How to improve patient and taxpayer outcomes with innovation

By Stuart Watkins

Stuart Watkins, Strategy Manager for Health at Crown Commercial Service (CCS), explains the 3 main stages of buying digital transformation solutions in the NHS, with a clear breakdown of programme stages and projects along the way.

Digital transformation solutions in the NHS can help health and care professionals communicate better and enable patients to access the care they need quickly and easily, when it suits them. It’s vital that our NHS health services, staff and patients are ready.

How, where, and when patient care is given is evolving towards smart healthcare services, where technology is embedded across clinical pathways and the digital patient is the new normal.

From websites and apps that make care and advice easy to access wherever you are, to connected computer systems that give staff the test results, history and evidence they need to make the best decisions for patients, technology can support improvements in patient care.

Innovative technology procurement

Technology procurement in the NHS touches on everything from network refreshes to artificial intelligence, virtual wards and patient self-referral. Health organisations, at whatever stage of their smart healthcare journey, require a robust technology procurement strategy that builds close collaboration between their procurement and ICT functions.

They also need to achieve value for money through their procurements, delivering against clear integrated care system requirements and cost improvement programmes – all while keeping social value and carbon net zero agendas front of mind.

A 3-step guide to digital transformation

To help the NHS meet these objectives for procurements, CCS has developed a step-by-step guide, setting out the three main stages of buying digital transformation solutions in the NHS, with a clear breakdown of programme stages and projects along the way.

Aimed at clinicians, ICT professionals, procurement professionals, CEOs and board executives, the guide supports NHS England’s ‘digital first’ guidance and makes a process that can all too easily go wrong more straightforward.

NHS trusts and ICS digital programmes that need to rationalise suppliers, save money, secure value, and ensure interoperability requirements are met will benefit from using the guide.

Covering a comprehensive programme of projects, the guide makes it straightforward for the NHS ICT functions to assimilate into their own ‘live’ digital programmes today. It is organised around the 3 key phrases of digital transformation (Prepare, Transform, Enhance).

Let’s take a brief look at these 3 phases:

1. Prepare

The first step is to develop a technology strategy that aligns with the trust’s organisational development plan and its intended outcomes. From here, you can develop your programme, create your design and delivery structure, prepare outline and full business cases, and allocate budgets.

Next, it is important to review existing assets with the aim of getting the “maximum value from what you already have”. Start by looking at where your core infrastructure and networks need refreshing. Then, explore how unified communications can bring together phone, email, and instant messaging to complement each other and encourage collaboration.

This is also the stage to consider how devices, applications, and databases will be rolled out and managed, and how cyber security requirements can be met.

2. Transform

The ‘transform’ stage invites users to consider how best to digitise patient records: these can be integrated into software and clinical systems, facilitating the delivery and receipt of patient data digitally at the point of service.

For example, if you need to scan historic paper records, consider what further processes and resources are required. You’ll need a validation process to check that scanned documents match the original paper versions and create new workflows to ensure they are available securely.

Smart technologies can also be deployed to enable patient participation and empowerment throughout their clinical pathways. You could integrate systems such as picture archiving and communication (PACS), radiology, pathology, pharmacy, and bedside monitoring, focusing on interconnection and sharing of data, using unified messaging standards such as Health Level Seven. This is also a good time to:

Review data warehousing, looking at how a central data store could improve reporting and analysis.
Build integration into your solutions.
Consider how to extend use securely to other organisations, such as primary, acute, mental health, and social services.

3. Enhance

In the ‘enhance’ stage of the digital transformation process, the focus should be on early intervention and prevention initiatives, in partnership with other healthcare providers in the integrated care system. Everyone involved in the technology procurement should be thinking about people, not tech. At this stage, you should be aiming to put the digital patient at the heart of everything you do.

Smart “champions” who take ownership of the process can help keep the focus on the people who are supposed to benefit from the transformation, while training providers can create bespoke training programmes that empower users and tackle change resistance.
You may even want to consider how apps could help improve the patient experience and provide easy access to clinical services.

The guide suggests that the “enthusiasm” of patients who are already using smart technologies to manage their health can be utilised to encourage widespread change. But it also emphasises the importance of ensuring that digital healthcare solutions are inclusive and accessible to the most vulnerable and disadvantaged people.

There is danger in assuming that all patients and their carers have the necessary digital skills to benefit from new digital healthcare services. This is not always the case and why you should consider how to provide support to anyone who cannot access digital services independently, helping them to find information and complete transactions.

Finally, it’s vital to ensure digital inclusion by helping patients and their carers gain basic digital skills so that they can access these digital services in order to benefit from better healthcare.

You can download the guide from the CCS website.

*Stuart Watkins, Strategy Manager for Health at Crown Commercial Service*

12 questions that NHS IT buyers should ask communications technology vendors

By Dave O'Shaughnessy

While digital communications solutions are plentiful, budgetary constraints mean that asking the right questions of technology vendors is more important than ever, writes Dave O’Shaughnessy.

Today’s experience economy is not only applicable to customer-facing businesses. In the NHS, patients are the equivalent of customers and staff wellbeing is as important as in any other organisation. This means that putting experiences at the centre of NHS trusts and ICSs —for both patients and healthcare professionals—matters more than ever.

Because good communication and collaboration is at the heart of positive human experiences, every healthcare provider should aspire to an ICS-wide communications and collaboration layer. As NHS IT buyers look to realise the potential of transforming communications and collaboration efficiencies – not least improving their platforms’ ability to speak to one another and deliver service interoperability – what questions should they be asking their technology vendors? Here are some suggestions:

1. Innovation without disruption to day-to-day operations – it’s important to maximise the value and benefit from legacy investments by integrating modern communication solutions with existing technology. Ask technology vendors if they can layer on innovative and valuable features – that address real challenges and meet short-term objectives and long-term goals – without disruption to day-to-day operations.

2. Availability – check if a technology vendor is committed to delivering 99.999 per cent availability for communication services. This is important because, when it comes to hospitals, the availability of timely and dependable communications services can be seen as a matter of life and death. If systems drop or become unavailable because of cloud failure, lives are potentially at risk.

3. Security – the NHS needs the same security and reliability in its communications and collaboration solutions as those enjoyed by similarly sized government organisations worldwide, so a key question for vendors is: where will any cloud or hybrid cloud data reside?

4. Existing system interoperability – a new system must be able to push and pull data from the NHS trust’s current systems, including Patient CRMs or Electronic Health Records but if custom integrated work is needed, time-to-value can exacerbate project costs. This means that it’s important to ask if vendors have out-of-the-box connectors for current systems and how interoperability of digital systems and apps for previous clients has been ensured.

5. Single sign-on – ask if a vendor’s solutions are able to integrate with the current credentials system because single sign-on means staff can use their existing trust credentials to access new systems, minimising security-threats and vulnerabilities, while additionally reducing any complex technology-overhead on staff for accessing multiple applications and services.

6. Legacy device retirement – ask if a new system can take over functions presently performed by pagers, alarms, and notification systems. This matters because Trusts still using pagers and other legacy alerting and communication devices need modern solutions that enable legacy devices to be retired when ready and for modern communications and notifications technology to be rolled out.

7. Workflow automation – the NHS needs technology to help automate as many of its existing manual and time-consuming workflows and processes as is suitably possible. Therefore, a key question for vendors is: can you integrate with a hospital’s CRM or EHR systems so as to facilitate automated or self-service patient and staff services?

8. Remote/WFH capability – facilitating high-quality care even when employees aren’t onsite reduces the need for patients to travel to hospital, improving infection control. At the same time, suitable staff must be able to work remotely or from home without service disruption, so vendors should be asked how they would enable staff to communicate and collaborate remotely without hampering productivity.

9. Mobile experience – smart mobile devices that enable staff to access patient data while making a one-touch call to an on-call specialist accelerate traditionally disparate, time-consuming tasks, so be sure to ask vendors how they have integrated healthcare and communication systems using mobile solutions for previous clients.

10. Multilingual capability – the NHS needs healthcare applications that provide their complete set of features and services in as many languages as possible because it’s important to provide services to all who need them in a language they understand. This means that a key question for vendors is: how easy would it be for a patient to select their preferred language using your application?

11. Device and OS agnosticism – it’s important that digital services for staff and patients are available and deliverable across all access interfaces, so be sure to ask vendors if staff and patients will be able access services over various devices, browsers, and operating systems.

12. Video capability – integrated video calls improve engagement, enhance collaboration, and optimise services delivery, so ask vendors how staff and patients will be able to make video calls using their chosen device, and if the calls will be integrated with other digital applications.

Modern integrated unified communications can make the NHS more collaborative across all trusts, departments, and practice areas, enabling healthcare professionals to overcome frustrating pain points, by optimising every communication and collaboration experience for staff and patients alike.

Taking an Innovation Maturity Model assessment can help trusts and ICSs benchmark themselves against industry standards and visualise their readiness and capacity to maximise the use of existing technology and where holes need to be plugged. A great place to start a digitisation journey is to work with a trusted leader in customer experience. This helps leverage existing communications and collaboration investments and adds capabilities from advanced solutions that deliver enhanced experiences across a patient’s experience lifecycle.

Dave O’Shaughnessy, Healthcare Practice Leader, Avaya International

RIVIAM Digital Care’s Hospital Discharge: ready for NHSE’s Care Traffic Control Centre roll out

By Claire Hopkins, RIVIAM Digital Care

Delayed discharge cost the NHS an estimated £1.7 billion in 2022/23. RIVIAM’s Hospital Discharge service connects third sector partners and NHS trusts with the data they need, speeding up discharge, reducing readmission rates and supporting system-wide efficiency.

In 2023, RIVIAM introduced its Hospital Discharge service which is currently being piloted at the Royal United Hospitals Bath NHS Foundation Trust (RUH). Following the pilot, the service will be available on all wards to fast-track patient hospital discharge. The service enables RUH ward teams to make patient referrals simultaneously to multiple community, housing and voluntary sector services working together using RIVIAM at the Community Wellbeing Hub (CWH) in Bath and North East Somerset.¹

Staff at the RUH can then see the status of the care in real time via RIVIAM’s Care Control Dashboard. NHS England plans to expand such Care Traffic Control Centres across England to boostcapacity and improve patient flow^.2 RIVIAM’s Hospital Discharge service is a ready-made digital solution to support this ambition.

The challenge

According to NHS England, there are “more than 12,000 patients every day in hospital despite being medically fit for discharge.”³ Data from The King’s Fund also suggests that discharge delays in England increased throughout 2022 and that the cost of delays in 2022/2023 was at least £1.7 billion, at a time when the NHS is pushing to find cost savings.⁴ For patients, being stuck in hospital when they are fit enough to leave is also upsetting.

One of the challenges with reducing delayed discharges is how to access capacity in the care system provided by social care, community, housing and voluntary sector organisations. To make and coordinate discharge dependent referrals to these services often means multiple different referral routes and phone calls – this takes time that hinders patient flow and could be better spent delivering care.

For community, housing and voluntary sector services receiving referrals, it’s hard to access the latest patient information and to co-ordinate referrals for the best follow up care.

RIVIAM’s Solution

With RIVIAM’s Hospital Discharge service, ward teams at the RUH complete an Onward Admission Referral form giving them one place to refer a patient to a wide range of available community, housing and voluntary sector services at the CWH. This includes commissioned discharge dependent services which cross local authority boundaries.

Immediately reducing admin burden, the referral process is quick and seamless. RIVIAM also auto checks the patient’s details against the NHS Spine Mini service ensuring a high level of data accuracy is captured during the referral process.

Ward teams then use a Care Control Dashboard to see in real time what’s happening regarding the care they have requested for a person. Status updates and useful information are easily accessible. Online communication reduces the need for phone calls and emails which introduce time delays to a patient’s discharge.

A view of the dashboard is also available for the 20 different partners at the CWH so staff can easily see the person’s most recent ward, their expected discharge date and the different services requested.

Integration with the hospital’s Electronic Health Record (EHR), Cerner Millennium®, means that the dashboard data is seamlessly updated in near real time providing timely visibility of this critical information.

For CWH partners, RIVIAM makes it easy to co-ordinate care for a person with each other, reducing duplication, providing efficiencies, and improving the person’s experience.

Benefits of using RIVIAM’s Hospital Discharge service:

Improves patient care and prevents readmission. People leave hospital as soon as they are medically fit with the right support in place.
Frees up beds. Patient flow of those who are Clinically Ready for Discharge is improved, relieving pressure on hospital beds.
Utilises community and voluntary sector capacity. People can recover from a hospital visit at home, with access to local services.
Increases team productivity through data-driven decision making. There is one place for ward staff to see the latest information about the community care lined up for a person, communicate with them more easily and make quick decisions about discharge.
Delivers integrated care. Health, social care and voluntary sector providers can receive, manage and co-ordinate and care delivery and communicate with hospital ward teams.
Greater system-wide efficiency. Real time integration with electronic health records (EHR) provides seamless information flows and insights to reduce time delays, duplication and enable improved care.

“The impact of this digital transformation is plain to see. For ward staff, the ability to easily make referrals to multiple organisations at the click of a button is revolutionary. However, the ability for Discharge Co-ordinators to then easily see when support has been put in place gives much more assurance that a person can return home safely. This platform is not just a tool; it’s a conduit for change, enabling us to reach those who need us most,right when they need us.” – Simon Allen, CEO, Age UK Bath and North East Somerset

To find out how RIVIAM can support your organisation via hello@riviam.com or 01225 945020.

Visit www.riviam.com

¹ The CWH uses RIVIAM’s Multi-agency Referral Hub service to receive and manage referrals in Bath and North East Somerset for 20 social care, community, housing and voluntary sector organisations.

² https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

³ https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

⁴ https://www.kingsfund.org.uk/blog/2023/03/hidden-problems-behind-delayed-discharges#:~:text=That%20means%20that%20the%20direct,at%20least%20%C2%A31.7%20billion

Using digital across adult social care to enable independence for longer

By Integrated Care Journal

This content is supported by Access Group.

In January of this year, PPP published their report, A care system for the future: how digital development can transform adult social care. The report examined the status of the social care system, focusing on the use of technology to support services, and the steps that need to be taken to support the full digital transformation of the sector for improved care, increased efficiency, and workforce satisfaction.

Recommendations from the report covered enabling DHSC to ease the burden of social care providers operating in multiple ICS footprints who deal with a variety of Shared Care Record formats, the support of digital inclusion among people receiving adult social care by local authorities and mandatory basic digital training for adult social care professionals.

The government has recently announced that £600 million is to be allocated to the adult social care sector to boost winter capacity, fund a research programme to determine future policies for social care, and follow through on commitments made in the Next Steps to Put People at the Heart of Care white paper. In order to achieve these goals, DHSC should not undermine the importance of investing in digital technologies within the social care sector, which will increase efficiencies and reduce pressure on frontline staff.

Examples of this type of technology are provided by The Access Group and include Access Assure and Oysta Technology – part of their Technology Enabled Care (TEC) solutions. The Health, Support and Care division (HSC), of which Access TEC is a part, works with more than 10,000 registered care providers, more than 200 local authority departments, and 50 NHS trusts, providing technology that helps these organisations deliver more efficient and personalised care.

Access Assure is a key pioneering technology supporting the adult social care sector by allowing vulnerable individuals to live independently for as long as possible and giving their loved ones peace of mind that they are safe, even when alone in their homes.

Alex Nash founded Alcuris – now Access Assure – in 2015 following his grandfather’s diagnosis with dementia, after noticing a lack of sufficient updates on his wellbeing. He developed a digital care solution that learns the behaviours of individuals and supports their independent living, while also providing the necessary information to the relevant health and care professionals.

The platform uses insights from social alarm and smart sensor technology to enable caregivers to provide proactive care by seeing where anomalies in data could be caused by health complications. These can include notifying carers if someone hasn’t been mobile, which could be due to a potential fall, or if they haven’t been going to the toilet regularly, which may be a symptom of a urinary tract infection (UTI), which is one of the biggest causes of hospital admissions for older people in the UK.

NHS East Lothian has been using the product since 2019 to review patient data and make decisions about the care of each individual. The system has enabled them to change care packages by identifying issues such as UTIs, making their delivery of care preventive of larger issues. By connecting direct costs in care to the use of Access Assure at NHS Lothian, it can be seen that each UTI avoided, or detected early on, produces a cost avoidance of around £3,000 per event.

A 2020 white paper titled Next Generation Telecare: The evidence to date, focusing on 29 family members users using Access Assure, also showed that 83 per cent of families felt it provided increased reassurance because even when not with their loved ones, they can still support them remotely and check-in.

Across the Access Assure customer base, staff have reported significant improvements to their work experience since using the technology. Tools embedded within the system have streamlined administration processes, helping staff cut admin time from 4 hours to a few minutes per individual, releasing time to care. Local authorities can also access the data to intervene swiftly, reducing the need for emergency care and improving quality of life for individuals. When the average wait time for an ambulance is 56 minutes and each callout costs the NHS around £252, the ability to pinpoint potential health complications early with platforms like Access Assure can prove significant in alleviating current pressures on emergency care.

Plus, the Access Assure dashboard, which has been developed over the last year, allows all Access Assure devices and their data to be pulled together into a single resource. Considering the insights provided by Access Assure, the Next Generation Telecare white paper also highlighted that over 40 per cent of care plans were amended after close interrogation of the data, resulting in better care for individuals and a reduction in hospital visits. The dashboard highlights information which can be saved as a PDF so that local authorities can quickly recognise any anomalies and spot where intervention may be needed.

Using Access Assure, patients can be supported to live independently for longer, and care providers and staff are able to drive care management forward. And collectively, with Access’ other technology enabled care solution, Oysta Technology, and wider HSC portfolio of technology, health and care professionals can take a more proactive and preventative approac h to person-centred and participatory care. Access TEC supports NHS, local government and registered care organisation customers wishing to ensure service-users maintain and enhance their independence and confidence, while having dignity, security, and reassurance. These solutions also prevent, reduce or delay hospital admissions or the need to access care home settings and improve the quality of life for the cared for as well as family members and informal carers so that people are supported to stay safe, happy, and healthy in the communities they call home.

Government launches pilot pathway to accelerate access to innovative medical technologies

By Integrated Care Journal

The new Innovative Devices Access Pathway (IDAP) pilot is an initiative to bring new technologies and solutions to the NHS faster and will focus on addressing unmet needs.

The government has launched the pilot of IDAP, a new initiative aiming to accelerate the adoption of “innovative and transformative medical devices” within the NHS. Supported by £10m of government funding, the IDAP is a multi-partner pathway that offers product developers and manufacturers access to tailored support and scientific advice from a team of experts. The latter will in turn develop a bespoke Target Development Profile (TDP) roadmap for successful applicants to help bring their products to market more quickly.

The TDP roadmap will define the regulatory and access touchpoints pertaining to each product’s development, which can include:

Quality management system support
Advice on system navigation
A fast-tracked clinical investigation
Joint scientific advice with partners
Support with Health Technology Assessments (HTA) for product realisation and adoption
Safe-harbour meetings to discuss adoption within the NHS
Exceptional use authorisation granted by the Medicines and Healthcare products Regulatory Agency (MHRA), provided necessary safety standards are met

The IDAP is open to applications from UK and international commercial and non-commercial technology developers, subject to eligibility criteria. During the pilot phase, the IDAP partners, which include the Department of Health and Social Care, the MHRA, NICE and the Office of Life Sciences, will select eight products that best meet the eligibility criteria and that are most likely to benefit from the support and advice available. The pilot will see the main elements of the pathway tested and used to inform the future development of the IDAP.

Dr Marc Bailey, MHRA Chief Science and Innovation Officer, said: “The IDAP launch marks an exciting step in accelerating the delivery of cutting-edge medical technologies safely to patients across the UK. The insights gained during the pilot phase will be crucial in shaping the future direction of this new pathway.

“We encourage medical technology innovators in the UK and abroad to submit their applications and benefit from this combined support service. By working together, we can fast-track access to the most advanced technologies for those in urgent need.”

Mark Chapman, interim Director of Medical Technology and Digital Evaluations at NICE, commented: “We look forward to working with industry to continue the acceleration of our evaluations and with the MHRA to align our work for the benefit of patients.”

Why healthtech providers to the NHS have a responsibility to design interoperable solutions

By Dr Anas Nader

Boosting access to innovative technology has never been more important for the NHS. But providers have a duty to ensure interoperability is at the core of all solutions, writes Dr Anas Nader.

With the NHS facing increasing challenges, from extensive waiting lists to rising staff burn-out, boosting access to innovative technology across the industry is becoming a growing priority. The Health Secretary has promised to ringfence funding for health tech, highlighting it as a key investment for the future of the health service; and there is no shortage of emerging tech offering to step to the fore and build new solutions.

Many are already shaping up to deliver on this promise – from remote patient monitoring to increased surgical accuracy. But there is one thing that must not be overlooked: if these solutions are to have a long-term tangible impact, and support more joined-up care delivery across new integrated care systems (ICSs), they must be designed with interoperability in mind.

An interoperable solution is one that can connect with other systems, allowing for information to be easily and safely shared without the need for manual intervention. With hundreds of digital systems in use across the NHS – including databases such as the Electronic Staff Record – new tech must be able to ‘speak to’ these and share information directly if it is to have a viable long-term benefit. This is especially vital for facilitating cross-service collaboration within ICSs, enabling systems at different organisations to effectively and securely send information to each other.

For this reason, NHS England has identified interoperability as a key area of focus, to help boost the capabilities of ICSs, which were set up to drive the shift towards more joined-up care. This is a goal echoed by other recent reports, including the Hewitt Review, which highlights the importance of joined-up care and the effective interchange of information across organisational boundaries.

While new healthtech innovations are often built with the best of intentions, tech that cannot be successfully used in conjunction with other systems can inhibit this much-needed collaboration. Whether that’s by creating silos which slow down communication or increasing the admin burden on clinicians by requiring data to be manually re-entered; without interoperability, new technology can become difficult to use, and ultimately risks being abandoned by the clinicians it was built to support.

Indeed, a lack of interoperability between systems has been flagged as an ongoing problem in the NHS, with 76 per cent of doctors viewing this as a ‘significant barrier’ to digital transformation. According to the BMA, 13.5 million working hours are lost in England each year as a result of fragmented tech and IT systems.

To create a successful product that can make real change in the NHS, and facilitate genuine ICS-wide collaboration, healthtech companies must take into account the complex ecosystem of healthcare IT systems within the NHS. Providers have a responsibility to build in a way that ensures our solutions deliver genuine interoperability as standard.

How healthtech providers can deliver on interoperability

The biggest mistake that health innovators building tech for the NHS can make when approaching interoperability is viewing their product and the NHS as completely separate entities. Rather than being built for and with the NHS, solutions are often built in isolation, and then have to be retrofitted to meet the needs of each ICS. This is a surefire way to create a tech solution that is inherently incompatible with other NHS systems. To avoid this, companies must build in a way that prioritises interoperability from day one, with a close appreciation for the other systems tech must work alongside.

In the same vein, innovators must ensure their solution can be adapted to the many different healthcare contexts in which it could be used across each ICS. It may need to communicate with systems in primary care, hospitals, outpatient settings, or community and mental health care services. Ensuring full interoperability will allow for greater flexibility and mean it can be successfully adopted in different settings across ICSs, facilitating effective cross-service collaboration as a result.

Interoperability is not a ‘one and done’ exercise. Within systems as complex as the NHS, tech solutions must be flexible and able to continually evolve to meet the changing needs of the services using them. Healthtech companies should provide ongoing technical support and remain on-hand post-implementation to ensure that the solution continues to be a success. Parachuting in tech without this continued support may simply place a shelf life on the solution, especially if it is unable to integrate with future systems that are brought in across the ICS.

If technology is to fulfil the needs of the NHS’s staff and patients, interoperability must be prioritised at every step. This is vital for ensuring that the solution helps, rather than hinders, the healthcare service and offers a long-term solution which enables effective collaboration within the ICSs using it.

A failure to design interoperable software will result not only in an increased burden for NHS staff, but a lack of adoption and success. It’s a two-way street: working in partnership with the NHS to ensure systems are able to embrace new technologies is key. But innovators must actively take up the charge to prioritise interoperability and build solutions equipped to effectively support more ICS-wide, joined-up care.

Dr Anas Nader is the Co-founder and CEO of Patchwork Health: a digital solution that connects NHS organisations to a growing number of healthcare workers, reducing the reliance on locum agencies and improving the experience of flexible working in the NHS.

Winter is coming: how Doccla’s virtual ward pathways support Urgent and Emergency Care

By Tara Donnelly

Tara Donnelly, Founder of Digital Care Limited, explains how Doccla is supporting NHS Urgent and Emergency Care through an innovative suite of virtual ward and remote patient monitoring technologies.

Emergency Departments (EDs) across the NHS in England have experienced another record-breaking year, both in terms of increased volumes of patients attending – more than 24 million emergency attendances – and decreases in performance against waiting time standards. Pressures on EDs are no longer seasonal but exist all year round, leading to adverse patient experiences. It is imperative that all those involved reimagine how Urgent and Emergency Care (UEC) services are delivered to support NHS colleagues who are bracing for a challenging winter ahead.

There is increased recognition that digital solutions could help to alleviate some of this burden. NHS England’s latest guidance to deliver the UEC Recovery Plan spotlights the expansion of virtual wards as a high impact intervention this winter. Doccla, a leading provider of virtual wards and remote patient monitoring, is working closely with its NHS partners to provide alternatives to admission and to relieve bed congestion by supporting early discharge. The team works with more than a third of integrated care boards, providing:

A customised suite of technology to help clinicians and carers monitor patients at home.
Clinical dashboards that enhance caseload management through holistic views of patient cohorts and visualisations of patient data trends over time.
Integration with electronic patient records to enable flow of coded data from the Doccla dashboard to the patient’s medical record during their stay on the virtual ward.
Access to multi-disciplinary clinicians with specialist training in remote monitoring.
An end-to-end logistics service that task-shifts administrative and non-clinical activity from busy clinicians.
Access to a patient support team, which uses a variety of accessibility tools to ensure patients from all demographics are aptly supported on virtual wards, from onboarding through to discharge.

Doccla’s technology has been pivotal in enhancing various admission avoidance pathways within UEC settings.

Remote monitoring available to community urgent response teams

Doccla’s technology is integrated within Hertfordshire Community NHS Trust’s (HCT) virtual ward service. Under the guidance of HCT’s Medical Director, Dr. Elizabeth Kendrick, the service has enabled the rapid assessment, diagnosis, early treatment and discharge of over 4,000 patients – recently winning a Parliamentary Award for its work.

Hertforshire Community Trust’s Hospital at Home service, using Doccla technology, has recently won a Parliamentary Award for its work.

Most recently, the technology has been deployed to HCT’s urgent care and response teams tackling ambulance wait times. Rather alarmingly, one in 10 ambulances spend more than an hour waiting outside hospitals. Joining forces with the East of England Ambulance Service, HCT equipped its community urgent response service with Doccla remote monitoring boxes so they could have an additional tool to support people to stay at home. Early evaluation of the pilot showed promising results, including:

Reduced ambulance conveyance rate to 33 per cent (from an anticipated 100per cent conveyance rate).
Reduced ambulance attendances by 18 per cent at East and North Herts NHS Trust.
Increased time available for crew to respond to acute emergency calls.
Reduced handover delays outside hospital.

Tackling surges in respiratory admissions this winter

Seasonal variations in respiratory admissions are a major contributor to pressures within emergency care settings over winter. There are 80 per cent more lung disease admissions in the winter months of December, January and February than there are in the warmer spring months of March, April and May.

Virtual wards provide an alternative mechanism for services to manage patient flow and to cope with the surge in respiratory admissions. The Doccla-supported ARI pathway at Northampton General Hospital (NGH) has demonstrated considerable efficiencies for the delivery of care. By supporting early discharge, NGH’s virtual ward service achieved:

11 per cent reduction in length of stay.
30 per cent reduction in bed days.

Likewise, tech-enabled remote monitoring enabled earlier detection of, and interventions for, deteriorating patients, resulting in a 15 per cent reduction in readmission.

While additional UEC funding has been injected into integrated care systems, allocation of monies is challenging when there are competing needs across care settings. It is paramount that the additional funding is maximised. NGH’s virtual ward service demonstrates a £13,000 per month saving (associated with the reduction in bed days) and more broadly, has enabled workforce capacity savings. Analysis in 2021 showed on non-tech enabled wards, there is 1 nurse per 8.3 patients on average. Doccla’s tech efficiency gains have expanded this to 1 nurse per 10 patients.

Augmenting SDEC services

Bristol, North Somerset and South Gloucestershire (BNSSG) is another example of how effective partnership between clinical and operational teams, in conjunction with Doccla’s innovative technology, can reduce admission rates. Between February and May this year alone, BNSSG’s NHS@Home service:

Provided an alternative to admission or supported earlier discharge 487 times.
Enabled local people to be cared for at home for an additional 4442 days
Supported cost savings of £1,479,186.
Avoided readmission for 87 per cent of patients.

In collaboration with Doccla’s remote monitoring technology, BNSSG NHS@Home teams are pioneering the use of remote monitoring for same day emergency care (SDEC) patients to avoid inpatient stays within North Bristol Trust – with the SDEC model contributing approximately 20 per cent of NBT’s weekly referrals to the NHS@Home service.

An example of a presenting condition being cared for in this way is the bacterial infection Cellulitis, which results in more than 100,000 hospital admissions per year in England alone. The new pathway has the patient set up for remote monitoring while in the hospital; they are given a Doccla box to take home and asked to send in their readings over the next few days, to indicate to the clinical teams whether or not the infection is under control. Given that 1.6 per cent of all NHS hospital admissions are due to Cellulitis, enabling speedy discharge or reduction of inpatient stays for patients with the condition has the potential to shift the dial on bed pressures this winter.

Conclusion

It feels important both for patients and the sustainability of the NHS that we do everything in our power to rapidly scale innovative solutions that are demonstrating impact in tackling pressures in Urgent and Emergency Care pressures.

As a trusted partner to health systems and providers, Doccla’s technology is being flexed in agile and impactful ways to support urgent care pathways this winter.

If this has sparked ideas that you are keen to action locally, please reach out to the Doccla team here. Doccla will be attending Public Policy Projects’ ICS Delivery Forum on 4th October to continue the conversation.

Tara Donnelly, Founder of Digital Care Limited

Report finds doctors and nurses ready to embrace generative AI

By Integrated Care Journal

Elsevier Health’s landmark Clinician of the Future 2023 report highlights new opportunities technology will play in providing relief for healthcare workers and geographical differences in opinion

Global information and data analytics leader, Elsevier Health, has today released its Clinician of the Future 2023 report, offering a snapshot view on what doctors and nurses think about the changes and current challenges in healthcare, including the rapid rise of generative AI products and platforms.

The report finds that nearly half of all doctors and nurses surveyed are eager to make use of these new technologies to support their clinical decision-making. While only 11 per cent of today’s clinical decisions are assisted by generative AI tools, 48 per cent of respondents said that doctors using these tools to help make clinical decisions will be ‘desirable’ within two-three years’ time.

The current study comes one year after the launch of the inaugural Clinician of the Future report, which aimed to provide a voice for clinicians and a mandate for change to help ‘future-proof’ the global health industry. This new report canvassed the views and opinions of 2,607 doctors and nurses worldwide, building upon the understanding of healthcare workforce challenges highlighted in the original survey, but now putting an additional lens on the future of generative AI technologies across global healthcare.

Participants across both Clinician of the Future reports spotlight concerns around overwhelming resource issues for healthcare systems worldwide, even as they face substantial treatment backlogs. Clinician shortages remain the top concern in North America and Europe, with 54 per cent of clinicians surveyed for the 2023 report identifying nurse shortages as a pressing health priority.

“73 per cent of doctors surveyed believe they themselves will need to be experts in the use of digital health technologies…within the next two-three years.”

45 per cent similarly reported the need to tackle doctor shortages, reinforcing the urgent need for innovative solutions, such as generative AI, to address clinician shortages, as well as identifying opportunities for efficiencies and training to both enhance clinical readiness and provide much needed clinician support.

Additionally, doctors surveyed believe that they will themselves need to be experts in the use of digital health technologies, with 73 per cent of clinicians agreeing that these skills will be ‘desirable’ within the next two-three years. Accordingly, 55 per cent expressed as ‘desirable’ the transition towards ‘telehealth’, agreeing that remote routine checkups should form the majority of patient-clinician interactions within the next 2-3 years.

While more than half (51 per cent) of clinicians welcomed the prospect of medical students using generative AI-powered tools as part of their medical education in the next 2-3 years, clinicians from the UK and the US were found to be more reserved about generative AI technologies supporting medical students; only 33 per cent in the UK and 40 per cent in the US found this ‘desirable’.

Jan Herzhoff, President of Elsevier Health said: “As healthcare systems continue to face significant challenges, we must raise the voices of doctors and nurses worldwide to understand how we can best support them and the patients they care for. In this pursuit, advanced technology combined with trusted medical content emerges as a powerful ally, and generative AI, particularly, shows immense promise in helping clinicians.”

Mr. Herzhoff added: “By equipping clinicians with advanced tools and training to support their clinical decision-making, doctors and nurses will be empowered to allocate more time to the human aspect of patient care.”

As global healthcare systems progress towards a more digital-first approach, the findings in the Clinician of the Future 2023 report demonstrate that the workforce not only recognises the potential new technologies like generative AI can provide to innovate global healthcare, but also their beneficial impacts on patient care.

Josh Schoeller, President, Global Clinical Solutions at Elsevier and CEO, Healthcare at LexisNexis Risk Solutions said, “Elsevier is renowned for powerful point-of-care solutions that support clinicians throughout their workday. We have been at the forefront of developing clinical solutions tools, prioritising the responsible use of AI, while anticipating and staying ahead of the latest technology trends. We are deeply committed to listening to the needs of clinicians so we can continuously enhance our products to create efficiencies, enabling clinicians to prioritise delivering life-saving care.

For the full ‘Clinician of the Future 2023’ report, which includes robust data on global attitudes on the future of healthcare, important insights on training and development and more, click here.

Protecting the dignity of vulnerable people through technology

By Gavin Bashar

Gavin Bashar, Managing Director at Tunstall Healthcare, discusses why it’s important to protect the dignity of vulnerable people and how technology can be used to achieve this while improving health and care outcomes.

As the health and care needs of our population change, it’s important to uphold the dignity and rights of those who use health, housing and social care services. There are a number of strategies and innovations that providers can implement to help them deliver high quality services that support the dignity of vulnerable people.

Protecting the dignity of vulnerable people

As the health and care needs of our population change and the number of older people increases, it is important that service providers understand why and how care provision can play a crucial role in protecting the dignity of vulnerable people.

Dignity can be defined as the state of being worthy of honour and respect. When it comes to health, housing and social care services, this particularly focuses on being able to provide care that is tailored to meet the needs of each individual, their circumstances and wishes.

Robust and integrated systems can be well placed to deliver improved outcomes for citizens, reducing their need for emergency and more extensive care, such as hospital admission. The longer that people are able to remain independent without the need for acute services, the more their dignity and quality of life will be protected.

The role of technology

One of the prime objectives for technology-based solutions is to put people at the heart of their own health and care needs, protect their independence and dignity, and achieve citizen-focused outcomes. With the right digital frameworks in place, services can become focused on engaging each individual with their own health and care support.

When technology is embedded seamlessly into care and support services, it can be transformative, helping people to live happy, fulfilled lives in their homes and communities. Digital tools can also be used to ensure timely and appropriate responses to emergency events, encourage greater engagement from citizens, and provide more person-centred care.

Developments in the provision, scale and quality of digital technology can support improvements in how care providers are able to collaborate and provide person centred care. The UK’s transition to a digital communications network brings a once-in-a-generation opportunity to modernise, improve and shift the sector and its thinking from a reactive, to a proactive delivery model. This in turn can improve health outcomes for citizens, deliver efficiencies, and enable people to live independently for as long as possible.

Investment in digital solutions will support health and social care providers in reconfiguring services to make them more agile and integrated, leading to better outcomes. Utilising data and technology to create a connected approach can also provide actionable insights to deliver more informed, and more effective care.

Importance of collaboration

Last year saw the introduction of integrated care systems (ICSs) across the UK. ICSs should help us to integrate services effectively and drive collaboration between service providers, such as care homes, GPs and hospitals. Collaboration across sectors is essential to keep people healthy, reduce inequalities, enhance productivity and value, and support economic and social development. ICSs will play a key role in enabling us to remove silos between health and social care providers, while increased collaboration will reduce duplication and fragmentation, disseminate best practice and progress in technology.

Through collaboration we can create a truly joined up approach where we listen to citizens, understand their everyday needs and work together to bridge gaps in our services. Building on ongoing collaborations will see a system begin to emerge that is better connected and user focused. The latest generation of digital solutions broaden the circle of care to engage families, friends and communities, and promote services that are connected and data-driven.

Strong relationships between health and care providers and end users is vital to ensure users feel both respected and protected. This in turn can lead to clearer communication, giving care providers the opportunity to deliver care that is targeted to the requirements of individuals.

The workplace and a cultural shift

The digital transition is an opportunity to create a clearer and consistent approach to care delivery. Collaboration is essential but to encourage this, a cultural shift must take place. While technology has sometimes previously been viewed as an additional aspect of service delivery, embedding digital solutions into services will contribute to the successful transformation of existing care models, and provide more intelligent insight to improve health outcomes and protect the dignity of vulnerable people.

Increasing system capacity and capability, as well as providing a foundation for future technological advancement, will see health and care services more able to effectively meet the changing demands of the population. There are compelling benefits for all stakeholders when it comes to technology, particularly from an economic and operational perspective. By driving education within the health and care landscape and building on an already shifting culture, we’ll see more professionals become open to the idea of using technology and transfer their skills, knowledge and experience to the people they care for, to create a digitised world.

A dignified future for care users

As people live longer, increased pressure is put on our care services. Technology has the ability to aid the management of this and potentially reduce pressure points. If successful and integrated digital services for citizens can be realised, the benefits flow will through the health and care system. If we get our approach right, citizens can live independently for longer and have more choice and control.

As we look to a more digital future, we must consider how we can best harness the power of the connected world and the value that can come from technology solutions. By committing to investment in more technological solutions, we will reform our services, improve outcomes and place users at the centre of care to protect their dignity.

For more information, please visit www.tunstall.co.uk.

Digital Implementation, News August 21, 2023

BEAMS banishes alarm fatigue at Sheffield Children’s

By Integrated Care Journal and Gabriel Blaazer

On a recent visit to Sheffield Children’s Hospital, ICJ found out about the benefits that BEAMS – the world’s first acoustic bedside equipment alarm monitoring system – has had on patient safety and staff workload.

Hospital staff are rightly keen to have all the tools at their disposal to be able to respond to urgent situations on wards and prioritise patient care effectively.

Bedside alarms are a case in point. They improve patient care, reduce stress for staff, and produce better outcomes for the wider health system. When Sheffield Children’s NHS Foundation Trust approached TBG Solutions in 2018, the trust was soon to be opening a new hospital wing, housing wards up to two times bigger than previously existed. The wing would also feature a higher percentage of single bedrooms than there were in the past.

While a boon to patient privacy and dignity, and better for infection control, the shift presented Sheffield Children’s then Medical Director, Professor Derek Burke, with a conundrum; how to preserve patient safety and ensure that alarms were heard and responded to when patients were behind closed doors?

Founded in 1876, Sheffield Children’s is one of only three stand-alone specialist children’s hospitals in the UK, primarily covering Sheffield and South Yorkshire but also offering specialist services to children from across the UK and internationally.

ICJ recently visited Sheffield Children’s to speak to the Matron for Medicine Care Group, Joanne Reid-Roberts, about the impact that BEAMS has had on nursing practice and patient safety in the new wing. We also asked Paul Rawlinson, Managing Director of TBG Solutions and sister company Tutum Medical, to speak to ICJ about the inception, design and roll-out of BEAMS, and about his vision for the future of BEAMS.

Why BEAMS?

Although not a medical device company, TBG Solutions is no stranger to highly complex technology, operating as a provider of testing, measurement, and control solutions to the aerospace, automotive, defence, medical and energy sectors. As such, they were well placed to take up Sheffield Children’s challenge, which Paul Rawlinson explains: “Most monitoring systems require central monitoring, and every piece of equipment needs to be plugged in to power and ethernet. If you’ve got eight or nine different pieces from different manufacturers, your only option is to have eight or nine central monitoring systems.

“Alternatively, you can go to a third party who will give you one interface, but you need to have the software library to mimic the instrument or touchscreen. If you need to add a new piece of equipment and there’s no software library from these third parties, then there is no interface. These solutions are also expensive,” adds Paul.

After a period of close consultation between Sheffield Children’s and TBG Solutions, the latter “concluded that for the best possible benefit to patient safety, you need a nurse in each room – which of course, you’re not going to get – but putting the ear of a nurse in the room is the next best thing.”

BEAMS utilises its own Wi-Fi mesh network, removing the need to interface with existing hospital infrastructure.

From this brief, BEAMS – and Tutum Medical – were born. BEAMS works by picking up and identifying tonal noises emitted by alarms, routing alerts to a central monitoring system through its own Wi-Fi mesh network – removing the need to interface with existing hospital infrastructure.

“Not only can it do this in an environment that might have a radio or TV on,” maintains Paul, “it can also identify what the equipment is doing. It could be a ventilator’s high priority alarm, and BEAMS can provide this detailed data. And so, if a nurse has four or five alarms going off, such as a ventilator alarm and an end-of-infusion alarm for an IV drip, they are able to prioritise which one to address first.”

Fewer alarms, safer patients

Following a clinical trial, designed to make it possible to compare alarm response times before and after the installation of BEAMS, the system was found to produce an 84 per cent reduction in the maximum alarm response time, and a 74 per cent average alarm response time. The system was subsequently installed into 70 single-occupancy rooms, and it has fast become a vital fixture for the Matron, Joanne Reid-Roberts.

Joanne tells Hospital Times that she “couldn’t imagine being on the wards without it”. She credits BEAMS with inducing a “calmer, and more relaxed atmosphere” on the wing, and helping to address the harmful consequences of alarm fatigue.

Studies have shown that in paediatric wards, up to 99 per cent of clinical alarms are either false or clinically insignificant (such as a battery needing to be changed) and do not warrant clinical intervention. Research also shows the consequences of this dynamic – alarm fatigue – which arises when alarms are so numerous (and often inconsequential) that they blend into the background and are missed.

BEAMS addresses alarm fatigue by helping to reduce the number of alarms sounding at any one time, relaying alarm information in a details spoken notification and making it more likely that any one will be picked up. The statistics appear to back this up; alarm response times at Sheffield Children’s have been cut by an average of 90 per cent, down to just 40 seconds.

“We wouldn’t be able to function without it.”

These efficiency savings add up, bringing benefits to patient safety. “If a patient is on intravenous antibiotics,” Joanne illustrates, “BEAMS alerts us to say that the infusion has ended. If we missed that alert even for 30 minutes previously, what should have taken an hour would end up taking an hour and a half. It may sound small, but this can have a big impact on recovery.”

The second generation of BEAMS, currently in use at Sheffield Children’s and at Leeds Children’s Hospital, communicates the precise nature and severity of alarms, enabling the efficient delegation of tasks and saving precious clinical resource. It can now be instantly established whether an alarm requires the intervention of clinical staff or a support worker, “which has really improved the utilisation of our time,” Joanne adds.

Another important aspect of BEAMS is its reporting mechanism, which allows ward managers to see week-to-week reports detailing the number, location and nature of alarms, and response times, allowing them to pinpoint exactly where improvements are needed. Joanne is under no illusions that such comprehensive data reporting strengthened the impact of the BEAMS pilot, allowing them to demonstrate proof of concept and gain buy-in from the trust’s procurement and finance managers.

Importantly, and key for the workforce, Joanne is certain that BEAMS “has taken away many aspects of stress for staff. We no longer have to walk corridors just in case there is an alarm going off. It’s simple when you think about it, but we wouldn’t be able to function without it.”

Peace of mind for patients and carers

Having a loved one in hospital can be a troubling and anxious experience for anybody, not least when the patient is a child. In paediatrics, mere seconds can prove the difference between life and death – under certain conditions, children can reach an emergency condition faster than adults. This is often the case with respiratory conditions, where the smaller relative size of children’s airways can lead to greater difficulty with breathing than in adults.

Joanne Reid-Roberts, Matron for Medicine Care Group, Sheffield Children’s Hospital (L) and Paul Rawlinson, Managing Director, TBG Solutions and Tutum Medical (R)

While BEAMS has been successful in reducing average alarm response times, feedback from patients, parents and carers at Sheffield Children’s shows the reassuring effect it can also have. “It gives parents peace of mind,” Joanne relates. “It used to be normal that parents complained that alarms weren’t being addressed in a timely manner but that almost never happens anymore.”

She finds that most parents do not like to press the nurse call alarm for fear of wasting their time, yet are also fearful of what might happen if they are not at their child’s bedside. But, “BEAMS gives parents the confidence to know that the nurses will respond to their child’s needs if they are not there, and patients feel reassured because they know that somebody is coming,” a factor that can be important for recovery, explains Joanne.

Just the beginning for BEAMS

Joanne was full of praise for the manner in which Tutum Medical supported Sheffield Children’s throughout the trialling of BEAMS, recalling how easy it was to contact the company, and the fact that “they listened to our feedback and changed the product” according to need.

Why has BEAMS mostly been taken up in paediatric settings thus far? “It just so happened to be Sheffield Children’s who first wanted to trial BEAMS,” Paul says, “and Leeds like to look at what other children’s hospitals are doing.” Looking to the future, however, Paul hopes to see BEAMS deployed in other, non-paediatric settings (citing its particular utility for respiratory wards), and trials are indeed underway at a number of hospitals in England. According to Joanne, “there is no reason why BEAMS couldn’t go into adult services, as they will experience the same issues as us and will probably have less staff than we do.”

At Sheffield Children’s at least, the results are in; BEAMS is one of the tools that helps healthcare staff to provide the best possible care for their patients.

To find out more about BEAMS, visit www.tutummedical.com.

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