HTN Summit 2020: Day One

Welcome to the HTN Summit 2020 summary of the key themes and discussions from the first day. In this article we round-up all the action from the webinars that took place.

The HTN Summit is a two-day digital event showcasing innovation in health technology across eleven online sessions, where healthcare providers and suppliers present their innovations, projects, learnings and share their work.

Our first presentation, Hugo Mathias, CIO of Northampton General Hospital (NGH) NHS Trust, discussed robotic process automation (RPA), data and analytics.

NGH is working towards implementing their IT strategy which includes going paperless, making data available, sharing information and resources, as well as utilising information.

Hugo said: “Across the board, there are lots of opportunities to provide automation, and we’ve recognised trying to implement our IT strategy without automation was going to be a very difficult task.”

In order to implement automation, the trust purchased 6 robots to be trained to complete complex logic-based tasks.

The five main areas the robots have been used at the trust are to integrate systems, improve accuracy, increase speed, identify errors, and transform data.

The robots have also been used throughout the Covid-19 pandemic in monitoring oxygen levels.

“The first robot we built was for monitoring oxygen; when Covid kicked-in, our oxygen demand was through the roof and we were worried about how we were going to measure that. The access to the measuring tool was on the internet, meaning someone would have to log in every hour to pick up the oxygen levels.”

“We got the robot to pick that data up and feed that data to the site, then through to the site room on an hourly basis to the dashboard.”

“We were talking to Automation Anywhere about how we can get RPA in, but the problem happened when another trust reached the maximum of their oxygen supply. Our trust panicked that the same would happen to us.”

“We needed to get someone to read the tank every hour, but we knew there would be human error.”

“Automation Anywhere then built the robot for us using the data from the website, putting that data into a spreadsheet, and then created a figure that could feed into our real-time information system.”

“We then had an hourly updated oxygen levels information system, which measures the number of inches of oxygen left in the tank.”

Following Hugo, Tom Scott, Regional Sales Director at Alcidion, talked us throughorchestrating care – the key to connected healthcare delivery’ 

Orchestrating care is built up of the following elements: interoperability, data quality, clinical engagement, and connecting care.

“Interoperability identifies a single source of truth, and is a crucial underpinning in improving patient care. It creates a ‘system of engagement’ rather than a system of record,” Tom said.

“Over the past few months data quality has been brought into focus.”

Tom talked us through how the above elements apply to the NHS environment. Best of Breed and the EPR approach are two of the settings Tom talked through including the challenges with interoperability in both of these environments.

Alcidion are supporting 300 hospitals across 63 organisations, with 68,000 users. The Miya Precision, recently launched, allows for tailored clinical decision support engineering, creates an ecosystem for innovation and partners, and uses open standards.

Tom went through the Miya Precision interface where the platform is categorised into different departments such as radiology and pharmacy. Then, real-time, FHIR and interoperability methods are used to link to a multitude of data that is collected and analysed by the platform.

Some of the challenges Alcidion is trying to overcome are patient flow, patient safety, clinical productivity and new models of care.

“By introducing the platform, we solve the interoperability challenges for our customers.”

Tom then delved into the Miya Memory App, talking us through the app’s features and the data it can provide a clinician. The Miya Memory app encourages a ‘friendship’ to be developed;

“Every click or tap with a clinician is pushing a friendship.”

The mobile EMR provides fast access to real-time clinical information from enterprise EMR systems and information is risk rated to highlight risk across all patients. The app customises views for different specialities to improve clinical productivity.

The benefits to the NHS include complementing the BoB and EPR strategies with “a single intuitive UI.”

Also, it adapts to different care settings, supports new models of care in and out of hospital, reduces cognitive burden and clinical variation, delivers mobility and usability, and more.

“We are supporting the right thing to do as the easiest thing to do.”

“Capabilities on top of the data layer can be deployed modularly to support local demands and needs; modular approach can be 3 to 9 months and is tailored to the organisation we are engaged with.”

“Decision support is about tailoring and understanding the clinical context.”

Peter Thomas, Director of Digital Innovation and Consultant Ophthalmologist at Moorfields Eye Hospital was third up, and took us through Digital Innovation and Clinical Tech Strategy at the trust.

“We can divide clinical interactions into ‘in-person or remote’, which can be further divided into traditional clinics and virtual clinics, and synchronous care and A-synchronous care.”

The difference between synchronous and A-synchronous care is where the former is a live stream, and the latter an uploaded video file for example.

“We are one of the largest providers of video consultations in the NHS.”

Moorfields conducted its first work with video consultations back in September 2019 with the world’s first 4k tele-examination of an eye using a 5G phone network.

“We did a technology demonstration with Attend Anywhere which was live streamed where an examination of my eye took place.”

Peter took us through home monitoring where measuring vision at home has been the most popular approach during Covid lockdown.

There are high tech and low-tech approaches to this; the former uses smartphone-based vision testing, and the latter uses a paper-based vision testing.

The smartphone app encourages the user to line up dots on the screen. Also, an Amazon Alexa can be used to conduct a voice vision test where the user has to read out loud letters on a screen.

Looking to the future, Peter told us that AI is to be used for diagnosis and referral in ophthalmology.

“Deep learning can triage and categorise retina disease better than top expert could.”

Peter described how the combination of advanced technology such as AI and deep learning could power a smart service.

A local optometrist would collect patient data to then upload that data to the hospital cloud platform. From there, AI would perform an automated analysis of the data and create a diagnosis and management plan if the issue is simple. If a complex issue is detected, then the data would be passed on to a clinician for further analysis.

The ‘simple’ issue would be dealt with through a virtual AI-powered assistant to inform the patient, where a ‘complex’ issue would be dealt with by the clinician speaking directly to the patient.

“It is not too far in the future where we could have an automated pathway in managing eye disease without the patient ever having to visit the hospital.”

Our penultimate presentation of the day saw Dilshan Arawwawala discuss the application of NHSDA Learning to the real-world problem of Covid-19 testing.

Dilshan is a CCIO and Consultant in anaesthesia for the Mid and South Essex Hospitals Foundation Trust.

“The problem we were trying to resolve was access to Covid testing and receiving back results.”

Dilshan explained that the process initially took around 9 days to be tested and to receive results, where the process involved various tasks to be carried out including calling through to the hospital, driving to the hospital to see the nurse for swabs and then the actual waiting period.

A Covid PCR Process Map was presented by Dilshan to explain what the platform would actually deliver;

“People could sign up to, enter profile information for risk-rated scoring, select a test, book into a mobile test centre, receive an email with all arrival information, and the tests would then be conducted and processed by the lab, then the result manually inputted into the system.”

The platform was subject to horizontal and vertical expansion which included allowing for Covid antibody testing;

“What’s already present in the platform, what’s missing, and what do we need to build, as well as determine any new risks that may arise and how we mitigate those risks.”

The platform was used to process 18,700 tests; “to date, we’ve done over 18,000 antibody tests and have launched new test centres, we have improved the user experience where cancelling and rescheduling appointments can take place.”

Dilshan finalised the presentation by talking through some of the lessons learnt, which include identifying problems and then build and procure to address problems; beware of scope creep – where timelines can be tight; don’t forget the governance; optimise continuously, and take a collaborative approach with those who have common interests.

Our final presentation of the day saw the return of David Kwo, who has presented at both HTN Digital Weeks this year. David discussed today the language of EPRs and Interoperability.

David is an EPR Consultant and Researcher. He has 35 years in UK and US hospitals and implemented several EPRs.

“There are 42 STPs that are due to turn into ICSs by 2021, and each of these serves 1.2million people.”

“We are all moving towards ICSs as the new unit of care organisations, where each ICS is intentionally delivering integrated care across all care settings in that particular area.”

EPRs allow for real-time, digital, patient-centred records that make information available instantly and securely to authorised users, and the three main features of an EPR include; Data, Decision Support, and Workflow Support.

“A truly integrated EPR system has applications designed to work together, where an integrated EPR system has applications connected using an interface broker, a clinical portal, and other tools and techniques.”

“With a best of breed EPR, the focus of the system is on the department, whereas the integrated EPR is more focused on the patient and are now seen to be supporting mature patient portals.”

David talks about a whole host of pros and cons between integrated EPRs and best of breed systems focusing on clinical departments, functionality within a module, and entry costs.