A person-centred, digital first approach to recovery

By Patricia Wynn

Ensuring that patient pathways are digitally enabled and person-centred is critical to tackling the elective backlog, writes Patricia Wynn, Director and Sales Leader, International Public Sector Health, Cerner Corporation

NHSE guidance states that “our ambition is to improve core digital and data services in hospitals to ensure we have the basics right.” A leading EPR provider in the UK and globally, Cerner supports systems to reach the minimum digital foundation and strive for HIMSS Stage 7 and beyond.

Cerner work across provider collaboratives to enable shared instances of the EPR. ICS-level collaboration reduces total cost of ownership and enables sharing of resources, such as PMO, training, back office and support. For example, a shared instance of Cerner accelerated provider collaboration across North West London ICS.

Imperial and ChelWest began sharing a domain in 2019 and now London North West and Hillingdon are set to join. According to Kevin Jarrold, ICS data and digital lead, “we have a growing agenda around collaboration across care pathways and the shared domain is absolutely fundamental.”

A shared domain has enabled NWL to gain efficiencies and generate much-needed capacity. Leaders can see across the system and transfer patients more effectively from one site to another. Virtual ward capacity is also managed centrally and embedded into the core EPR. Remote patient monitoring is leveraged from a variety of vendors, with all data feeding centrally into virtual wards created within the core EPR, enabling more efficient workflows and the sharing of virtual care staff.

Prioritising care

The national guidance outlines care must be prioritised based on clinical urgency, the impact of waiting on individuals and potential inequalities. To achieve this, North Central London (NCL) ICS uses Cerner HealtheIntent^®, a data and analytics platform that provides a single longitudinal record for every citizen, comprising data from all health and care organisations across the ICS.

According to Amy Bowen, director of system improvement, “[We built] an elective waiting list dashboard in HealtheIntent. Now we can show GPs for the first time ever what their waiting list looks like. We can cut that data by all the demographic factors, e.g. how many people have long-term conditions and how many? We can look and see by ethnicity, by deprivation – we can combine several factors. And we can actually understand that population at a practice level, at primary care network (PCN) level; by specialty, by borough.”

Transforming care

NHS guidance outlines transformation should focus on flexibility, ease of access and citizen control. Re-envisioning patient pathways – and ensuring they are digitally enabled and person-centred – will be critical. Royal Free London (RFL) has standardised and digitised 40 pathways.

Cerner experts are involved from the beginning of pathway design. Dr John Connolly, CEO of the Royal Free Hospital and group director of clinical pathways shares, “The goal of this ambitious programme is to ensure every patient can get the same high-quality treatment in any of the Trust’s three hospitals… and to create value for the entire healthcare system in the locality – not just our hospitals, but also primary care and public health services in an area that has high levels of deprivation.”

Supporting patients

Ultimately, a person-centred, digital first approach must include the person at the centre. Cerner Patient Portal UK, delivered in collaboration with Induction Healthcare, enables interaction and engagement between caregivers and their populations. A prostate cancer survivor in the Wirral explained, “I cannot emphasise how much the patient portal has improved the quality of my life. Those two weeks of waiting – the stress of revisiting the room where I was given my diagnosis – all that is gone now.”

NHSE’s operating priorities will not be achieved by overworking caregivers and staff, but by enabling them to work smarter and more collaboratively. Contact Cerner Corporation if you share a belief in the power of technology-enabled transformation and want to discuss how Cerner can support your system as in tackling the unprecedented backlog of demand.

Digital revolution – the benefits of paperless

By Marvin Douglas

The digital revolution is well underway, and the innovative new technologies utilised by start-ups have completely transformed business operations. However, there is still a significant number of SMEs and larger corporations that are completely reliant on paper. 41 per cent of businesses agree that moving to digital would cut operational costs significantly. However, the heavy initial investment and potential skills gap is presenting a tough hurdle for many organisations.

According to a study by Xerox, 55 per cent of businesses across western Europe and North America are still completely reliant on paper. A similar study found that 70 per cent of these businesses admit that they would fail within just three weeks should key documents go missing. With all this in mind, we look at the key benefits of going digital.

Why risk it?

Words like ‘audit’, ‘security breach’ and ‘compromised data’ are enough to raise the hairs on any businesses neck. Physical documents pose a multitude of problems when it comes to security, there is a huge reduction in the level of control the business has over them. Paper documents can be scanned, shared, and viewed indefinitely by anyone at all.

Research by AIIM reported that up to 50 per cent of businesses surveyed were unsure whether they had ever suffered a security breach due to a complete lack of visibility. Moreover, 31 per cent stated they had encountered poor record keeping to the extent that it would negatively impact regulation checks and audits.

Smarter, faster, stronger

Productivity is a key priority on any business’s agenda, to get the most from their employees a business should endeavour to establish streamlined processes, efficient operations and transparency. Utilising digital document management reduces the amount of time spent looking for required information dramatically.

Digitally stored data is easier to find, and the quality of data collected is improved; through digital templates and pre-agreed parameters companies can maintain consistent data standards universally. Lengthy approval processes and over complicated workflows are also a thing of the past, digital signatures make authorisation and communication much more efficient. The ability to access documents anywhere at any time through a centralised digital solution will reduce the risk of missed deadlines when employees need to work remotely.

Going digital provides a centralised view of all documents. Access can be controlled, allowing only the necessary and authorised employees to view confidential data. Clear trails can be established to monitor the progression and movement of key information and backups are easily created to avoid the heart-stopping loss of key business information.

Cutting the cost

The reason behind most business activity is to protect and improve profitability; going digital also has a compelling impact on a company’s operational costs. US research from The EPA found that companies choosing to go digital could save as much as $80 per employee in printing resources and the efficiencies that come with streamlining manual processes. For a business of 400 employees this is a sizeable saving of $32,000 per year.

Small businesses can benefit too. For smaller, less established businesses the transition to digital is likely to be much easier as there is less physical documentation to convert. This could mean the ROI is visible much sooner. Digitalisation will make the business considerably more agile and responsive, where competition is fierce the need to respond quickly and accurately to customer enquiries, competitor activity and market demand is essential – this is made much easier with visibility and strict organisation.

Going green – not to be barked at

Although this could quite easily be tied into an organisation’s profitability, reducing carbon footprint often comes with more benefits than just lower operational costs. Corporate social responsibility is a hot topic globally and is only set to get hotter. Recent data in the US showed that the average employee uses a staggering 10,000 sheets of paper a year, the equivalent of a 100ft fir tree.

In many cases, a company’s activity surrounding CSR has become an integral part of a prospects decision-making process. For those in B2B, many businesses with strong CSR values will actively seek out equally responsible organisations to purchase from.

Digital revolution requires effective physical device management solutions

As part of the digital revolution, businesses will be investing heavily in the devices that enable the process. The increasing number of physical devices in the workplace such as laptops, Chromebooks, tablets, smartphones, and other media devices means it has become necessary to implement effective physical device management solutions, protecting the longevity of the initial investment.

To find out why LapCabby provides the perfect storage, charging and syncing solutions for your new tech please visit our website: www.lapcabby.com.

North Lincs and Goole replace data warehouse in preparation for shared digital services across region

By Integrated Care Journal

NLaG chose Insource as strategic data management partner – initially as unified data foundation across three hospitals and community services.

Insource has been chosen by Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) as its foundational data management platform and ultimately as a joint strategic solution in its move towards shared digital services with partner trust, Hull University Teaching Hospitals NHS Trust.

The partnership falls under the NHS Digital Aspirant programme, which is providing funds to nearly 60 NHS trusts to facilitate digitisation and help deliver a set of core digital capabilities. It is hoped that Insource’s platform, Health Data Enterprise, will see a significant upgrade to NLaG’s ageing data infrastructure system.

Christopher Evans, Associate Director of Information Systems, for NLaG commented, “whilst this is initially about replacing our ageing data warehouse, the core decision is primarily to ensure strategic alignment and collaboration between our two organisations. We already have a shared vision between NLaG and HUTH and we will be merging onto a single platform across both organisations within the next couple of years. What Insource gives us is data consistency and continuity of reporting across the wider regional footprint while we redesign clinical services and pathways to meet our integrated care goals.”

Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) serves a population of more than 450,000 people covering North Lincolnshire, North East Lincolnshire and East Riding of Yorkshire. The Trust runs three hospitals: Diana, Princess of Wales in Grimsby, Scunthorpe General Hospital, Goole and District Hospital and also provides a range of community services across North and North East Lincolnshire.

Emil Peters discusses the next steps for the health and care technology sector

By David Duffy

Emil Peters speaks to Integrated Care Journal

Recently appointed CEO of Tunstall Healthcare, Emil Peters speaks to ICJ about the future of telecare and telehealth and the impact of a seismic era of system transformation for UK health and care.

“Great advances in medicine have been made during periods of immense stress and strain,” says Emil Peters, recently appointed Tunstall CEO. Peters finds himself at the helm of the largest social care technology provider in the country during a period of critical reform for the health sector. “A lot of our early medicinal advances originated from battlefields and war injuries,” explains Peters and the pandemic, he insists, has been the latest catalyst for change in the health sector – but the reform has not come from new antibiotics or medicines, but a newfound acceptance of the value of medical technologies, such as telehealth.

“Tunstall today has become an integral part of a constantly evolving definition of health and care“

Peters, who moved to Tunstall after 25 years at health technology giant Cerner (the last five of which were spent as President of the International markets), is no stranger to major upheaval in health reform – but even he would admit that the current period of turbulence is unlike any other the sector has faced. He enters his new role as the UK government releases a slew of policy reforms, with the intention of turbo charging a digital and data led transformation of the health and care sector. The latest paper Digital revolution to bust COVID backlogs and deliver more tailored care for patients, places telehealth as a central priority of the government’s digital transformation of the sector.

Peters likens Covid-19 to a dark cloud with a silver lining, “the pandemic has given us lived experience of technology, forcing our lives to be lived through screens whether they be your phone or whether they be your computer or your television.” Interestingly, Tunstall began as a Yorkshire based television repair company but has since grow to over five million users globally and almost two million in the UK alone, becoming one of the biggest players in telecare in the process. Now, Peters hopes to use this position of strengths to take on a newfound leadership position within the sector, helping to drive technology based transformational change, enhancing access to health care to disenfranchised communities and reducing rampant health inequality across the country.

At one point, the health tech industry was still arguing with hospitals as to the benefits of using digital over paper-based methods. Today it is widely accepted that telehealth is now central to the evolution of the concepts of health and care. “Through being able to connect patients and carers in the broadest possible terms, Tunstall today has become an integral part of a constantly evolving definition of health and care,” affirms Peters.

Evolving telehealth in an ICS context

If Covid was the “slap in the face” as to the value and potential of health and care technologies, then the prospect of integrated care in the UK could prove to be the mechanism which permanently embeds technology like telecare and telehealth into care pathways.

Each integrated care system (ICS) has placed preventative and personalised care, defined through population health management approaches, as central priorities to care delivery. In many ways, telecare and telehealth could be the glue that connects ICS wellness strategy, via enhanced access to care and reduced strain on healthcare services.

“The pandemic reminded all of us of the value of working together”

Previous barriers to technology adoption are being eroded in favour of holistically implemented transformational change and the rapid growth of the telehealth sector is helping to shift discourse away from simply reducing acute sector pressures. Priorities are now shifting towards maintaining good health for people as long as possible, keeping people healthy and supporting them in the best version of their life as they define it.

“Among many other things, the pandemic reminded all of us of the value of working together. Previous hesitations to collaboration have held the sector back – but these barriers are gradually being eroded and this collaborative momentum has manifested itself in the integrated care agenda.

“In the same vein that we used technology for our supply and demand calculations for the testing of PPE, we now need to think about that in terms of cancer, orthopaedics, neurology, all the other things that we need to be bringing to people because frankly, we kind of went away with that.”

A new era for health and care technology?

Peters considers the current moment a once in a generation opportunity to shift norms. “Historically the system has found ways of preserving itself. We were constantly training for trying to find ways to preserve what we have. Business as usual is no longer an option.”

“I’ve seen a lot of ‘tech for tech’s sake’, and those endeavours tend to be like shooting stars. They burn bright and they fade away“

“Telehealth can enable clinicians to see the people they need to see. It allows people within the clinical space to operate to the top of their licence. And it allows me as a son and as a neighbour to operate to the top of my licence when caring for loved ones. Technology like telecare can help me check in on my elderly neighbour, to check in on my mother, who lives in San Antonio, Texas, thousands of miles away.”

Peters’ bread and butter is facilitating health and care innovation but his focus with Tunstall will be less on the outright ‘technical innovation’. Rather, Peters is interested in innovating the constructs of how they apply technology. “Our focus is much more centred on value. What is the value of what we’re about to go do? Is it just tech for tech’s sake? Or is there a clearly defined purpose in mind?”

Peters wants to move the sector from a ‘thousand flowers blooming at once’ mentality to innovation, and towards a focused approach built upon consistent standards. “I’ve seen a lot of ‘tech for tech’s sake’, and those endeavours tend to be like shooting stars. They burn bright and they fade away. But the innovations that really produce value for the provider, for the person, for the family, those are the things that that will truly be lasting.”

“It’s up to us, how much we harness this moment,” insists Peters, who warns that a complacent approach to innovation risks returning to a ‘business as normal scenario’. “Are we going to try to fight to go back to the way that we did and run our outpatient clinics the way that we had? Or has this given us a new view on how things can happen? Clinicians want and need to spend time with the people that truly need attention from someone of their levels of qualifications and who can truly have an impact.”

In Peters’ mind, the impact that is needed with technology cannot be understated insisting that, “it must become this century’s version of a clean water supply for the health and care sector.”

In September 2022, Tunstall will be joining ICJ and PPP for the ICS Roadhshow, a series of regional conferences to discuss the progress of integrated care at a localised level. To find out how to get involved, please visit our ICS Roadshow homepage.

Digital communications tool provides solution for healthcare data protection

By Joost Bruggeman

Joost Bruggeman, former surgery resident at Amsterdam University Medical Centre, and CEO and co-founder of Siilo, discusses how secure digital communications tools can ensure patient confidentiality and solve healthcare data protection issues.

Instant messaging apps have become essential tools in our daily lives – their convenience, reliability and sheer ubiquity have transformed how most people communicate, both socially and professionally. At the height of the pandemic, their value within the healthcare sector became even more pronounced, as they enabled rapid information-sharing to help medical professionals learn how to deal with a hitherto unknown virus.

In these circumstances, medical staff came to appreciate the benefits of being able to share details about individual patient cases, including photographs and other sensitive medical data. It facilitated timely and seamless collaboration, without which many more lives would have been lost.

The benefits of ‘off-the-shelf’ messaging apps, however, don’t come without risks. Within the medical sphere in particular, a mistaken message could put patient confidentiality and data protection in jeopardy, while threatening one of the most fundamental aspects of healthcare ethics.

Overcoming data protection issues

Since instant messaging apps are clearly of value within the health and social care sectors, a solution is needed to overcome data protection issues. In fact, this challenge was understood some time ago, and was a key influence behind the development of specialist healthcare apps such as Siilo, which places data security and medical compliance at the heart of its development.

Designed specifically for healthcare professionals, Siilo undertook the task of preserving the usability that people expect from the technology, while simultaneously ensuring that patient data could be exchanged safely and compliantly.

Paul Cowley, Chief Information Officer at St. John & St. Elizabeth Hospital (HJE) in St. John’s Wood, London, recognised the importance of adopting a messenger service which has been tailored to the healthcare sector’s unique challenges. “Timely, effective and safe patient care often requires rapid communication with multiple clinicians and sometimes offsite. A secure, easy-to-use app is needed to facilitate this level of care.

“While temporary guidance was issued during the pandemic that allowed the use of well-known commercial messenger services to help reduce the risk of patient care being compromised, as a hospital we recognised that such services increase risk both in terms of patient data security and patient care, particularly because of the need to anonymise communications wherever practical.”

Security and compliance

Unfortunately, many health and social care professionals and organisations are unacquainted with these issues. Indeed, a survey by the European Heart Rhythm Association (EHRA) revealed that 88.3 per cent of its members regularly use commercial instant messaging apps, like WhatsApp, for sharing clinical information with medical colleagues, yet 29.3 per cent admitted they were unaware of EU data protection regulations. A further 46.7 per cent indicated there are no regulations in place at their institution regarding the sharing of clinical data via instant messaging.

Given that specialist tools have been developed, why are they not mandated among healthcare professionals? The problem is that many health and social care providers still don’t understand the risks involved with off-the-shelf messaging apps because of a simple failure to differentiate between security and compliance.

The basic promise of ‘end-to-end’ encryption, which is offered by the best-known messaging apps, certainly provides a strong element of security. It means the servers of the vendor cannot decrypt the message data even if they wanted to because they don’t have access to the encryption keys that belong to this encrypted data. However, this only applies to data while it is ‘in transit’ from one phone to another. What happens when the data is ‘at rest’, i.e. delivered to a phone or other device?

After a phone receives a message, several synchronisations take place with common messaging apps;photos and videos are synced automatically to the photo library of the phone, where the media is not encrypted; all conversations are backed-up by default and automatically go onto the cloud services of the phone provider – where message data is also stored unencrypted. As such, all these unencrypted conversations are exposed to unauthorized third parties.

Importantly, the professional who makes the decision to share information about their patient is always held responsible for protecting the patient’s confidential data. On a messenger app, this remains the same – the sender is always responsible and therefore needs to have control of what happens with the information on the receiving end of that communication. This control is often not possible and means many conversations taking place over common messenger apps are not compliant with medical confidentiality laws.

This is a huge problem because it becomes impossible for any healthcare professional sending an instant message on most services to be able to guarantee patient confidentiality. A way which is often used to get around this is to anonymise patient information within communications, but this also brings problems.

As recognised early on by Paul and his team at HJE, if healthcare teams cannot clearly identify which patient they are communicating about, it will almost certainly lead to confusion and mistakes. Since all healthcare professionals have sworn an oath to “do no harm”, this risk is often one not worth taking.

Communication and collaboration

For staff at HJE, Siilo has become a key tool in improving communication and collaboration between staff, and therefore improving patient care. A good example of this can be highlighted via its use in supporting the hospital’s Urgent Care Clinic (UCC), which is also helping to drive adoption in other departments.

“If a UCC doctor feels the need for input from a specialist consultant or the patient needs onward referral to a consultant, the UCC doctor can now use Siilo to contact a relevant specialist consultant rapidly and securely wherever they are.”

It is also proving to be an invaluable component in the day-to-day running of its medical team. “Siilo is now the ‘go to’ for some of our multi-disciplinary team meetings (MDTs). It solved a problem with a desire to increase the frequency of our MDT meetings without placing undue burden on the clinicians that contribute.

“It also allows ad-hoc MDT meetings where clinical circumstances dictate a patient’s case needs a review ahead of the next scheduled meeting. The messenger app allows clinicians to collaborate securely and contribute from whatever location they are working, regardless of their diary commitments.

We know the opportunities for the app are vast and since adoption, we are already seeing options becoming wider and wider, with more exciting use-cases being frequently put forward by staff.”

A growing number of healthcare organisations in the UK are recognising the tremendous benefits offered by digitalisation to the healthcare sector. While this is encouraging, it is essential that tools and technologies are truly fit to meet the standards expected. For communications technologies, this means applying absolute rigour to ensure patient confidentiality.

Joost Bruggeman is a former surgery resident at Amsterdam University Medical Centre and now CEO and co-founder of Siilo. For more information, please visit www.siilo.com.

For more information about St. John and St. Elizabeth Hospital, please visit: www.hje.org.uk

Built Environment, Digital Implementation June 16, 2022

Driving innovation: a case study using a simple evaluation tool

By Simon Dodds; Alan Macdonald; Fay Wilson; Terry Young

Professor Terry Young, Dr Fay Wilson, Alan MacDonald and Mr Simon Dodds describe for ICJ an evaluation tool that was used to support the development of a rapid access clinic in an existing health centre in Erdington.

Project management is simple: look after people, plan well, monitor effectively and intervene as needed. However, people, planning, monitoring and intervening are complicated, so good project managers mix in experience and tools they pick up over a lifetime.

Figure 1: Map of the project design to extend the capacity of an existing health centre (in blue) with rapid access care (click to enlarge).

Case study

The team from Badger (Birmingham and District GP Emergency Room) Group used a 6M Design® approach with three pre-implementation stages (map, measure, model – a prototype based on a simulation), and three phases of implementation (modify, monitor, maintain).

Once a working upgrade of the facility was in place, two reviews were conducted in January 2022, using a simulated set of patients (based on a typical case-mix) and putting this stream of virtual patients through the service to see how it was responding.

Across the two days, the workforce involved in the review included: heath care support workers; receptionists; and clinicians – around 8 people in all. A 4N framework was used for collecting and analysing the feedback.

To understand 4N, figure 2 (used with permission from SaaSoft) shows a creative journey into new territory – leaving behind what is already there and implementing what is desired. Specifically, 4N feedback uses the dimensions of time (present/future) and emotions (positive/negative) to create a chart which is split into quadrants, defined as:

Nuggets (relates to the present and the things about which the stakeholders have positive feelings)
Niggles (relating to the present but capturing features where the feelings are negative)
Nice Ifs (similarly, relating to the future and positive feelings)
No Nos (finally, relating to the future and negative feelings)

Niggles identify what hasn’t gone to plan to date. To grasp this feedback, an improvement tool called a Niggle-o-gram® was used, based on the familiar failure modes and effects analysis (FMEA). The list of niggles was graded based on three scores:

Incidence: how often does this niggle occur (never, 0 to 9, always)?
Impact: what is its effect (no impact, 0 to major impact, 9)
Influence: how much can we do (nothing, 0 to 9, change it completely)

Using this scheme, niggles that nobody could do anything about were assigned low priority. In this case, the top 5 niggles came out as shown in table 1.

Figure 2: Bridging the creative gap, while taking what works well with you. — Figure 2: Bridging the creative gap, while taking what works well with you (click to enlarge).

A more intuitive way of grasping the feedback is to produce a word cloud, weighting the size of words in each quadrant by their priority in the rankings.

Figure 3: Word cloud of key issues raised in all four quadrants of the 4N feedback process. — Figure 3: Word cloud of key issues raised in all four quadrants of the 4N feedback process (click to enlarge).

Using the findings to address key issues

One tension to emerge was around staffing, since booking patients in at reception takes less time than appointments with the healthcare worker or clinical staff. With everything running absolutely smoothly, a single receptionist might have coped, but interruptions and sporadic other tasks meant that having two receptionists was important for safety.

In turn, this created a tension between having a workload that would utilise two receptionists, and the capacity for healthcare and clinical appointments. In the end, a system designed for 10-minute appointments was fine tuned to 12-minute appointments to get the best combination of reception and other staff usage.

A second issue was Covid safety in a waiting room that could only accommodate 4 patients. Again, from modelling and other analysis, this was too few to manage the overall capacity planned for the centre, so a new process was developed whereby patients arriving in their cars would use their cars as their waiting room (and the receptionist would contact them to walk straight to their appointment), freeing up the waiting room for the exclusive use of those who arrived in other ways.

In the end…

Using a 4N framework as part of the management of an expansion of a health centre, an existing service was quickly upgraded for rapid access Covid patients, and tested robustly for capacity, throughput and safety.

Tools such as this are critical to the success of any agile or pop-up service. The good news is that the 4N approach is easy to understand, straightforward to implement and bridges the worlds of experience and clinical quality.

About the authors

Mr Simon Dodds, MA, MS, FRCS

Mr Simon Dodds is a general surgeon at University Hospitals Birmingham NHS Foundation Trust. He studied medicine and digital systems engineering before following a career in general and then vascular surgery. In 1999, he was appointed as a consultant surgeon at Good Hope Hospital in North Birmingham and applied his skills as an engineer and a clinician in the redesign of the vascular surgery clinic and the leg ulcer service.

In 2004, the project was awarded a national innovation award for service improvement. This experience led to the design, development, and delivery of the Health Care Systems Engineering (HCSE) programme.

Alan MacDonald, BSc

Alan studied at Nottingham Trent University and has a BSc (Hons) in Biomedical Science.

He worked for the Badger Group as an Out-Of-Hours primary care team leader and later became a data analyst. Since the start of the COVID-19 pandemic in March 2020, he became directly involved with the development of a multi-lane drive through Covid Referral Centre at the NEC.

He has been instrumental in the deployment of other temporary drive through clinics across Birmingham. He has also been actively part of the original team who were successful in applying this concept to the first purpose-built drive through clinic in the UK

He is frequently involved in new & novel projects within the out of hours primary care sector and is currently studying Health Care Systems Engineering.

Dr Fay Wilson, MBChB, FRCGP

Fay trained in Birmingham and has practiced there as a GP there since 1985. Her extensive national and local portfolio includes: NHS HA Non Exec, GMC fitness to practise chair, and associate postgraduate dean at Health Education West Midlands. She has served on the council of the BMA and other bodies. Fay brings people together to develop new models of care, a notable success being the Birmingham Multifund co-operative, a pioneering nurse-led walk-in centre and a prototype GP provider-at-scale ahead of its time in the mid-1990s.

Dr Wilson is medical director and co-founder of Badger, a GP social enterprise since 1996 providing out of hours and urgent primary care. COVID-19 introduced her to systems engineering, new people and new ways of thinking. Her ambition for the last decade has been to slow down.

Prof Terry Young, BSc, PhD, FBCS

After 16½ years as a research Engineer, Divisional Manager and Business Development Director, Terry became a professor at Brunel University London for 17 years.

He has a BSc in Electronic Engineering and Physics, a PhD in laser spectroscopy both from the University of Birmingham, UK.

His research has been in health technology, health services, and information systems. He has taught information system management, project management and e-Business.

His awards include the Operational Research Society’s Griffiths Medal, 2021, for analysing the return simulation methods offer when used to improve healthcare services.

Prof Young set up Datchet Consulting in 2018 to support innovation on the borders of academia, health and industry, of which the project reported here is an excellent example.

All news

Health-tech sector can prosper from UK’s commitment to unleash potential of data

By Joost Bruggeman

The role of digital data in the UK’s healthcare systems is set to gain newfound recognition and clarity when the government unveils its Data Saves Lives strategy this spring. If it lives up to its promise, the plan will help to drive the efficiency and effectiveness of data infrastructure and promote interoperability, while establishing clear and open standards for safely sharing data.

The backdrop to the new strategy is the tumult caused by the pandemic, and the ensuing acceleration of digital trends. The government now wants to build on the momentum which has been established in the push towards digital transformation. Similar exercises can be seen elsewhere in Europe, such as in Germany, which is set to invest €59 billion into healthcare technology and digitalisation in the rush to improve services.

While the UK’s strategy is primarily focused on the internal workings of the national healthcare system, the implications are positive for all healthcare technology organisations which have demonstrated a commitment to data safety and security. It means they are well-placed, both technically and culturally, to support the NHS on its journey.

Encouraging innovation

On reading the draft document, what is most encouraging is the focus on supporting innovators – those most likely to be responsible for developing and delivering new solutions to benefit both healthcare professionals and patients. The new strategy is set to provide a clear set of standards for those creating or deploying new data-driven technology.

“We find ourselves in the middle of a very exciting time in the digital development of healthcare in the UK.” Joost Bruggeman, Siilo messenger co-founder

This commitment to creating an innovation-friendly environment, with a framework for testing, approval and deployment, can be the catalyst for continuous improvement in the technologies used by healthcare professionals. It will provide the confidence to support investment, rather than the hit-and-miss, rather opportunistic nature of the current environment.

**Joost Bruggeman, CEO of co-founder of Siilo**

As CEO and co-founder of Siilo, a healthcare specific digital communications tool, I understand the fine line that the Government needs to walk. On the one hand, it needs to build on the huge opportunities that new technologies present by keeping its doors open to innovation – doors which opened because of the challenges brought by the pandemic. But on the other hand, the Government needs to regulate and manage the relentless growth of new technologies.

Covid-19 played a part in Siilo’s own pathway into the UK healthcare market, due to the urgent need for rapid, reliable communication and information sharing. The other issue which facilitated Siilo’s entry was a series of daunting ransomware attacks in the UK, which prompted hospital boards to take preventive measures on all digital aspects of healthcare, pushing data security to the forefront, and seeing hospitals reject unsafe commercial messenger apps that posed a threat to data safety.

**Siilo’s image ‘edit’ function allows users to blur and anonymise information and point out specific details on an image using the ‘Arrow’ tool**

Without these driving factors, there is no doubt that Siilo’s route into the UK healthcare sector would have been far more difficult, especially as a tech company from outside the UK. So now that the panic of the pandemic is subsiding, the Data Saves Lives strategy is aiming to create an environment which is conducive to technological innovation, at a level which is appropriate for the NHS.

This is a significant challenge because oversight boards have to make decisions on topics and technologies that they may not be familiar with. Conversely, technology often develops so quickly that in vast structures such as the NHS, conducting a swift quality assurance and compliance strategy, as well as putting new regulations in place, is far more easily said than done.

**Siilo’s Messenger App allows patients and healthcare professionals to communicate instantly**

Siilo looks at the proposed strategy with great anticipation, while at the same time. understanding how things work in the real world. There’s unlikely to be a perfect solution, but that doesn’t mean that innovators should sit and wait until everything becomes more crystalised. It is the responsibility of the technology sector to interact with healthcare providers and the NHS, so we can hold up our side of any mutual agreement.

In short, it is also our job to provide clear data on our services so that decision makers have a good understanding of what we bring to the table, how we work, and how we can contribute to the NHS’s future aspirations and security regulations. And the sector should welcome any opportunities for dialogue, for we find ourselves in the middle of a very exciting time in the digital development of healthcare in the UK.

Joost Bruggeman is a former surgery resident at Amsterdam University Medical Centre and now CEO and co-founder of Siilo – Europe’s largest medical messenger app. For more information, please visit www.siilo.com.

New digital maternity pathway goes live in Devon

By TPP UK

TPP SystmOne Maternity technology goes live at Torbay and South Devon NHS Foundation, digitising the entire maternity pathway, from ante to postnatal care.

This week, Torbay and South Devon NHS Foundation Trust have gone live with TPP SystmOne Maternity. The system has enabled the Trust to digitise their entire maternity pathway, from antenatal through to postnatal care. It is being used by all midwives in the region, including those based at the hospital and those working in the community. More than 2,500 women will benefit from the new system every year, with their maternity care now centred on a complete, integrated digital care record.

Following the go-live, midwives now have instant access to all of the maternity data they need. For example, midwives working in postnatal care can easily view all antenatal care and delivery details. All medical and nursing notes are captured in a single record. This provides staff with the information required to make the best clinical decisions and improve safety for mothers and babies. Advanced functionality in the system is also supporting staff with the management of more complex pregnancies, through enhanced clinical decision support, alerts, and a complete maternity timeline.

TPP maternity — TPP SystmOne Maternity in use at Torbay Hospital

There has been strong clinical engagement throughout the project, from midwives, doctors and nurses. The teams have used TPP’s powerful Clinical Development Kit (CDK) functionality to develop exactly the data entry templates and visualisations they wanted. All staff members can quickly capture the information they need for a complete antenatal, labour, delivery and postnatal record. The Trust have also used CDK functionality to create customised safeguarding content, helping to support and protect the most vulnerable families. Staff are also benefiting from interactive inpatient screens in the system, allowing them to manage bed capacity and perform safe, efficient handovers.

The go-live has also included providing TPP’s smartphone application, Airmid, to all women under the maternity service. This is putting women at the very centre of their pregnancy journey. Airmid allows women to access their maternity records, manage their upcoming appointments, complete questionnaires at home, and receive personalised advice and education material. Airmid supports better engagement and seamless communication between women and their maternity care team.

SystmOne also provides significant improvements to integrated care across the region and to multidisciplinary working. For example, maternity staff can immediately access any important information entered by GPs. This is significantly improving patient experience. Women only have to tell their story once, without having to repeat themselves. GPs can directly refer into the maternity unit, improving efficiency across both services. Additionally, all new births are now automatically registered with regional Child Health services, with no extra burden placed on NHS staff.

Tracy Moss, Head of Strategic Systems’ Software Development at the Trust, said: “We are excited to be working with TPP to introduce a new maternity IT system here at Torbay and South Devon NHS Foundation Trust. The new system is expected to bring a wealth of clinical as well as efficiency benefits for our maternity teams and the wider organisation. The families we care for will also benefit from the system, as the new associated Airmid patient app will allow them to view their records, access information and be more involved in their care. Moving forward, we would like to continue to work with TPP to deploy other SystmOne products, both within our maternity unit and across our wider Torbay and South Devon organisation.”

Charlotte Knowles, Managing Director at TPP, said that “maternity services will always hold a particular place in my heart. Having had three babies, I know, from personal experience, what a superb job they do. We are delighted that the Trust are already seeing significant benefits for staff and patients from TPP Maternity. The dedication of the staff here has been truly inspiring. We are looking forward to working together to continue to make better use of technology to improve the experience and outcomes for pregnant women and their families.”

Addressing the increased demand in healthcare

By Capita Healthcare Decisions

With the current increased demand within health and care, it is vitality important for providers to recover from the pandemic and address the challenges faced around growing elective care backlogs, staffing pressures and rising costs.

Addressing these challenges requires industry leaders to come together and adopt value-adding solutions and technology.

In November 2021, Capita Healthcare Decisions announced a partnership with Microsoft, integrating our clinical content into the Azure Health Bot, part of Microsoft’s Health Cloud platform. The key purpose around this has been to address the patient backlogs faced and improving the patient experience through the use of new technology.

How does it work?

Capita Healthcare Decisions’ content on Health Bot uses AI to pre-empt a wide variety of patient conditions and emergencies, with 164 symptom-based algorithms and over 40 scenarios ranging from ‘call an ambulance’ to ‘self-care’. The content is customisable and adaptable, with 500 sets of care instructions, including appropriate medical information and guidance on what to do if symptoms worsen.

Health Bot users can now gain access to Capita Healthcare Decisions’ content, meaning providers have access to the evidence-based healthcare content service. Saving the patient time is a goal of the collaboration and simple everyday language is used in the place of clinical and medical terminology – delivering a more user-centric approach and promoting ease of understanding.

The service aims to give users flexibility through access to information on different devices and channels, enabling a swift referral to appropriate care. Health Bot also aims to reduce the risk to patients of ‘self-triage’ – when a person evaluates their own health concerns to determine what they should do next.

What makes the clinical content unique?

Capita Healthcare Decisions produces content which is peer-reviewed and updated by an internal team of doctors and nurses to ensure robust clinical governance.

The Health Bot is available through Microsoft’s Cloud for Healthcare, a platform that provides the structure which supports health information and patient management across healthcare organisations and health providers, both public and private. The service provides AI-powered medical data which is used by some of the largest healthcare providers, pharmaceutical companies, and tele-medicine services in the world.

How will this help?

Steve Fearon, CEO of Capita Health Decisions, said: “We are proud and excited that our relationship with Microsoft continues to grow and strengthen. With this collaboration of our world-leading clinical content, available within the Microsoft health ecosystem, we have recognised the need to provide instant access to safe and accurate medical and peer reviewed content to support positive health outcomes. We are seeing just how vital the need for this offering has become, especially at a time of growing misinformation online.

“We see this collaboration as a great opportunity for organisations to completely transform and revolutionise access to healthcare, levelling the playing field in terms of equity in access to the most up to date health guidance, and ensuring that health resources are optimised to drive clinical and operational efficiency and effectiveness.”

Hadas Bitran, Partner Group Manager at Microsoft Health and Life Sciences, said: “Capita’s content is a valuable asset in the Health Bot service that empowers healthcare organisations to assist in triaging and directing patients to the appropriate level of care and to navigate the services available to them. Timely access to quality medical information saves lives; and deepening our relationship with Capita will further strengthen the patient-centric approach that is fundamental to our Health Bot service.”

Capita Healthcare Decisions have been at the forefront of tackling the challenges within healthcare systems for over 27 years. To find out more, visit: https://capitahealthcaredecisions.com/healthbot-cs/

Clarifying the metrics: A true picture of system wide activity

By Maria Kane

Maria Kane, Chief Executive of North Bristol NHS Trust, addresses the need for defined and aligned metrics to provide one overall picture of system wide activity and reveal where improvements can be made.

Every acute trust is facing three challenges: the elective care debt, urgent care recovery and an exhausted and depleted workforce. With Integrated Care Systems (ICSs) on the horizon, we have an opportunity to step back and look at the bigger picture to see where we can make system improvements to meet these challenges and add value to the patient, public and taxpayer.

However, it is difficult to understand what is going on in any given health and care system. This is because the finance framework and metrics currently available are not defined or aligned enough to help determine the exact value (cost and outcome) of activity the funding is producing.

A clear picture of each health system

Each ICS will be responsible for allocation of funding at system level. The aim is to distribute resources according to population need and to help reduce health inequalities. However, all payment systems are complex and to ensure the right calculations for payment of care and enable health systems to provide the right care in the right places, it is vital to have access to the right sources of data. Where patient-level data is limited, this can impact on how system budgets are allocated.

Currently, trusts are operating with a mixed economy of block and activity contracts. Most of these are now block contracts since Covid-19 began, but there are also have large numbers of individual providers on specialist and general contracts, which makes it difficult to see the big picture. Specialist contracts, for example, can cover wide areas which makes it harder to pin down what is happening in each ICS. Operating with a variety of contracts like this can create significant challenges when trying to set out a whole system budget.

A greater understanding of each system

ICSs provide the health system with an opportunity to clarify and get on top of the metrics and to have a single interpretation within each system. This will allow the scope to broaden and incorporate areas such as mental health.

Giving full responsibility of finances to ICSs and enabling them to operate the whole budget will bring many benefits and allow good population health management. However, there needs to be a shared understanding of how local services are run to ensure all areas of the system are given adequate funding. All members of the ICS need to understand how each part of the system works and it is crucial that financial decisions are based on a sound knowledge of the challenges across the whole system.

Bringing together sources of data from across community, primary and acute care can help to provide one overall picture of how the system is performing. Data can highlight where funding needs to be focused to help create change, improvement and the best patient care, as well as being able to highlight areas where proactive care can start to make a difference, but the finance framework and metrics need to be tackled first.

Capita Healthcare Decisions have been at the forefront of tackling the challenges within healthcare systems for over 27 years. To find out more visit: https://capitahealthcaredecisions.com/