Designing person-centred digitally-enabled models of care

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There is a lot of anxiety from some consumers about digital health, and rightly so. Digital health landed upon us with unforeseeable speed as a result of the pandemic, and while many of us can appreciate the ‘system’ having been forced to accelerate adoption, the result has meant that we were not able to undertake the necessary codesign to ensure the products met the users’ needs (both consumer-users and clinician-users).

We regularly hear about barriers to use, in particular for telehealth – from community members who are at greater risk of poorer health outcomes. This includes those in rural and remote areas, people with chronic and complex problems, First Nations Australians, people with communication disorders or language barriers, among others. For some, connectivity is an issue and for others, a lack of financial means to afford data. Some community members find it difficult to absorb all of the information and recommendations through a screen (risking patient engagement in care), and others are concerned that telehealth will replace access to in-person healthcare professionals. There is variable digital literacy – not only among consumers but also among service providers. We hear about gaps in clinician digital literacy, enabled by lack of training supports.

Many people are concerned that digital health is yet another driver of inequities in health outcomes.

Yet for every concern we hear from consumers, there is another success story where digital health solutions are improving access to care which would otherwise be not available. We work with rural Urgent Care Centres where access to My Emergency Dr by the nursing team provides timely and high-quality emergency care to rural consumers, saving them a four hour drive at night and taking pressure off the nursing team. We hear stories about hybrid models using two-person teams with a health assistant onsite working with a remote allied health professional to complete assessments and deliver the necessary interventions to increase mobility for elderly or chronically ill patients in remote locations. The groundbreaking HoloLens technology is bringing augmented specialist care using a virtual consulting room in which the remote clinician uses a headset to give a treating doctor real-time vision and audio and allows them to direct care. And remote patient monitoring systems for chronic disease patients are helping to reduce avoidable hospitalisations. For example, for people with heart failure, a daily weight check in can detect risk acceleration early.

We have the opportunity to rapidly increase the numbers of care models that can be enhanced using digital supports. These models have the potential to:

  • improve service access for consumers
  • alleviate workforce pressures
  • provide much-needed flexibility to clinicians to avoid burnout, and
  • create value through more cost-effective care delivery.

Consumers desperately want improved communication and information sharing between health care providers and themselves, and for that communication to be timely, and the opportunities for more integrated management of chronic illness are significant.

We hear from consumers that they want fit-for-purpose use of digital health in service models. For example,

  • Supported access, alongside a local primary health care provider (for example, nurse, care coordinator, health educator, allied health assistant) who can build digital literacy and confidence for consumers and support them during and after appointments
  • Hybrid service models which include in-person and telehealth care, which harness the opportunities of technology, and use remote care options when appropriate, such as for reviews and follow-ups rather than assessments, or provide links to allied health professionals and specialists located remotely for consultations and case conferencing
  • ‘Opt-in’ approaches.

We need to continue to better understand the consumer experience of telehealth and other digital health products, particularly to continue to improve access to care in rural and remote Australia.

Like any healthcare, we want telehealth, and digital health more broadly, to deliver quality, accessibility, effectiveness and a positive experience for consumers, and so we need to ensure person-centred design of new telehealth-inclusive models.

We need to design and trial innovative and future-focused models of care with a focus on improving consumer health outcomes and delivering system benefits around integration and efficiency.

At Larter, we use a six-pronged codesign framework to design fit-for-purpose person-centred models that are designed for outcomes, for equity, for value, for measurement and adaptability, and scalability.

Contact us if you are considering enhancing the use of digital components in your service or commissioning strategy and require a person-centred design approach.