It has been more than a year and a half since the World Health Organization (WHO) declared the outbreak of the new coronavirus a pandemic. Since the corona crisis, many lives have become more digital than before. Recent years have seen a lot of talk about bumps and bottlenecks in the deployment of digital applications in healthcare, but the pandemic has accelerated the digitisation of various aspects of healthcare by at least a decade. The pressure on the healthcare system (in terms of physical capacity and manpower) and the measures taken contributed to rapid dynamic shifts in demand, capacity and even contextual aspects of healthcare. With the aim of increasing the efficiency of a small number of healthcare professionals, decentralizing care with minimal physical contact points and reducing the time spent in healthcare facilities. The COVID-19 pandemic abruptly changed the motivation to use digital technology in healthcare; in many cases, the use of digital technology has shifted from an interesting and promising opportunity to an immediate necessity[1].

We now have a clear picture of the increased interest in digital healthcare technology[2,3]. Hospital care, GP care, mental health care, nursing home care, district nursing, and social services: they have all taken digital steps in the last few months due, in part, to the Corona crisis. Almost a third of all polyclinic visits is now conducted digitally and the number of video consultations in Dutch hospitals is growing rapidly: from an average of 500 per quarter in 2019 to 18,000 in the first quarter of 2021. In the same period, the number of remote monitoring actions grew from 19,000 to 28,000[4].In addition, around 90,000 new health apps were launched around the globe in 2020 and the number of downloads increased by 34% compared to 2019[5]. Furthermore, global funding of healthcare technology doubled in the past two years and venture capitalists in Europe invested 2.6 times as much in digital health start-ups compared to the year before [6].

Although the virus is still roaming at the time of writing and the pandemic remains a factor, it is good to look ahead to the post-COVID era. After all, many communities are already reopening their doors. What broad tendencies were we able to identify during the pandemic, what concrete applications developed and what does this mean for the future of digital healthcare? COVID-19 showed that healthcare can be digitised. Digital resources became the front door of the healthcare system. It is not called a digital transformation for nothing. For, in order to reap the benefits of digitization, more needs to be done than just integrating new technology. A digital transformation is about creating a versatile and future-proof organization, which resolves around the end user. Contrary to using eHealth and other digital solutions in an old care process, it is about a fundamental redesign of care processes. Technology is thus not the goal, but an enabler[7].

While some of the digital tools employed were new (particularly apps for, in example, contact tracing), many of the underlying technologies used during the pandemic already existed. It was because efforts were made to ease well-known system-level obstacles to support the use of digital tools during the pandemic that the deployment tended to increase. This includes additional financing options, new and appropriate reimbursement strategies and investments in digital tools and the underlying infrastructure to support them[1]. In order to preserve the positive developments surrounding digital care post-COVID, it was concluded to pay extra attention to three subjects, namely: 1. (Scientific) evidence, 2. Education, and 3. Reimbursement strategies[3]. Similar conclusions were also made by the WHO [1]. At the same time, in the past the primary focus was often on removing the obstacles, but in the future the focus should be on learning the digital (implementation and upscaling) lessons from the past period. In order to jointly develop the right (policy, financial and legal) frameworks for large-scale deployment in the future.

  HEALTHCARE PHASE 1: PREVENTION & HEALTHY LIVING  

The pandemic emphasised the importance of good population health and prevention. We see confronting figures about the effect of lifestyle on the progression of corona, revealing that both society and government need to up the ante when it comes to investing in a healthy lifestyle[8]. Many preventive interventions have a digital component, such as lifestyle apps that have been around for a while, interactive websites but also smartwatches that have seen a global shipment increase of 43-62% in the past year[9].
The pandemic era also saw several new digital initiatives in prevention and healthcare promotion. SyncVR and Reducept developed VR games for corona patients aiming to alleviate their symptomsl[10]. And health inequity came into the spotlight during the corona crisis, e.g. between people of various ethnic backgrounds and social classes. Google launched the global Health Equity Tracker platform that gave political leaders a better understanding of various health outcomes within their population[11]. The corona crisis shows us that investments in digital healthcare can pay for themselves by reducing working pressure and healthcare costs[12]. Based on these insights, we expect digital technology to become a more prominent aspect of preventive healthcare.

 HEALTHCARE PHASE 2: CONSULTation  

The corona crisis saw an explosion in remote consultations. Research among 1,443 Dutch general practices shows that 75% of participating practices implemented more new e-health applications or intensified their use. Of that group, 64% implemented video calling with patients for the first time during the COVID-19 pandemic[13]. Indeed, remote healthcare exploded outside the Netherlands as well: In the United States (US), the last week of March 2020 saw the number of remote consultations increase by 154% compared to a year earlier[14]. And it is even said that the use of remote healthcare in the US stabilised in July 2021 at 38 times pre-corona levels[15]. In addition to the rise of remote consultations, new online social networking platforms emerged as well. Broedplaats Zorg is a vivid example, where visitors can read blogs about experiences and tips during the corona pandemic[16].

Many healthcare organisations seem set on sticking with remote consultations even after the pandemic. Odds are that we will continue to use digital forms of consultation in the future, with three important factors at play: 1) increased consumer willingness to use remote healthcare; 2) increased willingness among providers to use remote healthcare; and 3) changed regulations that improve access to and insurance coverage of remote consultation[11].

  HEALTHCARE PHASE 3: DIAGNOSE  

Early and accurate diagnostics are vital when it comes to effectively combating a pandemic. A diagnosis can be made in various ways and has been moving from the healthcare institution to the home more and more. Partially driven by corona, we have become increasingly open to self-diagnostics, such as corona self-tests and apps and scanners for measuring temperature or oxygen levels. The technology has made some major developments as well. Since the pandemic, the demand for molecular diagnostics in Europe and the US increased twentyfold and a total of 600 additional RT-PCR labs have been established in India[17].

Various new diagnostic technologies emerged during the pandemic. One example is the Smartphone COVID test that is able to diagnose corona within 55 minutes via an add-on and a smartphone[18]. Furthermore, we witnessed an acceleration in the adoption of AI-assisted diagnostics. Various hospitals, both domestic and abroad, are now using the CoLab blood test score for quick corona diagnosis[19]. And then there is Aeonose, an electronic nose which we have written about before and that has now been proven to distinguish COVID-19 positive from COVID-19 negative patients via a simple breathalyser[20]. For some time we have been seeing a movement towards advanced (self)diagnostics, varying from DNA tests to birthmark scans and AI-based assessment of medical imaging. Corona clearly accelerated the adoption of new techniques and we can expect more digital, consumer-oriented, personalised diagnostics in the future as a result.

  HEALTHCARE PHASE 4: TREATMENT & GUIDANCE  

We noticed a focus on shifting or digitising treatments to the patient’s home, e.g. via an app or online platform for effective treatment and support. This development was clearly driven by the fact that hospital beds were being occupied by COVID patients and the shortage of medically educated staff, with a lot of postponed healthcare and a loss of 34 to 87 thousand years of life as a result[21]. In the United Kingdom, access to regular healthcare dropped by 20% on average with major decreases in mental healthcare and oncology (25% and 22% respectively)[22].

In order to keep the pressure on healthcare as low as possible and ensure that a maximum number of patients could receive the care they needed, the application and scaling of various types of technologies was accelerated. For example, virtual reality was used to train healthcare professionals quickly without them having to come into contact with the patient themselves[23]. In addition, the technology was used for post-treatment of patients and healthcare professionals with physical or mental issues due to the impact of the virus, just like various other apps and platforms[6]. Furthermore, 3D-printed test rods were developed to make corona testing more comfortable[25].

Looking ahead to the post-COVID era, we can expect both remote healthcare by healthcare institutions and consumer-oriented software-as-a-drug initiatives to play a larger role in healthcare.

  HEALTHCARE PHASE 5: CONTROLE & MONITORING  

To ease the pressure on healthcare facilities, monitoring applications were increasingly used during the pandemic. For example, chronic patients and COVID patients who were discharged from hospital could often be monitored remotely in a new, digital way, e.g. via home monitoring apps. The result? Corona patients’ length of stay in hospital could be reduced by an average of 5 days and a cost reduction of almost €3,000 per patient was achieved[26]. One hospital after the other appeared in the media with a home monitoring app to support ex-corona patients with monitoring and oxygen supply if necessary. Responses were largely positive: the number of hospital visits was reduced and clinical decline could be detected at an early stage[27]. And for the first time, we saw the clear potential of artificial intelligence in detecting and monitoring virus outbreaks. Several corona surveillance platforms were created, using machine learning to recognise potential outbreaks early so that additional preventive measures could be implemented in time. And based on the patterns found during an outbreak, the extent, speed and direction of the spread could be predicted[28,29].
Digital technologies for monitoring both health and the spread of disease will become increasingly important in the future. The corona pandemic made us aware of the cost and health benefits of home monitoring and the importance of good epidemiological surveillance. The use of these technologies in healthcare is expected to intensify dramatically.