Source : IN VIVO
Now that peak COVID-19 infection rates have been reached and passed in many countries, governments and health care systems are turning their attention towards managing a sustainable recovery. Returning secondary care to its pre-crisis activity levels and broad mix of services has become a new priority.
But among the lessons for providers learned during the pandemic, a major one is that digital health care must be central in future challenges of these proportions – and increasingly in routine health care too. Bricks-and-mortar health care and its scarce resources are insufficiently equipped to meet COVID-19-type demand peaks, nor fast-rising “peace-time” health care needs.
Antoine Valterio, RESMED's Country Manager, UK And Ireland
Digital technologies have come into their own in recent months, as the experiences of ResMed Inc., a digital health care company active in sleep and respiratory care devices, show. The company’s respiratory care portfolio of ventilators, masks and consumables for chronic lung disease patients immediately put it on the front line of COVID-19 control.
The company rose to the challenge, Antoine Valterio, ResMed country manager for the UK and Ireland, said in an interview. “Early in the crisis, we saw in Wuhan that ventilators were in huge demand for treating patients in hospitals,” said Valterio. The company then focused its resources on building as many ventilators it could and getting them out to patients globally.
“In the January to March period, which was the peak of demand, we built 52,000 ventilators – three times what we did a year ago,” he said. The rise was from across the board, in all types of ventilators: noninvasive and invasive models with masks or with tracheostomy tubes, for intubations in the ICU. ResMed’s respiratory division increased its mask production 10-fold during the same period.
It did this while continuing to support its sleep business. The San Diego based group is the global market leader in the production and marketing of CPAP devices and bilevel devices and their masks, and consumables that are used in obstructive sleep apnea (OSA). Up to a billion people may suffer from OSA, according to a January 2020 report in The Lancet.
ResMed has a third division, Software as a Service (SaaS), which is mainly US-focused. This division is growing, with the 2016 acquisitions of SaaS specialists Bright Tree and MatrixCare helping to laying a firmer base on which ResMed will develop its out-of-hospital software services. This makes joined-up care – and moving care from one setting to another – attainable goals.
Offering more care at home was a major step in bringing all parts of health care together, said Valterio. This capability was a major component to get ResMed to its aim of “reaching 250 million lives globally by 2025,” he said. ("Exec Chat ResMeds CEO Mick Farrell Outlines 2025 Strategy For 250 Million Users" "Medtech Insight" ) The 2018 purchase of US group Propeller Health similarly fits the ResMed philosophy of connecting medical devices and turning the data into actionable information for clinicians. ("Aptars Focus On Digital Connectivity Presents New Drug Delivery Opportunities" "In Vivo" )
It was widely observed that during the pandemic that patients with non-COVID-19 health care issues were avoiding going to the hospital. In ResMed’s case, ventilation patients with neuromuscular or COPD issues use their ventilators at home but go to the hospital for check-ups. The fear of infection with coronavirus prevented this for some patients.
As a solution, ResMed accelerated development of its airView app for this category of patients. The airView telemetry and ecosystem was already available and working well for monitoring sleep patients remotely, said Valterio. “We had been working on a version for ventilated patients, and when we realized what was happening with COVID-19, we brought forward the release of that software to customers by many months.”
Valterio described this as example ResMed’s soft- and hardware efforts coming together to meet the acute needs of the UK National Health Service (NHS) and the European health care provider community. “Clients were able to set up virtual clinics, and patients said they appreciated the innovative way in which they could get care without leaving their homes,” he said.
airView enables clinicians to log on and monitor patients remotely. They can then trouble-shoot and anticipate potential issues. The technology showed its value in the pandemic, said Valterio. ResMed also operates the myAir app for sleep patients who are seeking improved outcomes. Its smart algorithms can provide training and coaching to patients, who can troubleshoot for themselves and seek therapy if needed.
Valterio sees this as further proof of health care systems' embracing of digital technologies that deliver better outcomes and maximize the delivery of care in times of scarce health care resources. “COVID-19 effectively accelerated our strategy,” he said. “We saw a shift during the pandemic to digital tools and accelerated the deployment of our software solutions,” by the NHS during the pandemic, he added.
But the benefits of these COVID-19 responses are being carried over into the post-recovery stage for providers. ResMed customers are setting up their own remote pathways using digital health tech to ensure they get back up to pre-COVID-19 levels of service as quickly as possible during the ongoing era of social distancing.
The NHS Long Term Plan also stresses the need for digitization of health care services. Valterio agreed: “Digital health is here to stay, and looking beyond the mid-term recovery, it will continue to provide care to millions of people in the UK and Ireland.” ("The New Culture Club UK NHS Goes Upstream For Care Delivery And Offers New Chances For Medtechs" "Medtech Insight" )
ResMed has focused on a range of data-enabled, connected care services, allowing it on behalf of the NHS to send devices to patients in their homes, help them operate them remotely, upload the data to the cloud, score it, and use it to make an informed decision about, say, whether a patient has OSA. “By offering that service, we add to the NHS’s capacity to serve patients.”
The company also offers remote CPAP set ups, and replenishment of masks in the home, etc. “If a patient needs a mask, the hospital refers the patient to us and we can dispatch it to their home without the patient leaving home. This model will continue to flourish during this recovery phase,” said Valterio.
Data privacy is an ever-present issue for device companies. But the ResMed country manager has noticed something of a shift in this context. The company (compliant with all relevant legislation, including the EU's GDPR – General Data Protection Regulation) has seen increasing adoption by the NHS of data-driven software, giving it more flexibility in the use of data that creates clear patient benefits. “We’ve seen that data can be put to good use for patients, but also by the NHS, who can operate their services more effectively,” Valterio said. This should lead to greater acceptance of the use of data.
This change could be an important turning point as the UK passes its COVID-19 peak and slowly returns to a new normal. It could also help the NHS as it recovers from the pandemic and starts to reopen other services. ResMed sees a strong role for itself in helping the provider get back up to speed.
ResMed in the UK established a direct relationship with the UK Department of Health and Social Care during the pandemic and contributed to the national response plan. This was not just in the provision of products, but in terms of training materials for the NHS.
It also played a role in the COVID-19 strategy and planning of the Association of British HealthTech Industries (ABHI), which offered a consolidated approach for all industry players and as such was a “great ally,” said Valterio. ResMed applauded the efforts of the Ventilator Challenge UK (a cross industries initiative launched early in the pandemic to increase the availability of respiratory support devices in the NHS), while its own drive was to increase capacity to meet the demands of governments around the world.
The changing needs in terms of ventilator types under the pandemic was monitored by ResMed’s medical team, gathering scientific and clinical evidence. COVID-19 continues to be a very dynamic environment. Valerio said the group’s COVID-microsite, offering videos and technical information, had drawn from a variety of sources that could be shared by HCPs in the pursuit of best practice.
ResMed has leaned heavily on its respiratory division in discharging its duty to protect lives during the pandemic. Ventilators were the clear priority, but not at the expense of ResMed’s sleep patients. Valterio said, proudly, that ResMed remained able to oversee multiple priorities in recent months despite being understandably distracted by COVID-19
“We now want to actively support the NHS getting back on its feet as quickly as possible by using digitally enabled services to help it during the recovery,” he said. “We also want to make sure that all the benefits accrued by digital health during this crisis are institutionalized in the NHS, so that it can continue to flourish in the future.”
By Ashley Yeo