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Critical Engagement with Digital Health Technologies for NHS STPs

Critical Engagement with Digital Health Technologies for NHS STPs

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Let's get digital
What happens when forty researchers, patients, entrepreneurs and health and social care staff come together to discuss digital technologies and their impact on NHS sustainability and transformation?

That was the experiment at the University of Southampton' s Web Sciences Institute on 16 January, at a workshop sponsored by the Institute, the CLAHRC and Wessex AHSN.

And the result?
A highly energetic and constructive exchange of views from the diverse stakeholders in the room.

The take away messages:

1. The NHS has to embrace digital technologies to survive but precisely how it embraces these is critical;

2. successful adoption of digital technologies needs to take account of:

• the political imperative of developing a compact between public services, service providers and citizens about how their data may be used;

• the social processes involved in patient and workforce adaption to technologies and the substantial research base that already exists in this field *the technical challenges involved in ensuring that a proliferation of health data and digital devices develops in a way that supports integrated, patient-centred care rather than promoting fragmented data and digital silos;

• developing the capacity to adapt to and exploit fundamentally disruptive innovation from within the NHS and from SMEs many of which have their origins in academic research or front-line clinical practice

Next steps?
How might we maintain and develop the coalition of interests that met in the workshop to underpin a research-driven, innovation-friendly digital technologies implementation plan for the NHS in Hampshire and the Isle of Wight. Watch this space.

Let's get digital
What happens when forty researchers, patients, entrepreneurs and health and social care staff come together to discuss digital technologies and their impact on NHS sustainability and transformation?

That was the experiment at the University of Southampton' s Web Sciences Institute on 16 January, at a workshop sponsored by the Institute, the CLAHRC and Wessex AHSN.

And the result?
A highly energetic and constructive exchange of views from the diverse stakeholders in the room.

The take away messages:

1. The NHS has to embrace digital technologies to survive but precisely how it embraces these is critical;

2. successful adoption of digital technologies needs to take account of:

• the political imperative of developing a compact between public services, service providers and citizens about how their data may be used;

• the social processes involved in patient and workforce adaption to technologies and the substantial research base that already exists in this field *the technical challenges involved in ensuring that a proliferation of health data and digital devices develops in a way that supports integrated, patient-centred care rather than promoting fragmented data and digital silos;

• developing the capacity to adapt to and exploit fundamentally disruptive innovation from within the NHS and from SMEs many of which have their origins in academic research or front-line clinical practice

Next steps?
How might we maintain and develop the coalition of interests that met in the workshop to underpin a research-driven, innovation-friendly digital technologies implementation plan for the NHS in Hampshire and the Isle of Wight. Watch this space.

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Critical Engagement with Digital Health Technologies for NHS STPs

  1. 1. Critical Engagement with Digital Health Technologies for NHS Sustainability and Transformation
  2. 2. Transforming health and care in Hampshire and Isle of Wight Health and Academic Sector Engagement 17 January 2017 Richard Samuel Lead, Hampshire and Isle of Wight Sustainability and Transformation Plan
  3. 3. 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
  4. 4. 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 change Health care today is too reactive Healthier lives, world class sustainable services, strong primary and community care
  5. 5. Focus for transformation Healthier lives, world class sustainable services, strong primary and community care 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
  6. 6. Shape of Transformation Healthier lives, world class sustainable services, strong primary and community care 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
  7. 7. Questions? Healthier lives, world class sustainable services, strong primary and community care
  8. 8. Critical Engagement with Digital Health Technologies for NHS Sustainability and Transformation
  9. 9. User experiences of telehealth and telecare: learning from studies of LTCs adaption and adoption Anne Rogers, Faculty of Health Sciences, University of Southampton UK
  10. 10. Telehealth interventions
  11. 11. 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.
  12. 12. 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/new s/from_the_dh_pilots_update/december_2 009_wsd.html
  13. 13. 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
  14. 14. 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.
  15. 15. 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)
  16. 16. “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)
  17. 17. 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)
  18. 18. 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,)
  19. 19. 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)
  20. 20. : using new technology adaptations by users ID168, W, 77 yrs, COPD
  21. 21. 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)
  22. 22. 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)
  23. 23. 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)
  24. 24. Paradoxes An 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 making Paradox reliance acceptance of TC +creation of new relationships and dependencies
  25. 25. 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
  26. 26. Critical Engagement with Digital Health Technologies for NHS Sustainability and Transformation
  27. 27. Simon Bourne DM, FRCP (UK) CEO my mhealth Limited NHS NIA Fellow Respiratory Consultant Portsmouth Hospitals NHS Trust An evidence-based approach for the design and delivery of mHealth products for people with long term conditions
  28. 28. Where are we with mhealth?
  29. 29. English subtitles for hard of hearing and language translation Polish Punjabi Urdu Bengali Gujarati Arabic French Chinese Portuguese Spanish Tamil Turkish Italian Somali Lithuanian German Persian Farsi Tagalog Filipino Romanian (C) my mhealth limited 2016 - Not for distribution outside agreements 2017 Reaching areas where current clinical services struggle
  30. 30. Connectable (C) my mhealth limited 2017 - Not for distribution outside agreements Next Generation POC Diagnostics Home Diagnostics Biometric wearables Cloud Platform Clinician Software New models of care
  31. 31. Clinical Studies
  32. 32. 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
  33. 33. Critical Engagement with Digital Health Technologies for NHS Sustainability and Transformation
  34. 34. © xim ltd 2016
  35. 35. The self-care challenge
  36. 36. © 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
  37. 37. 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
  38. 38. Alignment with STP Characteristics STP Lifelight™ Self-care Ease of use Affordability Adherence Pro-active Avoidable admissions Removal of variation
  39. 39. Alignment with STP Characteristics STP Lifelight™ Self-care Ease of use Affordability Adherence Pro-active Early warning via NEWS Avoidable admissions Removal of variation
  40. 40. Alignment with STP Characteristics STP Lifelight™ Self-care Ease of use Affordability Adherence Pro-active Early warning via NEWS Avoidable admissions Prevention by NEWS Removal of variation
  41. 41. Alignment with STP Characteristics STP Lifelight™ Self-care Ease of use Affordability Adherence Pro-active Early warning via NEWS Avoidable admissions Prevention by NEWS Removal of variation Measure outcomes with post-discharge data
  42. 42. Challenges to adoption • Pilots -> partnerships • Building evidence base • Culture change - spend to save
  43. 43. Other issues for digital self-care Ease of use and ease of management Design digital into new preventative care models Consent, privacy and security Data ownership Primary and secondary care blurring lines Open data Hampshire Health Record and IoW integrated model Analytics
  44. 44. Thank you Laurence Pearce Contact @laurencepearce laurence@xim.ai XIM Ltd Catalyst Centre, University of Southampton Science Park www.xim.ai © xim ltd 2017
  45. 45. Critical Engagement with Digital Health Technologies for NHS Sustainability and Transformation
  46. 46. Health workforce challenges and opportunities in the digital age Jeremy Wyatt DM FRCP ACMI Fellow Professor of Digital Healthcare & Director Wessex Institute of Health & Research
  47. 47. Examples of digital health innovations GENIE – web tool to map personal support network, identify community resources Personal Health Records – eg. UHS Prostate service Quantified Self movement; wearables Body worn sensors for eg. blood sugar, alcohol Self hacking movement – insulin pumps Patients Like Me: online patient community running “citizen science” studies Patients Know Best: personal health record I control, share with clinicians when I decide to Google DeepMind Acute Kidney Injury app at RFH
  48. 48. Expected changes due to digital tools & methods In 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
  49. 49. 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
  50. 50. 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…
  51. 51. 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?
  52. 52. Conclusions 1. Digital is already changing the shape and practice of healthcare, and will accelerate over next 5-10 years 2. This opens up welcome professional opportunities, but also poses some challenges 3. We need facilities to train health professionals to provide safe, effective “distance medicine” services 4. 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 J.C.Wyatt@soton.ac.uk
  53. 53. Critical Engagement with Digital Health Technologies for NHS Sustainability and Transformation

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