‘Never let a good crisis go to waste’: the future of digital health

Commentators will argue the source – Churchill, Machiavelli, Alinsky, Harbison – but the phrase 'never let a good crisis go to waste' has been cited many times during the COVID-19 pandemic.

While nothing compensates for the terrible global tragedy of the thousands of lives lost, crises often present an opportunity for change. Nowhere is this more apparent currently than in the field of digital health. 

The uptake of online consultations, video calls, and general use of digital technology has increased more in the last four months than the last ten years. Although this is satisfying for those of us researching barriers to digital health and working collaboratively to overcome or find ways around them, there is also a tinge of disappointment. Is all that prior research now worthless?

Does a four-year PhD study [1] that examined how to get care homes to make better use of video calls become immediately obsolete when prohibition of visitors means the NHSX introduction of thousands of Facebook Portals becomes overwhelmingly the obvious route? Are the identified learning needs of clinicians in using video calls to support families at end-of-life [2] unnecessary because it is going to happen anyway? 

Are our studies, more than halfway through, of the implementation in Devon and Cornwall of the online GP consultation tool eConsult and the remote monitoring system, myCOPD, now irrelevant? Or could they actually be more relevant?

How do we re-interpret previous and ongoing research on digital health implementation?

Operating within the coastal and rural south-west peninsula of Devon and Cornwall has meant facing the problem of isolation, loneliness, and distance to stretched health and care services. This was already our ‘normal’. Because of COVID-19, the lockdowns that were experienced across the UK and around the world meant isolation has now also become a national and global challenge.

COVID-19 hit as our eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC) project, run from the University’s Centre for Health Technology, was coming to the end of its first three years and transitioning to a further three. Pre-COVID-19, one project was to ‘normalise’ use of smart speakers in care homes – for the benefit of residents, but also to start the development of a market for voice-activated solutions in health and care within Cornwall. 

Working with the care sector, we installed 150 Amazon Echo spots in two thirds of all care homes in the county – it took six months. We found they were used mainly for music but also for poetry, recipes, controlling lights, jokes and video calls. Care home managers reported major benefit for residents and staff.

We know that new technologies can be successfully implemented within care settings if barriers such as workloads, need for training, and reluctance to change working practice are overcome. We have done this in ‘normal’ circumstances, showing the multifaceted benefits of smart speakers within health and care. Voice-activated technologies are easy to use and make infection control easier.

The pandemic has accelerated the acceptance of technology such as video calling, smart speakers, and care robots to maintain quality of life in care homes. The added benefits in time of lockdown have tipped the benefits to barriers comparison, giving impetus and urgency to digital health implementation. This may mean that our research needs to be reinterpreted but it also provides an opportunity to proceed at pace. We will continue our work in developing the eHealth sector in Cornwall but we certainly should not ‘waste this crisis’.

Professor Ray Jones

Professor Ray Jones is Professor of Health Informatics and Co-Director of the Centre for Health Technology at the University of Plymouth. 

He leads the eHealth and Productivity in Cornwall and the Isles of Scilly (EPIC) project (funded by the European Regional Development Fund), which works to create a sustainable eHealth sector in the region, supporting regional businesses and addressing the challenges faced by ageing communities in coastal and rural settings.

Find out more about Professor Ray Jones


The Old Normal: Our Future Health 

The Centre for Health Technology brings together researchers with over 30 years of evidence-based research experience in health and technology. Together, they work to enable innovative healthcare solutions that reduce the pressure on services, support healthy ageing in our communities and stimulate an economy of wellbeing that benefits all. 

In this series, they share their views on the current state of health and care in the UK, and what its future could look like.


References

[1] Zamir S. Skype on Wheels: Implementation of video-calls to reduce feelings of loneliness and social isolation for older people living in care. PhD Thesis. University of Plymouth December 2019.

[2] Statton, S., Jones, R., Thomas, M. et al. Professional learning needs in using video calls identified through workshops. BMC Med Educ 16, 140 (2016). https://doi.org/10.1186/s12909-016-0657-6

May, C.R., Mair, F., Finch, T. et al. Development of a theory of implementation and integration: Normalization Process Theory. Implementation Sci 4, 29 (2009). https://doi.org/10.1186/1748-5908-4-29