Kyle Tang

My Topol fellowship problem / project:

Whilst there was rapid adoption of remote consultations through the first phase COVID-19 pandemic, it soon became apparent that there was a lack of digital infrastructure to support efficient, effective and safe remote consultation.

Three main problems are as the following:

Fragmentation of information platforms: Whilst there are now many systems to provide solutions to support virtual clinics, many digital systems simply do not talk to each other. The clinicians, therefore, may need to use one system for recording patient’s height, weight and patient reported outcomes (PROMs), one for documenting the consultation onto the digital health record (DHR) and yet another for blood tests ordering and prescriptions. The clinicians often were required to collate information from multiple sources of and sometimes replicate the same information onto different systems. This duplication of entries is not only inefficient but is prone to human error. In the case of prescription of immunosuppressive medication or biologics medication, this can mean weeks of unnecessary delays for patients.

Lack of patient participation and involvement: Traditionally, the management for patients with chronic skin conditions have been for hospital clinicians to see them every 3-6 months. Whilst some patients find these regular visits useful and reassuring. Others find them a source of anxiety and not particularly helpful unless they have a particular concern they wish to discuss with their doctor or nurse. Outpatient visits that do not add any value for patients are a waste of resources for patients, hospitals and the wider public. A more agile and responsive system to empower patients to take greater charge of their care using digital tools may help to change this. With digital solutions, patients may report patient reported outcomes (PROMs) between hospital visits and arrange patient-initiated follow ups (PIFU). In that way, patients may communicate with the clinicians effectively and help to free up appointments for those who need face-to-face consultations.

Lack of a robust database for patients on immunosuppressive treatments: It became apparent after the first-wave of the pandemic that not every hospital trust has up-to- date lists of all patients on immunosuppressive medications.

As mentioned in the first point of fragmentation of information platforms, many clinicians simply do not have enough time to help identify and maintain a database for these patients on top of current routine clinical practice. Many of the paper-based documentation also meant important routine clinical data that could have been easily collected were not. Further analysis of these data can provide critical information on clinical effectiveness, facilitate clinical and managerial decision making, and inform further researches.

As remote consultations are likely to be part of routine clinical practice, the move to create a responsive, agile, patient-centred and efficient digital infrastructure is therefore urgently needed. To address the issues mentioned, my current thought is to create a unified platform to collect, record, and populate crucial data in a flexible and secure platform.