The urgency for digital innovation in urgent and emergency care

Blog

The desperate need for digital innovation in urgent and emergency care – sparking connections and inspiring innovations

Written by Lesley Soden, Programme Director, Innovation Theme, Health Innovation Network

This winter has once again been a record-breaking one for A&E departments across the country —but not in a good way. Programme Director of Innovation, Lesley Soden, reflects on how technology, and not targets, needs to be the centre of the discussion to really support health and care providers delivering urgent care.

According to data and analysis published in the Health Service Journal earlier this month, overall type-one performance in emergency and urgent care units—the turnaround time for treating the most critical patients in A&E—has fallen nearly 11 percentage points since December 2018, while some individual trusts have experienced a year-on-year slide of between 20 and 30 per cent.

But how can anyone be surprised when in London alone, A&Es saw over 25,000 more patients in December 2019 than they did in December 2018.[1] Service expectations and pressures grow higher, while clinical staff continue to be spread thinner.

But instead of joining in the discussion on whether the targets need to change, I want to talk to you about the impact that existing technology could have on the urgent and emergency care system. Last October, at Health Innovation Network (HIN), we partnered with the DigitalHealth.London Accelerator programme to host an Innovation Exchange event to debate exactly the question I believe is the most important to answer – how can technology help? At the event, we brought together key stakeholders from the urgent and emergency care sector in London and creators of some of the latest innovations tackling ever-growing issues with the wait times and overall efficiency  The event sought to achieve two things; firstly, to share a deeper understanding of vital NHS needs with the health tech innovators, and secondly, to start the conversation about how digital innovations that are already transforming other areas of healthcare might be able to help.

An honest discussion

Determined not to present an idealistic view of transformation, we started the day discussing the complexities of digital innovation. There are 32 CCGs across London, each with different systems, providers, patient pathways and data flows. This lack of cohesion across the board can result in real challenges for the introduction of new innovations, particularly digital ones. For example, a product may fit into one hospital easily, but be incompatible with another. Similarly, a product may require or generate specific data that we don’t have a standard process for sharing across multiple settings. These challenges are best appreciated when you look at urgent and emergency care. It is here that speed and effectiveness can make the difference in highly pressurised life or death situations.

It was eye-opening to hear about the level of activity that the London Ambulance Service (LAS) experiences. LAS handle approximately 5,000 emergency calls every day in London and has approximately 6,000 staff, 65 per cent of them front line staff responding to emergencies. On average, the LAS responds to all Category 1 calls (the most serious of emergency calls) within 6 mins 28 seconds. In these often-chaotic situations, bandwidth, hardware and human factors such as the staff’s experience of the technology, are all integral to a successful A&E handover.

Where technology is already helping

Stuart Crichton, Chief Clinical Information Officer (CCIO) at the LAS, described one of the challenges they experienced when implementing the use of iPads. The issue lay with ensuring that paramedics remembered their most up-to-date passwords. As we all do on occasion, staff kept forgetting their login details or couldn’t access their most up-to-date credentials (a password reminder was sent to an email address they couldn’t easily access). To resolve this issue, LAS removed the need for usernames and passwords, opting instead for using fingerprint recognition, the same type of technology many people use day-to-day with smart phones and tablets. Stuart described this as an exciting breakthrough, and a simple solution the LAS believes will have a positive impact in crucial life and death situations.

Dr. Gabriel Jones, Consultant of Emergency Medicine at St George’s NHS Foundation Trust, described the lightbulb moment he had when looking around the waiting room one day and noticing that almost all the patients who were waiting were using their smart phones. In the UK, 78 per cent of adults now have a smartphone. Dr. Jones recognised this as an opportunity to try something new. They designed a digital solution and set up a pilot, known at the hospital as ED Check-in, that enables patients to input information to a secure mobile website via their smart phones while they wait. A doctor can then access that information instantly, and it follows the patients through their hospital journey, keeping clinicians informed at each stage. Sometimes, clinicians with an entrepreneurial nature can design the best solutions to challenges within their health services, which is why it’s so important that they’re included in conversations around digital innovation.

… to create positive change, it’s imperative that today’s innovators understand the complications as well so they can deliver the most appropriate digital solutions

At the event, we were lucky enough to have guest speaker Eileen Sutton, Head of Urgent and Emergency Care at the Healthy London Partnership (HLP) and London Regional Integrated Urgent Care (IUC) Lead at NHS England. Eileen is a District Nurse by background and has a range of experience across the IUC system. She identified the need to reduce the number of people turning up at A&E with conditions or illnesses that could be treated at home, by a community pharmacist or other care professionals, and the need to improve patient flow to reduce the time spent waiting to be treated upon arriving at A&E as some of the greatest challenges. We know that NHS expert staff are the only ones who really understand the high complexity and nuance of these situations, but in order to create positive change, it’s imperative that today’s innovators understand the complications as well so they can deliver the most appropriate digital solutions.

Working with the DigtialHealth.London Accelerator Programme, we were able to identify 11 companies that offer solutions to these two main challenges. We held a rigorous and open application process for innovators to attend this event, during which they had the opportunity to pitch their innovations to London NHS commissioners, trusts and other NHS expert staff.

The companies selected to present were:

To demonstrate the real-world application of the innovations, we created some fictional scenarios in which the innovators present could help to reduce A&E attendance and improve patient flow.

Scenario one: Reducing A&E attendance challenge

We discussed Ahmed, a frequent visitor to his A&E for a number of minor ailments that could be managed by a pharmacy or primary care. At his next visit, he is referred to the Health Navigator solution and assigned a Health Coach, with whom he speaks weekly. He now rarely visits A&E and has joined local classes.

And Claire, who is worried that she has a UTI. We offer her a virtual and confidential consultation via Q Doctor with a doctor at a local urgent care centre instead. The doctor refers her to the local pharmacy to use the Dip-IO test from Healthy.io, which tests positive and the pharmacist then prescribes antibiotics.

And then Bob who calls 111. He is re-directed to the MedicSpot station at his local pharmacy, where he is given a remote consultation with a virtual doctor, who takes his blood pressure checks for other vital signs.

All three patients are given the care they needed in a timely and effective manner, without the need for ambulance or a prolonged wait in A&E.

Scenario two: Improving patient flow and reducing waiting times challenge 

For our next challenge, we talked about Mary, who has multiple complex co-morbidities and goes to her local A&E when she experiences tingling in her legs. In the reception area, there are tablets with the eConsult triage system. Mary checks in using a tablet, by answering a few brief clinical questions about her symptoms. The system automatically triages Mary by her clinical symptoms within five minutes of her arrival.

While Mary is in the waiting area, she also inputs her symptoms, medication and medical history into the MedCircuit app, which helps save the doctor time and uses Mary’s wait more efficiently.

Mary sees the A&E doctor, but the light isn’t working in one of the consultation rooms. She uses the MediShout app to report this logistical issue, which links to the estates helpdesk and reports it immediately. She receives a notification that it will be fixed in two hours.

The doctor runs a full blood count test using Horiba’s Microsemi CRP device, which gives test results in four minutes. Mary is transferred to the x-ray department using the Infinity ePortering system to request a porter, saving critical time for herself and the doctors.

The A&E department also uses CEMBooks, which allows the consultant managing Mary’s case to plan her care and predict the demand for inpatient beds if this is required.

Mary deteriorates rapidly and requires a transfer to a specialist hospital. During her transfer in the ambulance, the MediVue platform provides real-time data taken from her monitor and active correspondence between the transferring doctor and the receiving hospital.

When she arrives at the specialist hospital, staff are prepared to smoothly transfer her to the appropriate unit, having already been informed of her history and symptoms.

These may be fictional scenarios, but they represent just a fraction of the real-life attendances to emergency care that technology could be helping make safer, more efficient and a better experience for both staff and patients. And most significantly, whilst time and efficiency were intended benefits of the digital solutions presented at the event, the focus of our discussions were about patient outcomes and supporting staff to deliver. Maybe if we changed the focus from targets to technology nationally too, we’d get to a clearer solution more quickly.

About the author

Lesley Soden
Programme Director – Innovation Theme, Health Innovation Network

Lesley has led the HIN’s Innovation Exchange function since 2017. She has over 20 years’ experience in the NHS and public sector working in senior business/strategy and programme management roles. Her roles have included work with transformation, contracts and commercial, programme delivery, business development/ planning, bid writing and clinical service re-design, all delivered in collaboration with a variety of partnerships. She is interested in new ways of working and maximising technology to improve patient care.

Learn more

Health Innovation Network is well placed to bring together key NHS staff and specialist innovators to help deliver the best in health and care in London together.

Meet the innovator: James Flint

Blog

Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with James Flint, CEO and Co-Founder at Hospify; a compliant, trusted healthcare messaging app.

Pictured above R – L: James Flint, Co-founder and CEO with Neville Dastur, Co-founder at Hospify.

Tell us about your innovation in a sentence

Available for free in the Apple and Android app stores, Hospify puts a simple, affordable alternative to non-compliant consumer messaging services like WhatsApp, Viber, Telegram and Messenger directly into the hands of healthcare professionals and patients.

What was the ‘lightbulb’ moment?

Meeting with the Head of Health for the Information Commissioner’s Office in 2015 and discovering that, while a very big chunk of the NHS was using WhatsApp to communicate while at work, once GDPR arrived in 2018 they were going to have to stop doing this.

What three bits of advice would you give budding innovators?

    1. Be prepared for the long haul. And I mean long.
    2. Keep it simple.
    3. Never miss lunch.

What’s been your toughest obstacle?

Getting sufficient funding, without a doubt.

What’s been your innovator journey highlight?

Getting on the NHS digital heath accelerator last year. It felt like we’d finally been given the official stamp of approval.

Best part of your job now?

Meeting nurses and hearing directly from them what a difference Hospify can make to their working lives.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Implement and support proper health data interoperability standards. I know this Is finally happening, but it’s still the most important single thing that needs to be done.

A typical day for you would include..

Answering a lot of email, talking to my development team, meeting or calling potential investors, networking or promoting Hospify at some kind of health event, answering customer support questions about the platform. Usually all on the same day and sometimes all at the same time!

For more information on Hospify visit www.hospify.com, Facebook, LinkedIn or follow them on Twitter @hospifyapp

Meet the innovator: Lydia Yarlott

Blog

Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with Lydia Yarlott, Co-Founder at Forward Health; a secure messaging and workflow app, connecting care workers around patient pathways.

Pictured above: Lydia Yarlott.

Tell us about your innovation in a sentence

Forward is a mobile communications platform aiming to connect healthcare professionals for the first time.

What was the ‘lightbulb’ moment?

Probably being a first year doctor on my own in an NHS ward at 2am in the morning trying to get help for a deteriorating patient and being unable to contact anyone. Poor communication leads to a real feeling of helplessness, and I want to change that for doctors and nurses everywhere. It’s hard to believe we’re still using pagers and resorting to WhatsApp to get hold of each other in hospitals, so it wasn’t so much a lightbulb moment as an increasing feeling that something had to change!

What three bits of advice would you give budding innovators?

    1. Talk to everyone, and anyone, you can about your idea. You never know what will happen next. My great friend Will worked with me as a junior doctor; he’s now with us on Forward full-time. We never would have had him as part of the team if we hadn’t spent hours on night shifts discussing the problem together!
    2. Find a Co-Founder (or several!) I couldn’t imagine doing this alone. Philip and Barney are both amazing people and amazing leaders, and it’s their drive and optimism that got us to where we are today – 5% of the doctors in the UK and growing. Whenever one of you is losing faith (inevitable at times!) the others can put you back on your feet and help you with that resilience you need in spades to be a successful Founder.
    3. Care about your problem more than your solution. Get as close to it as you can and stay there. Your solution will be wrong first time around, but as long as the problem isn’t solved, you have a chance of something really worthwhile.

What’s been your toughest obstacle?

Personal doubt!

What’s been your innovator journey highlight?

Getting our first real use cases. Watching our product change the way people work, resulting in better, faster care for patients. We have an amazing group of physios and orthopaedic surgeons using Forward to streamline shoulder surgery for patients, and another group who are using it to coordinate the multidisciplinary team in paediatric allergy. I can’t get enough of those stories because I know how tough it can be on the frontline of the NHS.

Best part of your job now?

The great privilege of working as a doctor and as a Co-Founder. I love clinical work, but I get frustrated by outdated systems, and I would hate it if I couldn’t focus on changing that. I care about healthcare at a systemic level and I want the NHS to survive, but I know that for that to be the case things will have to move forward, fast. I want to be a part of that.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Get Trusts talking to one another and sharing what they do. Incentivise knowledge transfer – both successes and failures. Share the ways in which they are working with others, including start-ups and small businesses, to foster innovation at scale.

A typical day for you would include..

A typical day being a paediatrician is just that – looking after sick children! I’m a junior doctor, so I’m still learning a lot, and working closely within a team to achieve the best outcome for the patient. When I’m at Forward, I spend most of my time meeting with the team to discuss progress and strategy, representing the clinical face of the company and the problem we’re trying to solve. The two jobs couldn’t be more different, but ultimately they are focused on the same thing – improving healthcare for everyone. I love what we’re building at Forward and I love the team – even those of us who aren’t from a healthcare background are driven by the mission to improve communication, and you can feel that energy walking into the office.

For more information on Forward Health visit www.forwardhealth.co or follow them on Twitter @ForwardHealth_

Meet the innovator: Vivek Patni

Blog

Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Vivek Patni, Director and Co-Founder of WeMa Life; an online marketplace that brings customers and their families together with social care and community care service providers.

Pictured above: Vivek Patni.

Tell us about your innovation in a sentence

WeMa Life is an online marketplace that brings customers and their families together with social care and community care service providers; giving choice, accessibility and efficiency in the service procurement and delivery pathway.

What was the ‘lightbulb’ moment?

As an informal carer for my grandfather, I was immediately shocked by the lack of innovation in supporting families to find, coordinate and manage local care services for their loved one, hence WeMa Life was born. I find online marketplaces very convenient and use them for so many aspects of my life – products, clothes, hotels, restaurants – I knew a similar digital environment was needed for care services. Using WeMa Life as a customer I can search, compare, purchase and rate local care services whilst as a provider I can digitise the outdated, manual, paper-based visit records and manage my daily business activity.

What three bits of advice would you give budding innovators?

    1. Stay flexible: it’s tempting to start a business with a clear idea of how things will unfold; but this is rarely the case. Pivot and react to obstacles and have an open approach to finding the best solutions to all your problems.
    2. User experience: test your product constantly and get as much feedback as you can from all your user groups. Simple solutions sit very well in such a diverse industry.
    3. Be creative in your approach to developing tech and running your business. There are so many applications and tools to create efficiency and cost saving in finding resources, marketing and development, so use them!

What’s been your toughest obstacle?

Where I had faced the difficulty from a customer side of social care, I was less aware of the complexity in delivering publicly funded social and community care to different user groups. This meant learning the nuances of each service type/provider and creating a fluid product that would fit all.

What’s been your innovator journey highlight?

Designing the tech architecture from scratch, building an international technology development team and bringing my ideas to life in just eight months is something I am very proud of.

Best part of your job now?

Taking my product into the market! Now that the product is live, I am driving its use through digital marketing and sales. I meet so many interesting people on a daily basis who bring exciting new ideas to what we do – my mental technology roadmap is never ending.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I would give more opportunity and financial incentives to SME’s. There are a huge number of SME’s with great ideas and technology, they tend to be more fluid, interoperable and customisable to the needs of the NHS; they would be able to make a real change to the daily lives of providers and customers.

A typical day for you would include..

Typically, my days are devoted to technology and selling. My morning tends to be engagement with my India tech team to make sure we are always refining and innovating our solution. Afternoons will be selling, calling and meeting as many people as I can. I get energised by talking to people about what we do so I try to do that as much as possible.

For more information on WeMa Life visit www.wemalife.com or follow them on Twitter @wemalife

Meet the Innovator

Blog

Meet the Innovator

Each issue we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Dr Sukhbinder Noorpuri, Founder and CEO of i-GP, an online consultation platform to allow patients faster access to primary care for minor illnesses.

Pictured above L-R: Dr Sukhbinder Noorpuri with Co-Founder, Dr Aleesha Dhillon.

Tell us about your innovation in a sentence

i-GP provides digital consultations for minor illnesses, using interactive pictures and online questions. It is accessible to patients 24/7 from any device, and 90% of users can start their treatment within just one hour.

What was the ‘lightbulb’ moment?

When I was working as a GP, I met Michael, a 70 year old gentleman who waited three hours to see me at a walk in centre back in 2015. I thought that there must be an easier way to access healthcare. So I started looking into alternatives, and when I found none, I decided to go about creating one. I have been fortunate enough to have a great Co-Founder in Aleesha who has been instrumental in developing creative solutions to all the challenges that we have encountered.

What three bits of advice would you give budding innovators?

  • Have a vision and make it a big one – set your goals globally rather than just locally in the spirit of true disruption.
  • Be relentless in the pursuit of this vision and always try and learn from every experience or opportunity which comes your way – know your market, keep reading about it and stay focused.
  • Build a world class team and inspire them to believe in the company mission. Be confident in your leadership and enjoy the process. A successful entrepreneur may build a well respected company, but a successful team will change the world.

What’s been your toughest obstacle?

Healthcare innovation is very challenging because impact takes time to achieve. However, your clinical experience is really the key differentiator in the marketplace. If you genuinely feel you have a clear perspective on the problem and have created the solution then building the evidence for your product, despite being time consuming, is the clearest way to show its potential.

Some regard regulation as being a tough element of service delivery, but embrace the challenge as a well executed process is the reason you will stand out in the industry.

What’s been your innovator journey highlight?

Over the last three years, we have won or been shortlisted for 22 healthcare awards as a result of the innovations we have developed in digital care. This has led us to international recognition and the opportunity to showcase i-GP at Conferences all over the world.

Learning to adapt and raise healthcare standards has been a reflection of the dedicated team approach to the venture. However, this recognition is secondary to the feedback we receive from our patients as this is our main driving force. Impacting the patient journey to care on a daily basis  is the motivation and inspiration to transform traditional routes of service. For example last week, we treated a patient who was due to catch a flight abroad for her sister’s wedding but was suffering with a urinary tract infection. It was late at night, she was in a rush and her chosen pharmacy was closed. We managed to arrange her prescription at the chemist within the airport just before she was due to take off. When she returned she was so thankful that her trip hadn’t been ruined by illness and she had been well enough to enjoy the celebrations.

Best part of your job now?

Without a doubt, my greatest fulfilment comes from leading our team. We are all passionate about seizing this opportunity in time to showcase the good that technology can bring to healthcare and the NHS. Digital health is still very much in its early stage of adoption and even though smartphones have been commonplace for several years, we are still on the cusp of widespread digital use. The service that we implement today, we hope, will continue for many years to come.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

There has been a real drive recently with Rt Hon. Matthew Hancock advocating technology to modernise the NHS. Accompanying this, are the additional Government funds being made available to trial new products. This combination offers a paradigm shift from previous regimes and as innovators, we are very much looking forward to this filtering down to provide new opportunities. I also feel it is imperative that decision makers utilise patient feedback to help determine the future course and not just rely on industry advisers.

A typical day for you would include..

Most days are very varied due to the wide scope of avenues we are exploring at i-GP. I usually like to hold key meetings in the morning with either members of the team or board to review processes and define our future strategy.

We have a schedule over the week to assign time to all the key aspects of service from marketing to patient outcomes and from technology developments to the financial structure we have adopted. Reflection is part of this process and the opportunity to network with other innovators is often on the timetable to ascertain the potential for collaboration.

Liasing with the Accelerator team and our navigator Sara is also a key part of our time as we look to integrate further into the NHS.

We would like to take this opportunity to congratulate Dr Sukhbinder Noorpuri who recently won the Chairman’s Entrepreneur Award (pictured above) at the TiE Awards Wednesday 5 December. Find out more about the awards here

For more information on i-GP visit i-gp.co.uk or follow them on Twitter @wellness_igp_uk

Meet the Innovator

Blog

Meet the Innovator

Each issue we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Dr Nicholas Andreou, Co-Founder of Locums Nest, a staff bank management app; connecting healthcare professionals to temporary work.

Pictured above r-l: Dr Nicholas Andreou with fellow Co-Founder of Locums Nest, Ahmed Shahrabanian.

Tell us about your innovation in a sentence

Locums Nest bridges the gap between hospitals and doctors. Making staff vacancies easier and simpler to fill, without the expensive agency middle man.

What was the ‘lightbulb’ moment?

Working as junior doctors in the NHS and experiencing first-hand the frustrations and inefficiencies of filling gaps in the rota.

What three bits of advice would you give budding innovators?

  • Be tenacious- don’t take no for an answer, have thick skin
  • Hire people with purpose who believe in your message
  • Be kind to everyone you meet.

What’s been your toughest obstacle?

Trying to positively change an established institution, with large long-standing incumbents. Challenging the status quo.

What’s been your innovator journey highlight?

With our help, a Trust managed to staff a winter pressures ward without going to an agency. This meant they saved £1.6m in the first 10 months.

Best part of your job now?

Meeting different people in different environments; realising the NHS is enriched with experience and expertise from a vast range of backgrounds.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Open up the barriers to meeting the right people in the system to support innovation.

A typical day for you would include..

There’s no such thing! One day I could be travelling across the country for meetings, in the office for a full day product meeting or spending the day supporting our NHS clients.

Contact us

W: locumsnest.co.uk

T: @locumsnest