by Dr Murray Ellender

A quick look at the long overdue digital health revolution

Murray Ellender discusses AI, online consultations and integrated care in the British Journal of Healthcare Computing

The healthcare sector has been relatively resistant to digital transformation compared to other industries – the NHS remains, after all, the world’s largest purchaser of fax machines. Yet it’s clear the tide is beginning to turn: by the end of 2018, every NHS patient in England is expected to be able to consult online with their own GP. Within five years, nine out of ten consultations are likely to start via a digital platform. The health technology space is blooming.

For many of us working on the frontline, this digital revolution feels long overdue. Pressure on the NHS is greater than it has ever been, and this is no more acutely felt than in general practice. With an ageing and increasingly complex patient population, demand for appointments is rising – but issues with recruitment and retention mean the number of GPs is not keeping pace. Harnessing technology to support new ways of working remains critical to the future of primary care, and to the NHS as a whole.

Innovative new ways of consulting

Fortunately, the challenges facing today’s general practice have also presented opportunities for creative thinking and innovative solutions. eConsult is one such example. Born out of frustration at the confines of the traditional GP consulting model – which has remained resolutely analogue in an increasingly digital world – eConsult is now the most widely used digital triage tool in the NHS, connecting millions of patients to their own GP online. In a world where we are used to accessing everything at the click of a button or swipe of a screen, this feels like a natural next step.

A number of different online models are currently being tested within the NHS, including algorithm-led, digital triage platforms, such as eConsult, as well as those predicated on artificial intelligence (AI) and video. Video consulting is often the first thing people think of when it comes to online consultations, and even though there are certain situations where it can work very well, current NHS IT infrastructure is unfortunately not at a stage to support its roll-out at scale.

There is also the issue of efficiency: video consultations may be more convenient, but they don’t they actually save any time. To make video consulting work, you still need to coordinate ten minutes of GP time and ten minutes of patient time in front of a camera. Asynchronous online tools, however, allow patients to seek advice from their GP at a time and place that suits them. Serious or sinister symptoms raise a red flag immediately, while more routine concerns can be dealt with remotely, saving both GPs and patients precious time.

Artificial intelligence – the future of medicine?

There has been a lot of interest recently in artificial intelligence and its potential to revolutionise the health sector. From interpreting medical images to predicting disease patterns to large-scale analysis of patient data, AI holds huge promise for both the treatment and prevention of disease.

But does an intelligent chatbot really provide a viable alternative to consulting with a doctor? I would argue at this point, no. AI has yet to prove its efficacy, accuracy and, most importantly, safety, when it comes to clinical decision making. That’s not to say it won’t play a vital role in the future: as the technology becomes more sophisticated, AI will almost certainly begin to supplement and support healthcare professionals in their decision making processes. But that does not mean robots will render our human profession obsolete. Like all technological innovations, advances in AI should be focused on enhancing the doctor-patient relationship, rather than replacing it.

Connecting primary and secondary care

The digital health space is a dynamic and fast-moving one, and online consulting is just the beginning. Our next focus is how we can use this technology to improve integration of NHS services and truly transform the patient journey. eConsult is pioneering a new integrated primary and urgent care system in Bexley, South East London, which connects residents to their local GP surgery and urgent care centre via an NHS Online app. The app triages patients from home, signposting them to the right place at the right time so they receive the most appropriate care as quickly as possible. The pilot has already seen promising results, reducing inappropriate appointments, improving patient outcomes and taking the pressure off an overstretched system.

There’s no doubt that general practice will look very different in ten years’ time than it does right now. Tomorrow’s reality will be one where walls no longer matter; where smart healthcare will be available to everyone, 24/7, and where patients will no longer go to their GP surgery, it will come to them. As the digital landscape evolves, it’s vital that we develop these technologies as an integrated part of established general practice. Only then can we, and our patients, truly reap the benefits of digitally-enabled care.

This article originally appeared in the British Journal of Healthcare Computing