HTN Digital Week June 2020: Day Two

On the back of a hugely successful day one, where we saw the largest engagement through HTN to date, we commenced day two with Julie Jones, Client Relationship Manager and Caroline Palmer, Digital Development Clinical Lead at Leicestershire Partnership NHS Trust, on Using Digital Technology to Improve Service Access.

The session focused on technology ‘Chat Health’, an application for confidential help and advice. It allows the user to speak to a qualified health professional via a message, where this can be done anonymously. It is discreet and quick with the user receiving confidential advice from trained health staff in their area.

Caroline started off by explaining that messaging is now the most popular way of communicating: “This is not about replacing face to face care for us, it is another tool in providing access to care. We are really conscious we need to provide service users with safe and secure tools, but we also need to protect healthcare professionals.”

“We spend a lot of time looking at how we can ensure a safe and secure service from development to use of a product.”

The types of issues clinicians worry about with digital working are that it could be high risk for patients, with safeguarding issues, as well as it being a new way of working that they are potential not familiar with.

In answering the above points, Caroline introduced ‘Chat Health’ as “the safe and secure messaging platform, which enables users to speak securely with a healthcare professional.”

Some features of Chat Health include a service which signposts to other places even if Chat Health is contacted out of hours, where the Chat Health System is on the NHS N3 Network.

50% of school nurses use chat health in England, and it is also used in sexual health, perinatal mental health and young people’s mental health and has currently been adopted by almost 50 trusts and health organisations.

Julie then takes over from Caroline to talk about three websites created by Leicester Partnership Trust Services – Health for Under 5s, Health for Kids, and Health for Teens.

Health for Kids is aimed at those that work or care for children from 5 to 11 years old and is split into themes to create better engagement on specific health topics; bullying to brushing teeth.

The health for Teens site was created 5 years ago with “feature style chunks of information.”

“The local areas in the site are managed by some of our trusts that have joined us, where their local information is pulled through to the site; it can show posts, links to national websites and local area links.”

During Covid, the stats for the sites have risen significantly, where the majority of users on the sites have expressed positive feedback that the service has been helpful to them.

Julie goes on to explain about their digital health forms: “The purpose of the forms is for young people to raise issues.”

As the user answers questions through the form, there is a progress bar. Questions which receive ‘unhappy faced’ answers, bring up further information. Notifications are received by the admin team if the user clicks on ‘suicidal’ for example and depending on what answer the user gives to certain questions, further information can appear.

22 schools used the forms in 2019/2020, where 3,099 forms were used by young people. There were 1,562 red flags from the use of the forms which shows that the service is detecting safeguarding issues with young people.

“Some young people were disclosing things they would not have done before.”

Second today, we were joined by Mike Cosgrove Project Manager, Mark Filby Information Systems Programme Manager, Lee Hickson Information Systems Manager, and Jamie Innes Product Director are those presenting on the City Health Care Partnership: Our Digital Health Journey, from Immunisations to Covid-19.

The key challenges in their digital health strategy includes: dealing with a large variety of suppliers, finding a lack of systems integration, having limited flexibility in configuration and development, having a limited choice for patients to engage with digital services, and education and interactivity was often found to be lacking.

CHCP have been running a telehealth service across multiple platforms using Inhealthcare Technology.

Also, CHCP have an anticoagulation service, as well as digital immunisations that have been rolled out to schools across the East Riding, Covid-19 projects where a screening service has been offered, and a care home service with digital monitoring and support with Internet of Things proof of concept.

Mark Filby provided an overview of The Inhealthcare platform “There’s a number of different elements to the platform; the first stage is patient engagement.”

Patients can be communicated with through a variety of channels where Mark says ‘choice’ is the most important aspect. “We want digital health to be inclusive, and we promote this through our platform. Patient engagement can be implemented through SMS, automated phone calls, emails, apps, online, Alexa, care homes and video.”

Patients can utilise devices and sensors such as IOT sensors, wearables such as smart watches as well as third party applications.

The pathway engine for the platform integrates with existing national and local clinical systems, it also possesses open standards-based APIs to be interoperable with health and council systems.

“We believe in open integration across the NHS so that data can be accessible and available to the clinicians that need it most.”

There are also data analytics and reporting dashboards to provide access to operational service data with predictive analytical tools to identify trends. Data from third party services can be used to deliver processes; PAS data, public health data and weather data.  School immunisations have also been stood up onto the Inhealthcare Platform.

The idea being was to provide a digital immunisation programme to reduce manual activities which was heavily paper-based and inefficient. There were previously a high number of data quality issues on existing forms, which would take a significant amount of work through contacting parents and guardians for instance.

Mike summarised the presentation explaining what CHCP wanted to accomplish in the near future: “Moving forward we are adding additional resource to support wider rollout and internal development; this is an opportunity for us to drive forward a solution that works in the community.”

Our penultimate presentation today saw Healthcare Communications talk on Managing the Covid-19 Recovery Demand.

Presenting the webinar was Kenny Bloxham, Managing Director for Healthcare Communications, alongside co-presenters Concepta Wayment, VP of Transformation, and Lesley Lloyd, Digital Outcomes & Benefits Specialist. 

Concepta began speaking on the challenges Healthcare Communications have discovered and wish to share with the audience.

“Patients will, if they haven’t already, contact trusts if they are unaware of the next steps in their treatment. Nothing happens in a hospital without your administrators; you need to acknowledge that when planning your capacity.”

Concepta also mentioned the exhaustion of workforce and annual leave will further exacerbate capacity pressures.

The potential solutions to capacity was then discussed by Kenny and Lesley.

“We deploy a strategy based on 4 key pillars” said Kenny.

Digital first, Intelligent communications, Automation and Inclusivity being the 4 key pillars.

“I like to think we walk the walk on inclusivity; it could be as simple as an SMS message going out, or large font on a yellow paper, or a message going out in a different language.”

“The lowest form of automation could be simply an SMS coming back to yourself; what we want to create is automation around the patient journey.”

A scalable proactive communication platform is something that Kenny said is the only way to address communication challenges.

“What we’ve tried to do with the platform, is give clinicians as much opportunity to communicate with the patient.”

The platform supports Android and Apple as well as WhatsApp and others to assist the patient in communicating with their clinician. The platform works on existing platforms from other providers; iMessage for example.

Lesley then presents the Patient Portal: “The portal enables instant delivery, patient reassurance, is very accessible in terms of languages, fonts and colour, the portal has automation such as speech feedback, also it is fully audited.”

There are pre-built templates within the portal for each patient – initial holding communications, waiting list validation, triage eForms, appointments, post-discharge results, DNA and discharge.

An SMS to the patient activates the portal link. Once logged in, the patient can see their letters. This keeps communications concise and easy to read for the patient. The letter can be translated inside the portal by using a simple language tool. The NHS widget within the app can direct the patient to an NHS page, pushing them to get the right information.

Back to Kenny on empowering patients to self-serve and demoing the service:

“We’ve built the app specifically so it can be interactive.”

The patient can change an appointment via SMS chatbot or even find out information about car parking. Rescheduling an appointment is just a matter of clicking a green button, or clicking a link to start a chat.

The portal begins to shift to virtual by default where all services are linked into one place.

Also, patient call deflection features in the software where if a long queue is about to be experienced by the patient via the phone, the patient will be given the choice to be redirected back to a chatbot to solve their query.

“The patient is redirected back to the pathway wherever possible.”

Entry points are inputted in to the chatbot such as complaints, general enquiries, PIFU and appointments and encourage the patient to self-serve.

“Most common enquiries are handled by the chatbot with intelligent enquiry routing for complex enquiries.”

The idea behind the chatbot is to reduce staff burden as well as manage the influx of phone traffic.

Our final presentation of the day saw Chris McCann, CEO and Co-Founder of Current Health present on his learnings on what the next 6 to 12 months might hold.

Chris begins with what he thinks the future holds in healthcare in terms of Covid.

“We don’t have any idea yet how Covid will impact patients going forward.”

Longer term morbidity from Covid-19 is currently unknown. A new cohort of patients may require long term management post-infection from Covid-19.

“Covid has created the necessity to accelerate telehealth.”

Healthcare will continue to be displaced to the community where admissions from ED were also down 35%. Ambulance changes didn’t change significantly although there was a huge increase of 90% in London of patients being treated at home.

“It will be interesting to see what happens next on this trend” Chris continues, as this will be how the change will happen in the NHS delivering care.

Patients are more reluctant now to visit ED as we have seen over the past few months; patients not turning up for cancer treatment and other serious illness treatments.

“It will be interesting to see if these changes to patient behaviour mitigate elected backlogs.”

According to Chris and from what we’ve seen, community health services are under serious pressure. The potential remedy to that, is for the greater adoption of digital health technology to support rapid changes to the delivery of healthcare.

“7 in 100 patients were being seen physical by GPs at one point, and there has been significant growth in remote health monitoring.”

“There is now a greater level of funding at central and local level for digital health initiatives, although this is now slowing. During Covid there was more a focus on implementing anything that may help, without considering the long-term benefit.”

Chris goes on to explain who Current Health are:

“We work with 20 trusts and have extensive operations in the US, we also work with some large integrated health systems. We allow our clients to monitor, analyse and engage their patients. We present all patient data on one single dashboard and list patients by risk so clinicians can assess and intervene.”

Chris then presents Current Health’s wearable device which monitors respiratory rate, oxygen saturation, pulse, temperature, step count and so on, 24/7 for the patient.

“When you continuously monitor a patient, the information gets interesting; you can see what’s happening when the patient sleeps for example.”

When an example of a patient’s data was analysed after continuous observation, the clinician could diagnose the patient with sleep aponia which could not have been so quickly diagnosed with spot monitoring.

“Technology is only 20% of the solution, the healthcare model is 80% and the most critical part.”

The model Chris provided is simple but effective; monitoring, to actionable insight, to intervention, and to outcome.

Monitoring, according to Chris, is where too much focus happens; “this is the bit that is the least relevant, we need to focus on the whole pathway.”

The whole pathway being all the way through to positive outcome. The outcome should be measurable and provide a feedback loop.

“Too often, the NHS uses their existing teams to monitor but who are already too stretched; this is detrimental to the outcome.”

Chris goes on to state that NHS Trusts need to have a more centralised approach for remote monitoring to be more effective: “Early supported discharge, care home monitoring, chronic disease management, hospital at home and care management.”