Part one of a two-part series on digital healthcare exploring how patients are moving centre stage in a seismic shift that will lower costs and improve outcomes.

A senior citizen with a chronic illness settles down to watch their favourite TV show and sees a reminder flash onto the screen to take their medicine. A doctor on ward round receives an SMS alert to attend a patient, whose pattern of physiological readings is recognised by an algorithm to be life-threatening. Both scenarios are examples of patient-centred care, an approach that uses technology to deliver the right healthcare at the right time and place — benefitting every actor in the health ecosystem.

Patient-centred care is being embraced by healthcare organisations and governments around the world as they face common problems of ageing populations and rising costs of medicine and equipment, and as they need to deliver telehealth services when people cannot meet doctors in person.

With the world’s older population set to double by 2050 and health challenges emerging on the back of environmental change, sustainable healthcare is a global priority. Putting patients at the centre of healthcare, instead of the institutions that deliver it, promises to lower costs and improve outcomes.

Care moves out of the hospital and into the home

The Topol Review, Preparing the healthcare workforce to deliver the digital future, published in February 2019, makes the case for patient-centred care, enabled by a gamut of new technologies and a fresh focus. “Genomics, digital medicine, artificial intelligence (AI) and robotics are a new means of addressing the big healthcare challenges of the 21st century. AI will transform patient-generated data into clinically useful information and empower patients to manage their own health or seek appropriate health support.”

A primary challenge, according to Will Smart, former chief information officer of the National Health Service (NHS) and now global director for Customer Engagement, Healthcare and Life Sciences at DXC Technology, is how to reorganise healthcare systemically. “Systems need to manage their resources effectively in order to deliver the right care for their population, and this entails a huge shift of care from the hospital into the home. It means moving from a reactive model of care to a proactive model, with real-time monitoring of health data from consumer devices.”

Transform and personalise healthcare with technology

Much of the patient-centric shift will be enabled by specialised new technology, such as miniaturisation and medical biotech innovation, which will bring care closer to the patient. It’s now possible to plug a miniature ultrasound machine into a smartphone, which allows a patient to self-scan an organ, while magnetic resonance imaging (MRI) scanners are located in ambulances to assess head trauma. AI is regularly used to classify medical images, and their diagnostic rate is as good as the best clinicians in the world.

But existing consumer technology — especially the ubiquitous smartphone — will play a key part in making specialised technologies accessible to patients everywhere. “Digital consumer technology can be utilized to support carers and non-professionals who can then intervene in new, useful ways”, says Smart. NHS Trusts are using smartphones to access care records and prescriptions, increasing patient safety. Such practices can easily be transposed to other care locations, including the home and residential care.

However, digital technologies alone cannot deliver patient-centred care, as Smart explains: “It needs multiple organisations across primary, secondary and social care to rethink how care works and to put the patient at centre.” The rethinking has to extend to the use of buildings and people, culture and skills to reimagine how care is delivered, he says, adding, “We need to step back from institutions and their four walls and think about wider health systems and how they interact”.

Make patient outcomes the driver of funding models

Reorganising systems more sensibly across health ecosystems won’t work without a parallel change in the way care is funded, explains Smart. Without a corresponding change in funding models, he says, “You can easily end up with a series of ‘perverse incentives’ where everyone is trying to manage each individual institution’s financial and operational performance and not the system’s performance” [i.e., the wider health ecosystem].

Smart cites the example of a patient who remains longer than necessary and even stuck in the costliest medical intervention of all — a hospital bed — because it may not be in the interest of the local council, which finances social services, to make the necessary modifications to a house that would enable the patient’s discharge. “The end result is [that] everyone does the wrong thing for right reasons”, he says.

Harness digital innovation for personalised healthcare

Looking outside healthcare offers fresh perspectives of new and proven ways that technology can personalise services, which would also work very well for patients, advises Smart. “When I log onto Netflix, it gives me recommendations based on my viewing history. Healthcare will start to use AI and algorithms to personalise healthcare in the same way.” The more that care providers know about an individual, the more effectively they can nudge that person to take medication at the right time — perhaps by flagging a reminder on the TV ahead of their favourite show.

Such digitally-enabled interventions in patient care are being researched and implemented around the globe. The new Care Research and Technology Centre at Imperial College, London, is experimenting with a smartphone app to show early-stage dementia patients how to carry out everyday tasks and how to personalise live radio. In Australia, the Commonwealth Scientific and Industrial Research Organisation (CSIRO), is researching the use of chatbots to improve social interaction for autistic children and vulnerable people.

The revolution is already happening

Elsewhere, ground-breaking research entails the use of sensors coupled with AI-based speech to alert vulnerable people in their homes if their behaviour — such as smoking too often — is unsafe. These smart interventions using patient data present potentially difficult terrain to navigate, since they touch on issues of privacy and consent. But they also present huge opportunities for patients to be more active participants in their own care.

Realising the opportunity of patient-centred care is a mammoth task, but the good news, says Smart, is that enormous change and improvement has already been achieved by harnessing technologies. “We’re able to do things that 20 years ago no one dreamt of. Previously fatal diseases can now be managed as chronic conditions, thanks to amazing strides in medical research combined with emerging technologies that will enable better monitoring and timely interventions.”