2020 was a year like no other and the first signs of impending trouble were in December 2019 which is when the first reports of a new pandemic emanating in Wuhan, China, became public. The rest is history and indelibly etched in every human on earth as we have witnessed a year of disruption and change to a degree which was unimaginable only a few months previously.

The SARS2-COV19 virus which caused the COVID-19 pandemic has been described as a child of its age, where, because of its infectivity and asymptomatic transmission was ideally suited to take full advantage of the interconnected 21st-century global village. It will also be remembered as the pandemic which largely outpaced the ability of nations’ health and care systems to contain and manage it.

As we approach 2021, there is some hope at last. Vaccine announcements have been very positive and there is at last a ray of hope that we can start to rebuild and reconnect with colleagues and friends all over the world after months of lockdown.

The learnings from 2020

So, what have we learnt over 2020, a year which many will be very pleased is coming to an end?

• The management of non-communicable disease. Even well-developed health and care systems were largely overwhelmed by the first or subsequent waves of this disease. Those that largely managed to limit spread still struggled to deliver care and do so consistently and to the standards they aspired to. All health systems struggled to manage both covid and non-covid patients concurrently, not only because of the complexities of managing nosocomial infections in hospitals and health centres, but also because of the inability to manage both at the same time associated with scarce and pressurised workforce. The number of excess deaths associated with the first wave in particular should not have come as a surprise – as people did not seek treatment for non-communicable diseases partly out of fear and partly because they knew that the care systems were under significant pressure.  Those who did seek help did not always receive it in as fast as they were used to as systems were strained in many cases and frankly barely functioning during the peaks of the pandemic. Unsurprisingly, numbers of heart attacks, strokes and exacerbations of symptoms of other non-communicable diseases did not abate. Thus, the first lesson from the pandemic could be to remember to manage both the covid and non-covid populations during each wave.
• Dimensions of safety. We have always talked of safety as being very high in our thinking when designing new pathways of care but tended to think only of patients in this regard. COVID-19 changed all of that. Large numbers of clinicians were affected by the virus particularly in the early stages when we were unaware of the degree of asymptomatic transmission and also where PPE supplies were very limited. We now understand that we also need to think about the workforce when we talk of safety. This factor contributed to the veritable explosion of adoption of telehealth and other digital modalities when it comes to the delivery of care.
•  Data and data driven decision making. It was clear very early in the pandemic that the systems which had access to data fared better than the ones that did not. Also, during the year, we have seen a remarkable reprioritisation of many of the prequisites of digital transformation – like interoperability and increased emphasis on analytics. This is no surprise. Data became more “real-time“ as the months wore on and more granular in nature as attempts were being made to manage smaller and smaller geographies to avoid the significant economic effects associated with global country shutdowns.
• Workforce has becomes a greater issue as factors such as ageing and burnout exacerbated an already very pressurised cadre. This emphasis on our most precious resource is long overdue.  
• Attitudes to risk were rebased. Previously, health systems always cited potential risk associated with change when asked why digital transformation was not advancing as rapidly as anticipated. COVID-19 made change inevitable as systems embraced these new modalities with remarkable speed and what was “risky” yesterday was deployed without delay. Sometimes this was done too fast with the change management dimensions and aspects of cybersecurity not quite as prominent as they should have been. Lessons have been learnt however, and in many respects, there is consensus we are now in a new world where digital modalities, long promised and awaited, have now become mainstream.
• We have much to do to regain the trust of the citizen (in some instances). Deployments of track and trace applications were subject to significant debate in many countries and trust deficits which had existed unnoticed between the citizen and governments were visible in the light of day and really quite stark. We need to urgently engage with people and continue to debate the balance between personal privacy and the duties to fellow citizens in times of pandemics. 

Some of the lessons have been painful whilst others have been unexpected. Who would have ever thought that it would take a pandemic of the proportions COVID-19 turned out to be, to drive digital transformation at a speed and pace which no one could ever have envisaged? It is true that complex adaptive systems like health and care often display unexpected consequences when challenged, and if one felt one needed proof, here it is. 

A brighter, digitally-enabled, future

We start 2021 with hope and well-founded optimism. Despite the ravages of the pandemic, we look forward to regaining some mobility and communication with colleagues. As social beings, most of us have missed the personal interactions and contact and this is all very welcome. We have lots to look forward to in 2021 and this is a taster of what I anticipate we will see. 

• Telehealth will continue to mature in terms of its rate of adoption and in its range of implementation. It offers a window on the whole new world of digital transformation and for many clinicians will have been a ‘taster” of things to come
• Workforce will continue to be valued – and we will see many more systemic attempts to ensure we nurture and value staff and manage burnout better. 
• There will be more emphasis on managing unwarranted variation in healthcare delivery. In many respects we will be continuing the journey started with the triple aim in 2006. There will also be more emphasis on driving interoperability, managing taxonomy better and developing more mature clinical governance systems.  All these are prerequisites to a modern, efficient health and care system.
• The process of personalisation and customisation of care around empowered individuals will continue as we start to adopt more precise approaches as will the debates around the use of data and issues to do with consent. Perhaps we will also see instances where dynamic consent approaches are successfully deployed more often.
• There will be a renaissance in the appreciation of the importance of techniques like behavioural change and these skills will become more mainstream in clinical practice.
• No doubt, some of the technologies we are already starting to use will “come of age” – their additive effects on the consultation could well be transformative. Perhaps 2021 will be the year of voice, or the year where the internet of things, enabled by 5G becomes a significant area of development. What is certain is there will be change and the rate of change will continue to accelerate.

Finally, we need to remember that, as alluded to previously, complex adaptive systems often have unexpected consequences, and it would be surprising if 2021 is not remembered for some as yet unexpected new development. We need to remain optimistic that 2021 will be a year that will be better than the year that preceded it.  Let us make it a memorable year for change and renewal and one where we continue to aspire to HIMSS vision which is to realize the full health potential of every human, everywhere.  

Dr Charles Alessi is the chief clinical officer at HIMSS.