HTN Digital Week Day One: Monday 20th January 2020
We are delighted to announce the start of HTN Digital Week, where between now and Friday the 25th, we will be reporting on the highlights of each day.
In this article we have curated what we think were the key pieces of information from each live webinar. We would like to say a huge thank you to the presenter and organisers, the quality of content was extremely high.
Also, be sure to check out an opinion article on How the home tech revolution can ease Britain’s social care crisis, and our case study into the North Bristol Trust going paperless as part of the content produced for HTN Digital Week.
Session one, David Kwo the former director of EHRS and Informatics at UCLH presented ‘Lessons learned from implementation of the Epic electronic patient record system at large NHS teaching hospitals.’
David was responsible for the Epic implementation at UCLH. The trust’s Epic journey started when the business case was approved in 2017, and they went live in 2019. 23 modules, 6 hospitals, 1000 beds and 10000 staff. It was also delivered on time and on budget.
“The four key lessons (non-Epic) – invest in IT infrastructure today or it will cost more tomorrow. You need amazing leaders for these types of journeys and we definitely had that. There are bumpy periods and processes are changed everywhere. Also, look after your staff! The organisational commitment is crucial and requires a complex team effort; always recognise the role of the EHRS team.”
“Implementing an EPR system is a complex and challenging endeavour which requires full scope implementations. It is not just about improvement of software; it requires massive change and is a people driven endeavour, communications and commitment are critical where training is crucial to the success of an EPR. Additionally, relentless focus is important.”
“In our roll-out our CEO did a live demo of the system! That was important because there’s large scale changes such as service redesign, workflow, clinical processes, patient experience, legacy systems to research. Make sure your roll-out and training plan is communicated atleast 6 months in advance and be willing to think about how you work and be open to changing practices. And engage, engage and engage, you need a relentless focus.”
Session two, Paul Charnley, Director of Information at the Wirral Teaching Hospital discussed ‘The journey and experience that the Wirral team have been on as they have worked to implement new ways of working on new digital solutions, to better manager population health in the region.’
Paul opened to provide an overview of the Wirral care record, using data to help manage the populations health:
“Not just health and social care data, not just determinants; the use of data to help make informed judgements, supporting resource prioritisation, enabling working together and releasing time away from digital methods to improve patient interaction.”
The PHM is the first outside of North America. “We have issued a blueprint for information governance, hopefully published by February. The idea is to pull data together into the infrastructure, then to turn that data into intelligence or an understanding. We can then visualise data and have brought together numerous partners to analyse data. We are currently at the state of looking at how to design interventions and what work can we do to change the way we deliver care. Also, planning new models and looking at kinds of interventions, where bringing clinical teams together is an important step.”
“We began the project in 2015, and was one of the Vanguard projects. Initially, we were awarded funding, and set up contract with Cerner, but the following year funding ceased and we had to disband the project. After, we tried to get the project back up and running with our own resources. It has only been over the last couple of years where we have made progress. September marked our ribbon cutting launch event. It has been an up and down journey but now it is up and running.”
“Our focus is the primary care network, personalised care, population health management, essentially the 3 P’s. The project places people in the Wirral at the centre. Our vision is to help people live longer and healthier lives regardless of demographics. We have found that deprivation is inextricably linked to life expectancy and there is a clear divide between the Liverpool side and the Welsh side of Wirral, whereby the Liverpool side is much more deprived. Our aim is to understand what drives the issues in demographics within healthcare. If we took 100 people as a focus group across the Wirral, a third of them would be living in deprived areas.”
“We asked the population, “what is important?”. They answered, being confident, having a strong community and having joined up healthcare services”. Patients clearly feel disjointedness, which the project is seeking to smooth over or eradicate.”
“We have identified that 5% of patients are a very high risk, with 30% a rising risk and the rest easily managed. It is about pulling the whole community together.”
“Where we are now; we have data flowing in overnight; GP records, social care records, hospital records, community records and mental health records means we have a comprehensive Wirral health record”.
“Over the last 18 months we have acquired 100% of GP data, hospital data, community data, cancer centre data and mental health data. Our team incorporates the programme team, healthy Wirral partner project leads, clinical leads, system leads and the Cerner team”.
“Through creating disease and wellness registries, we can identify patient phases – phase 1: adult diabetes, child diabetes, adult asthma, childhood asthma and COPD. Phase 2: cardiovascular disease, wellness, mental health, frailty and supportive care.”
“As we map data in registries, we have a record in the EPR to say if the target has been achieved by the patient. Targets can become timed out if not acted upon. The view of the registries is different in EPRs but is still the same content. We will soon provide access to the whole application through EMIS”.
“The benefits our platform provides – targeted intervention, interconnect organisations, patient data sharing, culture change, communication and avoiding waste.”
In terms of what is possible then, is a platform that links data sources together, standardisation of data into coherent records, one analytical portal for the Whole Healthy Wirral partnership and industry leading visualisation tools.
“We have enabled unique insight; one tool for analysis and data manipulation, enabling new ways of working, ease of use and stringent security.”
“Our next objectives are to truly innovate and acquire system wide ownership at all levels. To give the patient the ability to organise their own care over the next 5 years.”
Our midday session, Liz Ashall-Payne, founder and CEO of ORCHA presented ‘Determining and evaluating the quality of Health Apps’
“There are four important questions to consider: how many health apps do you think there are available to us? How many people download a health app every day? What percentage of healthcare professionals think that health apps could help their patients? Out of every 10 young people aged between 11 to 16, how many own a smart phone?”
“There are over 365,000 health apps where 30,000 people download one every day. 93% think health care apps could help their patients and 9/10 young people own a smartphone. The statistics are shocking.“
“73% of health apps were focused on fitness a few years ago. Now, health apps are mainly concerned with the management of health. 28% of health condition solution apps focus on mental health, with approximately 19,000 apps. This shows us the landscape of health apps where there is always a solution with a health app, but is there a good solution? How can we leverage this opportunity?”
“There are 15% to 20% of health apps that meet expected quality, you are more likely to find a bad product than a good product.”
“There are 250 products available that have the word ‘prank’ in the title, one such product was downloaded 10,000,000 times and gives a false positive, basically informing you that you are healthy when in reality, the app cannot medically know. Who holds the risk of the product if the product changes over time? How do we govern changes? We need to review these products to check quality.”
“Our mission is to distribute apps; the question is how do you do that?”
“Where do you start? You start with an overview of that landscape. We grab data from app stores and filter information to see if the product has been updated in the last 18 months. If not, it is disqualified as it can be a risk to data breaching. We then contact developers and invite them to update. 2/3rds get disqualified for just not being updated in an 18-month period. The remaining 1/3rd get filtered into 350 categories and ordered from most downloaded backwards. We have built a classification system to recognise not all solutions are the same. We can’t assess all products in the same way, the same as you wouldn’t assess a mode of transport in the same way.”
“We then work out functions and features within the app.” Different features trigger different risk thresholds. There are 4 domains – all round data privacy (GDPR), security, clinical assurance and end user.
There are three case studies that Liz presented and are worthy of looking into – South Yorkshire NHS partnership trust, East Cheshire local authority and The Health App Finder.
“Finally, we believe there are four steps to digital integration – 1) accreditation – which products are safe. 2) promotion – of safe products only. 3) integration – with a professional focus, supporting health care professionals to understand the app, which product should we use at which point along the pathway. 4) formal prescription – prescribing the app formally to the patient.”
Neil Perry, Director Digital Transformation, Dartford & Gravesham NHS Trust presented ‘Innovating Pathways through Radiology AI, Wearables for Remote Patient Monitoring, Robotics & ChatBots’
Neil begin his presentation defining what artificial intelligence is and the subsets of it: machine learning and deep learning. Previously at HTN, we have published articles regarding the aforementioned terms and Neil provided us with a look at how AI works specifically within radiology, health sensor wearing and chatbots.
AI in radiology is necessary as the UK has the lowest lung cancer survival rate – 25.7% diagnosis at an early stage, and as such equals a 1-year survival of 38.5 and a 5-year survival of 15.2%. Once an X ray is taken at a hospital, for example after a patient having a persistent cough, there could be an 8-week turnaround. 3D rendering can determine if it is cancer, but then the patient goes back again for biopsy, which is a very slow process relatively.
“Our tech can work out within 23 seconds if it is abnormal, if it is abnormal, you can arrange there and then for a CT scan to be conducted and/or a cancer specialist nurse to see them immediately.”
“We can tell from the nodules and masses if it is cancer – the shape, size etc. This way, we can improve pathways to be more efficient and save a vast amount of time.”
The AI algorithm can allow the patient to have a same day X Ray to CT scan and reduces time from CXR to CT by 2 weeks. There is also the potential to remove the first CT scan and move to biopsy immediately. Also, the AI can save up to 35% of workload for clinicians.
Neil also described health sensor wearing – real time monitoring of a patient even whilst sleeping with real time alerts to the patient’s care team automatic through the app, 24/7 vital sign monitoring – respiratory rate, pulse rate, oxygen saturation, skin temperature, mobility, posture and step count. All this creates a 1-day reduction in hospital stay length, 22% reduction in home visits, 92% patient adherence and improved hospital flow.
“We have been doing it for 1 year and have found that patients between a certain rating need monitoring every 25 minutes.”
The trust is also working on chat bots at the moment, it is a type of AI which can be used to simulate chat with a user – natural language understanding and is the most advanced type of interaction between computers and humans.
There is a vast landscape of chat bots, which has grown since 2016 exponentially; “we can integrate chat bots into our website – more interactive function, changes appointments, asking questions etc.”
“Chatbots in health care can provide administrative support, as in when is my next appointment, the ability to change appointments, gather test result enquiries etc.”
The final live webinar of the day, Kevin Hamer from University Hospitals Southampton presented ‘My Medical Record – UHSFT patient online solution’
A cloud-based service hosted in MS Azure – a way for patients to connect to the hospital when being away from the hospital.
“Patients really value the service despite us not thinking it to be not that clever. The true value is the ability to send data in both directions – we can send data to patients and they can send data back to us. A cloud-based record where we can interact with the patient.”
“We see this as putting the patient at the centre of their care rather than just having things done to them.”
“Why do this? We should be doing these things because they are the right things to do – patients first, co-production, demand management, early intervention and strategic alignment (10-year plan, paperless).”
“The power of these types of platforms is the ability to have early intervention.”
“Patients have asked to see on the front screen is a unified view of their appointments with new data being displayed. Patients have their personal information including allergies, emergency contacts etc, and patient’s documents such as questionnaires, medication information etc. Also, surveys can be published and conducted there for both the patients benefit and our benefit to support early intervention.”
“A specific example would be how the system can be used with prostate cancer; increasing diagnosis and greater awareness about the disease. 112 men diagnosed every day. There is no adequate system of follow up after treatment is finished and as such, men feel abandoned.”
“The system is essentially a replication of what would happen face to face without the need of course for the patient to come in to see a clinician; it encourages the patient to self-manage. The system posts lab results so the patient can get the results they anxiously want without the long wait times.”
“There is a secure messaging service where the patient can directly message their clinician. Finding support, self-management, managing side effects, healthier lifestyle and computer IT skills are some of the potential screens that the patient can access.”
“Since the project started in 2014, 4400 patients are enrolled with an estimated 15000 appointments saved. Nurses can review 20 plus patients digitally per hour vs 6 in the clinic. The system is now in 11 hospitals, and it will be expected to be live in 25 hospitals by 2020/2021.”
“What do patients think? We interviewed over 1000 patients asking how likely are they to recommend the service; 64% answering 9/10 score NPS score 49. Age doesn’t appear to be a barrier with this platform as there are two 90+ year olds using it with the platform being rated by 70% of users as being ‘easy’ or ‘very easy’.”
“What are the benefits? Patients waited 13 fewer days to get blood test results. 75% of patients are reviewed 3 weeks earlier. Also, cash savings, prostate service saved over £40k in 18/19, patients saved over £19k on travel costs to and from hospital and other costs associated with hospital visits.”
“The platform is untethered being cloud hosted, and is not connected to any main systems. We see the platform going everywhere across all our trusts. The patients have just one login to be able to get all their data in one place.”
”An untethered personal health record supported by NHS open standards, which can be accessed with an NHS login.”