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Revolutionary, chaotic, or stagnating? The future of digital tech in health and care in the UK

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Despite significant investment and well over a decade of different transformation plans and initiatives, there’s still much to do before the health and care system has truly gone through a digital revolution.

It is inarguable that the change process has already started, and the seeds we are planting now will determine the future of digital health and care. It’s difficult, perhaps impossible, to predict the future, especially considering the health and care system is complex. I’ve been wrestling with some questions to look deeper at the seeds being sown and understand where digital health and care is heading.

Is the development of digital tools being driven by the needs of staff and patients?

Suppose users (staff and patients) don’t drive the selection and use of new digital tools. In that case, these tools will likely not solve the fundamental problems facing the health and care system, and they may not fit workflows, creating inefficiencies and duplication. At best, a small subset of users is currently selecting new digital tools. This means only a subset of user priorities drives technology selection, making it unlikely solutions will fully address user needs. If the technology selected does not work for users, time and effort go into developing workarounds, adding more complexity to workflows and cognitive burden.

Are we developing digital tools that make life easier, better, and more effective for patients and staff?

For digital technologies to be the go-to solution, they need to work well for all staff and patients. This also creates a culture more readily accepting of the increased use of digital technologies. Currently, persistent fundamental problems mean high levels of continued dissatisfaction with digital technology. This can perpetuate a reluctance to engage in digital change.

The design and implementation of technology have a decisive determining factor in how it affects staff. Research shows electronic health records (EHRs), a key technology for the digitalization of health and care, can have below acceptable useability. This is linked to increased cognitive burden and burnout due to non-intuitive implementation into pathways. But we also know digital tools like EHRs can drive improvements in patient safety, safeguarding, and medicines optimization. Similarly, data-driven systems can improve population health and resource allocation, while AI can improve accuracy, reproducibility, and speed of services. But the technology also has knock-on implications by placing new demands on staff, with data-driven care meaning a need for higher quantities and quality of data but the limitations of digital systems risk highly skilled clinical teams becoming data clerks.

NHS Digital Academy and local training programs create a digitally competent workforce, increasing staff confidence to use and engage with the development of digital tools and pathways. However, the tools supplied need to work for digitally qualified staff without becoming technical experts.

Is technology helping or hindering greater equality in outcomes and access?

How technology and digital healthcare information are designed and implemented can exclude or include different groups of people based on the complex interplay of numerous variables, such as device access, skills, culture, and language. For example, a patient portal gives patients access to their health and care information but is often designed with a narrowly defined user. Instead of empowering people, they exclude many. Researchers of data-driven tools are concerned that their effectiveness depends on data quantity and diversity, which can be highly non-representative. This means it’s doubtful that a single solution will work effectively for each individual within a diverse community.

However, providers and services commonly prefer a single tool for a specific task. It’s likely the combination of procurement approaches and scarce resources incentivize this. National procurement sets a price cap but allows for local purchasing agreements, so the price can be negotiated locally often for exclusivity, locking in selecting a single tool. A diverse range of tools for various patients and staff could lead to better outcomes. Incentivizing using a single digital device and the difficulty of interchanging tools means settling for a digital agency with an unequal performance from one demographic to the next. This could mean unequal care services, risking worsening inequalities and unequal care.

Is there a sustainable supply of good value digital technologies?

The Secretary of State recently highlighted the financial sustainability of the NHS as a challenge, and in the long-term, we need to consider the role technology has to play. The common assumption is digitalization will cut healthcare costs, but this is only true if specific criteria can be met, including benefitting from consumer technologies, interchangeable tools, and preventing incumbent legacy tools. One of the many drivers of digital health transformation is the consumer technology boom. But consumer technology develops faster than medical and health technologies – robust regulation and evidence are essential to ensure safety, efficacy, and value, but this takes time. The military and defense sector invests heavily in technology and has been caught by the increasing cost of trying to maintain legacy technology. A long-term strategy for digital health needs to ensure the health and care system can have a vibrant supply chain at national and global levels to keep costs competitive and encourage innovation while avoiding embedding incumbents.

A dynamic implementation environment must complement a vibrant supply of digital tools – arguably, one cannot exist without the other – but the NHS struggles with scale, spread and adoption. The digital health technology ecosystem is incredibly fragmented and consolidated in different parts. Historical approaches to digitalizing in siloes and by tasks have created a health and care system beset with siloed technologies with varying degrees of overlapping functionality. This constrains the supplier market dynamics as the incumbent systems grow in complexity and capability, becoming more challenging to replace. New entrants have higher barriers to entry which stifles innovation and reduces the leverage alternative solutions enable. This creates a supply chain where suppliers face significant challenges becoming established or scaling.

Today’s seeds turn into the fruits of tomorrow.

The vision for digital health and care is compelling. We’ve seen and experienced how transformative it can be in each digitalization sector; sectors are as diverse as banking, media, and transport. We’ve learned about its potential in health and care, and while it’s yet to be realized, there’s been tantalizing glimmers of potential.

However, in our rush to digitalize, the seeds we are planting today are not necessarily the ones that will grow the fruit we aspire to have in the future. Instead, we may have tools that poorly suit the problems we seek to solve, add burden on staff, become increasingly expensive while increasing inequalities. Focusing on achieving digitalization isn’t enough; there’s an equal need to scrutinize the future state of digital health and have a more active role in shaping how digital tools are developed, supplied, and implemented.

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Florida woman pays $6,000 for Coronavirus and associated tests at AdventHealth.

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One day, your body starts aching. You begin to cough and can’t catch your breath. You have just returned from an overseas trip. You think you have the Coronavirus.

You do exactly what you are supposed to do. Reach out to your primary healthcare provider. The doctor tells you to go to a local hospital and get tested. So you get tested.

You are then hit with medical bills that exceed $6,000.

Sounds like a bad dream, right?

After receiving a test at AdventHealth, DeLand, a Volusia County resident, shared her medical bills with The Daytona Beach News-Journal.

Due to the stigma associated with Coronavirus, the woman requested that her name be kept private. AdventHealth officials declined to comment on the newspaper’s request.

The woman said she didn’t know that testing would be so expensive. According to everything she read, she believed that the test was free. The ER visit and a series of unrelated tests she received led to a bill she is still trying to understand how to pay.

After undergoing coronavirus testing, a DeLand woman aged 23 received her initial bill from AdventHealth DeLand.

The 23-year-old DeLand woman said she felt fine after returning from Spain on March 17. After teaching English abroad, she returned to the United States after coronavirus cases began rising in Europe.

She said she had a headache and a fever the day she returned from Spain. After her fever had spiked, she called her family doctor on March 19, and they diagnosed her with a mild cough. She also began experiencing chest irritation.

AdventHealth DeLand was recommended to her. This was before coronavirus testing expanded throughout the state. The only option for testing was through the Florida Department of Health or local hospitals.

She said she was directed straight to the entrance for those who believed they might have COVID-19 when she arrived. The hospital staff performed various tests on her, including one for the flu and one for strep. A chest X-ray was also performed.

AdventHealth

The woman explained that she had only gone for the coronavirus test and that they did tests she didn’t request. They didn’t ask me questions about them or whether I wanted them. They said that they would do this, that, and this. I should have stated that I wouldn’t say I liked the other stuff. It was just something I felt had to be done.

The staff should have told her what it would cost or how much she would have to pay.

She said, “I assumed it would most likely be free because coronavirus testing was free.”

She was sent an invoice for $4,356.28 after her initial visit. She was charged for IV therapy, laboratory services, pharmacy, and emergency center fees. Because the bill did not include it, it is unclear if she was accused of coronavirus testing.

Three weeks later, she received a second bill for $1969 for ER physician services.

She said that she and her dad were frustrated. “Disbelief that coronavirus testing should be free, but it’s misleading that you go to the hospital and get tested. No one warns you or asks if it will cost you hundreds of thousands.”

AdventHealth was asked by The News-Journal why patients were receiving tests they did not request and why patients needed to be informed about the cost of the tests before they were performed. A spokesman JeffGrainger asked for the patient’s name, which The News-Journal gave him along with consent from the woman.

In the past two weeks, the newspaper made multiple unsuccessful attempts to obtain additional information from AdventHealth.

According to the woman, her father tried numerous times to contact AdventHealth to inquire about her bills.

She said Wednesday that Mike, AdventHealth’s customer service director, called her twice to get me to pay the bill. “He claimed that the coronavirus charge wasn’t on my bill, even though I only requested it at the hospital. I was not given a choice about the treatment I received.”

She said she must pay $871 of the first and second bills totaling $2,840. She claimed she had Spanish health insurance through her employer. However, the policy is no longer valid in the United States.

She stated that she was asking the hospital to review the charges and remove them.

She was even more frustrated when her coronavirus testing came back three days later.

Her 56-year-old mother and her 20-year-old brother, with whom she lived with her 64-year-old father, were tested at the Florida Department of Health office in Daytona Beach. They did not have to pay for the test, and they didn’t receive additional testing.

Holly Smith, the spokeswoman of the Volusia County FDOH office, said that “when the Department of Health conducts a testing, it is part of an epidemiological investigation.” This includes taking a history. It has no additional tests or exams and is free to the patient.

The mother of the woman tested positive for the virus. Although her brother was negative for the virus, they believe he may have contracted it while studying in London. Her father was not tested for the virus.

The woman believes she is fortunate, except for AdventHealth’s bill. She was able to stay at home throughout her illness. Her fever lasted only 24 hours. After being tested, she had only a slight cough and chest irritation for 12 days.

She said, “I feel fortunate, I suppose.” “It’s a very new virus, and they don’t know why some people are more affected than others.”

Her mother, however, had worse symptoms. She had a mild fever, cough, and fatigue for four days. Her symptoms lasted longer than those of her daughters.

She stated earlier that she was more concerned about her mom’s health since she had a positive test. “Mostly, I am worried about my parents.”

She advised others to verify the cost of testing at the beginning.

“I appreciated their thoroughness, but I didn’t anticipate how much it would cost.”

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