Case Studies, Content, News

Feature: #HealthTechToShoutAbout

The health tech industry has rallied to support health and care over the past few weeks. As part of the HTN #HealthTechToShoutAbout feature series, supported by Highland Marketing, we spoke to 6 health tech suppliers to hear more about their recent work in response.

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Care communities move to full Covid-19 tracking

Sharing information, and using that shared information to make complex decisions, has never been more important for the NHS as it copes with Covid-19.

Graphnet has been focused on supporting its customers by accelerating key shared record projects already underway, deploying new products and rolling out new releases of its software with new Covid-19 functionality.

New Covid-19 features released to CareCentric shared record customers include a Covid-19 summary page for each patient which displays any available information to professionals across a care community.  Information such as Covid-19 tested, suspected diagnosis, and confirmed diagnosis is displayed in chronological order. In addition, an alert ‘pop-up’ flags the most clinical useful/important Covid-19 information about a patient when that patient record is accessed, and the information displayed includes ‘shielded patients’ so key professionals are aware of their status.

Changes have also been made to display known advance care planning decisions, such as those concerning life sustaining treatments and the citizen’s wishes, and to make these very prominent in the shared record.

The company said to HTN “Some customers of Graphnet have deployed additional functionality. Frimley Health and Care ICS is in the process of incorporating information from the regional 111 service, for example, where a patient dialogue has resulted in highlighting the patient as a possible Covid-19 case, and then flagging this to clinicians who view the record.

“The use of analytics layered on top of the shared record has real transformative potential, even more so in the current crisis.  Graphnet’s population health team is currently rolling out the CareCentric Population Health Analytics Covid-19 dashboard.

“The dashboard analyses primary and secondary care data to identify citizens with a Covid-19 event. It also includes an ‘enhanced case finding’ function to allow searches which identify patients at risk and in need of intervention.  The dashboard is an operational tool and can also help predict demand.

“Elsewhere, shared records that would usually take six months or more to put in are being deployed in a matter of weeks.”

Brian Waters, chief executive of Graphnet, said “As well as focussing on new functionality, we are very aware that Covid-19 use cases for our products continue to emerge from our customers, where people have used or deployed products in innovative ways to help with the crisis.  We are documenting these and making them available to the entire user base.  Our focus is on working as flexibly as possible to best support our customers, prioritising clinical safety while reducing any cumbersome administrative barriers.”

“The coming weeks will be particularly challenging for everyone working in health and social care and we are committed to assist our customers in any way we can during the outbreak.”

How NHS hospitals are adapting their Allscripts systems to treat COVID-19 patients

Anna Bayes, UK medical director, Allscripts said to HTN “In these unprecedented times, I’m in awe at what healthcare organisations and professionals are dealing with daily. So, we were awe-struck when two of our UK clients chose to continue planned implementations of new functionality during the week of 23 March.

“At Bolton NHS Foundation Trust, the activation of new mobile functionality for community paediatric services went ahead as scheduled. Many of the staff who will benefit from this functionality – which includes offline working for home visits – have been redeployed to acute services; but once this crisis has passed, they will be able to start using this new software right away.

“At Gloucestershire Hospitals NHS Foundation Trust, the recent activation of Sunrise EPR nursing documentation at both Gloucester and Cheltenham hospitals has now been augmented with electronic observation recording, including National Early Warning Score2 (NEWS2) scoring. This will help staff monitor for signs of deterioration and intervene earlier, if required.”

Enabling change

“Other Allscripts clients in the UK have made significant, rapid changes that will help their staff manage those suspected of having COVID-19 and those who have been confirmed. At The Dudley Group NHS Foundation Trust, patients with suspected or confirmed COVID-19 are identified by an icon on the patient header in their electronic record.

“At Gloucestershire Hospitals and Wrightington, Wigan and Leigh NHS Foundation Trust, a specific icon has been added to the ward tracking board, so patients can be identified and managed at ward level and across the hospital. Specific patient lists can also be generated for managing patients requiring isolation.

“Salford Royal NHS Foundation Trust updated its Emergency Department clerking documentation to record salient COVID-19 features, enabling a streamlined clerking process and a direct link to a pre-defined battery of pathology and radiology investigations. Again, the ED tracking board provides staff with at-a-glance information about COVID-19 status, so they can put on the appropriate level of protective clothing – prior to entering the patient cubicle.”

Supporting reporting and analysis

“Salford Royal has also made changes to Sunrise critical care documents to ensure appropriate, structured data is recorded consistently. In parallel, its reporting team is providing reports that give an overview of current inpatients and use of high-acuity beds.

“Liverpool Heart and Chest Hospital NHS Foundation Trust also updated documentation templates. In particular, Liverpool has updated critical care documentation to record symptom onset as well as standard respiratory support requirements. Currently, the trust is looking to convey this data for automatic upload to the Public Health England COVID-19 Hospitalisation in England Surveillance System (CHESS) database to minimise reporting effort and reduce transcription errors.”

Looking to the future

“We are working with our clients to share their newly configured content, together with COVID-19-specific content and decision support rules built by Allscripts. We are also working with them to make sure their systems are ready for the complex protocols that will be required for anticipated COVID-19 drug trials.

“We want to make sure that data is collected as a by-product of normal clinical documentation, rather than requiring re-keying of clinical data to support this research. Not only will the COVID-19 drug trials be amongst the fastest mobilised, but the ability to review and report iterative, consistent outcome data from the EPR in near real-time will be a key benefit to the global fight to stem this pandemic.”

Remote monitoring to support high-risk patients

Remote patient monitoring can extend a vital lifeline to the 1.5m Britons told to stay at home because they are extremely vulnerable to the coronavirus, according to Inhealthcare.

The company has rolled out more than 100 digital services in partnership with NHS and care home organisations across the UK to support patients living with long-term health conditions.  It’s now seeing unprecedented demand for remote monitoring as NHS and care providers seek to create capacity in hospitals, deliver continuous care to people at home and protect staff from the risk of infection.

Last year, the NHS fulfilled more than 97m outpatient appointments, illustrating the scale of the challenge for the health service in maintaining “business as usual”. 

Bryn Sage, chief executive of Inhealthcare, said “Before coronavirus, our partnerships helped people lead healthier lives for longer and kept them out of hospital when they did not need to be there. After the onset, we are doing all that and working hard to help protect staff as well.”

The Government has advised people with underlying conditions including cancers, respiratory illnesses, organ transplants or pregnancies to stay at home and avoid any face-to-face contact for 12 weeks.

Ordinarily these patients would be seen regularly at outpatient appointments or community nurse visits for routine checks and treatments but the threat of coronavirus has made this difficult and dangerous.

The threat also appears to have deterred people with underlying conditions from seeking emergency treatment, as suggested by a dramatic fall in A&E attendances.

Mr Sage said “Our message to NHS and care home organisations is we can help you care for your high-risk patients. Remote monitoring is a mature and inclusive technology and is trusted by a growing number of NHS and care home providers across the UK.”

The company said “Inhealthcare, which is part of the financially strong Intechnology plc, owns and operates the UK’s only dedicated platform for remote patient monitoring and digital health.  

“The platform allows for the creation of new digital health services within 24 hours. For example, Inhealthcare last month rapidly developed and deployed a new Covid-19 symptom checker service for a major NHS provider to screen thousands of daily outpatient appointments.

“The Inhealthcare platform enables patients to communicate readings with health and care professionals through a choice of channels ranging from Amazon Alexa to the telephone landline.

“The fully inclusive approach, which includes video, SMS and apps, makes digital health services accessible to the vast majority of the population, regardless of age and ability.

“All alerts are automatically flagged up and shared with clinicians for review, allowing providers to focus their resources on those who need care the most.

“Patient information is fed into leading health and social care systems, overcoming any interoperability issues, and securely stored within the Government’s new Health and Social Care Network.”

Mr Sage said “We have been developing and delivering these services for a long time now and are proud to be stepping up at this time of great national need.”

Tracking COVID-19 Data with Lyniate Interoperability Platforms

As healthcare organisations throughout the world work to reduce the spread of COVID-19 and care for an overwhelming number of infected patients, the need for sharing patient data between systems, departments, organisations, and regions has never been greater.

Lyniate said to HTN “Globally, we are going through a healthcare crisis, and Lyniate is part of the solution to help the interoperability of the healthcare delivery system.

“Lyniate’s interoperability platform, Rhapsody, enables seamless data exchange among disparate organisations within healthcare, including health systems, telehealth platforms, Electronic Health Records and health IT vendors.”

The platforms support all health data formats and standards — including FHIR — allowing healthcare organisations to integrate quickly, easily, and securely either as an on-premise or cloud-hosted solution. Once in place, the platform ticks away in the background ensuring guaranteed message delivery so that healthcare staff can focus on patient care.

The company said “Our products enable a critical layer of interoperability to health IT infrastructure, allowing healthcare organisations to share, exchange, and report clinical data. For instance, which patients have been tested? How are patients’ outcomes being monitored and tracked? Which providers have access to that data to ensure continuity of patient care? How is that data being reported to public health agencies?

“Using data sharing to track information about symptoms, recovery times, and efficacy of treatments from disparate locations can help to identify further insights into the disease as health experts across the globe look to better understand the virus, care for patients who are exposed to it, and develop a vaccine for COVID-19.”

Here’s how the platform can help during the COVID-19 health crisis:

  • Inspect every message or document flowing through the integration engine to identify those with COVID-19 codes, as well as site-specific codes where required. (Rhapsody has added similar flags for other results, such as MRSA and C.DIFF, which have won awards for our customers for innovation.)
  • Supports multiple message formats, including Hl7v2, CDA, FHIR, CSV, JSON, XML
  • Inspects all coded elements in your document or message
  • Log and/or report each (matching) document or message
  • A report can include all matches found in the document or message, identifying the matching codes and context
  • Add metadata for patient ID and document ID
  • Optionally send the results to a data store for extended reporting
  • Easily scale up and cope with increased volumes of testing

“While the most important mission right now is saving lives, the COVID-19 pandemic will eventually force healthcare organisations to consider how well their systems enable data exchange — not only because it is the right thing to do for patients, but because we must be better prepared for the next public health crisis. As business models evolve, organisations that are best at enabling data portability and scalability — in a way that is efficient, accurate, secure, and shareable with any destination system — we can better address public health crises such as the coronavirus in new ways.

“During a time when so much is uncertain, it takes data that is easily shareable and actionable to help us make the right decisions and create a health system that is better equipped to care for patients in times of calm and in times of crisis.”

Real-time patient data

Liam King, Commercial Director, Healthcare Gateway said to HTN “The MIG shares data either as a HTML rendered view or in a structured format from a multitude of different health and care settings ranging through GP, community, mental health, acute, and social care.

“An example is Kent and Medway, where the population exceeds 1.8m. The MIG is utilised to connect all GP practices within the Sustainability and Transformation Partnership (STP), sharing GP data into 15 separate NHS organisations, in addition providing real-time feeds of data from acute, community and mental health back into those endpoints and also back into the GP surgeries. Going forward it will also be supporting real-time feeds into the Kent Care Record (Graphnet).

“We are committed to supporting the NHS during this critical time and as such made updates that include updating the MIG content model to include Covid-19 SNOMED CT concepts from all GP system providers. For EMIS, and Vision GP practices the SNOMED CT concepts will be added to the following sections; contra-indication, diagnosis, immunisation, microbiology and other investigations. TPP sections are to be confirmed.”

“The MIG GP Journal View displays all contacts and observations over the last 12 months and includes GP notes/annotations. Where a healthcare professional records multiple items within a consultation or template, the information is displayed as one encounter within the Journal View.”

“In some regions, EMIS GP datasets have been updated to include frailty indicators to support healthcare professionals in making informed decisions.”

“We have supported The Nightingale Hospital at ExCeL London. This is a fantastic feat and will be using the NHS Bart’s Health Trust instance of Cerner Millennium as its EHR. Healthcare Gateway provide GP data into this instance already and are proud to be supporting this project.

“The wider London estate is connected via the One London Central Hub; Healthcare Gateway have implemented additional MIG connectivity for the surrounding areas, including Hertfordshire STP, meaning that London and out of area patient data can be accessed right across health services.

“Across the North West we are supporting Covid-19 pathway management with the sharing of GP, care planning and community. We have begun to enhance our connectivity between health and care and the North West Ambulance Service (NWAS) into Orion and are in discussions to include all MIG connected CCGs. We see this as vital in supporting the pandemic for the North West.

“There is an expansion of Share2Care (North West England) and LPRES (Lancashire Person Record Exchange Service) to add an additional 12 CCGs (20 in total). This is configured to share GP and care planning information from EMIS and TPP into Philips Forcare and TianiSpirit respectfully.

“We have enabled new endpoints across the Midlands and have also connected Coventry, Rugby and North Warwickshire CCGs to our existing WMAS for 999 (Cleric) and 111 (Adastra).”

Driving the evolution of doctor-patient communication 

Paul Bensley, CEO of primary care communication specialists X-on said to HTN “Before the nightmare of COVID19 engulfed the nation’s healthcare system, doctor-patient communication within primary care was already embarked on an evolution.

“The centrally-driven goal, enshrined within the NHS Long Term Plan, was for “digital-first” primary care, with Primary Care Networks (PCNs) building on pilots to deliver roll-out of online consultations this year, and development of video consultations to follow.

“The current pandemic has simplified much of that debate, requiring a pragmatic assessment by PCNs, GPs and practices as to what the essentials are for effective, remote triage and consultation with patients.

“As strict national measures to manage COVID19 were imposed, GP practices were swamped with calls, putting a huge strain on surgery legacy systems. This and other issues including bandwidth and limited phone functionality when working remotely, a requirement for conference call capability, and a need at speed to set up patient contact centres, were all pinpointed by X-on at the outset as problem areas revealed as a result of the pandemic.

“To address such issues, different package options of X-on’s Surgery Connect phone system – currently used by 600 practices – have been introduced, supported by tailored advice and guidance for practice customers.

“In close collaboration with GPs, a GP@Home service has recently been developed which allows doctors to provide patients with the same level of phone and video care from their own home as from their surgery.

“It has received very positive feedback from senior medical figures who have been “really impressed” with how it can help them work more safely, and allow home workers to answer the phone as if they were in the surgery.

“Amongst features, it enables calls to be made on a personal mobile without call costs being incurred on the personal account, provides a softphone interface for use on a smartphone or laptop, enables a switch to video-on-demand for a consultation with one click, and also for calls to be recorded.

“Practices are being offered a free trial as they grapple with the pandemic.

“Surgery Connect’s Video Connect has been developed too, which also enables GPs to switch from phone to video consultation in a single click on the clinician’s handset, integrated with major clinical systems such as EMIS and TPP’s SystmOne, which are used to hold patient information.

“Unlike many other systems, the patient does not need to download an app, and the doctor does not have to schedule when a video consultation will take place.

“One senior GP and Clinical Commissioning Group Clinical Lead describes it as a “game changing” piece of software that has enabled his practice to perform normally through the current crisis. He says he has been able to assess the clinical condition of a patient confidently through high quality video, saving face to face appointments at the surgery and in turn increasing the access capacity of the surgery.

“To help local and regional co-ordination of the response, X-on is also offering free teleconferencing services to PCNs and CCGs.

“The pace and scale of the digital transformation of the local family doctor has significantly intensified due to the demands of managing COVID19.

“It has highlighted how in the move to digital-first primary care, integrated digital telephony can be the key to supporting effective, safe and modern patient care and should remain a focus in the future.”