With the outbreak of the COVID-19 across the globe, many patients with long-term conditions have been confined to their homes, leading to new ways to interact with clinicians.
For example, for the first time ever, more than 85% of primary care prescriptions in England are now processed electronically, after a rise in use of the service during the coronavirus (COVID-19) pandemic.
‘Technology has been an incredibly powerful tool in our response to coronavirus. We have learned so much about what can be done online, and in some cases what is better done that way. Technology will play a growing and vital role in the future,’ said Matt Hancock, Health Secretary.
Telehealth is a combination of equipment, monitoring and response that can help individuals to remain independent at home. Telehealth is a means of relaying specific physiological data from patients in their homes to clinicians in hospital, general practice or community / mental health settings, to support objective decisions about their clinical management. It can enable a clinical team to establish a ‘virtual ward’ of specific patients with remote monitoring of their vital signs. When telehealth is in place a patient’s vital signs and/or test results can be made available to clinicians caring for them from afar - in real time or close to real time; and patients are much more aware of how their body is functioning.
Many GP appointments can be done remotely, and as well as being safer during the COVID-19 pandemic. This option is more convenient for many patients, but there are of course still times when it is necessary to see patients. Health leaders had already signaled the intention to move towards digital first primary care in the NHS Long Term Plan. But progress towards this has accelerated during the pandemic, with 99% of GP practices now activating remote consultation platforms, and NHS bosses are now examining how this progress can be locked in.
Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.
‘Even during these unprecedented times, if people need help from a family doctor they are able to get it. Our GPs are quickly adapting to new technology – including phone and video consultations – to continue providing care in a different way,’ said Raj Patel deputy medical director of primary care at NHS England and practising GP.
‘Not only do remote appointments allow patients to consult their GP from the comfort of their own home, it helps protect staff and patients by limiting exposure to infection. If you are unwell, the NHS is here for you and practice staff are working hard to ensure that everyone gets the care they need, whether that is face to face or virtually.’
In light of COVID-19, the NHS is turning to remote consultations in order to minimise the risk of infection for staff and patients. According to guidance from NHS England, practices must now move to a triage first model for consultations. NHS England has developed a range of resources to help practices implement this approach. Practices in other nations are also moving towards this model. Additonally practices are asked to use telephone, video and online consultations to support triage and remote management of patients.
In particular, staff being are encouraged to promote online consultations to patients and introduce this service where they don’t already have it. Video consultations should be used where possible, however, telephone access will be used where there are barriers to digital access.
‘We have moved to a principle of digital first in primary care and with outpatients, unless there are clinical or practical reasons, all consultations should be done by telemedicine,’ said Matt Hancock, Secretary of State for Health and Social Care.
One group of patients at high risk are those with cystic fibrosis. These patients are among those classed as at extreme risk from the coronavirus and have been advised by the Government to follow specific shielding advice. Under new NHS England plans, thousands of these patients and dozens recovering from coronavirus are being given devices and apps so that medics can monitor their condition remotely. Home-based spirometry has been hailed as ‘the most important intervention’ for cystic fibrosis patients by the CF National Network. NHS England has accelerated the roll out to help ensure people can stay safe at home during the pandemic, while at the same time ensuring that those whose condition worsens can get the right help fast.
‘The measurement of lung function, which normally occurs in hospitals, is essential to tracking disease progression and deciding changes in treatment,’ said Professor Andrew Menzies-Gow, NHS England national clinical director for respiratory services.
‘Enabling thousands of people with cystic fibrosis across England to provide this information without leaving their home is a vitally important step change in reducing the need for hospital attendances or admissions.’
At the same time, the NHS is trialling the use of oximeters, combined with app-based check-ins with clinicians, which will make it easier to spot whether people need to be re-admitted to hospital. The new oximeter service is being trialled with more than 150 patients in sites in Watford, Hertfordshire and north London, with the NHS’s digital transformation unit, NHSX, working with British digital health start-up, Huma.
Clinicians in ‘virtual wards’ are able to track patients’ vital signs – including temperature, heart rate and blood oxygen saturation – in near real-time, receiving alerts if they suggest a patient is deteriorating so that further assessments and care can be arranged.
The service has since been extended to additional sites in West London, with plans for further pilots in other areas of the country including higher-risk patients who have recently tested positive for COVID-19. If the trials show the model to be safe and beneficial for patients, they could help to inform a national rollout ahead of the coming winter.
‘This is a great example of how new technology is supporting healthcare professionals to provide the right care at the right time. With COVID-19, it’s vital that we make use of digital tools that can help support patients who don’t need immediate hospital care and allow close monitoring of their condition,’ said Tara Donnelly, chief digital officer, NHSX.
‘The feedback we are getting from patients is that the remote monitoring with clinical oversight is really reassuring to them, and they are grateful to be at home while they recover, rather than in a hospital bed. The clinical team is finding it helps give them very rapid feedback on their patients and they are able to keep an eye on a number of people at a glance, which is working much better for them than the previous system which relied on phone calls.’
As the COVID-19 pandemic continues to threaten the public’s health, it is vital that other conditions that require close management do not fall ot the wayside. The rapid changes in technology could prove life saving for thosusands in this country,
‘While we restore face to face NHS services too, new innovations will ensure patients can benefit from the comfort of home, with the reassurance that they can be fast tracked to support from the NHS should they need,’ said Matt Hancock.
Footnote: What is telehealth?
Referring to health information services, health care education, and health care services in a broad sense, the term telehealth is an all-encompassing one. In fact, telecare and telemedicine are generally covered within the broader scope of the term telehealth. Examples of telehealth includes health education services, remote monitoring of vital signs, ECG or blood pressure and remote doctor-patient consultations.
Telehealth technology enables the remote diagnoses and evaluation of patients in addition to the ability to remote detection of fluctuations in the medical condition of the patient at home so that the medications or the specific therapy can be altered accordingly.