What should be the digital priorities for integrated care systems?
If we want people to have longer, healthier and more independent lives, we have to think about much more than just healthcare.
Imagine someone with diabetes, who is struggling to manage their blood sugar levels. If that person lives in a bedsit and only has access to a kettle and a microwave, simply instructing them to “improve their diet” will be a struggle. You have to look at all their circumstances to identify the best intervention.
The new integrated care systems (ICSs) are designed to address precisely this problem, by taking a holistic, person-centric approach to health and social care. We’ve already seen that this cross-organisational approach can work, in the incredible emergency response to COVID-19.
Technology will be key to building on these partnerships to meet the backlog of post-pandemic healthcare needs. Guidelines from NHS England say that by April 2022 every ICS should look to have smart digital and data foundations in place.
Technology can be a powerful tool for connecting teams and empowering patients, but there are hurdles to overcome. In my time in the NHS, I often saw people carrying two laptops to every meeting – because each one could only access certain networks. We want to provide integrated care, but right now the technology isn’t always integrated.
Likewise, we need to think carefully about how we use technology to ensure that no one is left behind. People who are digitally excluded tend to be excluded in other ways too and can face stark health inequalities. Digital inclusion will be crucial to the success of ICSs.
So as integrated care systems transform in the months and years ahead, where can technology have the greatest impact – and what should our digital priorities be?
The digitally empowered patient
Integrated care services are built on the concept of personalised, patient-centric care. This isn’t a new idea; healthcare has always been tailored to each individual person. You might have medication out of a box, but how it’s delivered to you and how you take it is decided through consultations with your healthcare professionals.
Going forward, digital can help to complement and extend that personalised care, in particular supporting patient activation. Technology can help people to both understand the outcomes they should be looking to achieve and get feedback on progress to improve their overall health.
Integrated care providers can use digital channels to provide guidance – and it’s straightforward to tailor generic information to specific conditions. For example, someone with diabetes that reports a HbA1c of over 50 could be directed to personalised advice on the next step to take.
Once patients are armed with this information, digital devices provide a way to measure and record different aspects of their health, from scales and blood pressure monitors to smart watches. And finally, when people do need to access care, online portals can make it easier to arrange appointments flexibly, to suit their working or lifestyle patterns.
With this combination of insight and feedback, patients can become more engaged and activated – supporting the IC principle of earlier, more effective and cost-efficient intervention. But it is critical that no one is left behind. Every digital strategy must include measures to improve digital inclusion across society, working with frontline staff, volunteers and technology experts. Like so many healthcare interventions, digitally empowered patient care will only be truly effective if it reaches everyone.
Creating connected, secure services
Integrated care systems involve a wide range of participants, from frontline staff and clinical leadership teams to back-office functions and volunteer services. From the digital perspective, every stakeholder has to be able to cross over traditional organisational boundaries, accessing different datasets, systems, networks and even buildings to collaborate effectively. It’s time for an end to the “two laptop” solution, moving instead to a more integrated model.
ICSs will need a unified digital front door. This means bringing together disparate networks and data centres, aligning communication systems and enabling staff to collaborate seamlessly. It might seem like a big undertaking, but with technology partners it’s possible to make incremental changes and build on the infrastructure already in place.
Security is another critical component for keeping IC services safe and private – and again collaboration is key. Today, cybersecurity threats are extremely complex, so we need to enable organisations’ security specialists to work together and share expertise and resources.
To create a security envelope around the ICS, teams should align on everything from technologies to threat responses and staff training. Choosing technology with security built in, such as software defined wide-area networks (SD-WAN), will help. Importantly, a single pane of glass view will enable teams to respond to any situations quickly, so should be a consideration for every digital plan.
Everything starts with the front line
Digital strategies need to be much more than a piece of paper. The most effective plans are built on consensus – and that means listening to the real issues on the frontline. IC leaders should begin their planning with a consultation, to understand the challenges faced by carers, nurses, volunteers and everyone providing services to patients.
Bringing in all of these community assets is the best way to understand patients’ needs in a particular area. Voluntary teams, for example, can give a clear view on digital exclusion and the best ways to engage people with new services.
It’s also valuable to work with technology specialists as early as possible – before, rather than after, the strategy is decided. These experts can help you to understand what’s possible with digital tools – and the most effective ways to support the frontline. Technology organisations can also share insights from other countries and even other sectors, to create the most effective strategy possible.
It’s important to remember that technology also offers an opportunity to improve the working lives of people on the frontline, through hybrid working. With effective video conferencing and remote collaboration tools, multidisciplinary meetings can involve people working anywhere, from hospitals to patients’ homes. This can save time and offer greater autonomy for workers.
Hybrid working represents a cultural, as well as a technological, shift, and it’s necessary to establish new practices so that everyone can participate fully, wherever they are. Ultimately, this hybrid working model can enable us to create more flexible and family-friendly jobs, helping to attract the very best talent to frontline roles.
Realising the potential of integrated care
Integrated care could bring enormous benefits for both health and social care providers and the people they serve. It’s a model that can lead to better outcomes for patients and support the efficiency needed to meet the post-pandemic backlog. But using technology in the right way will be key to ICSs’ long-term success.
Listen to frontline workers and use technology to empower them and their patients. Put collaboration at the core of the digital strategy, whether it’s aligning security specialists or supporting hybrid working. And critically, focus on digital inclusion across the community, so that no one is left behind. That way, integrated care can deliver on its huge potential.
Want to hear more? I recently joined a panel with the Health Service Journal on this topic – watch it here.