During the coronavirus crisis, the use of technology has been accelerated across Wales, significantly increasing the number of people accessing healthcare advice and services from their homes. There has been a national roll-out of video-consultations supporting key services including GPs, community nurses, mental health teams, midwives and diabetes clinics to maintain a visual link with their patients.

The Welsh government has supported the Digital Communities Wales programme to expand their digital device loan scheme by 1,100 devices and are prioritising the supply to care homes, so residents can continue access to health services. Welsh health minister, Vaughan Gething, has said that new virtual-consultations fast-tracked to support non-contact consultations in NHS Wales during the coronavirus pandemic, is here to stay.

Ifan Evans, director of technology, digital & transformation, Welsh Government Health and Social Services, has lead responsibility in Wales for digital and technology policy, strategy and transformation, innovation and industry engagement. Evans works closely with NHS and social care leaders across Wales, and with other key stakeholders, to drive strategic change.  

In September, he will be speaking at HIMSS & Health 2.0 European Digital Event on the topic of, ‘Critical Care in Critical Settings: Lessons Learned from COVID-19 Preparing for the Next Wave.’

In this interview for Healthcare IT News (HITN), Evans talks about the digital strategy that Wales has adopted during the pandemic and the digital innovation he hopes to see deployed in the future.   

This interview has been edited for length and clarity.

HITN: Can you give our readers a summary of the digital strategy that Wales has embarked on during the pandemic?

Evans: I think “strategy” is probably a bit of a retrospective way to describe it. It didn’t feel like a strategy at the time, it felt like a very urgent tactical response and a prioritisation approach. We moved to gathering all of our digital system leaders three times a week and making decisions in that kind of rapid environment.

Our first priority was enabling remote working for clinicians. A lot of them out of necessity were working from home, because hospitals were being repurposed to other things, because they were unable to meet patients face to face, or because they were themselves self-isolating during lockdown.

Alongside that, we prioritised enabling patients and the public to access health services over video. Through the remote working capabilities we were giving our staff, we were making telephone triage and telephone consultations work, but we felt we needed to do more on video. We put a lot of effort into video for things which needed a visual engagement. 

And thirdly we also strengthened our network infrastructure to cope with the additional demand of lots of remote working, video-consultation and video teams working within service. There was a significant bandwidth increase needed across the system, as well as things like reinforcing VPN servers and other key elements of the network infrastructure.

We rolled-out new tools on a phased basis. For video-consultation, it was General Practice in April, then we started running secondary care in May and early June and then from late June we extended that to the remainder of primary care, pharmacy, opticians and dentists. We now have universal coverage of video-consultation across all health and care services in Wales. On remote working, we deployed Microsoft Teams to the entire NHS Wales workforce within about six weeks by early May. There was an Office 365 deployment programme already in place, going at a traditional pace over three years. We drastically accelerated and made Teams the first part of deployment, rather than the last.

HITN: Are there any updates on the Welsh contact tracing strategy?

Evans: We had been doing localised contact tracing as part of the containment phase across the UK in February and early March, but we realised that we needed to build something that was capable of national scale. Starting early May, we scoped the market, completed commercial discussions, built, configured, tested and deployed an all-Wales contact tracing platform. The system went live at the beginning of June, with just under 2,000 users, in teams employed by 30 different organisations. We deliberately organised as a local and regional approach to contact tracing in Wales, rather than a central national one. We rolled-out version two early in July and version 2.5 early August. We’ll have version three by September. This fast track and sprint approach I would say was more tactical than strategic. Certainly, that’s how it felt at the time.

HITN: What are some digital tools you think that will stick in the next wave? And what are things we will leave behind?

Evans: I think remote working and video-consultation is going to stay. What we’ve seen is that as GP surgeries have re-opened their usage of video-consultations has scaled back a little. They’re still using video but not as intensively as they were, now that face to face is available again. But in secondary care, we’re still very much on an upwards trajectory in terms of usage of video-consultation. I think in all areas of health care and delivery in Wales, we’ll see video-consultation being persistent and remaining, and I think we’ll see remote working and home working being persistent and permanent as well.

Contact tracing and apps at some point will dial back a bit, and will potentially morph into something different. At a national level, contact tracing and apps dedicated specifically to one illness like COVID-19 is something that I would hope we wouldn’t have three years from now. But having a national CRM system for direct engagement with the public? Maybe. There’s a lot of learning to be taken from the way that we’ve structured a national digital platform with local and regional delivery teams. I would hope we can, when we’ve got a bit more headroom, explore how we can translate that into certain other areas, like supported rehabilitation, self-management of chronic conditions, mental health, and targeted early intervention activity. For example, when we ask people to self-isolate we contact them daily just to check that they’re still self-isolating - they get regular personal contacts through the tracing system, and that’s not a million miles away from checking in with people who suffer from any other chronic condition.  

HITN: What has been the general collaborative relationship with the rest of the UK? Are there areas you feel Wales was ahead of the curve? If so, are there things other countries can learn from Wales?

Evans: I think there’s been generally very good collaborative working. Certainly, we’ve worked closely with the department of health and social care, NHS England, NHS Digital, NHSX, on a whole variety of different things. One of the standout examples is the UK test booking platform and the way the networks of COVID-19 testing facilities work, and the way we’ve integrated that into our own systems in Wales. There has been close and constructive working between health systems. We’ve also worked closely with the Information Commissioner’s Office and others in terms of how we’ve been able to relax some of our usual data protection requirements, in a controlled way, in order to support sharing of information.

There’s been a lot of cooperation and people being focused on getting things done, and that’s been good. It’s not the right approach for everything but there are still opportunities to share learning. For the Wales-only CRM system, we worked closely with Microsoft, on the software, hosting and development, and we’ve been able to share how we did that, with other devolved administrations and with England, so they could learn from us. We have learned things from them as well. There’s been a lot of open learning as well as a lot of close collaboration and joint working.

It hasn’t always been smooth, because there are different policy choices being made about the speed of relaxing lockdown restrictions in different parts of the UK, but at the operational level, with the digital tools that we need, it’s been very collaborative and productive working.

HITN: What are your hopes for digital transformation in the next few months? 

Evans: I would hope to see a recognition of the value for money that digital has provided. The amount of money spent on bringing forward digital deployment is relatively small compared to the cost of PPE, field hospitals, even the cost of additional staffing. When you look at digital health spend it is almost microscopic in the context of the economic support that there’s been across the UK, but digital has been absolutely essential to enabling systems to continue to work and maintaining essential health and care services.

Everybody is using video-conferencing routinely, so in a sense, everything else that we’re doing in response to COVID-19 is being enabled by digital. Digital is a major enabler of the test, trace and protect approach in every single country. I think digital has been absolutely critical, and it’s been cheap compared to lots of the other things we’ve had to do in response to COVID-19. I’d like to see that being widely recognised, because the digital leadership community has often struggled to make the case for the benefits of digital spend, and I think there’s a real opportunity there to change people’s appreciation of the return on investment.

HITN: Are there any innovations or digital developments we can look forward to?

Evans: The other digital development we can look forward to is that we are going to see a big step forward in the use of real-time data analytics. Test, trace and protect is close to real-time stuff, it requires the pooling of data on health conditions across geographies and from different sources, and I think the learning from that, and the experience from having done that, is going to roll into managing other conditions across health and social care.

I think we’ll see new or more prominent digital technologies outside of hospital. Most digital health technologies focus on in-hospital services, but a lot of what we’ve had to do in terms of COVID is shifting things out of hospitals. So whether it’s enabling patient self-management, or digital infrastructure, or point of care testing in primary and community care, or enabling people to have appointments without having to go into hospital - I think we’ll see a growth in these areas and that’s very welcome. I hope everybody recognises that we want to be using digital and technology to move services out of hospital and to empower patients and put more into their hands.

I’m maybe being over optimistic with this last one, but there’s a very strong preventative element in responding to COVID-19. The objective is to stop people catching it in the first place. As part of test, trace and protect, the reason you trace is to give people advice they can then act upon in order to not catch it or spread it further, and that’s something that health systems have always struggled with. Health systems tend to be reactive, with an emphasis on treating people when they become ill. In that sense it’s not really a national health service, it’s a national treatment service. All the effort that we’re putting in now is trying to be preventative and to stop COVID-19 before people have got it. I’d like to hope that some of the tools and technology that we’ve used for that will be used to prevent other illnesses, in a way that shifts the balance of our health system.

HITN: Are there any additional comments or topics you want to cover?

I think it is an exciting time for digital transformation. Of course, there have been some hiccups and failures, but we’ve learned from those quickly, and I think digital is overall working well and has made a real difference in our response to COVID-19. The appreciation and understanding of digital technologies and what they can offer has been boosted, and I hope we can hold on to that in the next few years.

Thank you for your time. More information about HIMSS & Health 2.0 European Digital Event (7-11 September 2020) can be found here.