Part two of a two-part series on digital healthcare explores the patient journey and opportunities that arise from end-to-end transparency across health ecosystems.

Part one of this series set out the logic of putting patients at the centre of healthcare, describing the better outcomes — financially and medically — that accompany this shift. Another natural consequence is a focus on the patient’s journey, which may traverse different professionals, carers and organisations along the way. Here, in Part two, we explore the opportunities that arise when the patient’s journey is transparent and managed end-to-end.

Opening access to electronic patient records (EPR) in real time for health and care workers using everyday digital devices is the starting point in creating a view of a patient’s journey that’s transparent and visible, end-to-end. Augmenting care with capabilities such as scanning bar-coded objects from smartphones (enabling devices, drugs and patients within hospitals to be tracked), along with deep learning algorithms and augmented reality, yields a host of innovative healthcare scenarios.

Digital connects the patient journey

Will Smart, former chief information officer of the National Health Service (NHS) and now global director of Customer Engagement, Healthcare and Life Sciences at DXC Technology, sets the scene of how patient care looks when managed in this way. At present, healthcare is organised and managed episodically, consisting of a visit to the general practitioner (GP), an operation in hospital, and a series of community care visits, for example. All of these healthcare episodes are treated as discrete events, says Smart, whereas a well-managed healthcare system seeks to organise the patient journey as a set of “connected points of contact towards one destination.”

Admissions of elderly residents from care homes are one example of frequent and costly occurrences, as Smart describes. “Often care homes don’t have clinical professionals on-site. A common situation is for a resident to become acutely unwell, be taken to the emergency unit and be admitted for treatment. Often care homes don’t have clinical professionals on-site, meaning that the opportunity to intervene is lost before the resident becomes too unwell to stay at home because their health is not routinely monitored.”

Open the window into home-based care  

As was described in part one of this series, consumer devices such as smartphones, either on their own or together with medical equipment plug-ins, mean that carers or patients can monitor temperature, blood pressure and pulse at home. If a pattern of physiological measurements indicates, or a threshold is breached, a district nurse or general practitioner could be called to intervene, potentially avoiding an expensive and distressing hospitalisation.

Digital devices can be used as part of a virtual ward to remotely monitor the health of patients who would otherwise be admitted to the hospital, enabling them to stay at home. Clinicians would have access to the patient’s physiological measurements, captured through a telehealth platform, and could see whether and when they need to intervene. The virtual ward is a better experience for the patient and makes a better use of expensive hospital resources.

In both of these scenarios, the first port of call is no longer the hospital, and the sharing of real-time data with health and social care professionals involved in a citizen’s care will bring wholesale changes to the patient journey.

Social determinants inform the journey
The World Health Organisation and other institutes confirm the powerful role that social determinants play in health outcomes: according to the Health Foundation, social isolation is associated with a 30 per cent increased risk of heart disease and stroke. Digital technologies promise to cheaply and effectively connect patients with agencies and professionals from different spheres, improving their health and employment chances, and creating a lifelong well-being journey.

Smart explains that if about 20 per cent of an individual’s well-being is related to the quality of healthcare and clinicians, then the other 80 per cent is influenced by social factors such as employment, housing, networks and neighbourhood. “The more we can understand and engage each citizen, the greater the opportunity to nudge individuals to make [the] right decisions to support their own health and well-being.”

It might be about taking medicine regularly, but equally it will be about accessing and engaging with services within their community. As Smart points out, “We have a medicalised view of healthcare and think it’s about doctors doing clever things. But it’s about so much more — helping people get access to services so they can live as healthy a life as possible.”

Societal benefits arise from joined-up journeys

The bigger, and equally exciting, picture of the digitally connected and transparent patient journey is one of a vastly reduced national health bill, and greater economic prosperity. Eliminating duplication or “counter-prescriptions” (that act against each other) of medication by unconnected parties is wasteful, while non-adherence is costly. Making earlier interventions in healthcare also produces better outcomes, liberating money for new research and treatments.

Connected ecosystems are financially beneficial because they enable different agencies to work better together and share the rewards of patient outcomes; professionals and agencies working across one network can share the economies yielded by disease prevention and avoidance of hospitalisations. Health workers, patients and supply chain members, enabled by consumer devices, can work together transparently across networks to deliver economies in new models that may peg healthcare costs to patient outcomes.

Shared ecosystems improve employee experiences

A final, but by no means trivial, aspect of a seamless and transparent patient journey is the higher levels of satisfaction it affords for patients and health workers. Says Smart. “When patients are surveyed, the scores spike at the touch points when they interact with clinicians — typically the process of administration and appointment management would score badly. Using digital to get the patient in front of right clinician would potentially be an easy win for patient experience.”

Equally, the aspects of their job that health workers like least are those where they think they add the least value. So, taking the paperwork and bureaucratic drudgery out of managing patients and letting the workers deliver care would improve the satisfaction of employees, too. Removing bureaucracy from the system would drive efficiency, making health systems more streamlined and liberating healthcare professionals to focus on care.

Digitally enabled patient journeys and care ecosystems are part of a new terrain and present fresh challenges that must be navigated. These include handling data privacy and patient consent securely, and sharing healthcare costs and savings (from better outcomes) equitably among healthcare actors. The advantages of moving from mammoth and separate healthcare systems to extended and connected patient journeys are huge — and the journey has already started.