In this two part feature HTN asked health tech experts to reflect on some of their learnings this year, an exercise we also did at HTN and found extremely valuable.
Following an open brief, we were looking for a variety of comments, in which we have received. The contributors reflect on technology and data, and ask were we technologically ready for the pandemic? Others focus on the agility and speed in response, however what comes through often is the importance of people throughout.
- Dr Mala Mawkin, Head of Market Development, Cellen
- Julie Pelta, Director of Business Development, DataArt UK
- Will Temple, Managing Director, Meddbase
- Andy Webster, CCIO & Consultant in Emergency Medicine, Leeds Teaching Hospitals
- Dr Alec Price-Forbes, Chief Clinical Information Officer for Coventry and Warwickshire Health and Care Partnership (STP)
- Claire Aldred, Commercial Director (UK & Europe), RLDatix
- Netta Nyrhinen. Head of Events, PR & Comms
- Dr Lloyd Humphreys is a clinical psychologist, NHS Innovation Accelerator alumnus and Head of Europe at SilverCloud Health
- Vijay Magon, Managing Director, CCube Solutions
- Tim Quainton, Managing Director, Silverlink Software
- Elliott Engers, CEO, Infinity Health
- Rob Child, Digital Health Programme Manager, Leeds Teaching Hospitals NHS Trust
For all health professionals across every discipline the past six months have been and remain a challenging period that at times has tested personal skills, knowledge, vocation and mental strength.
Mental health has had a very different experience during COVID-19 than the acute services coping with managing the infection, where capacity was significantly increased. Instead, mental health services have been closed, staff re-deployed or had to work from home and referrals have fallen, nationally by over 50% and even greater in some local services.
As a result, from a professional perspective one of the emerging lessons is that we are at a turning point, whether the pandemic has forced it or not, to re-evaluate and even recalibrate what and how services are delivered most effectively.
It is not just about the requirement for more funding for mental health services, including to cover costs such as ensuring services are COVID-safe, but also the need to adapt mental health services to alternative delivery models.
Facing a significant rise in demand for mental health services and likely continuing social distancing, the proven benefits in treating conditions such as anxiety and depression through digital mental health therapy mean it now stands to come of age. Coupled with the fact that almost a third of all primary care mental health (IAPT) treatment was delivered via internet-based Cognitive Behavioural Therapy (iCBT), it is time for digital therapeutics to have parity with traditional forms of intervention.
Vijay Magon, Managing Director, CCube Solutions
It has been a valuable exercise to take a minute and reflect as a team on our learnings this year. We have always believed that strong working partnerships and people are key to successful programmes and projects, so to pick one learning from this year it’s very much on these lines. Our learning is largely about people rather than technology, but our healthcare teams very much need technology that works, and particularly in readiness for unimaginable events like we have seen this year. Make sure you look after yourself and those people around you, because together you can take on any challenge. Our industry has always been about people, with the ideal that the technology supports in many ways such as safety, decisions, collaboration, remote consultations, reducing costs or saving time.
Tim Quainton, Managing Director, Silverlink Software
Reflecting on the past few months, the key learnings I have taken from my professional role predominantly centre around the speed at which decisions can be made and executed during times of emergency. Above all else, you learn how quickly people can — and are willing — to come together and collaborate for the greater good of staff and patients alike, and how much more you are able to achieve when everybody is pulling in the same direction.
At the Nightingale in Harrogate, for example, where we implemented our Patient Administration System; they had specialist staff from Leeds, infrastructure from Harrogate, and support from almost every other NHS site across the region. The attitude was ‘let’s make it happen’ rather than simply covering normalities, and the results speak for themselves.
As we see it, it’s our responsibility to build upon this forward momentum by working with healthcare organisations to continue to utilise technology to respond to the pandemic, and accelerate innovation across the whole of the NHS.
Elliott Engers, CEO, Infinity Health
The last few months have been a testing time for many of us, but as the CEO of a healthtech company focused on helping NHS organisations make safety and efficiency improvements, I have learnt a lot.
Secondly, I’ve learnt that remote implementations are not only possible, but can also be beneficial in many ways. I had concerns about our team not being able to learn and communicate with users face-to-face, and the challenges this could cause. However, removing barriers like travel time, the need to be co-located for training sessions, and even being unable to hear properly if sitting at the back of a training session, has resulted in better attendance and engagement. We’ve also had to be more creative with our training, which ultimately has resulted in a more flexible, adaptable approach – creating videos for example that can be accessed at the user’s convenience.
Rob Child, Digital Health Programme Manager, Leeds Teaching Hospitals NHS Trust
Personally, I think it’s amazing how the NHS has adapted to cope throughout Covid – it’s completely changed the way I think and feel about managing projects and programmes. I’m used to managing so many different things at once, juggling priorities and competing demands, but almost overnight the focus moved to a single objective. It goes to show what can be achieved when everyone focuses on the same thing. Now we’ve done it, we need to find ways of keeping that agility moving forward.
Dr Natalie Savage, Project Manager, DigitalHealth.London Accelerator
It feels like now more than ever, people recognise that digital health is strongly shaping how healthcare is delivered. This year, we experienced an increase in applications to the DigitalHealth.London Accelerator and there has been a real willingness from stakeholders across our network to engage with our programme.
Sara Nelson, Programme Lead DigitalHealth.London Digital Pioneer Fellowship, said:
We had a 48% increase in the volume of applications to the Digital Pioneer Fellowship programme this year. When reviewing the applications, it is clear there is no shortage of people in the NHS who want to make things better by trying new and interesting pathways using digital technology. The calibre of applications is really inspirational and the selection of successful candidates is highly competitive.
Claire Aldred, Commercial Director (UK & Europe), RLDatix
Like many other businesses, at RLDatix we had to scramble at short notice to enable everyone to work safely and effectively from home when lockdown hit.
What we have learned from this experience is that leadership needs to work that much harder at being sensitive to changes in the business, in people, and in the attendant risks to the business. When you have upheaval due to a huge change in behaviour and processes, it is that much harder to spot changes that may signal a potential problem. To combat this, organisations need to invest in the tools that provide leaders with the visibility of business pressures and business risk.
We are hearing similar stories from our customers throughout the NHS. When everyone is working to manage changing organisational behaviour its more important than ever for leaders to have clear and timely information to ensure that they are as sensitive to risks to the organisation and patients as they would have been before COVID. Without the technology to readily support their ‘new normal’ teams’ learning can become fragmented and potentially conflicting, and leadership will not have the information and insight required to properly support their teams in managing and growing under the new normal.
One other learning, or perhaps I should say, a confirmation, is that the healthcare sector is hugely resilient, with amazing staff that retain a remarkably positive attitude to getting on with the job of caring for patients. In seeing and experiencing this resilience it can be very easy to forget that this resilience is nurtured through a supportive and listening culture.
Dr Mala Mawkin, Head of Market Development, Cellen
The past few months have proved particularly challenging for patients suffering from chronic conditions, whose treatment has been hugely altered by the Coronavirus pandemic. There were problems with follow-up treatments: an estimated 150,000 pain appointments were delayed, and patients were left unsure of where to go for help and how to get hold of vital prescriptions.
As we saw across much of the health service, a lot of services migrated to digital platforms and, in many cases, this worked well. But for some, there were significant challenges, such as access to a computer or the ability to use one. So, I think the key learning I have taken from my professional role is the importance of digital inclusion, and that there is not, as of yet, a one-stop digital solution for chronic pain for patients.
Netta Nyrhinen. Head of Events, PR & Comms
As Covid has jolted healthcare into a stronger digital appetite, we’ve spent the last 6 months accelerating our product delivery and doing our best to keep up with the urgency. The biggest challenge for us hasn’t been coding in our bedrooms or conducting user testing via Zoom. The hardest thing has been protecting and nurturing the essence of the DrDoctor community – our unique culture. Hiring 20+ new team members and facilitating 2 million new users during lockdown has made us reaffirm our core value that we are all about our people. DrDoctor has really stepped up in these testing times. Of course, care packages and remote pub quizzes are nice, but I think the entire team will agree with me that there’s nothing we’re looking forward to more than getting together with our colleagues and NHS partners for one of our famous parties; once the world repairs.
Will Temple, Managing Director, Meddbase
The last few months have taught us to balance ideals with reality, and we learned just what our teams can accomplish when faced with a historic challenge.
At Meddbase we’ve been working on complex and highly nuanced healthcare development projects for over 15 years but Covid has highlighted the truth in the old adage ‘perfect is the enemy of good’.
Tasked with scaling up our telemedicine solution virtually overnight we had to stop asking ourselves ‘what’s the perfect way to do this?’ and instead ask ‘what’s the fastest way to do this – without losing our passion for quality?’
Not being able to wait for the right moment or the ideal way to deliver a project forced us to focus on one goal: simple, secure, swift delivery of the service being asked of us.
Andy Webster, CCIO & Consultant in Emergency Medicine, Leeds Teaching Hospitals NHS Trust
I’ve seen some major transformations throughout Covid thanks to digital innovation. Things we thought would take years have happened incredibly quickly, and this has really helped to amplify and explain the difference digital can make. For example, going paper-light throughout the Trust has had a huge impact in terms of infection prevention and efficiency, and it proves what a fantastic team we have here to be able to achieve that so quickly. I think this way of working has made us stronger as a team. It’s been incredibly tough at times but people have embraced the opportunity and shown real adaptability.
Julie Pelta, Director of Business Development, DataArt UK
During the first few weeks of WFH I had a hard time adapting to being less sensitive to body language, which is not amply communicable during video-conferencing. Communication online, without relying on body language, especially with someone you do not know well, requires a whole other listening skill. For this reason, relationship building has been more challenging in the with-COVID world. Still, our team adapted to the “new normal” quite well because of the unwritten productivity code that the teammates adhere to.
As a strategy to keep everyone in the team involved in daily all-online routine, I tried to delegate tasks by interest, not only by teammates’ strengths. I learned that if a task aligns with a personal passion, a person can move mountains. Another thing I discovered is that keeping the workflow visible on an online board not only increased the team productivity but also fostered a sense of unity and collective bond.
Dr Alec Price-Forbes, Chief Clinical Information Officer for Coventry and Warwickshire Health and Care Partnership (STP):
On reflection, to me the most critical factor from COVID-19, is that the health and care space was not prepared from a technological perspective for what was a population health crisis. This wasn’t an organisation or specialty challenge. We needed a holistic approach.
I’ve spent the past 12 years trying to implement solutions to change the way we work within a hospital setting. My experience in working in healthcare for nearly 25 years informed a simple vision for Coventry and Warwickshire; “to become the healthiest community in the UK”. This would move us towards that holistic view of person-centred care. This would also, however, be dependent on creating an appropriate modern infrastructure, by harnessing the power of the technology revolution which has transformed our daily lives. We needed to implement a single electronic patient record (EPR), which over time, would have the capability to be used by all health and care providers to create a unique electronic citizen record (ECR). This would be person-centric, rather than simply collating information pertaining to a single disease, organisation or location of care. This would ultimately facilitate a change in direction away from transaction-based, organisation-focused, siloed care, towards delivering true values and outcomes-based care both for the individual and for the population. It would mean that across our population, you could interact in a new way with health and healthcare. This would help focus on to keeping citizens healthy and well, whilst responding to those patients with an illness in a more predictable and proactive way, rather than the current ‘react and respond’ paternalistic construct, upon which the NHS is largely based. This requires bi-directional communication with the customer, the citizen/patient, to ensure they are in control (integrated patient portal) and appropriate tools to realise true population health management.
The COVID-19 pandemic, has exposed the fundamental shortcomings in our healthcare system, particularly around communication with patients and the lack of such integrated patient portals. The Government have tried to do track and trace; but the reality is that the NHS doesn’t have the required, modern infrastructure in place. We don’t have even simple things like current and up to date email addresses or mobile numbers, for our customers. These are fundamental, basic requirements for any other commercial aspect of society; those organisations we interact with for banking, shopping, entertainment etc have all those details. In fact, in this modern age you can’t really run a business without that information; but the NHS runs a business either without those details or where they do have them, there are multiple versions and it’s often incorrect, outdated information. Given how critical data is to providing and sharing information currently, COVID-19 has also exposed a lot of poor quality data. One example comes from ‘Operation Shield’; we had more than 50 different databases of patients from which we had to source data; 6 months on we are still identifying patients who were either missed nationally from datasets or locally. Organisations who had modern integrated EPRs were able to perform the task of identifying highest risk groups of patients in hours/day.
You have to choose the right technology, implement it properly, test it and train people to use it the way it’s designed to be used. The challenge of where the NHS is at right now, is that lots of fragmented technologies have been deployed in response to COVID-19 as tactical solutions. If you look at video consultations as an example, there are many platforms being used, but still very few consultations actually take place via video. The vast majority of interactions have been by phone in healthcare, as opposed to video for social connection during lockdown. Part of the reason is habit; we are all used to picking up a phone and speaking to people. It’s comfortable and intuitive to answer the phone. Despite the advent of zoom, many still don’t have the IT literacy to use apps/video conferencing solutions. We need to get the right technology in, but be strategic and ensure we test and train staff and patients to feel comfortable using it, just as they are using their phones. Otherwise, technology gets in the way of delivering healthcare.
The biggest take home is that we need to change the approach. We need a longer term strategic strategy to ensure we deploy technology which has the power to enable us to transform and reimagine the way we both focus on health and wellbeing, as well as deliver healthcare when it’s needed. This has to be done at a population level using the boundaries created by STPs.
Only 6 months from now, all STPs will need to become Integrated Care Systems (ICS). But integrated care requires integrated information. Digital, therefore, has to be the golden thread which flows through and enables these new ways of integrating care. Modern, fit for purpose integrated digital platforms will be critical to provide both the real-time, high quality data and functionality required, but centred around the whole person. At the heart of these new ICS, there will therefore need to be a single source of truth, which a single integrated EPR solution can provide. From there, the strategic vision should enable all health and care organisations to use the same information platform to move towards creating an ECR.