The Covid-19 pandemic has dominated 2021 as it dominated 2020. It is hard to believe that we have been living with this crisis for almost two-years now, but when it comes to the adoption of healthcare technology it’s clear that we have been working through a number of phases.  

When coronavirus first arrived, there was a rush to roll-out remote working solutions, virtual clinics and consultations. That push into the digital workspace was maintained right through the summer of 2020 and the initial vaccine roll-out. 

Recently, there has been some negative press around telemedicine, especially in general practice, and that may be contributing to more widespread face-to-face working and a focus on building new capacity to address the demand and waiting list pressures on the NHS. 

Overall, there was a lot of excitement when the take-up of digital technology accelerated, and since then there has been more variability. That has certainly been the experience of Orion Health. 

We have started working with some great new customers this year, as a result of NHS England’s decision to require all of the new integrated care systems to have a ‘basic’ shared care record in place by September 2021. We are well into our implementation projects with Derbyshire, and Cambridgeshire and Peterborough. 

We have also been supporting some of our existing customers, who have really stepped-up their use of our shared care record technology. Customers such as the Dorset Care Record has been able to announce an increase in significant levels of use almost every week! However, we have also seen other customers lose momentum due to the rightful prioritisation of the operational support of Covid-19, and now we need to re-engage. 

New year, new phase of digital adoption?  

The big question as we head into 2022 is whether we will see another wave of digital adoption, and I am optimistic that we will. Naturally, the initial surge we experienced has slowed down, I suspect this will pick up again in the coming year. 

As the pandemic has progressed through phases, people have tired, and not just in the NHS. I know that many of my colleagues are feeling the pressure of constant news updates and changing routines, despite the measures we have taken to support them. 

At the same time, the NHS has had other priorities alongside the pandemic. It is coming out of Covid-19 with a huge elective care backlog and heading into a difficult winter. Eventually, some of that pressure will be addressed at a system level by those new integrated care systems, which are being developed to join-up care and adopt a population health management approach.

It has taken time for the government to get the necessary legislation in place and for the right leaders to be found for these critical organisations. I expect to see a renewed focus on change and on digital technology as integrated care systems finally start work next year. 

Meanwhile, the centre has continued to focus on and invest in digital technology. NHS England has just brought NHSX and NHS Digital into its transformation directorate, which should provide exciting opportunities to align policy with technology-enabled delivery on the ground. 

NHS England has also said that it wants to build on those ‘basic’ shared care records and for all areas of England to have a ‘comprehensive’ shared care record in place by 2024. That is very exciting from an Orion Health point of view. 

It means that we can engage with our customers on our maturity model, which takes them from implementing our platform, to ‘viewing’ data via the shared care record, to ‘doing’ things with it; whether that is analysis using Discover Analytics or implementing new models of care using our Care Coordination tools. 

New for 2022… 

If I was going to make one prediction for the coming year, I’d say that we’re going to see a big increase in the extended use of shared care records in patient engagement in areas such as remote monitoring and through the development of digital front doors. We have been doing some work with our long standing customer Connecting Care in Bristol around managing citizens who have been discharged from hospital to help better manage the population workflow. 

They have taken the right approach, which is to identify a cohort of patients that can benefit, and then work out the best way to amend workflow using available tools to do it. I expect to see this approach extended to many more cohorts of patients, because if the pandemic has taught us anything, it is that we do not want to be bringing patients into hospitals and primary care unless we have to. 

I also expect to see more interest in patient engagement. Orion Health has been working with Ontario’s healthcare system on the development of their digital front door that takes their capabilities a step further and starts to address patient self-service; from the management of appointments to being active participants in their patient record through the completion of patient forms across the workflow. 

In England, we have seen a big increase in the use of the NHS App during Covid-19, but it doesn’t quite fulfill the same role. We think the digital front door can bring some fundamental but evolving technologies together, to create consistent, self-service access to local services for local people. 

Sometimes, progress comes from finding the right use case  

In the long term, these kinds of developments are critical, because they start to challenge the models of healthcare. Services need to collect data before they can analyse and work to develop more pro-active outcomes from the data, to support a shift from reactive, to proactive to predictive medicine. 

The coming year will focus on expanding shared care records, adding in more data, and making them available to new service users. We have expanded the use of the Care and Health Information Exchange to five hundred users in care homes in Hampshire, and I would expect users across the care spectrum to be a focus for many new ICSs as they develop. 

A final thought is that the pandemic has shown that we do not always need new technology to bring about change. Sometimes it is enough to find new uses for technology that we already have. Two-years ago, most of our meetings were face to face. Now we all do most of our meetings and interaction online. 

There are pros and cons to that, but the pros outweigh the cons when the use case and the resulting benefits are right. As we all emerge from what we hope will be the final stages of the pandemic, and integrated care systems arrive to kick-start the NHS transformation agenda, I think we will expand many more use cases for our technology. 
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