The below is an opinion piece that was first published on Health24 on the 18th of May 2020.
A shock to the system
Whether we should have been or not is up for debate, but when Covid-19 began its rapid spread across the globe we were shocked. Taken by surprise, we found we didn’t have nearly enough of what we needed to defend ourselves against the scale of this silent killer: resources, masks, ventilators, hospital beds, time. And so governments and health professionals around the world began the grim, morally fraught, emotionally wearying business of health risk triage: allocating resources, attention, time, equipment in a way that would do the most good, or the least harm.
As we enter into the second phase of our response to the pandemic, in which we reckon with the persistence of the infections, the lack of vaccines, and the ongoing behavioural responses that we’re going to need to make, we’re involved in triage on a different scale, judging prevention of the spread of the disease against its ongoing, devastating economic and social impact.
It is important, as we make these decisions, to be aware of their long-term impact, to make sure our decisions and motivations in healthcare are data- and evidence-based, and to consider both the demand and supply sides of the healthcare value chain. Value in healthcare is defined as health outcomes that matter to patients relative to the cost of achieving those outcomes. There are gaps within the current healthcare value chain that can be addressed in a meaningful way to make the system as a whole more efficient.
Filling the gaps
Increased digitisation of the healthcare value chain and the measuring of patient outcomes have been vital components for creating more efficient healthcare systems, but we haven’t had the impetus or available investments to implement this at scale. Covid-19 has been somewhat of a catalyst for the deployment of digital healthcare solutions that allow patients to interact with the healthcare system in a more coordinated and meaningful way.
What is critical now is to have a system that allows us to appropriately screen, report, treat and channel patients based on the care they require without overburdening the healthcare system. Predictive modelling, based on available data, is crucial in order to anticipate which facilities will be required to provide services, and then to direct patients accordingly.
In an environment of persistent, phased lockdown, we will presumably move in and out of scaled restrictions on our free movement. In this context, you also need to have an early warning system that can facilitate remote interactions and verifications between patients, pharmacies and healthcare professionals.
A digitised, trustworthy system allows patients to consult with health professionals via video-led technology and receive prescriptions without visiting the practitioner. Healthcare regulations are a vital enabler for innovative digital healthcare solutions to positively impact the demand and supply sides of healthcare. Digital electronic signatures facilitate e-scripting to pharmacies and referrals among healthcare providers. Patients could have a consultation with a healthcare professional, the script could be issued to a pharmacy, and the medication could be safely delivered to the patient’s doorstep without them leaving their home.
Most importantly, vulnerable individuals, i.e. the elderly, the immuno-compromised and people with co-morbidity need to be able to self-report via remote monitoring systems. These systems would allow healthcare professionals to effectively triage patients, and healthcare facilities would be able to deal with the more acute, serious cases without exposing patients with less severe conditions to the dangers of infection.
Healthcare resource allocation will increasingly be managed in terms of infection hotspots. Data management is crucial during this crisis and the South African government has been very responsive in terms of monitoring communities and identifying those hotspot areas. We will need the aggressive continuation of data collection and risk assessment to rapidly identify at-risk communities and prevent flareups.
This requires significant resources in itself, especially given the remoteness of some areas of South Africa. Crisis management systems, communications platforms, and remote support for healthcare workers all need to be rolled out evenly, not just focusing on urban centres. Messaging around behaviours required to prevent infection have to be consistent, clear, credible, and expanded so that remote areas are educated and informed. The more you create a trusted communication environment for communities, the more empowered and informed they are to make the right decisions.
The same is true in terms of the response of corporate South Africa. Certainty around which measures to take – and to invest resources in to protect employees and clients – at each stage of our evolving response to the pandemic will prevent missteps and mis-allocation of funding.
A clear set of protocols to guide the response of corporate South Africa, outlining the minimum effective standards (as set by government and the WHO) would need to be implemented and followed as lockdown restrictions ease.
I work for a company that specialises in technology and healthcare infrastructure design solutions. My colleagues across the EOH group have been hard at work over the last two months and have made some incredible strides in very little time, rolling out digital solutions such as thermal temperature scanning devices; patient referral and billing systems; eScripting solutions; fully equipped ICUlate mobile ICU and isolation units deployable in both rural and urban areas; the re-configuring of dental practices with effective extraction systems for Covid-19 risks; crisis management communication apps that monitor employee check-ins, office capacity and the health risk of a workforce returning to service; and new digital channels for remote servicing of clients now and well beyond the pandemic.
*Milton Streak is a former Executive Principal Officer of the Discovery Health Medical Scheme, and is currently an Executive at NEXTEC, one of the two operating subsidiaries of the EOH Group.