Discovering the right digital tools

There is potential for digital technology to significantly impact on the NHS Five Year Forward View ‘triple aim’ of providing better health, better care, and better value. Health Business examines the development of digital technology, as expressed in a new paper

A new report from NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association explores how five vanguards are implementing innovative digital technology solutions at the heart of a new approach to care.

In 2015, following the publication of the NHS Five Year Forward View the previous year, 50 local health and social care systems, otherwise known as ‘vanguards’, were selected to take the lead on the development of these new care models, with a number of them specifically focused on implementing digital solutions at the heart of a new approach to care.

New care models: harnessing technology analyses how East and North Hertfordshire, Better Care Together Morecambe Bay, Better Together Mid Nottinghamshire, Salford Together and East Midlands Radiology Consortium are overcoming myriad challenges in adopting digital technology in health and care, and are instead using it to enable more efficient, integrated, precise and personalised care. According to the authoring bodies, the starting point for any project introducing new technology should be the perspective of the end users. This means that any digital programmes should be ‘co-produced with people who use services’ so as to ‘ensure that the solutions are anchored in their needs and experiences’.

The report finds that technology should always aim to enhance, rather than replace, existing services. This is an area where technology adoption often falls short. NHS trusts must analyse how solutions will support existing systems, processes and ways of working, and make use of learning and evidence from other areas.

East and North Hertfordshire
Enhancing health in care homes is a project that has been undertaken by East and North Hertfordshire Clinical Commissioning Group (CCG), Hertfordshire County Council and Hertfordshire Care Home Providers Association (HCPA). In an age where the social care crisis is threatening to overspill, and consequently damage an already oversubscribed health system, the vanguard aims to help health and social care providers in Hertfordshire work together to provide greater levels of support for care home residents and avoid unnecessary trips to hospital.

HCPA implemented a Quantitative Timed Up and Go (QTUG) package within its residential care home exercise visits in 2015. The technology sees a tablet, installed with QTUG software, and two medical-grade sensors, attached below the knees, to monitor a patient’s walking. Measuring criteria such as gait and stride length, the sensors can calculate a person’s risk of falling. The data collected can then be cross-referenced and compared to data for people in the general population of the same height and weight to calculate falls risk. More immediately, the technology allows Hertfordshire care home staff to build a more rounded picture of each person and their specific needs.

HCPA has reported that the use of the QTUG device has resulted in a reduction in falls risk in 15 of the 19 nursing homes for residents who attended more than half of the association’s exercise classes. Interestingly, there was no change for those attending less than half of the classes, highlighting to HCPA staff, and the care home residents themselves, the importance of regular exercise.

As a result of the success of the care home pilot, and additional funding from NHS England, the HCPA team have been able to roll out the technology and exercise classes into community settings.

Better Care Together Morecambe Bay
The Better Care Together telemedicine project seeks to reduce unnecessary journeys taken by the public and ambulances in South West Cumbria. The town of Millom has a population of just 8,500, and generates over 22,900 one-hour journeys to Furness General Hospital each year, combining to over 1,000,000 miles travelled.

The project team believe telemedicine has the potential to transform health and care in a rural part of the country, hoping for telemedicine to account for 20 per cent of outpatient activity at University Hospitals of Morecambe Bay (UHMB) Foundation Trust within three years, with patients receiving the same level of care but in more convenient locations.

A video link between a GP surgery in Millom and Furness General Hospital Emergency Department has been set up, enabling for a triage to be remotely undertaken digitally. If travel to the hospital is required, this is immediately arranged. Virtual out of hours appointments and telehealth links have now been established between Millom Community Hospital and GPs at Cumbria Health on Call (CHOC) and between the hospitals and the Category C prison in the area.

Better Together Mid Nottinghamshire
More than 15 million people in England live with at least one long-term health condition, accounting for 70 per cent of NHS spending, representing 55 per cent of GP appointments and 77 per cent of inpatient bed days. The Better Together Mid Nottinghamshire telehealth project, which uses a Florence telehealth tool, was adopted in response to widespread interest from clinicians in tackling these issues.

Florence is an automated telehealth tool that uses SMS text messages to help people manage their own health conditions at home, using biometric devices such as blood pressure monitors. The system sends text messages to prompt patients to stick to tasks that they have agreed with their clinician, such as sending in vital sign readings. Patients reply to Florence via text message and the system responds in accordance with protocols agreed by the clinical team.

The Nottingham Assistive Technology Team first rolled-out Florence in 2012 within heart failure services. The project proved that hospital admissions were being avoided, in some cases by up to 35-48 per cent, as a result of detecting signs of deterioration earlier. In fact, at least 80 per cent of respondents from each patient group reported less frequent usage of GP services after they started using Florence.

Since the heart failure trial, Florence has been deployed across a range of areas, including diabetes, hypertension and blood test reminders. The system is continuing to be rolled-out across Nottinghamshire and across even more types of health conditions, including pain management and a project looking at cancer pathways and use of telehealth cognitive behaviour therapy.

Salford Together
Salford Together is a partnership between Salford City Council, NHS Salford Clinical Commissioning Group, Salford Royal NHS Foundation Trust, Salford Primary Care Together and Greater Manchester Mental Health NHS Foundation Trust. It aims to deliver £27 million of recurrent savings by 2021 through reducing hospital admissions and eliminating duplications across the health and social care system.

Salford Together vanguard are pursuing plans to become an Integrated Care Organisation (ICO) with intentions to bring a workable IT system and the right technology in place. A lot of work was undertaken to coordinate approaches to IT and get council and trust networks together. The ICO, which is delivered by Salford Royal, encourages the development of a shared care record system across many diverse systems – from GP, hospital and social care records.

In March 2016, Salford Royal selected Allscripts CareInMotion population health management platform to supersede their existing shared integrated record system. The platform shares data across disparate systems within clinicians’ workflows and offers a framework that enables healthcare organisations to address their specific population health priorities through, for example, predictive analytics, care coordination and patient engagement.

Salford Royal also uses the Allscripts Sunrise Clinical Manager, an electronic health record solution, in areas such as A&E and critical care, departments which previously relied on paper. This has enabled staff to electronically record and track decisions about patient care, which has been integral to the trust’s strategy to be the safest organisation in the NHS.

East Midlands Radiology Consortium
The East Midlands Radiology Consortium (EMRAD) covers over six million patients and eight trusts in the region and aims to deliver timely and expert radiology services to patients across the East Midlands, regardless of where they are being treated.

Figures show that the East Midlands has the lowest number of radiologists per 100,000 people out
of all the regions in the UK. A five per cent growth in the number of consultant radiologists between 2012 and 2015 was matched by a 30 per cent increase in the number of CT scans over the same period. Outsourcing radiology cost over £88 million in 2015 alone.

EMRAD, working with GE Healthcare, has created a cloud-based, shared, radiology IT system capable of handling of millions of patient events, which allows clinicians to access the complete radiology imaging record for all patients across the East Midlands, regardless of where they are based. This brings greater flexibility in the use of the radiologist workforce, resulting in additional capacity.

Over the first pilot, six neuro-radiologists looked through 1,160 images and helped 939 patients, and were able to significantly reduce the backlog of radiology images in a few weeks. Since then, Nottingham University Hospitals and Sherwood Forest Hospital have now implemented the IT system as a sustained live service (business as usual), proving there is the appetite, and capability, to make use of the technology across large teaching hospitals and smaller general hospitals. The IT system will also be rolled out to Chesterfield Royal Hospital in the near future.

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