Health systems are in need of radical change; virtual care will lead the way

The covid-19 pandemic has shown us how much health care is in need of not just tweaking but radical change. The pressure on global health systems, providers, and staff has already been increasing to unsustainable levels. But it also illustrates how much can be achieved in times of crisis: for example, China and the UK recently built thousands of extra beds in intensive care units, or ICUs, in less than two weeks. Health-care reform will need to spur a totally different approach to how care is organized, delivered, and distributed, which will be paramount in a (hopefully soon) post-covid-19 era. It's the only way to deliver the quadruple aim of health care: better outcomes, improved patient and staff experience, and lower cost of care.

Jeroen Tas is chief information and strategy officer at Philips, and Jan Kimpen is chief medical officer.

What would this change look like? With enormous stress on health-care systems around the globe, it is more urgent than ever before to step up collaboration, information and knowledge sharing, and agility in the delivery of diagnostic, respiratory, and monitoring systems at scale. One of the most powerful ways to achieve this is by building the technology to collect, qualify, and analyze data in ways that quickly reveal patterns and hidden insights. It highlights the need for robust health-data infrastructures.

For example, in the Netherlands, Philips has partnered with Erasmus Medical Center, Jeroen Bosch Hospital, and the Netherlands Ministry of Health, Welfare and Sport to create an online portal that allows Dutch hospitals to share covid-19 patient information with one another. It ensures that a patient's data is easily and securely transferred via the cloud from hospital A to hospital B. Being able to share patient data between hospitals at the touch of a button is vitally important to optimizing the use of health-care resources. It can, for example, assist in the seamless transfer of infected patients between hospitals to balance the load of critical-care units. Since its launch March 28, 95% of Dutch hospitals have already connected to the portal. In normal times this would have taken years.

How covid-19 is spurring the move to virtual care

A vital instrument for coping with a rapidly spreading infection like covid-19 is virtual care, or telehealth. With the large number of patients involved and the face-to-face risk of infecting other patients and staff, online consultations and remote patient management can provide valuable relief to the health-care system. Philips has made available a dedicated scalable telehealth application that facilitates the use of online patient screening and monitoring, supported by existing call centers. The application aims to prevent unnecessary visits to general practitioners and hospitals by remotely monitoring the vast majority of covid-19 patients who are quarantined at home. Patients infected with covid-19 can be assessed via smart questionnaires about their home situations and states of health. If intervention is needed in any particular case, clinicians will be notified and staff instructed.

During the current pandemic, where covid-19 occasionally results in severe pneumonia, we are seeing increasing numbers of patients requiring acute care in a hospital or an ICU. With numbers swelling to unmanageable proportions in many countries, health-care authorities face not only the challenge of limited numbers of ICU beds and ventilators but also staff shortages and burnout. Trained ICU doctors and nurses are already in short supply and repeated exposure to infected patients will increase their own risk of contracting the virus.

With the large number of patients involved and the face-to-face risk of infecting other patients and staff, online consultations and remote patient management can provide valuable relief to the health-care system.

A tele-ICU, or e-ICU, enables a co-located multi-disciplinary team of intensivists and critical-care nurses to remotely monitor patients in the ICU regardless of where patients are. Intensivists and nurses based in the telehealth e-ICU hub are supported by high-definition cameras, telemetry, predictive analytics, data visualization, and advanced reporting capabilities to support their frontline colleagues. Algorithms alert them to signs of patient deterioration or improvement. They help care teams to proactively intervene at an earlier stage or decide which patients have stabilized and can be transferred, allowing scarce ICU beds to be allocated to more acute patients. The tele-ICU can be embedded in a larger clinical and operations center that prioritizes patients on acuity and optimizes patient flow and logistics. This not only supports front-line staff to drive better patient outcomes but also helps optimize scarce resources.

Delivering predictive care beyond hospital walls

Advanced telemetry and camera technologies hold out the promise of monitoring acute patients at scale. In the near future, you can expect image analysis software that measures an ICU patient's temperature, heart rate, and respiration rate from a distance of several meters. Using existing patient monitoring solutions, artificial intelligence (AI) is already able to use the acquired data to predict when a patient's condition is about to deteriorate hours before a nurse would be able to spot it. And when patients do deteriorate, secure connections to external clinical experts allow appropriate treatment plans to be initiated. When there are staff shortages, such as reduced availability of night-shift staff, monitoring can be done from remote locations, even halfway across the world, where people are wide awake. At Philips, we are already deploying vital-signs camera technology to detect deterioration in patients waiting in emergency department waiting rooms so they can receive quick attention.

The remote monitoring approach can also be extended to the home, with smart wearables tracking patients who are infected or at risk of infection. These wearables, like the Philips smart biosensor patch, can measure body temperature, respiration, and heart rate, monitor sleep, and detect falls. All these measurements can be combined with contextual and behavioral information about patients to keep them as safe as possible.

Virtual care can also support other overburdened health-care fields, such as diagnosis. Ultrasound, x-ray, and CT scans are useful tools for covid-19 diagnosis and follow-up, but if patient numbers grow rapidly, the radiologists who assess them will be confronted by a much-increased workload. If there are not enough radiologists available in a hospital to take care of the local population, tele-radiology services can potentially offer them needed support. Radiologists from one hospital can remotely support their colleagues in another. Even so, with so many new covid-19 cases in countries around the world, patients often have to wait hours before getting the results. AI-enabled CT image analysis could potentially help to screen suspected covid-19 patients within minutes. This in turn could relieve pressure on complex laboratory-based tests to confirm the presence of coronavirus. But there are some tough challenges to be solved before an algorithm can distinguish influenza from covid-19.

A raft of innovative ideas and coping strategies are being tested worldwide. In the near future, we could see digital services closing the loop between consultations and the dispatch of care or prescription drugs, drones as vehicles for getting drugs to patients, and robots disinfecting contaminated areas. Apps and chat-bots that act as symptom checkers and provide up-to-the-minute travel and infection control advice. 5G-enabled cameras that check for symptoms in seconds. New ways of working that keep diagnostic procedures safe while still allowing fast assessment, such as the robot-guided ultrasound being trialed in China. Anything to keep the risk of disease transmission down to a minimum. Although these innovations won't play global roles in the current crisis, keep an eye on them. Many health systems may go back to the drawing board to improve their care based on today's experiences.

At Philips, we think the most important thing right now is that we work together to put the right measures in place on a global scale, with countries that have made it beyond the peak helping those in the middle of the pandemic. What we learn in the process will allow us to better predict and prepare for the future. One thing is certain, AI and virtual care, which are relatively new concepts to much of society, will play their part in combating the covid-19 pandemic. Experiencing these technologies firsthand will undoubtedly help shape the debate about their future role in health care-and what it means for all of us.

This article is a combination of two blog posts that first appeared on Philips.com: Going virtual to combat COVID-19" by Jeroen Tas, and How will COVID-19 change the working lives of doctors and nurses?" by Jan Kimpen.