ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
Enhancing patient care through innovation
A wireless sensor that better detects breathing rate in hospital patients, an app to help pregnant women monitor hypertension and another that directs patients with minor injuries to treatment units with the shortest queues are among the latest innovations set to be spread across the NHS. Health Business looks at the 11 ground-breaking projects from the third round of the NHS Innovation Accelerator programme
First launched in January 2015, the NHS Innovation Accelerator programme (NIA), is an NHS England initiative designed to develop and spread pioneering ideas, equipment and technology that have the potential to save lives as well as millions of pounds. The aim of the NIA is to support delivery of the commitment detailed within the Five Year Forward View: creating the conditions and cultural change necessary for proven innovations to be adopted faster and more systematically through the NHS, and to deliver examples into practice for demonstrable patient and population benefit. It is delivered in partnership with 15 NHS Academic Health Science Networks (AHSN) across England and is hosted at UCL Partners, an academic health science partnership that brings together people and organisations to transform the health and well-being of the population.
The 15 NHS AHSN provide a financial contribution to cover bursaries for fellows and support the cost of the NIA, as well as promote the adoption of these innovative ideas across the NHS. They include: Eastern AHSN; East Midlands AHSN; Greater Manchester AHSN; Health Innovation Network; Imperial College Health Partners; Innovation Agency (North West Coast); Kent, Surrey, Sussex AHSN; North East and North Cumbria; Oxford AHSN; South West AHSN; UCL Partners; Wessex; West Midlands AHSN; West of England; and Yorkshire and Humber ASHN. In addition to financially supporting fellows, the NIA and AHSN supports them by giving them access to mentorship from a range of experts and high profile mentors, offering peer to peer learning and support and inviting them to quarterly events. The support also includes access to a bursary of up to £30,000 and regular meeting and critical challenge from the NIA Core Team.
Transforming healthcare digitally
The latest, third round of the NIA programme saw the introduction of 11 new projects. Five of these projects are similar in that they utilise technology to bring healthcare within the home and reduce traffic in GPs and hospitals. The Common Approach To Children’s Health (CATCH), founded by Damibu CEO Dave Burrows, gives parents the appropriate and understandable information they need and want, in a timely and measured way and via a device they are familiar with, such as a smart phone. CATCH aggregates local and clinical knowledge from their council and GPs, building a region specific, tailored, trusted resource they can reuse, giving them confidence to look after their children at home. Since the launch of the project, there has been a three per cent reduction in overall A&E attendances reported by Eastern Cheshire CCG in winter 2016/17, and based on 284 responses from the CCG’s user satisfaction survey, 47 per cent of users decide on self-care over an A&E visit, 64 per cent decide on self-care over a GP visit, and 91 per cent would recommend CATCH to a friend or relative.
Dip.io, created by the chief commercial officer of Healthy.io Katherine Ward, also transforms the patient’s personal device, using computer video and user centric design to turn the smartphone into a urinalysis device. Dip.io complements established clinical efforts by empowering patients to test themselves at home with no quality compromise, and securely share results with a clinician. This project impacts a range of pathways including pre-natal, chronic kidney disease (CKD), and urinary tract infections (UTI). Dip.io is CE approved and ISO 13485 certified, with 99.5 per cent usability rates in FDA clinical trials covering 500 patients across demographics. A John Hopkins prenatal study demonstrated that less than 10 per cent of respondents preferred testing at the clinic, illustrating that the urinalysis device has had a positive response. Furthermore, the roll out of home-based albumin:creatinine screening for CKD is successfully being used in collaboration with US and Dutch National Kidney Foundations.
Asma Khalil, consultant obstetrician at St George’s Hospital and reader at St George’s Medical School, University of London, designed Home monitoring of hypertension in pregnancy (HaMpton). HaMpton is a new care pathway developed by the maternal fatal medicine team at St George’s Hospital which involves the use of an innovative smartphone app for monitoring high blood pressure at home. The app alerts women if they need to attend the hospital, and it also links with a hospital computer system where the data can be monitored by clinicians in real time. HaMpton reduces the number of hospital visits and has achieved excellent patient and staff satisfaction. Since its launch, there has been a 53 per cent reduction in number of appointments for hypertension monitoring and amount of time per appointment, and a £300 average cost saving per per patient per week, or £50 million potential annual cost saving if scaled up across the UK.
My Diabetes My Way (MDMW), founded by CEO of MyWay Digital Health Deborah Wake, is a low-cost, scalable, comprehensive online self-management platform for people with diabetes. It incorporates multimedia education, online health record data access, personalised tailored data-driven advice, communication tools for healthcare professional contact, and links in to social media and peer support. MDMW has been running across NHS Scotland since 2008 and currently has over 30,000 registered users. Its education sites have recently been launched commercially in Somerset and North West London. Based on a recent evaluation survey of 1,098 users, over 88 per cent felt MDMW helped them to manage their diabetes better. The project has also brought about improvements in long-term blood glucose sustained out to three years. An over 5:1 return on investment based on the analysis of outcome data from a long-term user in NHS England has also been achieved.
Liz Ashall-Payne founded the Organisation for the Review of Care and Health Application (ORCHA), which provides a live resource of reviewed health and care apps which can be easily searched, compared, recommended and downloaded through an easy-to-use platform. Thorough reviews and a simple scoring system highlight functional capabilities of the apps, making it easier for users to confidently and quickly compare and choose the best apps. ORCHA works with CCGs and providers to develop health app portals which integrate with local systems and strategies. It allows professionals easy and clear access to a verified resource, allowing them to enhance services and outcomes by finding and recommending the best apps to patients. ORCHA collates data and reports app usage by population, patient and professional group to help assess and prove digital strategies, investment and outcomes. It activates over eight million people and patients to use healthcare apps in England. A 2015 Research Now Group study of 500 healthcare professionals and 1,000 health app users showed that over 90 per cent of healthcare professionals believe health apps will increase their knowledge of patients’ conditions.
Simon Stevens, chief executive of NHS England, highlighted the impact of these home-based, innovative projects when he said: “Modern medicine is on the cusp of a huge shift in how care is delivered, and practical innovations like these show how NHS patients will now directly benefit. More tests and patient monitoring will be done at home or on the move, without the need to pitch up to a doctor’s appointment or hospital outpatients.”
Transforming healthcare physically
Another project included in the third round of the NIA programme is ESCAPE-pain. Michael Hurley, clinical director for the newly formed Musculoskeletal Programme of the Health Innovation Network South London, founded the six-week programme designed for groups of 10 people, aged 45 years or older, with knee and/or hip osteoarthritis (OA). It helps people understand their problem, advises them on what to do, and teaches them simple exercises that can alleviate pain, allowing them to do more, change the course of the condition and improve their lives. Behavioural change techniques – including goal-setting, action/coping planning, monitoring – are incorporated to encourage participants to maintain a healthy body weight and exercise regularly. The project proves beneficial for up to two and a half years after completing the programme, and has the potential to save £2.8 million annually in total health and social care for every 1,000 participants who undertake it.
Oviva Diabetes Support, founded by head of partnerships at Oviva UK Ltd Olivia Hind, is similar to ESCAPE-pain in that it is a technology-enabled and NICE-aligned programme of type 2 diabetes education that lasts 10-12 weeks. The programme is fully remote and goes beyond information given to patients with individualised care to support goal setting and development of sustainable self-management strategies. Oviva Diabetes Support contains high-frequency one-to-one support from a dietician with highly engaging evidence-based structured education materials that patients can access online at a pace that suits them. Participants also have access to the Oviva app to self-monitor weight, nutrition and progress against goals. This approach builds on evidence regarding improving access and uptake of structured education. The average uptake of Oviva Diabetes Support is 75 per cent, with 85 per cent of participants completing the programme, and 93 per cent of participants said they would recommend the programme to friends and family. It has made clinically meaningful improvements in diabetes treatment targets, as demonstrated by outcome data. Oviva Diabetes Support is estimated to save the NHS £1,000 per participant based on reduced medication need and use of services.
Another project that has had a great impact on the NHS and has transformed care for patients is Transforming Systems’ Alistair Martin’s WaitLess. Commissioned by CCGs and co-designed by patients and GPsm WaitLess was launched in east Kent in December 2016. The app allows people with minor injuries to select the location which will get them access to treatment fastest, by combining live feeds from A&E departments and all types of Urgent Treatment Centres, showing the number of people waiting and waiting time. The app then combines this with the travel time to the location and expresses this as a single figure. Since its launch, there has been an 11 per cent reduction in minor injuries activity in A&E, specially during the busiest times of day, and a five per cent reduction in minor injuries activity across the board. To date, WaitLess has been used 125,000 times with a 99.6 per cent patient satisfaction rate.
First Episode and Rapid Early Intervention for Eating Disorders (FREED), founded by clinical psychologist Karina Allen, provides a rapid early response intervention for young people aged 10 to 25 years with short (three years or less) first episode illness duration. FREED overcomes barriers to early treatment and recovery. Components include rapid screening and assessment protocols, evidence-based interventions that specifically attend to the needs of young people and their families (including options for online treatment), and an implementation toolkit. Based on an initial evaluation, FREED reduced waiting times for treatment by approximately 50 per cent compared to audit data from matched patients, and improved treatment uptake by 100 per cent compared to 73 per cent for audit patients. Additionally, FREED helped 59 per cent of patients with anorexia nervosa reach a healthy weight in 12 months, versus 17 per cent of the audit sample.
Of the NIA, Mike Hannay, chair of the NHS AHSN Network, said: “As a national NHS AHSN Network we remain committed to supporting the NIA to ensure that as many residents, patients and staff as possible can access these innovations, which support primary care and urgent and emergency care needs. We look forward to working with the new fellows over the coming months to deliver these innovations at scale across the country.”
Transforming healthcare for NHS staff
The last of the 11 innovations are designed directly for NHS staff so that they can improve care for patients. Lantum, founded by Melissa Morris, is a cloud-based tool built to help NHS Providers fill empty shifts in their clinical rotas. Designed by doctors and managers over the past five years, the tool has been specifically developed for staffing managers working in the NHS. Lantum offers a secure online environment where providers can advertise shifts for their own clinical staff to book at any time via any device. The tool integrates with clinical staff calendars to efficiently match available clinicians with open shifts, and the app for clinical staff allows them to cover shifts quickly on the go 24/7. Lantum has been adopted by 35 GP Federations, and is estimated to generate £3 million of savings for the NHS in under five years by providing a free platform for providers to manage their existing clinical workforce. As a result of the service, 30-50 per cent more shifts are being filled by providers’ own clinical staff banks, thereby reducing use of agency staff and improving continuity of care.
Finally, CEO of PMD Solutions, Myles Murray, founded RespiraSense, a device which offers medical teams the ability to detect signs of patient deterioration 12 hours earlier than the standard of care. It is body-worn and wireless, with a patented sensor to measure the mechanics of chest and abdomen movements during breathing. RespiraSense generates highly accurate respiratory rate data, and can be integrated with electronic health records. It improves patient flow by reducing the rate of preventable escalations of care, and supporting timelier patient discharge, and has the potential to save over £100 million in pneumonia and sepsis pathways, from five per cent reduction in preventable escalations of care.
Each of the 11 projects, which have already proved to be successful, do exactly what NHS England’s national director for strategy and innovation, Ian Dodge, said: “Since it started the NHS Innovation Accelerator has continued to deliver for patients and the taxpayer. It’s just one of the ways that the NHS is getting its act together to provide practical help for innovators with the best ideas. From a small investment, we are already seeing very big benefits – safer care for patients, better value for taxpayers, new jobs created and export wins.”