Digitalise that!

Life is mostly froth and bubble

Two things stand like stone.

Kindness in another’s trouble,

Courage in your own.                                                             Adam Lindsay Gordon

The moto of the Royal College of General Practitioners (RCGP) is 'Cum Scientia Caritas' — scientific knowledge applied with compassion. People within the healthcare industry have often talked about health digitalisation in terms of the former, I discuss here the importance of also considering the implications of digitalisation on the latter.

Many of us have championed the use of technology to drive the efficiency and effectiveness of clinical practice – for example; decision support, process automation, and improvement analytics have proved important and impactful for clinicians and healthcare commissioners. We have seen many examples of technology working alongside and complimenting the humanity and compassion of the skilled and experienced professionals. AI and machine learning technology is already building an evidence base and we are seeing its ability to augment clinicians. 

At its heart, however clinical practice is a human to human interaction. The coming together of two human stories one from the patient the other from the professional.  Care is as much about powerful and difficult emotions as it is dealing with dysfunctional body parts. People who find themselves in need of clinical care are sometimes in pain, sometimes distressed, often anxious, overwhelmed and powerless. Emotions are and will always be analogue territory.

Bad news, difficult choices, dealing with anxiety and loss are all routine elements of healthcare. I wonder whether, in our rush to digital nirvana, we consider adequately that part of medicine that treats humanity rather than pathology.  We can use digital technology to create the gift of time so these human issues can be given the space they deserve. Using more targeted services driven by data we have the potential to help make services more personal than ever. 

There is an argument that caregivers need to reclaim and protect the concept of “healer” from well-meaning digital evangelists.  A modern “healer” - more transparent, democratic and frankly less authoritarian than previous generations of clinicians.  Healthcare is built on the trusted relationship between a patient and a clinician. We need digital systems that acknowledge and support that dynamic. We must give the same consideration to the human stories that people bring to their healthcare professional we do to the data about their stories. 

I observe a troubling trend among the brilliant, energetic and inspiring generation of tech entrepreneurs driving digital transformation by founding start-ups. This is often driven by a hunger for redesigning antiquated care systems and a confidence that with digital anything is possible. In our enthusiasm to disrupt there is a risk that sometimes we regard traditional clinical values of humanity or clinical safety as quaint anachronisms. 

At the same time I see many experienced clinicians for whom this digital transformation seems less relevant and a bit of a distraction. Imagine the district nurse with a life time experience of navigating the human condition and a quiet professionalism that understands the importance of evidence and uncertainty in the context of sometimes intense human experiences. That nurse and the tech entrepreneur coming together and building a coalition of values would be the healthcare innovation dream team. This is a concept we might call ‘responsible disruption’. I think we are starting to see some digital innovators that are trying to get this balance right. 

I have spent most of my career working at the interface of clinical practice and technology because I believe it to be one of the most powerful tools we have to improve healthcare. But we need to tread carefully. How do we ensure that the two humans in the room are supported in a way that magnifies rather than diminishes the humanity of healthcare? When we are patients, we relish the opportunity to be more in control of our care, to have visibility of our own care record and supported to make our own decisions with personally relevant information. The advent of digital assistants and targeted data driven services herald an era of much more personalised care. The genomics revolution will take us yet further; to a level of granularity that targets our genetic code, shifting us from personal to precision care. In our rush to grasp the positive and important developments that we enjoy from other industries we have to be aware of the risk that with the incorrect implementation we could lose something important. 

The story that the clinicians bring to this is important too, not just the knowledge skills and expertise but the past experiences, personality and biases that are an inherent part of all of us and connected humanity. We know too that the morale and motivation of our clinical workforce is an important determinant of the quality and safety of care. There is potential to free up time by taking the administrative burden off clinicians and dealing with many routine tasks using technology. We can augment the memory and processing of these professionals using machine learning. We can use population insights to match our clinical resources against particular care pathways to make the most of the scarce resource that is clinical expertise and time. 

However, we also know the importance of user centred design in digital solutions to avoid adding to the stress in the working lives of professionals. Several studies from the US have demonstrated that the use of electronic medical records is associated with high levels of stress and burnout.1 Commissioned by the UK Government, the excellent Topol Report made a number of recommendations on the need to consider the human aspects of digital care. One important recommendation highlighted the need for NHS organisations to ensure that “patients, citizens and staff are involved in the co-design of transformation projects, particularly in identifying how digital healthcare technologies can help to improve both patient experience and staff productivity.”2

All this will only be possible if we ensure we have a clinical workforce that is trained up and ready to capitalise on this digital opportunity. This has as much to do with the redesign of undergraduate clinical training as it does professional development. Digital medicine opens up new way of organising services and new roles for clinicians. We will need to think through the professional competencies, behaviours and regulation of these new roles augmented by technology. Instead of operating at the top of our license, we may start talking about operating at the top of our augmented license.

I believe that getting the balance right between health science and health care– between data and empathy is one of the most critical challenges we face in digital transformation. We get it wrong at our peril. We get it right and we can unleash health technology for the good of all. I look forward to hearing what people have to say.

1.    Rebekah L Gardner, Emily Cooper, Jacqueline Haskell, Daniel A Harris, Sara Poplau, Philip J Kroth, Mark Linzer. Physician stress and burnout: the impact of health information technology. Journal of the American Medical Informatics Association, 2018; DOI: 10.1093/jamia/ocy145

2.    https://topol.hee.nhs.uk/wp-content/uploads/HEE-Topol-Review-2019.pdf