Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

Abstract

Objective: Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned. Methods: IMIA Primary Care Informatics Working Group members from Australia, Canada, United Kingdom and United States developed a standardised template for collection of information. The template guided a rapid literature review. We also included experiential learning from primary care and public health perspectives. Results: All countries responded rapidly. Common themes included rapid reductions then transformation to virtual visits, pausing of non-COVID related informatics projects, all against a background of non-standardized digital development and disparate territory or state regulations and guidance. Common barriers in these four and in less-resourced countries included disparities in internet access and availability including bandwidth limitations when internet access was available, initial lack of coding standards, and fears of primary care clinicians that patients were delaying care despite the availability of televisits. Conclusions: Primary care clinicians were able to respond to the COVID crisis through telehealth and electronic record enabled change. However, the lack of coordinated national strategies and regulation, assurance of financial viability, and working in silos remained limitations. The potential for primary care informatics to transform current practice was highlighted. More research is needed to confirm preliminary observations and trends noted.

Digitalization impacts the COVID-19 pandemic and the stringency of government measures

“…2c). Telehealth involves various technical methods (e.g., virtual consultations or remote patient monitoring) rapidly adopted in the US, UK, Australia, and elsewhere 24-26 . Such electronic communication tools improve access to care by eliminating the additional risk of exposure 24 .…”

“…An early adopter of robots, Guangdong Provincial People’s Hospital assisted the medical staff by disseminating health information or delivering medicines to isolation wards 31 . While telecommunication facilitates medical treatment in First Nations or sparsely populated islands 26 , illiterate or low-income populations are severely affected by the digital divide and face unequal access to telehealth 25 . Despite a high mobile penetration in India, the introduction of eHealth services proved difficult for similar reasons 26 .…”

Towards Equitable and Resilient Digital Primary Care Systems: An International Comparison and Insight for Moving Forward

“…While digital health solutions were essential in supporting regional, national and global responses to COVID-19, the benefit from these solutions were not shared equally across all populations. Negative unintended consequences (UICs) including inequity issues and uneven transition of some tasks to digital format were commonplace [10][11][12]. UICs often occur during and post health information technology (HIT) implementation [13,14].…”

Digital Inequalities in Cancer Care Delivery in India: An Overview of the Current Landscape and Recommendations for Large-Scale Adoption

“…The fragmentation between public and private sectors with respect to technology and lack of coo-ordination implies that integration of the system as a whole might not be feasible. Moreover, apart from socio-economic inequalities in usage of mobile phone and internet, the storage of data and interoperability remain key issues ( 22 ).…”