EHS-COVID (50) Q3. What have you, your health facility or country done to maintain essential health services? (1) Teleconsulting

16 November, 2020

I have pasted a synopsis of the WHO Maintaining Essential Health Services during covid19 - attached - document [*see note 1 below]. I have extracted information from a digital patient view point and in relation to an Neil’s invitation to join the WHO and HIFA dialogue about maintaining essential services. I have inserted in italics [*see note 2 below] in the extracts the NHS figures on patient use of digital services in England during September 2020: Telemedicine and patients using their own records will be [part of the response to Covid and may well remain mainstream after Covid.

WHO Maintaining essential health services: operational guidance for the COVID-19 context

Interim guidance 1 June 2020 (Through the eyes of a digital patient)

As the outbreak is brought under control and restrictive public health measures are gradually eased, some adaptations in service delivery may need to be reversed, others continued for a limited time, and yet others that are found to be effective, safe and beneficial can be incorporated into routine post-pandemic practice.

(NHS England September 2020 - use of On line services

*Percentage of patients enabled to book/cancel appointments on line 27.08%

*Number of appointments booked on line in September 2020 523,770

*Percentage of patients enabled to order repeat prescriptions on line 31.52%

*Number of prescription transactions on line in September 2020 4,500,000

*Percentage of patients enabled to view detailed record on line 9.84%

*Number of record view transactions on line in September 2020 9,930,000

*Percentage of patients enabled for at least one of these services 31.97%)

Successful implementation of these strategic shifts will require the active engagement of communities and public and private stakeholders, specific measures to ensure access for socially vulnerable populations, transparency and frequent communication with the public and a high degree of cooperation from individuals.

In particular, the pandemic has placed unprecedented demands on individuals to self-manage many health needs and on informal caregivers � inncluding families, frieends and neighbours � who should be exempted from travell restrictions that could preclude them from providing needed care.

When well-informed and coordinated, adaptations made in the COVID-19 context have the potential to build health system capacity that can be sustained throughout the pandemic and beyond.

In all systems, adaptations made in the pandemic context may provide a foundation for the transformation and integration of primary care services.

Use available technologies and associated regulations to facilitate the shift of clinical encounters to digital platforms and to support self-care interventions wherever appropriate (see Section 1.12).

Redesign chronic disease management strategies around limited or adapted provider encounters and increased self-management, while ensuring access to necessary medications and supplies.

Document adaptive responses (e.g. teleconsultation, integrated primary care, remapping of referral pathways) implemented during the pandemic phase that should be considered for longer-term integration into health system operations.

Utilizing online learning platforms and mobile technology to provide key training (e.g. on management of time sensitive conditions and common undifferentiated presentations in frontline care), clinical decision support and direct clinical services (e.g. telemedicine), if appropriate (see Section 1.12);

There are many relevant and practical examples of the use of digital technologies for maintaining and strengthening service delivery in the COVID-19 context. Telemedicine solutions include clinical consultations conducted via video chat or text message, staffed helplines, e-pharmacies and mobile clinics with remote connections to health facilities for timely access to patient data such as medication lists and diagnostic test results. Digital applications can be used as part of supportive supervision of health workers, and evidence-based digital tools can be used to support clinical decisions on diagnosis and treatment.

In addition, digital health technologies can support medication adherence and empower individuals to take more proactive measures to manage their own health. Evidence-based, high-quality self-care interventions can be delivered via digital technologies (26) and can offer effective alternatives to some face-to-face interactions with providers.

Establish interim guidance and regulation on the: dellivery of health services through digital health technologies, taking into account accessibility, liability, safety and privacy;

HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT

[*Note from HIFA moderator (Neil PW):

1. HIFA does not carry attachments. The WHO Guidance may be downloaded here:

2. The text to which Richard refers is marked with asterisks * ]