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Helping patients with long-term conditions access “cool” technology

Published by Michael Mbanunu

Ruth Bradbury, Senior NHS Navigator at DigitalHealth.London, shares her reflections from a recent panel discussion at HETT about the possibilities for patient facing technology.

When I was asked to be part of this panel at HETT I was excited to be able to share the trends I am seeing through my work at DigitalHealth.London. I was fortunate to be joined by clinicians and leaders with years of experience in implementing patient facing technologies.  They have seen it all from the highs to the lows.

Our Chair, Rishi Das Gupta, CEO of the Health Innovation Network South London, brought his enthusiasm for the topic with an opening question around what we have seen that is ‘cool’?  Now, there are lots of ‘cool’ technologies at different stages in development – emerging proof of concepts or established players delivering systemic change, but what makes something cool?  Is it the super-duper AI behind the scenes, the ease and convenience for the user, or the clinical outcomes?

My fellow panellists talked about their work in renal transplant and maternity care and how they have worked with patients and clinicians to improve the clinical pathway for their patients through implementing technology.  They also referenced groundbreaking AI technologies that turn your smartphone into a medical device equipped to measure clinical vital signs. For me though, the ‘cool’ bit about patient facing technology is where it enables the patient to be involved in their care and in an empowered position to take control of their condition and their management.

A current trend that we are seeing at DigitalHealth.London is in Long Term Condition (LTC) management. Patients with LTCs are a high need population for health and care services.  With clinical services that are stretched, risk stratification of patient need becomes even more valuable to ensure patients get clinical input at the right time.

Some examples that I have seen through my work include innovations which allow patients can share photos and videos of themselves; these can support their clinician to better manage their condition through the image record alone or AI analytics which can track change and direct management. Patients who are able to log their daily routines and medication can provide more reliable information to their clinicians to support virtual management or more effective face-to-face appointments. And technologies that support the patient to take control and ownership of their LTC can demonstrate improved clinical outcomes, reductions in secondary care re-admission or reduction in outpatient follow up, and overall improved quality of life. I think those are the impacts that make patient facing technologies cool!

One of the discussion points focused on the role of patients and users in the development and implementation of technology. Sian Thomas, SRO for Digital Maternity Cymru, talked about how her work rolling out a digital maternity record involved collaboration with women and birthing partners. Collaboration could involve co-design and co-production, but involvement of patients and users needs to consider the diversity of the population so that health inequalities are recognised and targeted. For the supplier developing a patient facing technology, understanding health inequality issues and engaging with the right people can be challenging, but there are broad brush actions that can be taken. For example, is the tech accessible in different languages or via mobile and web apps? Is the user interface and experience simple enough to manage differing levels of digital literacy? Beyond this, suppliers and health and care teams have a role to dig deeper into the specific needs of the target population so that implementation does not leave people behind.

So, we know there are many 'cool' patient facing technologies out there, with new ideas and products ready to be launched to the health and care system.  The un-cool part is how to get these ideas and products into the hands of the patients and clinicians; the challenge of navigating the system, finding the champion and ultimately the money.  At DigitalHealth.London we make this un-cool part part of our everyday mission. We work with innovators to help them understand where they should be focusing, where the need is, and who they should be talking to.  And not forgetting supporting innovators to build the evidence base to demonstrate the value of their ‘cool’ innovation.  For me, working with digital health innovators and clinicians to ultimately get technology into the hands of the patient is what makes it all possible.

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Making time: using technology to make clinicians’ days better

Published and last updated by Alex Chafey

HIN Chief Executive Rishi Das-Gupta writes about the potential of technology to reduce pressure on the NHS workforce.

The current industrial action by doctors and nurses is a symptom of a much deeper underlying problem which goes beyond pay, and the workforce crisis isn’t just that we don’t have enough staff. Our jobs have become much less human and ironically the way out may be through using technology better (and making it more fun) – giving us back time to care and improving our experience at work.

Workforce challenges

There are several complex factors that I think have led to a reduction in satisfaction, but among them are changes in working patterns and teams, increased workload and the need to use non-intuitive technology.

Firstly, we have been successful over 20 years in reducing the number of hours worked by clinical staff but often this has meant moving to a much more fragmented way of working with less continuity of care for patients and less satisfaction for medical staff. In addition, clinical staff now work with an ever-changing team and it’s harder to form the deep-peer support relationships.

Secondly, the workload has been increasing and we’ve had a 40 per cent productivity increase over the last 20 years in some areas.

Finally, poor interfaces for medical technology mean that new products and devices require training to use. This means that, rather than making clinicians’ lives easier from the outset, their adoption can be a struggle. Having spent some time looking at technology to support clinicians I believe that the next generation of technology can support our workforce in all three of these factors.

The four most promising uses of technology in my opinion are:

  1. Intelligent automation of note-taking and transcription tasks to make time to think;
  2. Scheduling staff and working patterns to make time for our lives;
  3. Remote working and communications technology to help at times of overload; and,
  4. Training and wellbeing support to prepare us to make the most of our time.

I will now briefly highlight the potential of each area with an example and I’ll expand each area in future blogs (depending where you’re interested)!

1. Intelligent automation

Firstly, the way we interact with computers to do day-to-day tasks is changing rapidly and some of the technology suppliers are using data from systems to improve the usability and staff satisfaction with their products – but this will take a product cycle (several years) to come to market. However, many of the processes we have are repetitive and require high levels of attention to do well. This is where we should be applying supervised intelligent automation (IA).

An example of this is automated note-taking in outpatients. I recently saw a prototype from Nuance for listening to a consultation in the background, transcribing this and using the transcript to populate a clinical note in an outpatient setting. This means talking as if there is an AI assistant in the room supporting us to write a clinic note. Voice interfaces and large language models (LLMs) are developing fast and have got a lot of press recently, but I think that the first application to clinical practice might be in note taking.

If we do this early, we’re likely to end up with products that suit our practices in the UK, and I can see advantages in partnering across the NHS with a tech provider to develop something to suit our needs. My hope is that if I’m a patient sitting opposite a doctor using this type of technology, they’ll look me in the eye and have time to think and to focus on me during a consultation.

2. Working patterns

Secondly, having moved to shift patterns and rolling-rotas, our ability to plan our lives has reduced. If I’m invited to wedding in December, I don’t know if I can attend. I recently saw a new product from Lantum designed to use artificial intelligence to fit rotas based on local rules to generate compliant rotas and enable swaps between people on the rota. Technologies like this offer the promise of more control over the trade-offs we make in our work-live balance.

3. Remote working

Thirdly, remote working and communications technology offers the ability to support us in real time but also the risk that we’ll always be working/available. We’ve all got used to zoom and phone calls for support but there is more we can do to have integrated communications that route calls to the right person to support us and to others if they are busy. The opportunity I see here is to support each other when the workload is really high or we need help to know what to do. This technology has been around for a while, but I’ve previously thought it suitable for deployment only by large organisations. At the Health plus Care show in April there were several companies with products addressing this including in assisted living facilities and care homes where I saw a demo of the Ascom solution which integrated an easy patient interface (using Amazon Alexa devices) with a clinician platform that meant that all calls can be prioritised. This need is reflected in the fact that a requirement for improved communications platforms has also been included in the new contract for GPs for this year.

4. Training and wellbeing

Fourthly, during the pandemic we saw a lot of training move online and we’ve been learning from this experience and adding well-being support to our staff development and support offers. Online and hybrid training can be delivered on-demand or at specified times in groups or alone. However, in addition to traditional training we’re also seeing other staff offers being delivered using non-face to face platforms such as mental fitness by Fika or meditation through apps like Headspace which were made available to NHS staff over the pandemic period.

This list isn’t exhaustive but I think outlines why I have hope that we could improve staff experience using technology that exists now… and the even bigger potential win would be embedding all this in a universal NHS staff app I could carry in my pocket that would integrate these features and my staff passport documents!

Staff experience impacts patient safety and evidence shows that Trusts delivering the best care have tended to also record high performing staff survey results. With tools like this I think that staff satisfaction can be impacted in months – and we need to measure it during that timeframe. NHSE has launched a shortened quarterly (NQPS) and monthly versions of the staff survey it used to publish annually (we are trialling the monthly people pulse survey at HIN) and I think it’s time we reframe the conversation about our work to bring staff experience and staff satisfaction to the forefront, alongside patient outcomes, and that we use metrics like productivity/throughput as measurable by-products of happier staff.

Although it’s easy to highlight shortfalls in the current approach I think we are at a point where we can see concrete ways to improve staff experience and to demonstrate the impact of this (and spread learnings fast) to improve the lives of hundreds of thousands of people working in health and care over the next year.

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Accelerating the remote monitoring market through partnership

Published and last updated by Alex Chafey

The Health Innovation Network and NHS England (London Region) recently held a series of procurement roundtables focused on remote monitoring. In this blog HIN Chief Executive Rishi Das-Gupta and NHS England Regional Director of Digital Transformation Luke Readman discuss how developmental partnerships offer the chance to accelerate the development of this emerging technology.

“Trust is hard won and easily lost. Any effective partnership needs to have a high level of trust, this means that partners must be willing to work together to solve problems collaboratively, agreeing to work in the best interests of the partnership goals.”

Healthy relationships need clear boundaries and shared goals; during the pandemic we had to procure remote monitoring solutions at pace, leaving precious little time to build trust and align visions. In London, some remote monitoring suppliers overpromised and underdelivered on the quality and time taken to build and deliver solutions; whilst service expectations were not always realistic which also contributed to the breakdown of some relationships.

The Health Innovation Network and NHS England (London Region) recently held a series of procurement roundtables, bringing together experts from across industry alongside commissioner and provider organisations to explore a better way forward.

Given our collaborative approach, it seems fitting that the “red thread” running through these lively discussions was the importance of developmental partnerships and contractually enabled collaboration to achieve our collective goals.

Some of the tactics discussed in the roundtable report include:

• Early market engagement: Co-defining problems with industry to lay the ground for partnership working through dialogue.

• Developmental contracting: Building the intention to develop a solution into contracting processes.

• Meeting future needs: Creating work packages which account for areas of uncertainty or with the flexibility to respond to “unknown unknowns”.

• Testing via pilots and evaluation: Testing work packages through contracts which build lower-risk pilots into delivery before committing to larger costs.

• Harnessing innovation: Contracting with multiple suppliers to harness innovation in all patient cohorts across a geography, including making use of Dynamic Purchasing Systems to allow new suppliers to join and local systems to articulate their own bespoke needs.

We are delighted to share the initial outputs of our roundtable events.

Further guidance and recommendations looking at how to procure and contract for partnerships can be found in our full report released in April 2023.

New report shows remote mental health consultations make care more accessible but are not the right solution for all patients

Published by Simon Ellery
Clinician pictured in remote consultation with patient

Remote technology has transformed mental health consultations during Covid-19 but it’s not the solution for every situation nor for all patients.

Key stats

  • 6,030 patients responded to the Trust surveys
  • 554 clinicians that responded to the Trust surveys
  • The report included a synthesis of 77 papers from 19 countries

A new report has found the shift to remote mental health consultations held by telephone or video, rather than face-to-face because of the pandemic, led to improved access, reduced missed appointments, and reduced travel stress. However, it also highlighted challenges, including access to technology, issues around broadband connectivity and data packages.

The report, produced by the NHS’s Health Innovation Network, NIHR Applied Research Collaboration South London, King’s Improvement Science and involving experts by experience, South London and Maudsley NHS Foundation Trust, South West London and St George’s Mental Health NHS Trust and Oxleas NHS Foundation Trust, makes several recommendations to inform clinical practice and to determine ongoing gaps in knowledge.

Key findings from the 6,030 patients who responded to the Trust surveys on remote consultations in mental health settings were that they allowed the flexibility of varying levels of support during the pandemic, and care was more accessible to populations who may have previously found travel to appointments challenging and some patients felt more relaxed in their own home during the consultation.

From the 554 clinicians that responded to the Trust surveys, including psychologists, psychiatrists, psychotherapists and nurses, training to use technology was raised as a need for both clinicians and patients.

Patients, carers, and clinicians said remote consultations were more convenient, reduced travel time, saved travel costs and meant family members were readily able to attend family sessions. In particular, remote mental health consultations were acceptable to people during Covid-19 to continue their treatment.

However, there is no ‘one size fits all’ and an individualised approach will always remain the gold standard, especially for new patients and children, those with a psychosis diagnosis, learning difficulties or the digitally excluded. Other barriers to remote consultations included where patients or clinicians could not access a private space where they were confident they would not be interrupted.

The report includes three evaluations:

  • Two evidence reviews of research both before and during Covid-19 were conducted jointly with the NIHR Mental Health Policy Research Unit.
  • Thematic analysis of patient and staff surveys from across the three Trusts, which received 6,608 responses.
  • The results of an e-survey on 32 projects with a focus on patient and/or staff perspectives on experience.
“Technology has allowed clinicians to provide consultations remotely, and this has been well received by many patients who say it is more convenient and saves the time and stress of having to travel to appointments. ”Dr Natasha Curran, Medical Director Health Innovation Network

Health Innovation Network Medical Director Natasha Curran said:

“Access to mental health services during Covid-19 has been disrupted as patients were isolated and clinicians were unable to hold face-to-face consultations. Technology has allowed clinicians to provide consultations remotely, and this has been well received by many patients who say it is more convenient and saves the time and stress of having to travel to appointments.

“This study also shows that remote consultations don’t work for everyone for a variety of reasons: the nature of some patients’ condition, technological barriers, or privacy, for both clinicians and patients. This comprehensive report points to the benefits of a hybrid system, the importance of patient choice, where some consultations can be carried out remotely and others face to face, that could support vital ongoing mental health treatment both during Covid-19 and beyond.”

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Modern telephony promises to transform the patient experience – but the marketplace is daunting for commissioners

Published and last updated by Simon Ellery
Clinician with mobile phone and computer

New telephony systems mean a revolution in the patient experience as part of the shift to ‘Total Triage’. But the wealth of systems on the market means GP surgeries face a daunting challenge identifying the right system, says Denis Duignan, the HIN’s Head of Digital Transformation & Technology.

Covid-19 has highlighted the inadequacies of traditional telephone systems in primary care. Patients waiting to get through on the phone, having to manually search for patient records and GP’s working remotely were all issues that have highlighted the shortcomings. But new systems help manage demand, enable remote working and improve the patient experience.

The promise of modern telephony is a transformed patient experience. However, with a multitude of systems on the market offering a range of different and complex packages, the decisions facing practices and Primary Care Networks (PCNs) keen to take advantage of new technology in this field are daunting.

The Health Innovation Network (HIN), working with Our Healthier South East London, has produced a ‘Commissioner’s Guide to Telephony’, which explores the primary care telephony market and aims to support better decision making for GP practices, federations, and primary care networks looking to upgrade or migrate their telephony solutions.

The inadequacies of traditional telephony

In 2019, poor telephone systems were identified as one of the key areas affecting patient experience and access to local primary care services within the London borough of Lambeth. The south east London Digital First Programme set out to improve primary care telephony through local healthcare, patient and industry stakeholder engagement which led to a workshop that stimulated many general practices to upgrade their systems. Whilst the learning from this was being consolidated, Covid-19 broke out across England. This very quickly highlighted the inadequacies of traditional telephone systems in facilitating an effective move to ‘Total Triage’ and remote working for clinical and non-clinical staff.
Many GP practices still use traditional phone systems, which consist of an on-site private branch exchange (PBX) which connects through fixed lines to the public switched telephone network (PSTN). This system has limited functionality and flexibility compared to more modern voice over internet protocol (VoIP) telephone systems.

What is Voice Over Internet Protocol?

Also called IP telephony, VoIP is defined as a method and group of technologies for the delivery of voice communications and multimedia sessions over Internet Protocol networks, such as the Internet. Some of the key areas where VoIP telephony has been seen to benefit primary care include:

  • Clinical system integration: The incoming caller’s patient record can be automatically ‘popped’ on screen, and calls can be made directly from the patient record using click-to-dial, streamlining the receptionist’s workflow.
  • Live call reporting and dashboards can enable practice managers to identify busy times and manage their workforce accordingly.
  • The ability to customise the phone system through an online portal giving practice managers control over auto-attendant/interactive voice response options so that they can route their calls in a way that suits their individual practice.
  • The flexibility of VoIP telephone systems enables them to be configured for different ways of working including central hub models and remote working using staff mobiles or telephony software on their laptops to receive and manage calls. The Commissioner’s Guide to Telephony provides further detail on the features and benefits of modern telephony systems.

The supplier market is large and complex

Another key area of guidance included in the report is in navigating the supplier market. The hosted telephony market in the UK is large and complex and comprises a diverse range of businesses from small family-run providers to large multi-national corporations, including both original equipment manufacturers and resellers. Understanding the capabilities of suppliers can be challenging for non-technical customers due to the number of acronyms, abbreviations, and jargon used and it is generally difficult to differentiate suppliers based on capabilities due to the range of add-on services a company can incorporate within their offer. In an effort to simplify the market for primary care, the guide includes a functional comparison of suppliers with primary care focussed products.

Practices that have adopted modern telephony systems have been overwhelmingly positive about the impact it has had on service delivery relative to their previous systems. This commissioning guide can assist other practices looking to update their telephony and realise the benefits of modern telephony.

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St George’s Hospital unveils dual electronic queue management and self check-in

Published and last updated by Simon Ellery
Clinicians in ED

St George’s University Hospital Emergency Department unveils one of UK’s first dual queuing and self check-in system where patients see real time updates of their queue position on TV screens and smartphones.

HIN Innovation Grants supported project

St George’s installed the system after winning a HIN Innovation Grants award in 2019

St George’s University Hospital is one of the first Emergency Departments in the UK to introduce a dual queuing and self check-in.

Patients in the ED can map their queue position through real time updates on TV screens and smartphones.

In a move that reassures patients that they have not been missed or bypassed, the new system called “Patientcheck.in” helps free up emergency reception staff who handle a high volume of questions from patients about their wait and queue position. This has a knock-on delay in booking in new patients. Patientcheck.in – previously called “EDck.in” – also allows patients to complete a brief assessment questionnaire while they wait, using their own smartphone, which saves time during the assessment.

The technology aims to reduce patient anxiety around waiting times and improve efficiency.

Funded by the NHS’s Health Innovation Network, a joint Emergency Department and Transformation project team at St George’s was awarded £9,928 to design and build the software system and install TV monitors in the waiting areas.

Previously, a whiteboard behind the reception desk was used to display general waiting times and updated every hour. Lack of visibility of individual positions in the queue can cause concern for patients, who can worry that they have been forgotten, passed over or missed their call to see the emergency team. This can lead to repeated queries to reception staff about the waiting time and occasionally result in aggressive and abusive behaviours which puts additional pressure on staff.

The second function – the assessment questionnaire – has three major benefits. It empowers patients to tell clinicians why they are in the ED, in their own words using a non-verbal communication channel; reduces clinical administration workload and creates better quality, standardised medical documentation.

Through its integration with Cerner, the hospitals’ electronic health record system, Patientcheck.in sends the questionnaire responses directly into the electronic clinical notes. This reduces note-typing time by around eight minutes per patient. Therefore, if just half of St George’s 400 ED daily attenders complete Patientcheck.in, this equates to a potential saving of more than 26 hours of clinical time every day.

The Health Innovation Network grant was used to develop and implement the system. Now live, the team hope that Patientcheck.in will be adopted by other NHS Emergency Departments. There is also an opportunity to use it in outpatient departments and development projects are underway.

Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust, said:

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.
“Emergency departments are pressured and all you want is to do the best for patients. It’s difficult at the moment when we can’t easily answer their top question: when will I be seen? With relatively simple technology we believe we can make a huge difference to their experience and support staff at the same time by reducing interruptions. Greater transparency over the complex queues we operate will help everyone gain a greater understanding of how teams are working to help people.”

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.”Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust

Health Innovation Network Programme Director for Innovation Lesley Soden said:
“Hospital emergency departments can often be highly volatile as by their nature they have anxious patients waiting to be seen. Those patients often worry that they have been missed or passed over by other patients and this can lead to repeated questions to hard pressed reception staff, who are then preventing from getting on with their work to triage.
“This is a simple system using existing technology that can improve the patient experience, free up reception staff to focus on registering arriving patients and ultimately lead to faster care in hospital emergency departments.”

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St George's Patientcheck.in

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