Delivering Digital Transformation for Healthcare: Setting the conditions for successful remote care at scale

Richard Wyatt-Haines, Director Health and Care Innovations (HCI), England

The challenge

Across the world there is a growing demand for health services and a global shortage of healthcare staff. Demand is particularly driven by an ageing, less healthy population, who have increasing numbers of multiple conditions.

Delivering more care closer to home is going to be one of the core tools to address the demand and supply imbalance and we can’t do that without the use of digital health.

So, what approaches are needed to enable digital remote care to succeed?

The patient perspective

It is our experience that successful remote care demands increasing levels of engagement and knowledge by patients:

5Es Model of Patient Self Care Maturity.

The table below describes the different stages and provides some examples of triggers that can be used to move the patient from one level to another.

Layer	Name	Description	Examples of Activators
5	Excelling	Empowering patients, using a digital closed loop approach	Making patient reported data available to the whole system to enable remote monitoring and support
4	Empowering	Giving patients the authority and co-responsibility for their health	Establish patient initiated clinics, using shared decision making and encouraging patients to identify what matters to them
3	Educating	Using information so that patients understand the what, why and how	Providing patients with simple & accessible education about their condition/health
2	Enabling	Giving patients the tools to participate in their own care	Provide patients with information they can action – e.g. symptom tracking, pathway activities to complete
1	Engaging	Getting patients involved in their disease and health management	Use the power of the clinician recommendation

If we are going to give involve to patients in this way, it is necessary to recognise that:

Information is power. If patients have more information and a greater understanding, they will also gain power.
Information flows will be two-way. Patients will increasingly be the source of data that enhances clinical decision-making using data collected in the home through devices and symptom tracking.
Patient participation in decision making will increase. Through models such as shared decision making, patients will increasingly take a more dominant role in the decisions about their treatment and conditions.

Health systems and healthcare professionals

In order to help patients progress up the 5Es ladder, there needs to be increasing capability within the health system and amongst healthcare professionals and the table below lays out the levels of performance that need to be achieved.

Maturity Levels	Local Health System Digital Health Capabilities – System Enablers					HCP Digital Health Capabilities
Maturity Levels	Digital Health Location	Data Handling Capabilities	Digital Health Value	Digital Health Budgets	Strategic Alignment	Digital Health Adoption	Digital Health Promotion	Digital Power Relationship
Optimising	Transferring knowledge & systems to other health systems at pace	Combining system data with large scale patient data	Maximising scale and value	Strategic funding	Delivering new strategic value	Leveraging digital for new value	Evangelists	Equality, HCPs are facilitators
Advanced	Dissemination across the system to address strategic issues	Integrated system-wide information used across the whole service	Assessing strategic value & transformational potential	Accelerator funding	Enabling strategic delivery	Wide-scale participation in digital initiatives	Active promoters, reinforcing the use of digital	Shared decision making enabled by patient and system data
Intermediate	Specialty wide testing, transferring to other specialties	Utilising in-house and external data to manage care	Measuring and evaluating KPI outcomes	Larger pilots, using allocated funding	Operational benefits	Engagement with local initiatives	Intermittent and sporadic	Shared decision making commonplace
Basic	Additional test sites	Digital education	Capturing anecdotal outcomes	Local pilots, using existing budgets	Local agendas	Compliant but not engaged	A few early adopters, silent majority	Sporadic shared decision making
Initial	Small scale testing	Separate databases/paper records	Personal success	Small scale, very local, spare funds	Individual driven projects	Disengaged	Reluctant	Clinician dominates

As a result local health leaders have to purposefully develop their organisations and staff to achieve these higher levels of capability with the aim of maximising the delivery of digital remote care.

To achieve this, a common lever will be the role of leaders and leadership:

Leaders have a key role in ensuring people understand where the organisation is going and why.
Leaders need to win the commitment of their people and patients to make the change.
Healthcare professionals will need to be as adept at using digital tools with patients as they are at undertaking a bed bath or carrying out an angiogram.

Conclusion

The macro conditions of supply and demand mean that a shift to digital health and the use of remote care is a necessity across the world.

In order to make the shift, patients have to be activated to achieve increasing levels of maturity of self-management and independence.

Patients will not do this on their own initiative and need to be encouraged, enabled and facilitated by local health systems and individual healthcare professionals at all levels.

For that to happen local leaders need to set the context and conditions to build the capabilities in their systems and staff to fulfil this role.

This article is an abbreviated version of a paper and presentation made by Richard to the United Nations General Assembly in New York on 27th September 2022. To see the full paper and the case study supporting it, please go to www.hci.digital/UNGA

Richard Wyatt-Haines, Director HCI www.hci.digital and richard@hci.digital