How Can Remote Monitoring and Associated Technology Enable Virtual Wards to Be Truly Innovative?

The Big Picture

The global healthcare landscape is increasingly embracing virtual care as a transformative solution to address challenges such as workforce capacity, system productivity, and personalised patient care. Virtual wards, which use remote monitoring technology and data platforms, offer a unique opportunity to provide hospital-level care in patients' homes. This approach not only improves patient experience but also supports preventative care and healthy ageing. As we explore the potential of remote monitoring and associated technology to innovate virtual wards, it is crucial to consider the strategic, technological, and patient-centred elements that will drive this transformation forward.

The UK Experience

In the UK virtual wards are not a new concept, there is a long history of Community Health delivering care to people in their own homes, however the introduction of remote monitoring technology and patient monitoring data platforms has revolutionised the way we now provide care at home.  Tech-enabled virtual wards use remote monitoring devices to collect patient data and send that data to clinical dashboards for clinicians to monitor from the hospital or other healthcare setting.  This has enabled both admission avoidance and early discharge pathways relieving pressure on inpatient capacity.

During the Covid-19 pandemic there was a diverse range of health technology products procured at pace due to the unprecedented circumstances. Virtual wards were identified as a key lever in preventing the spread of infection and several Covid-19 virtual wards were implemented using oximeters to monitor patients at home. In London alone, we saw over 70,000 patients be placed on remote monitoring pathways. Since then, tech-enabled virtual wards have been established for multiple clinical pathways, with an initial focus on ARI and Frailty.

Radical Transformation or Tech-enabling the Status-Quo?

It’s an understandable instinct to deploy novel technologies to digitally enable existing clinical pathways, however we limit ourselves to the most basic utilisation of these technologies if we don’t colour outside the lines. Existing virtual ward models use limited data points from clinical observations, focused on the delivery of direct care as part of a reactive episode of care. Choosing to monitor more than just clinical observations provides richer contextual data to support care planning and personalise healthcare interventions.

Future models of care will use multiple data sets and longitudinal individual patient data to plan and deliver highly personalised and proactive care. This supports the direction of travel in global healthcare towards preventative care and an emphasis on healthy living and ageing well. Healthcare policy and strategy should now be developed anticipating an enhanced data landscape, and recognising we are in an age where patient held data and actionable insights are becoming increasingly important too.

Hospital at Home & Home Instead of Hospital

There is great potential to transform the way we plan and deliver care if we shift the focus from replicating the ‘hospital’ experience to creating a new space and framework for patient care at home. The key to this transformation is data. By leveraging comprehensive and where appropriate continuous data collection, we can develop a framework where the patient's home becomes the first and preferred place for healthcare initiatives, interventions, and incentives. This approach not only enhances patient comfort and convenience but also allows for more personalised and proactive care.

In this innovative framework, remote monitoring devices and data platforms can capture a wide array of health metrics, including lifestyle factors, environmental conditions, and social determinants of health. This rich data can be analysed to provide actionable insights, enabling healthcare providers to tailor interventions to individual needs and predict potential health issues much earlier. In terms of patient activation, integrating healthcare initiatives within the home setting can foster a sense of empowerment and engagement, encouraging them to take an active role in managing their health.

Prevention Is Always Better Than Cure

Incentives for maintaining a healthy lifestyle and adhering to care plans can be seamlessly integrated into daily routines, making health management a natural part of everyday life. This shift towards home-based care not only reduces the burden on healthcare systems but also aligns with the broader goals of preventative care and healthy ageing. By prioritizing the home as the central hub for healthcare, we can create a more efficient, effective, and patient-centred healthcare system that meets the evolving needs of our communities.

Scaling Virtual Care

From a strategic perspective there have been a whole host of barriers to the implementation of virtual wards and other remote monitoring programmes. Clinical buy-in is not a given, and there is still much work to be done collecting evidence to support virtual models of care.  Increasing clinician confidence requires targeted and effective communication campaigns and dissemination of peer reviewed evidence.  Intelligence about remote monitoring and data platform technologies is not robust enough for the people responsible for designing services and procuring digital systems and services.  A key challenge cited by systems is a lack of knowledge and awareness leaving them feeling bewildered at the task of tech-enabling virtual wards.

Bold, creative vision is needed to transform the way we perceive virtual health from ‘nice-to-have-novelty’ to a default option for patients to engage with healthcare services. In the UK, we have recently seen changes in Primary Care to ensure patients have access to digital services such as online consultations. As this becomes embedded it will become accepted and expected by patients.  If we extend this approach to other care settings we will see the same shift in patient expectations. As with any digital transformation, especially in the clinical space, there will always be some tensions between the champions for new ways of working and defenders of the status quo, so there is much to be said for the power of patient demand to influence decision making.

The experience of being an inpatient versus being treated at home is significantly different.  There are of course, issues of safeguarding, poverty and inappropriate living conditions, informal carer responsibilities and other limitations to access to be considered, however we can confidently talk about the benefits of recovery at home and the reality of hospital-based harms. In a constrained economic climate, patient experience does not have the same value as economic benefits, and it is the challenge of systems to develop evaluations and business cases to balance these different types of benefits if we are to see the sort of scale, we need to realise radical transformation.

Evaluation of Existing Virtual Wards

Evaluating the effectiveness of existing virtual wards is crucial for understanding their impact on patient outcomes and healthcare systems. Comprehensive evaluations should consider various metrics, including patient satisfaction, clinical outcomes, readmission rates, and cost savings. For instance, studies have shown that virtual wards can significantly reduce hospital readmissions and support early discharge of high-acuity patients. Evaluations should also assess the integration of remote monitoring technologies and the ability to provide continuous, personalized care. By collecting and analysing data from these evaluations, healthcare providers can identify best practices, optimize virtual ward models, and address any challenges related to clinical buy-in and technology adoption.

Demonstrating Cost Benefits

The cost benefits of virtual wards are evident in both reactive health spaces and preventative long-term care (LTC) management. In the reactive health space, virtual wards have been shown to reduce the average cost per patient by enabling early discharge and preventing hospital readmissions. For example, UK evaluations indicate that a virtual ward stay costs, on average, £1,958 less per patient than an inpatient stay. In the preventative and LTC management space, virtual care using remote monitoring for early intervention can prevent the escalation of chronic conditions and reduce the need for emergency care. This proactive approach not only improves patient outcomes but also generates significant cost savings by reducing the frequency and severity of acute episodes. By demonstrating these cost benefits, healthcare systems can build a strong business case for the expansion and sustained investment in virtual wards.

Envisioning the Future

There are visionaries who see the potential for a revolution in the way we think about health and the tools we use to manage health at home and in our local communities.  Political and economic factors will always be as much of a risk to transformation as a driver, the pull to the familiar and predictable is strong in the face of external pressures; it is times like this when we need the champions, pioneers and visionaries most, to encourage and motivate us to stay the course.

To truly innovate and maximize the potential of virtual wards, we must embrace a holistic approach that integrates advanced technology, comprehensive data utilisation, and patient-centred care. The journey towards widespread adoption of tech-enabled virtual wards is complex, requiring collaboration across healthcare systems, policymakers, and technology providers. By fostering a culture of continuous improvement and leveraging the power of data, we can create a sustainable model that not only enhances patient outcomes but also addresses workforce capacity and system productivity challenges. The future of healthcare lies in our ability to adapt, innovate, and prioritise the needs of patients, ensuring that virtual care becomes a cornerstone of modern healthcare delivery.

References

[1] Evaluation of Virtual Ward Models in South West London
[2] The benefits of Virtual Wards: writing a sustainable business case
[3] Virtual wards: The good, the bad and the costly
[4] Using virtual wards and long-term conditions management network to ...
[5] Virtual Wards Performance Evaluation & Re-Design - Akeso
[6] Navigating Healthcare’s Future: The Rise of Virtual Wards
[7] 1. Cost Effectiveness of Virtual Wards as alternatives to ... - NICE
[8] Inpatient-level care at home delivered by virtual wards and hospital at ...

--Issue 05