The digital-first health strategies adopted by several countries to control the spread of the virus have irrevocably rerouted the way healthcare systems function. Remote monitoring and telehealth platforms, AI-powered assessment apps and devices; these have all become the new norm.

The UK is a prime example. With strong inroads already into digital health, its growing partnerships encouraged a healthy tech sector meaning that, when COVID-19 struck, many companies were offering solutions by adapting software that already existed, rather than starting from scratch.

Partner adoption

One such partner was Ada Health, the personal health companion provider that helps identify ailments by responding to symptoms and data supplied by patients. With a strong focus on the UK and Germany, they recognised the need to adapt their product as the virus started to spread beyond China. “Several weeks ago we modelled COVID-19 in our knowledge base so that it was one of the conditions that would be considered [in] a standard Ada assessment,” explains Dr Claire Novorol, Ada Health’s co-founder and chief medical officer, in an exclusive interview with Healthcare IT News.

Incorporating COVID-19 into the bank of potential diagnoses on the Ada app was an important step, but the team wanted to go further. “People [were] searching specifically for COVID and asking: ‘do I have it and, if so, what do I need to do?’,” continues Novorol. Consequently, Ada built a new app that specifically screens for coronavirus. It adheres to WHO guidance, asking multiple comprehensive questions in order to identify whether the patient is suffering from major (e.g. cough, exhaustion) or minor (e.g. muscle ache, loss of smell) symptoms, whether they may require urgent medical treatment and whether they have any preexisting medical conditions that make them high-risk. It also provides personalised guidance tailored to the particular conditions submitted by the patient, including whether or not they ought to seek further medical assessment.

Crucially, the screening app is being adopted by Ada partners, who are integrating it into their assessment strategies. This is a core part of Ada’s solution. “As much as people can get detailed information and guidance specific to their situation online, that reduces the number of people that need to make a phone call to triage lines, GPs or other health providers, freeing up that capacity for those who really need to speak to someone and seek care.” This is also true of the original Ada app, which will free up frontline services by eliminating a number of unnecessary consultations and guiding patients to an appropriate care solution.

Identify, manage and engage

Digital strategies are not limited to diagnosis and assessment. Orion Health, for instance, are offering their Outbreak Management Solution to reduce pressure on acute services. The system is split into three modules: ‘Identify’, to identify patients for remote monitoring and care; ‘Manage’, to manage patients preparing for hospital admission and, where appropriate, post-discharge; and ‘Engage’, a portal connecting patients and healthcare providers which enables results and enquiries to be messaged securely, reducing the need of hundreds of phone consults. Gary Birks, general manager for UK and Ireland at Orion Health, explained the solution: "The intention is to reduce the inevitable burden that virus outbreaks can place on an already stretched health service. We want to alleviate spikes in demand, reduce the risk of further spread of the virus and flatten the epidemiological curve. Our comprehensive solution strongly supports the shift to a virtual care approach.”

There has also been a shift towards using big data to inform solutions or pushing through technologies that do not meet GDPR or Data Protection standards. Although well intentioned, there has been some controversy as to the extent that companies like Palantir and WhatsApp have access to confidential health data. In an exclusive interview with Healthcare IT News, digital health advisor and former director of digital development at NHSX, Sam Shah, was clear that appropriate regulations and data protection cannot be a long-term victim of digitisation. Commenting on the relaxation of information governance, he said: “In order for us to infringe those fundamental freedoms and protections [of data privacy], we should have a very good reason to do so. There might be good reason to relax the rules for a period of time, however there will come a point where COVID-19 will not be something we’re facing and, at that point, how are we going to clear up what’s left as a result of relaxing the rules now?”

Shah continued: “Organisations across the NHS are trying to digitise and use remote working far more than they were before and the pace and rate of change is certainly much greater than it’s ever been.” He cited how, as recently as last year, he was arguing for the continued funding of NHS 111 online triaging service, which has subsequently become an integral part of the coronavirus response, inundated with traffic from concerned citizens in many multiples its usual rate. He thinks that after the crisis, there will be more support for these diverse digital services.

Exposed health inequity

COVID-19 has highlighted the need for larger structural change. Shah said: “[The pandemic] will change the way people behave, the way the health service is viewed and it will probably also change the responsibility deal between citizen, state and health.” The key word that comes up is ‘accessibility’. For instance, if health services continue to digitise then there needs to be a reciprocal availability of internet for all, regardless of cost, so as not to limit access. “With coronavirus, we have really exposed the fact that there are significant health inequalities in society and significant health inequity,” Shah concludes. “As we move towards a new world afterwards, we need to address these and work out how we can make digital services more accessible to those that need them most, even the most deprived. Digitisation could be one of the ways we do that but it needs support and funding.”