Critical Engagement with Digital Health Technologies for NHS STPs

Critical Engagement with Digital Health Technologiesfor NHS Sustainability and Transformation

Transforming

health and care

in Hampshire and Isle of

Wight

Health and Academic Sector Engagement

17 January 2017

Richard SamuelLead, Hampshire and Isle of Wight Sustainability and Transformation Plan

Goal

Meeting the many opportunities and challenges facing the local health and care system around the need to empower people to stay well and to provide safe, high quality, consistent and affordable health and care to everyone.

Healthier lives, world class sustainable services, strong primary and community care

The case for change

Health and care funding is

increasingly outstripped by

increasing demand

Workforce pressures

Accessing care, information and support is often complicated and

confusing

Too much variation in outcomes

across the area

Increasing pace of technological

changeHealth care today

is too reactive


Focus for transformation


Prevention at scale

New models of care

Effective Patient Flow and Discharge

Acute Physical Alliance

North & Mid Hampshire configuration

Mental Health Alliance

Digital transformation

Workforce

Estates

Commissioning

Shape of Transformation


Do Things Better (2.5%) AND Do Better Things

3 points of recognition:

- there is a burden of care- there are outcomes worse than death- there is predictability in much that we do

Break / Fix model to Proactive Population Health Management:- Reversing the specialisation trend- Capability in Behavioural insights- Founded on Predictive analytics using connected data- Channel shift and Care coordination - Actuarial and risk modelling

Questions?


User experiences of telehealth and telecare: learning from studies of

LTCs adaption and adoptionAnne Rogers,

Faculty of Health Sciences, University of Southampton UK

Telehealth interventions

Aspirations

•A means of making services more responsive, equitable, cost and clinically-effective

• Able to play a central part in mediating between service users, professionals, and service providers.

•Potential for Self care agenda policy vision of independent responsible self-managers.

Warning shot for aspirations•“Our assumption that all those who were eligible would want the technology proved to be the biggest challenge in the recruitment process.” (Martin Scarfe, Project Director Newham) http://www.wsdactionnetwork.org.uk/news/from_the_dh_pilots_update/december_2009_wsd.html

http://www.wsdactionnetwork.org.uk/news/from_the_dh_pilots_update/december_2009_wsd.html



Key themes for patient implementation

•Technology Design•Perceptions of health, self-care and dependency

•Views on technology and operational factors

•Expectations and experiences of changes in service provision and use

Three Principles for designing effective tele-health progs for LTCs

•Need to help people living with conditions to:• Build effective relationships with doctors, nurses and others.

•Be a good fit between the technology and everyday routine of the patient

•Provide a clear visual record of health results, such as blood glucose readings.

• Vassilev I, Rowsell A, Pope C et al. Assessing the implementability of telehealth interventions for self-management support: a realist review. Implement Sci.

2015;10:59.

http://www.implementationscience.com/content/10/1/59

self-care• Interventions improve motivation to improve self-care

This has helped since I've had the graphs going, that I know that day I had a drink, or extra piece of cake, so I make sure now that once I've had my dinner I don't take nothing else (ID78, M, 75yrs, diab)

“That big one, when it's gone up to eleven... which isn’t too bad? That was my birthday when I had a curry night and the kids came around and gave me about four Baileys” (ID78)

BUT Monitoring could also undermine self-care strategies

I think you feel like you're not in control of your life… from how he explained it, you tended to have to do your blood test every single day… I try to be a bit more relaxed and… I just felt it, it did put a bit more pressure on me…” (ID31, W, 61 yrs, Diab)

Threats to health and independence IF not targeted appropriately

I'd feel more crippled… As long as I can get out, that's all I am worried about…We see these old people... hobbling along, like, you know, and we're walking.. (ID28, M, 84 yrs, HF,)

Perceptions of technology• Concerns about technical competency

The older you get the more forgetful you get… younger people obviously are computer wise… when you are not used to it you need to read the manual every time. (Wife of ID33 M, 66yrs, COPD)

: using new technology adaptations by users

ID168, W, 77 yrs, COPD

experience of service change• Valued new relationships with staff

...my sugar level was high and one of the nurses called to see if I was alright… So I feel quite relieved because, if things did [go] wrong, I know there's somebody watching. (ID77, W, 59 yrs, diab)

experience of service change• Increased security

If there's anything wrong, they phone you up…Someone’s at the end all the time. I call them the angels (ID70, M, 66 yrs, diab)

Introduced into set expectations of services• Concern that good services would be undermined or taken away

They put things in your home don't they. You don't have to go to the doctors…Too complicated for me…I like things plain and simple. I'd sooner go over to the doctor. (ID27, W, 79 yrs, diab)

ParadoxesAn adequate substitution for traditional services & added benefits (minimising travel, reassurances of regular external surveillance)BUT Limited patient work low level rather than requiring higher level interpretation of readings and decision makingParadox reliance acceptance of TC +creation of new relationships and dependencies

A balancing act: Key Points •Facilitates & inhibits self management•Creates new relationships and dependencies•Participants may be active or more passively engaged

• Interventions may be perceived as threats to identity and independence

•Expectations and perceived technical competence are important

• Interaction/ communication is important for integration

Simon Bourne DM, FRCP (UK)CEO my mhealth Limited

NHS NIA FellowRespiratory Consultant Portsmouth Hospitals NHS Trust

An evidence-based approach for the design and delivery of

mHealth products for people with long term conditions

Where are we with mhealth?

English subtitles for hard of hearing and language translation

PolishPunjabiUrduBengaliGujaratiArabic French ChinesePortugueseSpanishTamilTurkishItalianSomaliLithuanianGermanPersianFarsiTagalogFilipinoRomanian

(C) my mhealth limited 2016 - Not for distribution outside agreements

2017

Reaching areas where current clinical services struggle

Connectable

(C) my mhealth limited 2017 - Not for distribution outside agreements

Next Generation

POC Diagnostics

Home DiagnosticsBiometric wearables

Cloud Platform

ClinicianSoftware

New models of care

Clinical Studies

New pathways….....ementation

Touch points Advantages

• Whole system communication• Enhances reach and impact of

current PR services• Proven inhaler education• 24/7 resource for patients• Helps with delivering the COPD

BPT• Assists with COPD patient

review• Predictive analytics

Digital hub

The self-care challenge

© Xim Ltd 2016

Standard smartphone camera: No custom hardware. No wearables.No contact. No wires.

Predict heart attack or other critical event 24 hours ahead. Before it’s too late.

Prediction for prevention

Use cases

• Self-care monitoring– Simplicity– Low cost– Adherence– NEWS/MEWS capture– Track deterioration

• Triage vitals in 30secs– Paramedic– Over a 111 call– GP reception– NEWS/MEWS capture– No training required

Alignment with STP Characteristics

STP Lifelight™Self-care Ease of use

AffordabilityAdherence

Pro-active

Avoidable admissions

Removal of variation




Pro-active Early warningvia NEWS








Prevention by NEWS







Prevention by NEWS


Measure outcomes with post-discharge data

Challenges to adoption

• Pilots -> partnerships• Building evidence base• Culture change - spend to save

Other issues for digital self-care

Ease of use and ease of managementDesign digital into new preventative care modelsConsent, privacy and securityData ownership

Primary and secondary care blurring linesOpen data

Hampshire Health Record and IoW integrated model Analytics

Thank you

Laurence Pearce

Contact@[email protected]

XIM Ltd Catalyst Centre, University of Southampton Science Parkwww.xim.ai

© xim ltd 2017

Health workforce challenges and opportunities in the digital age

Jeremy Wyatt DM FRCP ACMI FellowProfessor of Digital Healthcare & DirectorWessex Institute of Health & Research

Examples of digital health innovationsGENIE – web tool to map personal support network, identify community resourcesPersonal Health Records – eg. UHS Prostate serviceQuantified Self movement; wearablesBody worn sensors for eg. blood sugar, alcoholSelf hacking movement – insulin pumpsPatients Like Me: online patient community running “citizen science” studiesPatients Know Best: personal health record I control, share with clinicians when I decide toGoogle DeepMind Acute Kidney Injury app at RFH

Expected changes due to digital tools & methodsIn professional practice:• Data tsunami due to self / remote monitoring• Automated data interpretation, triage• Remote video consultations, data capture• Greater sharing of data with patient, others in own organisation, other

organisations• Increasing health literacy & self care activity

In health systems:• Global health services compete with GP practice down the road• Citizen participation in health decision making• Citizen organised research• Learning Health System

Some opportunities for staff• More flexible, mobile working (Skype clinic in Boston

after dinner?)• True partnership with patients via shared records• Active triage of patients – you only see the complex

or very sick patients• Rapid learning and feedback in LHS (cf. monthly /

annual clinical audit)• Future: don’t see patients at all – instead provide

professional EB updates to guidelines and other tools that manage patients

Some challenges for staff• Need to ensure record easy for patients, other professionals to

understand • Avoid data tsunami from remote / self monitoring: nurse-run call

centres, artificial intelligence algorithms• Distinguishing “normal” from “special cause” variation in disease

indicators – SPC methods ?• Ensuring continuity of digital services – don’t use personal email

address• Managing patient expectations for more responsive clinical services• Learning how to remotely consult, build therapeutic relationship, escalate to a FTF visit…

Training & other implications• Need for a “distance medicine” learning lab (role play

with digital tools in difficult scenarios); analogy is keyhole surgery training centres

• Need new codes of practice for carrying out & documenting remote consultations, computer assisted triage, etc.

• How to check quality of apps, decision support, triage algorithms etc. – look for CE mark; NICE / PHE work on apps

• How to check quality of digital services – CQC Key Lines of Enquiry for digital health services

• Will digital services attract and retain more staff, or not?

Conclusions1. Digital is already changing the shape and practice of

healthcare, and will accelerate over next 5-10 years2. This opens up welcome professional opportunities, but

also poses some challenges3. We need facilities to train health professionals to provide

safe, effective “distance medicine” services4. Healthcare organisations and clinical services may soon be

competing on a global stage to provide health services to “their” population

5. Research is needed to understand these challenges, and how to overcome them

[email protected]

Critical Engagement with Digital Health Technologies for NHS STPs

Health & Medicine

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