How technology can support evidence-based models to improve chronic care

In the first article of this series we discussed the state of the UK health infrastructure and the importance of addressing these concerns now to put in place systems that will continue to maintain high quality in the NHS. This following article focuses on how technology can support an evidence-based model in order to help improve chronic care.

The burden of chronic disease is one of the great challenges facing the UK health system. The fact that we are living longer lives, largely due to medicine’s improved ability to treat what were previously fatal conditions, is a main contributing factor.

People with long term conditions are generally the most frequent consumers of healthcare services. Those with long term conditions account for 29 per cent of the population, but use half of all GP appointments and 70 per cent of all inpatient bed days. In addition to the trying impact on individuals and their families, the burden on the economy is huge. It is estimated that the treatment and care of those with long term conditions accounts for 70 per cent of the primary and acute care budget in England. This means less than one third of the population account for over two thirds of the spend.

If we don’t reduce the pre-disposing risks and deploy more efficient and effective care models, chronic disease will impose a substantial and increasing burden on our health system and reduce quality of life for many Britons and their families.

• Read more on dealing with chronic disease

Which gives way for our second article discussion: changing the way we consult with patients.

When we talk about consultations and care planning, we generally refer to the planning for and treatment of long term conditions, such as heart disease, asthma and diabetes.  These efforts form a major element of the NHS’s work. Technology can help the treatment of chronic disease in two ways: better management for those who already have long-term conditions; and preventing these conditions in the first place.

Let’s start with the former. The management of long-term conditions is facilitated by disseminating information to patients and clinicians and enabling effective surveillance of chronic conditions to guide policy development and interventions.

Technology enables healthcare professionals to access relevant information on clinical and public health issues, epidemiological data and research, or participate in training and networking with colleagues both locally and internationally. Clinicians or specialists can then benefit from increased awareness of the consequences of risk factors, as well as access to resources and guidance specifically relating to their chronic condition, which can be especially beneficial in preventing disease progression towards co-morbidities.

In short, technology connects patients with clinicians and other healthcare professionals, and provides immediate insight into the latest information and treatment for long term illnesses. As an example; for diabetics, a crucial factor in formulating a successful health management plan is being aware of management strategies; such as diet, exercise and medication. Often, this awareness depends on the patients’ ability to observe relevant correlations, their memory, and communication skills in working with healthcare professionals.

Automatic capture of this information (i.e. blood sugar levels) and its connection with appropriate activities (i.e. exercise or medication) can quickly and efficiently inform individuals and their caregivers about a changed situation – and suggest any additions, alternates  or limitations to their medical schedule and lifestyle. 

Technology also has a critical role to play in the prevention of long-term illnesses. Here the goal is for services to inform, engage and educate the general public about lifestyle choices and the self-management services available to people who are well. Through this process, health organisations can help raise awareness, create tools which drive better interaction between the individual and their health, and educate individuals on how to access the most appropriate care services if needed. Access to this information can also help people identify illnesses early on and potentially avoid these illnesses developing into chronic diseases.

For those people that are developing symptoms of ill health, shared technology systems can enable speedy access to an informed first point of contact, usually in primary care, but including access out of hours. The aim is to facilitate accurate early diagnosis and appropriate management and to inform and to support people to manage their condition with help from family, community and voluntary sector partners. This minimises delays and duplication in assessments and enables earlier access to interventions.

Tough decisions will need to be made with regard to how the NHS funds chronic care with incentives and payment models rebalanced to support long-term care planning. Improvement will also require a reshaping of the relationship between patients and their care providers through:

• A shift from hospital-based episodic care towards long-term condition management in coordinated primary care settings and in the home;
• Greater integration and coordination around the needs of the patient, bringing together multiple disciplines;
• An increased ability to identify patients at risk with early intervention programmes that reduce the risk of disease onset or progression;
• Better tools to support clinical decision-making for an individual patient and for policy and management decisions at the population health level.

The opportunity and challenge for technology

Our experience shows that there are opportunities for collaborative technology to support the needs of the caregiver network. Central to this opportunity is the consideration of rich data, such as video and audio, as part of an individual health or education record.

There is incredible value in this rich data when it can be utilised effectively. For chronic conditions in which behavioural evidence is important (e.g., performance on activities of daily living for an ageing person, or self-stimulating behaviours for a child with autism), these richer data types are just as important as blood glucose measurements for a diabetic.

While the biggest barrier to the adoption of chronic care innovation is behavioural, both on the part of the clinician and the patient, technology innovations, such as the internet, the smartphone and social networking can drive improvements in chronic care in the UK. The chronic care model can be supported through familiar and currently available technology that practitioners can use to forge closer and more effective connections with their referral and care networks.

• Read more: technology in the NHS from HSJ’s Resource Centre

Collaborative technology and tools can also improve team communication and collaboration, generate insights for decision support, connect clinical information systems and enable self-management for patients.

With connected, interoperable systems, we can enable the flow of data across the health system; giving caregivers the information and insight they need to do their jobs better and consumers what they need to better manage their health.