One example is a nurse-led monitoring clinic where patients can submit symptoms or concerns to their care team, who respond in real-time via phone or secure messaging. Lovas says that the data captured during these encounters will feed algorithms to auto-recommend additional self-care education or services, and presents an opportunity to provide more remote care and weave hospital and community programmes together through auto-referrals to services such as sexual health or palliative care. “The data collected supplements the provider’s memory of programmes that might serve the patient, and it will also help us create predictive analytics to refine the way we provide proactive care for similar patients in the future.”
By extending care into patients’ homes on a continuous basis, telemedicine also sets the stage for a more preventative approach and better management of chronic conditions. This will be essential if services are not to be overwhelmed as lifespans lengthen and the rate of noncommunicable diseases continues to rise. “Healthcare has typically been reactive and intermittent, but we are finally moving away from an ethos of illness to an ethos of wellness and continuous, proactive health,” says Suzanne MacCormick, global healthcare lead at WSP. “COVID has shone a light on the fact that healthcare permeates everything we do and transcends all sectors. It is not just about seeking help when we get sick, it’s about how we keep people well in healthy, safe environments designed to enhance our wellbeing and quality of life.”
Keeping hospitals only for the sick
But why are there so many people with chronic conditions in hospital in the first place? Before COVID, many were already questioning the use of acute facilities for so many services, and the over-use of emergency departments for ailments that could be better dealt with in a primary-care setting. In response, there is a nascent shift of diagnostic or outpatient services to smaller, community hubs.
In the US, for example, providers are now incentivized to keep patients out of hospital where possible. Banner Health is building outpatient centres with a mix of services, from primary care to specialties such as cardiology and women’s health, to imaging suites, laboratories for analyzing blood and an on-site pharmacy. “So you can go and see a primary care physician, and they could say, ‘I noticed your heartbeat didn’t sound right’ and send you down the hall to the cardiologist, and they could send you for an MRI and to get some blood drawn so they can run some labs,” says Eiss at Banner. “That could all happen in the same building and then you pick up your prescription from the pharmacy on your way out.”
This type of facility is particularly applicable in remote communities, which cannot sustain a full-service hospital. “You would go there for things like dialysis, or nutrition information if you’re diabetic, or if you need help,” explains Kevin Cassidy, head of healthcare for Canada at WSP, which is involved with several projects like this in Nova Scotia. These facilities will be combined with long-term care homes and coffee shops and, in one case, a school. “So it’s more of a hub for wellness that’s embedded in the community, a destination for people to stop. It helps you stay healthy so you don’t need to drive to a distant major city so often. If we’re looking at how to reduce the cost to the system, you need to have a healthy lifestyle to begin with and that’s supported by these community health centres.”