eSystems for Remote Care: The Platform Approach

The eSystems Analogy

Sectors such as travel, banking and retail have been transformed by technology platforms sharing three characteristics: standards-based interoperability that allows multiple providers to connect without proprietary lock-in; a reusable core with flexible periphery; and combinatorial capability enabling multiple services to be combined into bespoke packages for individual users.

Technology use in care has historically failed to achieve this because interventions have been characterised as point innovations: closed, proprietary systems implementing one new way of doing one thing in one silo. This produces technology islands that sit outside normal practice, fail to integrate, and cannot be repurposed across pathways or populations.

Person-Centred Combinatorial Care

Each person receiving care has a unique combination of physiological, psychological, environmental and social-network factors. A platform approach enables person-centred combinatorial care: a menu of services (video consultation, remote physiological monitoring, social connection, care coordination, education and coaching) combined into a bespoke package for each person, adjusted over time as needs change. The same platform core supports all combinations; only the peripheral interface configuration changes.

The v-connect Platform

The v-connect communications platform, developed by Red Embedded Systems Ltd, is the primary technology referenced across this body of work. It uses SIP servers for standards-based communications routing, H264 video compression, AES encryption, and provisioning servers forming a "walled garden" of controlled, authenticated connections. Interfaces span TV (set-top box), tablets, PCs and smartphones.

Supported use cases include virtual ward rounds, virtual outpatient clinics, on-demand remote clinical support, virtual visiting for family and social connections, early supported discharge from hospital, video-enabled consultations for care home residents, and multi-way video for case reviews and multi-disciplinary meetings.

Barriers to an eSystems Approach

Two structural barriers dominate. First, organisational resistance above grassroots level: those with the power to commission new models bear the financial risk and operate within procurement frameworks — based on activity-based tariffs, EU procurement rules, and annual budgeting cycles — that are structurally incompatible with iterative, outcomes-based digital innovation.

Second, activity-based reimbursement: current mechanisms reward appointments, procedures and hours of care — not outcomes. Preventative interventions that avoid hospital admissions generate savings for the acute system but costs for the community or social care system that delivered them.

An Emerging Third Barrier

AI-specific information governance is an emerging barrier identified by Cripps and Scarbrough (2022). New AI-based clinical applications may fall foul of elaborate information governance requirements that make it difficult to access patient data effectively — even where data-sharing is technically and legally permissible. This concern is directly illustrated by the NHS Federated Data Platform, which has faced persistent data governance controversy despite contractual protections.