receive care whenever we need it, because the technology is always there for us. Now, when you are ill, you get seen in a hospital or GP surgery once or twice, or maybe four times a year for about 20 minutes if you are lucky. That is two hours of face-to-face time a year. Two hours of care try to to enable positive outcomes. Sometimes hospitals understand the value in transformation but end up entering the digital value chain from the wrong place or making financial commitments to the wrong tech. If you do not engage the patient as a real partner and empower them through transactional activities, transformation at scale will not be achieved. For example, records access is simply not enough; just like having a patient app or being able to get a video consultation with a doctor is not enough. These are all individual bricks that make up a structure, but on their own they do not make a house. A house is made up of all these pieces together, building from the bottom up in a way that is easy to access at any time. The key to getting digital transformation right is to introduce the online environment to patients from the moment their health journey begins. If it becomes the norm to manage hospital appointments online, and to access health data on your phone, it becomes the norm to allow technology to support care. If you can use your mobile phone to enter a secure portal where you can pick a date for your knee operation, find out how to prepare for it, and sign a consent form, it will be completely natural for you to turn to your phone to fill in an outcome measure questionnaire, to consult your doctor via video, or to keep track of symptoms. By experiencing care in this way, you will feel in control and able to get better with closer monitoring, both important ingredients for a great patient experience. What is also improved, however, is the cost that is associated with a traditional care pathway, or the cost that is incurred by seeing every patient in clinic every time. By putting emerging technologies to use, patients will not have to travel to the hospital for each of those face-to-face transactions. They will not have to wait for a letter for their random surgery date, then wait on the phone every time they try to reschedule it, or take time off work to travel to the hospital to sign papers before or after the operation. The clinics are busy, doctors stretched, car parks full, and patients probably feel rather disengaged and not very reassured. Technology and expertise need to come together to form an ecosystem of support that is enabled by open standards and interoperability. This can transform the NHS for the better. Digital transformation offers the tools for real patient engagement and enables healthcare to evolve into an efficient, sustainable system. By following the digital value chain, and building the house from the foundation up, the NHS can achieve superior patient experiences and outcomes as well as financial savings. 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