In my 2019 report 'Future Health, Care and Wellbeing' I identified a trend towards healthcare being delivered remotely and the use of digital technology to monitor patients. COVID-19 has accelerated this trend dramatically. At the height of the pandemic, patients were forced to consult family doctors (GPs) and nurses over the telephone, online or via video link, depending on the patient’s needs. The risk of spreading such a contagious infection was far too great for in-person consultations.
For many patients, phone consultations sufficed and the global use of 'telemedicine', as this type of care delivery is known, was 78 times higher in February 2021 than it had been a year earlier. Surprisingly, it has since stabilised at that vastly increased level, most likely due to familiarity and convenience.
For those patients who needed to 'show' their doctors their complaint (e.g. a rash), low-cost video conferencing using free-to-use software such as Zoom, Global Meet and Microsoft Teams provided a visual link. Luckily, network speeds (cellular and broadband) had increased in most countries before COVID-19 struck and this made video calls easy and effective, while the free-to-use software for video meetings was also mature and easy to operate.
Doctors were forced to 'see' most of their patients using new technological methods, while patients were also forced to get to grips with the technology necessary to consult their doctors. Of course, not every patient was able to access healthcare this way. The very elderly, the disadvantaged and the disabled were often unable to access or work the smartphone or computer technology required for video conferencing. Family members and carers frequently had to step in to help. GPs and nurses prioritised older patients, those patients shielding and patients with poor mental health for the few carefully sanitised in-person consultations that did take place.
Telemedicine, long touted as a huge potential efficiency benefit for primary care, was forced on medics and the community and, as the pandemic ebbs, there seems little chance that primary care providers will revert to seeing their patients in person for routine consultations. The pandemic has performed a feat of social engineering on public health; previously resistant doctors and hesitant patients have been dragged into the future of remote medicine by COVID-19.
Early reports suggest that patient satisfaction with telemedicine has been high – which may come as a surprise to many medical professionals. Patient surveys around the world typically report satisfaction levels above 70%, although many surveys pointed out that previously established trust between doctor and patient was a key component of reported satisfaction.
COVID-19 has stretched healthcare providers almost to breaking point and the future adoption and practice of remote consultations online and via telephone is providing the primary care sector with a lifeline.
Hospitals around the world were overwhelmed by COVID-19. As the number of mortalities grew, governments frantically built extra emergency hospitals and morgues, pulled doctors and nurses out of retirement and scoured the world for supplies of personal protection equipment for front line staff. In tandem, legislators rapidly passed draconian laws restricting public travel, personal movement and socialising. Those workers who could do so were instructed to work from home (a move which is now creating a whole new social revolution on its own).
Under intense pressure, hospitals were forced to strip back the services they offered. Elective surgery had to wait, routine patient hospital outpatient visits and follow-ups were either cancelled or were carried out remotely wherever possible. As a result of this experience, hospitals have been re-thinking how they will deliver many of their services in the future.
Remote care using a variety of technologies has now become an important goal for all public health services - as predicted in 'The World In 2040'. The long-touted ideas of 'distributed hospitals' or 'virtual wards' are now becoming reality. We don’t yet have widely accepted language or terminology for such developments: the concepts are too new.
Essentially, the pandemic is forcing healthcare providers to seek to adopt working practices that were not expected to be in general use until the mid-2030s. In the UK, the government is recruiting retired doctors and nurses to come back into service, some to work in hospitals and some to work from home, monitoring patients in 'virtual wards'. The aim is to keep non-acute patients at home in their own armchairs and beds using wearable and ambient sensor technology to monitor patients’ health status and care requirements online.
Non-critical patients treated at home in a virtual ward will have an array of on-body sensors, including finger-tip oximeters which will measure the important metric of oxygen levels circulating in their blood. Other sensors will detect and record pulse rates, body temperature, sleep patterns, blood glucose levels, respiration levels and the heart’s electrical activity. Patients with respiratory problems can use a wireless stethoscope which will allow doctors to listen to lung performance remotely. For babies, there are even smart socks which will keep track of vital signs. At the beginning of treatment, nurses will visit patients to setup the sensors and to instruct families/carers in their use, battery recharging and general trouble shooting.
Unlike existing hospital equipment, home patient technology will be wholly wireless and will transmit results via the networks to the doctors and nurses who are remotely monitoring the patients. For nearly all patients this would be preferable to lying on trolleys in hospital corridors, as so many patients had to do during the COVID-19 crisis.
The goal is to distribute hospital services out into the community. HealthTech – as the digital healthcare sector is known – has evolved from wearable fitness trackers such as FitBit and Garmin wrist devices, the Apple Watch and dozens of other specialist products such as Withings health watches and Samsung wrist devices.
Today, HealthTech devices offer consumers and medics virtual snapshots of a body’s vital signs, with such data stored on devices for weeks (and with permanent storage available when the data is transferred to an external device such as a smartphone).
As the virtual ward develops and more 'hospital patients' are treated at home in their own living rooms and beds, other sensors and monitors will provide additional information about the health and well-being of the patients to medics (and carers). These wireless sensors will include mats which can detect changes in a patient’s gait, cameras for patient observation (with permission from patients and families), motion sensors, electric plug and switch sensors, door sensors, humidity sensors and ambient temperature sensors.
Taken together with the patient’s personal vital sign information and general bio-data, this information will provide an even better view of how a patient is doing than can be achieved in a traditional hospital ward. Regular phone calls from nurses and doctors to discuss patient progress will provide human monitoring while physical nurse and doctor visits to the patient will be scheduled by routine and as required, according to the patient’s needs and health progress.
In the near future, monitoring patients in such 'virtual wards' will become less time-consuming and onerous for medics as artificial intelligence systems (AI) assume the role of monitoring the patients 24 hours a day. If an AI system detects an unexpected change to a patient’s temperature, heart rate, gait, respiration, blood oxygen level or blood pressure, the AI monitor will alert human medics who will intervene as required.
It may sound like science fiction, but such 'virtual wards' will become the normal experience for 'hospital patients' suffering from non-urgent chronic conditions in just a few years (and 58% of in-patients in hospital in the developed world today suffer from chronic rather than acute illnesses).
“.. virtual wards” will become the normal experience for “hospital patients” suffering from non-urgent chronic conditions in just a few years..
This is the future of hospital care in the developed world and, for those lucky enough to have a carer support system which facilitates care provision in the home. Medical treatment in such 'distributed hospitals' will provide even more detailed care than that now provided by today’s crowded and overworked physical hospital wards. And the risk of patients at home contracting C-DIF or MSRA infections during treatment is virtually eliminated.
