Accessibility and inclusion in digital health
Accessibility and inclusion in digital health

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Accessibility and inclusion in digital health

6 Digital health and the patient/professional relationship

The NHS Five year forward view, published in 2014, had a vision that the NHS should be paperless by 2020. The National Information Board (2014) then developed a framework of action which would see patients being able to use digital technology to manage their health, e.g. booking appointments, checking medical records and communicating with health professionals with the use of the internet, Skype or texts.

Since 2014, implementation of digital health schemes has been driven by local commissioning groups in the form of digital road maps (Honeyman et al., 2016).

At the time of writing (2019) there are a number of innovative digital health schemes in place across England, Wales, Scotland and Northern Ireland. Some of these schemes are targeted at specific sectors of the population and are designed to involve service users being more in control of their health and in accessing services. For example, in Wales ‘Patient Knows Best’ is an online portal which enables patients with diabetes to instantly access their medical records. Patients are able to obtain up-to-date information on treatments, acquire medication from the online portal and access messages from health professionals. This information can be shared securely with different medical teams and carers, and take-up of the service has been good, although not all patients are joining. However, this example is just one of many. It demonstrates both the potential benefits of the service and also the challenge it represents for some patients who may not have access to technology, or even their own email address.

Digital innovation is also deemed to be beneficial to the individual person and professional relationship because it empowers the patient (Meskó et al., 2019). A patient-centred approach is at the heart of many digital interventions, often being designed and developed along with potential recipients. Along with initiatives such as e-health records shared among professional teams and patients, this approach can help decisions to be made jointly, with the individual driving choice and control. However, there are potential barriers to empowering the individual, for example, a lack of knowledge about technology, access to knowledge and resources as well as language skills (Meskó et al., 2019).

This is the focus of the next activity, in which you will explore digital healthcare delivery from Wales and Northern Ireland as well as the way it changes the relationship between an individual and a health professional.

Activity 8 Going digital across the nations

Below are links to two examples of digital health that have helped people to be more in control of their health. Read these examples and make notes, as these will enable you to answer the questions below.

Part 1: Wales

Wales [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] : turn to p. 50 of the PDF and read the case study, ‘Telehealth for frail elderly people in rural North Wales’.

Where is the digital health delivery service located?
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Who is it intended for?
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Describe briefly what it is about.
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What are the benefits and how has the service transformed the relationship between patients and professionals?
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What, if any, are the challenges faced by the digital health service?
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Discussion

Where is the digital health delivery service located?

Betsi Cadwaladr Health Board Area in Wales.

Who is it intended for?

Patients over the age of 85.

Describe briefly what it is about.

Remote healthcare through Skype and online consultations are provided at a local community hospital (rather than a city hospital) in rural North Wales where there is poor public transport. Patients see their doctor by telemedicine clinics at their local community hospital.

What are the benefits and how has the service transformed the relationship between patients and professionals?

It reduces the need to travel for many frail patients. There has been positive feedback, with over 83% of patients stating they would recommend the clinics to family and friends. A digital inclusion officer secured the support of the community to use the service by working in consultation with county councillors, local community groups, the local media, patient champions and representatives. This provided the opportunity to raise awareness of the service but also to dispel any myths or anxieties. It also removed the need to travel which some people find extremely stressful. Individuals can converse with professionals in real time, be reassured and be provided with the right information by the professional to help them make the right choices. This gives the individual access, choice and control about the decisions they make about their health and provides for a much more equal relationship.

What, if any, are the challenges faced by the digital health service?

Some patients may still prefer to see a health professional in person.

Part 2: Northern Ireland

Northern Ireland: read the press release.

Who is it intended for?
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Describe briefly what it is about.
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How has the service transformed the relationship between patients and professionals?
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What, if any, are the challenges faced by the digital health service?
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Discussion

Describe briefly what it is about.

Orion is a shared care record about patients’ diabetes. This means that health professionals can now access more information about the patients and this information is shared between trusts.

How has the service transformed the relationship between patients and professionals?

Patients no longer need to repeat to different health professionals what their symptoms or current state of health are, because this information can now be accessed in a way that enables those professionals to offer more appropriate treatment and advice. This information can now be accessed by different professionals who can provide more appropriate treatment and advice. As a result, this should reduce the risk of the individual becoming frustrated and tired and the professional has the information to hand to be able to provide better advice more efficiently.

What, if any, are the challenges faced by the digital health service?

The shared record might mean more shared information, and the right treatment can be provided, but it doesn’t mean it can promote the right behaviour; for example, lifestyle choices (e.g. exercise, a good diet) to keep diabetes in check.

You may have identified some real benefits to certain members of the population. However, implementing and using digital health is not without its challenges. Implementing new systems requires financial resources and some organisations have struggled to find the funds to implement digital healthcare due to the cost of buying the hardware (Macguire et al., 2018). There are also cultural organisational factors such as a workforce’s willingness to change and engage with new systems when they are already feel stretched (Macguire et al., 2018). Others might be reluctant, fearing that digital health reduces the human face of healthcare because some digital health schemes are conducted remotely. However, the benefits to many people living in rural areas have been improved health and wellbeing because individuals are now able to access services that would otherwise be challenging for them to reach.

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