The approach translates into interactions with the person when they are well (precision health), not only when they are ill (precision medicine). These interactions also have a life course as the reference frame rather than commencing in older age groups when people typically start to exhibit symptoms of non-communicable diseases.
This is exemplified by the various efforts health systems are making to directly engage with people. Digital tools are being leveraged, in addition to techniques like 'nudge' and gamification, to assist with introducing, encouraging and sustaining behavioural change, as will be explored in more detail during the HIMSS & Health 2.0 European Digital Event (7-11 September 2020).
The acceleration of digital transformation
COVID-19 has given a new impetus to this process. Like all major adverse events which affect complex systems, there have been some occasional unexpected positive ones, like the fact that digital modalities have now become far more accepted. As Vladimir Ilyich Lenin, not ordinarily someone I would look to for inspiration, said: “There are decades where nothing happens; and there are weeks where decades happen”. This is precisely what has happened with digital transformation over the past few months, certainly with regard to the management of non-COVID conditions, where the speed of acceptance and the increasing levels of uptake of non-analogue approaches has surprised us all.
This opens the doors to the new world of precision health where personalised approaches to the management of existing non-communicable diseases as well as personalised approaches to risk reduction for people who have yet to develop them, are now far more common.
But COVID is likely to have had another couple of effects, ones which are only now starting to become visible.
It is very clear that the economic and social effects of national lockdowns are greater than originally anticipated. The 'V shaped' economic recoveries are all too often now observed to be more 'U' or even 'L' shaped. Furthermore, the effects of lockdown on the mental health of the population, pre-existing inequalities, and the impact on children and schooling, are also now understood to be challenging to manage. This leads countries to look to adopting more local approaches to avoid national solutions and clearly this is an intermediate step towards more personalised personal approaches. This will leverage the present precision approaches, as will the fact that COVID is not necessarily a condition which does not leave adverse events behind it, even if one does recover. There is increasing appreciation that it will be necessary to follow up with people more systematically even if they have survived an episode of COVID. Reports are starting to appear around the appearance of cardiac, neurological and respiratory complications, some of which are severe. Whilst the levels and incidence of these complications is not yet clear, what is increasingly clear is the need to look at these populations far more closely – which again potentiates the arguments for delivering a precision approach.
Adopting a more precise strategy
Finally, there is also an appreciation that this may not be the last pandemic we will have to deal with. Amongst the lessons we have learnt over the past few months, one which is resonating more loudly is the need to be able to access people individually and maintain a long-standing relationship with them. This will support a health system approach a pandemic with a more precise strategy, reducing the need for a national lockdown with all the potential adverse consequences of that approach.
Through all of this we also have to consider how to manage the physician and nurse interactions, as the requirements of personalised clinical decision support for clinicians is now even more pressing than it was before. This is a crying unmet need to help obviate the levels of burnout which exist amongst clinicians, and one where some solutions which are aligned to clinical flows and within EMRs are long overdue.
The phrase “winter is coming” now also has another meaning in our new post pandemic world. We need to use these few months very carefully and profitably to get our houses in order to ensure we are in the best possible position for winter when the conditions predisposing to transmission are more prevalent and the potential for a flu epidemic happening concurrently are a factor that has to be considered.
These topics will be explored in greater detail during the HIMSS & Health 2.0 European Digital Event (7-11 September 2020).