Apps, Interview

Interview Series: Steven Antrobus, Senior Technical Project Manager for Digital Health Software at The University of Manchester

At HTN we often cover the wide array of apps being rolled-out by forward-thinking NHS trusts and primary care providers. But it’s equally important to go further behind the scenes, to talk to those that help develop and tweak the technologies.

So, for this latest instalment in our interview series, we spoke to Steven Antrobus, Senior Technical Project Manager for Digital Health Software at The University of Manchester.

Steven’s team at the university help to co-design and co-produce smartphone apps, as well as other web-based clinician interfaces that enable health research to take place. Here, he provides examples of his team’s work and the real-world impact of their projects.

Hi Steven, tell us about your career background and role

My background is technical – it’s always been in IT. I’ve done some hands-on programming, IT project management, and consulting. Having worked in the private sector throughout my career, I felt I was missing a bit of job satisfaction– even if I liked my job, it didn’t get me excited. I wanted to work in an area that I thought would capture my interest and this role came up in technology and healthcare.

When I came to the university, I was really excited for it – it’s quite a different environment, a big change from the private to the public sector. I’m so glad I joined. I really feel like the work I put In makes a tangible difference.

What does the Digital Health Software team do?

We co-design and co-produce smartphone apps, databases and web-based interfaces as part of research for different health conditions. We don’t just focus on one specific area; we often work on projects where there are multiple co-morbidities.

Embedding [in projects] is where we differ slightly from an external software house. Because we work in a research institute and a university, we do tend to embed our team in bigger research projects. We don’t often take on a project that is, as an example, putting together a single web page. It’s more often [for someone with a] grant to do a three-year or five-year research study, where our  expertise in building web or mobile solutions are required.

Our contribution goes beyond just software, we often contribute to the funding application. We become part of the team – with one of our investigators on the project – and may also contribute or lead on papers after the research is completed. We don’t often have people come to us with a definite set of requirements for us to write a small piece of software, we’re normally part of finding out what needs to be delivered.

We also work along the translational pathway including exploratory technical feasibility studies. We’ve recently completed a wearable clinic project where we were working with integrating blood pressure cuffs to demonstrate real-time delivery of data to clinicians, combined with geo-location data.

We also have solutions that are in use in the NHS, at the other end of the translational spectrum, working with clinical teams and their day-to-day work. No two projects are the same for us.

What are you working on at the moment?

We’ve a lot of exciting projects at the moment. We naturally have a lot of projects in the mental health space – mobile technology lends itself well to providing resources and information to end users. There’s plenty of debate regarding technology versus contact with a clinician but I don’t think that’s ever the goal. Technology offers a way to get resources to people quickly – my smartphone is the first place I go whenever I’m looking for anything these days.

We have the project  in wearable technology that I’d mentioned, we’ve also just kicked-off a project on atrial fibrillation and co-morbidities. We’re also working with Manchester University NHS Foundation Trust to get real-time waveform data from one of their ICU machines. This project is trying to retrieve ICU waveform data to facilitate research, allowing for complex data analysis and investigations in to patterns and warning signs. That’s a very unusual project for us, we’ve never done anything else like that.

I know the software developers have really enjoyed working on a front-line project because they feel there’s a very tangible difference to be made –impacting NHS work. It is often cited as a key reason as to why most of our developers joined the team.

Do you have any case studies to share with us?

We have a few big projects at the moment that will occupy our team for a while. The first one is called AFFIRMO and it’s a Horizon 2020 project over five years. There’s going to be a randomised control trial across six European countries for patients with atrial fibrillation and other co-morbidities, focused on geriatric users.

We’ll be building a digital platform that will form the core of an intervention. It will be mobile and web but, at the moment, we’re still collecting all the requirements, so we’re expecting some wearable technology integration to happen and some diagnostics tools to be built and integrated. It’s going to be a big project; we’re going to have to translate our applications into multiple languages and working with the geriatric population is something that will be an interesting challenge for us.

Whilst we have a lot of design and user experience in our team, engaging with a geriatric population presents a new challenge – how can we engage that user demographic? We have plenty of data challenges [too] – we’ll be holding patient identifiable information from six different countries with potentially different regulations we’ll need to adhere to.

The second project is the platform I’ve worked on for most of my time at the university, called CFHealthHub. This is another digital platform at the heart of a programme of work supporting people with cystic fibrosis (CF). This platform is now used in 60 per cent of the adult NHS CF centres. The project focuses on empowering patients to adhere to their medications – CF is an illness that has quite a high burden in terms of treatment for the individual. They have to take nebuliser medicines several times a day, on top of cleaning and maintaining their nebulisers. This means that adherence to treatment is actually quite a challenge in this area.

CFHealthHub utilises bluetooth-enabled chipped nebulisers to provide us with data around frequency of use, as well as duration. We share that data with the clinical teams and the patients, so they can both see it. The idea behind that then is they’re both having very open and honest discussions.

The CFHealthHub collaborative has a diverse team of experts from software engineers through to health psychologists. We want to support patients, not provide a stick to beat them with. There’s an enormous amount of engagement work being done; we also give patients the power to stop sharing their data at any point should they wish to. It’s their data after all.

The collaborative is a really interesting place to work. I have a monthly drop-in session where any clinical end user of CFHealthHub can dial in to chat about the platform to give me bugs and pain points. It’s the project I’m most proud to work on, it really excites me.

We’ve hundreds of patients on CFHealth – there’s been a full randomised control trial, there’s a paediatric section, and we’ve even integrated additional third-party devices during COVID. It’s the project where I feel we have the biggest direct impact on the NHS and healthcare in the UK.

Any other projects to tell us about?

We’ve also got a Tinder-style app to gage interest in mental health research in Greater Manchester. Any mental health studies in Greater Manchester can be added to the PPIE app, with users wanting to be involved in research viewing cards that they can give a ‘yes’ or a ‘no’ [answer] to. A ‘yes’ answer results in receiving more information and future notifications.

That’s quite a fun little app. It’s a simple idea and we think it has the potential to grow into quite a substantial solution. It’s not just projects already being worked on, it’s very much focused on trying to create that link between people who would like to be involved in research and the researchers themselves.

This is very early stage, but long-term we hope for a large cohort of engaged users, with researchers able to get real-time information from them. We’re a distance from that yet, but we do have a beta version and we’re getting interest from areas other than mental health.

Do you work with NHS organisations on Electronic Health Records (EHRs)?

Yes, it’s something we are trying to do more of. Interoperability is one of the key focuses for NHS Digital and NHSX, and rightly so. One of my bug-bears in this space is that we’re building all these wonderful apps and then you go and see a team from Manchester Metropolitan University or the University of Liverpool building their own wonderful apps. We’re all here delivering great solutions, but they all live very much in isolation from each other.

At the moment, we’re working to facilitate single sign-on between an EHR and CFHealthHub. This would mean a clinical user already logged on to their EHR can click a button that says ‘open CFHealthHub’ and we use their EHR authentication as valid, so they no longer need their own username and password. That sounds like a small step but actually it’s important, as clinical teams have to remember a lot of passwords to get into different systems. Sustainability of these platforms has to involve integration with EHRs. I’m really excited about this piece, as I really want to see that agenda driven forwards.

What do you hope to see happening in the health tech space, going forward?

What I want to see is [more] use of remote technology. I’m very much in the camp of technology enhancing healthcare, not replacing the human element. I don’t think it’s ever the right thing to do, in healthcare in particular. There is already an incredible amount of intelligent wearable technology that exists – the opportunities are there for us to make a difference.

A good example taken from the wearable clinic project: imagine that instead of scheduling a clinician visit every six months and you attend because the diary tells you to, you attend when you need to. You wear the [blood pressure cuff] and all the signs are positive and you’re feeling well, save yourself the journey and free up the clinician to meet with someone else. However, if your data is showing something of concern or variability, you come in sooner. It would be great to do these things. I think we are a very long way from that, but I suspect the pandemic might accelerate it…

To find out more about Digital Health Software’s team and their projects, visit the website.