Interview with Consultant Cardiologist, Dr Andrew Mitchell

In the last decade we have seen an increase in the development and acceptance of remote devices for health and wellness. During COVID-19, patients with heart failure are at a higher-risk of injury if infected. While lockdown seemed to serve as a solution to prevent viral spreading, it limited regular follow-up visits and delayed direct medical assessments. Telemedicine has afforded the opportunity for both patient and clinician to remotely monitor health vitals particularly through ECG/EKG devices to track and ultimately prevent heart failure. In this part two of our interview with Consultant Cardiologist, Dr Andrew Mitchell in Jersey, we hear first-hand accounts of how heart health has been impacted by COVID-19 and the opportunity telemedicine has given cardiology.

The pandemic has affected all clinicians, how has cardiology been impacted with particular focus on chronic heart injury?
The initial impact of the pandemic was the sudden cancellation of elective cardiology operations and appointments across the world. We had to rapidly change the way that we were working and caring for our established heart patients whilst learning about the potential clinical consequences of COVID-19. Telemedicine became critical to provide care to patients who were isolating or in lockdown.

“Patients hospitalised with severe infection often developed heart rhythm changes as well as inflammation of their heart or myocarditis. Providing care for these patients whilst wearing full-PPE was challenging for our nursing and physiology staff.”

Many of the Jersey Heart Team were redeployed to provide cover for the Intensive Care Unit and our digital health research team were drafted in to develop data solutions including the development of a new business intelligence system and the Jersey COVID alert application. Now that we are starting to exit the peak of the pandemic, we are seeing some patients present with long-term consequences of COVID-19.

What have been the biggest challenges and benefits with the doctor-patient relationship in telemedicine?
The change to remote working meant that we relied on telephone and video consultation with patients. This was an efficient use of time and allowed us to process large volumes of patients without anyone having to travel. Many patients expressed their satisfaction in this type of meeting.

A consultation in cardiology however often requires a physical examination and clinical clues will be lost without same-room conversations. Similarly, many patients require heart tests such as an ECG and ultrasound scan so still needed to attend the hospital. Planning forward there will be opportunities to develop telemedicine for selected patients requiring heart care. Although the initial cardiology consultation will usually be a face-to-face meeting and examination, follow-up assessments can often be performed over the telephone or video chat. By empowering patients to take control of their own health data using ECG recorders we can allow patients to take control of their health.

Can you share any predictions you have for the future of healthcare and technology?
Accurate health data is critical to providing high quality healthcare. Historically data has been siloed in hospitals, health centres and private providers but we are at a stage now where technology will change this. By putting the patient in control of their health data and become the data controller, the patient can choose who to share their medical records with. Data accuracy will improve, duplication of information and tests reduced, and healthcare outcomes improved at reduced cost.

“Once patients own their health data and are given the digital tools to monitor themselves, they are more likely to look after themselves allowing a move towards a preventative focus for health.”

Patients can also start to choose who they would want to provide their health advice. With a digital enabled healthcare system there will always be a specialist up and awake in some part of the world so I suspect that 24/7 global access to remote specialist healthcare will become an accepted normal. Immersive health technologies such as virtual reality, artificial intelligence and other machine learning techniques will provide the treating clinician with augmented intelligence to make better informed decisions. Clinical accuracy will improve resulting in less need for more expensive and risky tests. Alongside this I think that we should examine the way that we train our doctors. Medical school training is long and expensive yet much of what is taught becomes less relevant in most career pathways.

More focussed specialist training can shorten the time to qualify and help fill the worldwide void that we have with under-provision of medical staff. Similarly, non-medical staff can be trained up quickly to provide some of the roles that take up doctor and nurses’ time. Human digital assistants will then be able to help take staff away from the keyboard and back to the bedside.