Digital Health during the Coronavirus Pandemic
It is difficult to turn on the television, read the news or even speak with friends without hearing the latest updates on the coronavirus (COVID-19)…. Read more
It is difficult to turn on the television, read the news or even speak with friends without hearing the latest updates on the coronavirus (COVID-19). At the time of writing, almost 200 countries have confirmed cases of coronavirus, although this number is likely to be much higher in reality. But in these times of uncertainty, what action is being taken to tackle the pandemic? And how is technology being used to address the difficulties that are being faced by the health industry?
Historically, there has been a hesitation or reluctance by many users, medical practitioners and regulators alike to implement pioneering technological changes in connection with our health system. However, the global coronavirus pandemic (in which health professionals across the world are reacting as quickly as possible) could act as a catalyst to introduce new measures and methods to integrate digital technologies into the health system, and hopefully ease the pressure on health services across the globe, including our NHS.
Existing technologies: Adoption of a ‘digital first approach’
There are various digital health offerings already on the market, which are being used to provide remote assistance for patients, for example:
- mobile doctor applications (like EMIS Health’s Patient Access app or Babylon Health’s GP at Hand). These can be used in place of traditional face-to-face appointments, and therefore reduce the potential transmission of COVID-19; and
- various symptom-checker bots (like Ada or Your.MD) allow people to check their symptoms and obtain tailored initial advice without the individual needing to speak directly with a healthcare professional.
NHS England has been following the lead of such online health companies, urging Britain’s 7,000 surgeries to reduce face-to-face appointments for patients displaying symptoms of COVID-19.
Health secretary Matt Hancock said digital technologies would be rolled out across the country with “immediate effect”, and “we will take a digital first approach to accessing primary care and outpatient appointments so that, wherever clinically and practically possible, people can access, and should access, primary care through phones and digital means”. This ‘digital first approach’ has led to a rapid increase in patients now interacting with medical staff via telephone, text or video services.
Meanwhile, the NHS has also updated the NHS 111 service to conduct coronavirus triage assessments online, helping to provide initial advice to individuals about coronavirus, as well as reducing the burden on their call centres, after a surge in enquiries.
Fortunately, several digital health companies have come to the aid of the NHS, offering access to tools and software to increase NHS capacity and capabilities, for example:
- AccuRx, which currently provides the Chain SMS Service (letting GP practices send text messages to patients, asking them to book tests, sending follow-up information after an appointment, and letting them know when a prescription is ready to collect), has announced that it is making its newly developed video consultation and pre-appointment screening products available to GP practices and NHS organisations.
- Modality Systems has offered NHS Trusts, as well as social care, care homes and domiciled care providers a licence to use its remote consultation solution, OneConsultation. OneConsultation integrates with Microsoft Teams and Skype for Business and allows patients to use their own mobile devices and laptops, without needing to download or install any additional software.
- Refero has offered its video consultation services, which are already used in several NHS Trusts across the UK, to all NHS Trusts, as well as to central and local government and the armed forces, in response to the COVID-19 outbreak. Refero’s video consultation technology, underpinned by Cisco Webex, enables clinicians to speak directly with their patients either remotely via mobile, or through desktop devices.
- X-on, the provider of the Surgery Connect digital telephone system, is working with hundreds of practices to keep their automated telephone messages up to date with the latest NHS guidance. In the wake of COVID-19, it is now developing a new service called Surgery Connect GP@Home, to enable GPs to take and receive calls at home, helping to minimise the spread of the infection.
- Klinik Healthcare Solutions updated the algorithm in its symptom checker and urgent assessment service within 24 hours, so that it can now detect symptoms of coronavirus and signpost patients to the official NHS guidance. Its solution is live in GP providers across the north of England, meaning GPs can provide appropriate care for patients with coronavirus symptoms, whilst keeping health professionals safe.
Collectively, these digital health service providers can help to ease the pressure on the NHS, while allowing doctors to keep in touch with their patients in a safe and effective manner. Lots of the above technology has been around for some time, but increased usage of existing technology in this pandemic may pave the way for a higher uptake of digital health solutions going forward, after the pandemic has subsided.
Innovation in the light of COVID-19
While the COVID-19 outbreak has seen the NHS dramatically increase its usage of existing digital health products, around the globe researchers and developers have been working to determine whether existing technologies can be given new applications to assist with the pandemic. Examples of such innovation include:
- Applying AI algorithms to mobile phone location data to predict disease spread, and using computer simulations to calculate the impact of interventions such as social distancing;
- Robots being used to clean hospitals and drones to deliver food to patients;
- Connecting wearables to health tracker apps to monitor for potential COVID-19 symptoms (for example, Verily, a subsidiary of Google, is developing a small, body-worn temperature patch that transmits data to a phone application to provide timely notification of fever and support early diagnosis and treatment of a viral infection like the flu or coronavirus);
- Top UK-based engineers are using their expertise to design and manufacture medical devices and equipment to meet demands:
a) The “VentilatorChallengeUK” consortium (which includes Airbus, BAE Systems, Ford, Rolls-Royce, Siemens, the Smiths Group, Unilever and the Project Pitlane Formula 1 teams) are working together to fulfil orders for more than 10,000 ventilators;
b) “Project Pitlane” consists of seven Formula 1 teams working on the reverse engineering of existing medical devices (as part of the VentilatorChallengeUK consortium), and the design and prototype manufacture of new devices for certification and subsequent production;
c) Dyson designed a new ventilator in 10 days and is creating 15,000 for use in fighting the pandemic;
d) 3D printers are being used to quickly manufacture ventilators and protective equipment; and
- Using AI algorithms for drug creation (for example, a leading pharmatech company, Exscientia, created the algorithms for a new AI-derived drug molecule within 12 months, compared with four or five years for traditional research).
Concerns and issues
Despite the significant progress that has been made in the past few weeks, with greater remote access to healthcare for patients, and the use of computer simulations to better understand the outbreak, such advances will always come with concerns around the reliability and resilience of the technology being used.
For example, many patient communication systems are being used in significantly higher volumes than previously predicted, and as such, it is possible that problems may occur with this rapid up-scaling. For instance, where patient communications are sent by mass-messaging systems, overloaded systems may fail, preventing important information being passed to patients (for example, some US hospital chains have reported issues with systems crashing as a result of increased demand due to the coronavirus pandemic). Vulnerabilities in software will need to be carefully monitored during this time to prevent similar issues and ensure communication systems are not left exposed.
It is humbling to see the number of companies providing their services to the NHS and further afield for reduced rates, or even for free, during these uncertain times. While these acts should not be overlooked, and their impact applauded, all parties should consider the risks of entering into hastily agreed licences and contracts, as this could cause issues further down the line. Parties should try to ensure that relationships are clearly defined and documented, and where possible details of the services to be provided are clearly set out, including for example, any agreed service levels and what happens at the end of the trial period or licence (for example, ensuring patient’s sensitive health data is protected).
Digital health companies will no doubt be aware of regulations relating to medical devices, the new Medical Device Regulation (MDR), which were due to come into force fully on 26 May 2020, once the transition period ends, but this has recently been delayed for 1 year as a result of the Coronavirus pandemic). Many symptom checker apps, which seek to provide advice on “diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of disease” will be categorised as Class IIa medical devices (or higher) under the MDR, and as such will face tighter regulation than at present (although companies can choose to comply with the new regulations now). In particular, where an app is categorised as a Class IIa (or higher) medical device, it will need to notify the appointed regulatory body of any major changes to its app, which may slow down innovation or emergency responses such as those required to cope with the coronavirus pandemic.
These are unprecedented times and all forms of health care companies will need to work together with the NHS in order to best tackle the pandemic. Existing technologies are already being rolled out across the country to enable health workers to maintain contact with their patients whilst minimising the spread of the virus, while scientists and developers are hard at work, using the latest technology and AI techniques to help limit the impact of COVID-19 as much as possible, and ultimately look for a treatment or vaccine. While these technological advances may be a little way off, we hope that the fantastic work that digital health companies across the UK and further afield are doing, combined with the tireless efforts of all health professionals, may help successfully tackle the pandemic, and maybe lead to a more ‘digital first’ healthcare system in the future.
http://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32017R0745&from=EN and in vitro diagnostic medical devices (IVDs) due to come into force fully on 26 May 2022 http://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32017R0746&from=EN
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