In the same survey we talked about previously [see Background], conducted in February 2020, we also asked members to think about their vision of 2040. One of those questions focused on innovation, and we asked:
In 2040, what do you think will be the biggest innovation that has changed practice in your field?
We analysed the responses we received using grounded theory, and the themes that emerged are presented in Figure 5.
Figure 5: responses to the question “In 2040, what do you think will be the biggest innovation that has changed practice in your field?”
Unsurprisingly, most of the responses focused on technology. Paediatricians told us that they expect growth in technology, such as artificial intelligence and genomics, to support faster and more accurate diagnosis. They also expect digitisation in the workplace, including electronic health records, better data linkage and improved systems for video consultation to enhance their communication and practice.
Also discussed was how personalised medicine and new models of care are likely to have a significant impact on paediatrics in the future.
Key considerations for future innovation in paediatrics
In 2019 we conducted a literature review, looking at the impact of health technology on the delivery of paediatric care in the last ten years. We included papers that studied young people up to the age of 24 or on those providing care for this population, and a thematic synthesis of the data from the included studies was undertaken using seven domains of paediatric care. 128 studies were included, highlighting the growing importance of technology in delivering paediatric care.
This literature review led us to the identification of six clear themes or enablers for successful delivery of paediatric care using technology. We believe that all new technology development and implementation should consider these six areas in order to succeed and flourish in both supporting care delivery and improving outcomes for children. References supporting these themes are available in the full literature review, published elsewhere.
Figure 6: Considerations for future innovation and technology in paediatrics: summary
An emerging theme from many of the studies was the need for clear guidelines or protocols when introducing new technologies in health settings. This includes ensuring protocols are context or country specific as health policies will differ depending on location.
Many care providers expressed the need to have more training on using innovations, whether face-to-face or online. Studies included in the primary care domain also highlighted the need for training, and authors reported lower compliance with interventions as well as reluctance to use innovations on younger age groups. Not all healthcare providers will be “digitally literate”, and so when implementing new innovations training and clear guidelines are necessary.
Continuity of care
Both patients and providers reported concerns for continuity of care. This was apparent in many of the communication studies which often included triage. Patients wished to receive consistent care and from the same clinician or community, and to not have to repeat themselves if they were referred to another professional.
Some interventions improved the number of detected cases of a specified condition, however clinicians expressed concerns over post-diagnosis follow-up for harder to reach populations if specialists were not available. This demonstrates the importance of clear protocols to give guidance about next steps following a diagnosis.
Many studies reported the importance of having privacy and confidentiality. This was especially the case for studies focusing on mental and sexual health and assuring confidentiality was even shown to improve result notification of positive results for sexually transmitted infections.
Providers also reported concerns regarding sharing data, especially in relation to younger populations in a primary care setting and parents of paediatric patients were significantly more restrictive in genomic data sharing decisions than adult participants.
Most studies reimbursed participants or covered the costs of mobile phone usage and had requirements of access to a stable internet connection and/or a smartphone for enrolment. It is important to consider the context of the environment when introducing an innovation and whether it is feasible for the respective populations to access the necessary technology. This will help ensure that underserved populations are not further isolated.
Personalised approach and user design
Studies that took a more personalised approach or included their target population in the development of the intervention often reported positive findings. This included being able to personally tailor messages and meeting with providers to schedule appropriate timings for phone calls, which received positive feedback from participants. This was also observed in studies that adapted innovations to suit the language or cultural needs of their target population.
A common theme in exit survey feedback was to make interventions more tailored. This included specifically targeting younger populations as separate from older adolescents and/or adults. The same theme emerged in separate survey work conducted through RCPCH with both paediatricians and with children and young people calling for more tailored healthcare and an increase in stratified medicine.
Technology to supplement, not replace
Participants (both care providers and care recipients) often stated a preference for interventions that used a blended approach. Patients reported they found it more comfortable and easier to engage with a clinician at in-person appointments. Another study reported that service users enjoyed using telemedicine but would prefer it as a supplement or form of follow-up instead of completely replacing the original service. Including face-to-face interactions was suggested by authors to improve acceptability of innovations, as discussion with a clinician may ensure credibility of the feedback.
Providers found that using technology prior to meeting with patients allowed for more specific discussions. Authors suggested that using, in this case, an app before meeting patients may be particularly useful in a primary care setting where time with patients is often limited. A blended approach was preferred when providing teaching or training for clinicians, to improve adherence to the intervention and provide familiarity with other participants when engaging in peer learning. This theme reinforces the importance of implementing a personalised approach to delivering paediatric care, as participants will have individual preferences about how they receive it.
Benniche, S.; Firth, A.; Jacob, H.; Roland, D. The Impact of Health Technology on the Delivery of Paediatric Care: A Narrative Review. Preprints 2021, 2021020462 (doi: 10.20944/preprints202102.0462.v1).