For the latest HTN Now Focus, we were joined by Jamie Innes, Product Director at Inhealthcare, a digital health technology provider, to tackle the topic of building ‘digital first’ Integrated Care Systems (ICSs).
Areas covered in the live webcast, which you can catch up on via the video at the bottom of this page, included the rise of digital health, the ICS digital agenda, top tips and what to consider when developing a ‘digital first’ ICS, real-world examples about regional approaches, and the power of collaboration.
Jamie began the event by providing a little bit of background on Inhealthcare and its aims, stating that the digital service provider supports over 1.5 million patients via its digital health platform, working across around 50 NHS trusts in England, as well as across regional health boards in Scotland and Northern Ireland.
The company’s focus is on supporting high-risk patients with long-term conditions like COPD and heart failure, short-term conditions such as IBS and gestational diabetes, and, more recently, COVID-19, as well as those who reside in care homes, through personalised and inclusive remote monitoring solutions.
What Inhealthcare is currently seeing, Jamie explained, is an increase in virtual wards being used to monitor patients with a broader range of conditions, as a result of the widespread use of COVID Oximetry @ Home during the height of the pandemic.
“As for ourselves, we were involved in monitoring over 7,500 patients within these virtual COVID-19 wards across the UK. Now what we’re starting to see with digital healthcare is the rapid adaptation of these virtual wards to monitor other conditions,” he said.
“This fits nicely into the ICS digital agenda”, he added, noting that from April 2022 – in just six month’s time – ICSs will be replacing Clinical Commissioning Groups (CCGs) across England, fulfilling the same services but with a greater regional focus.
Transforming services digitally is expected to be an important part of that and, Jamie said, ICSs will be presented with a “fantastic opportunity to make large-scale change[s].”
Jamie then went on to summarise the essential requirements to consider when creating an ICS with digital innovation at the forefront. His first top tip was to ensure that “your service meets real-world needs” by making sure it “solves the problems that you set out to resolve initially”, and not getting “carried away” with the technology or over-expanding the scope of a project.
Real-world examples provided by Inhealthcare here included the Oximetry @ Home virtual ward, which was developed with Hampshire and Isle of Wight CCG and the Wessex Academic Health Science Network. The lateral flow testing service for frontline workers, created with City Health Care Partnership Hull, and a heart failure monitoring pathway at Norfolk Health and Community Care Trust, were also highlighted in the presentation.
The second aspect to consider, Jamie said, was “the importance of co-design and development [of solutions] with the service users” and, “if at all possible”, involving patients in the initial stages of the process.
“The best services that I’ve seen being developed over the past decade have been where technical and clinical teams, and patients, have all collaborated and come together, so that they can design, develop and test the pathway at all the different stages,” he commented, explaining that it allows service users to shape services to their requirements, is more likely to fit the local population, and helps to avoid time wasting and management of expectations.
Digital inclusivity and accessibility was the third point Jamie raised, using Ofcom statistics to show that, in the UK, nearly one in 10 households with children do not have computers, 13 per cent of adults do not use the internet, and half of over 75s do not use the internet. Therefore, he said, “a single approach to digital services that relies on a smartphone app is not inclusive for many cohorts of patients and creates a tiered service.”
His tip for tackling this is to give patients choice and utilise a full range of communications channels, such as apps, web portals, video conferencing, emails, and Amazon Alexa, as well as SMS texts, automated calls, and the ability to speak to a person over the phone so that readings can be inputted manually.
Inclusivity is, Jamie said, also linked to his fourth area of focus: providing person-centred services.
“As well as providing patients with options about how they interact with their digital service, you also need to ensure that it meets a real need…and [that] it’s better than their existing way of receiving that care,” he noted.
NHS login was an apt example of this, he continued, and added that focusing on a patient-centred approach could lead to better uptake. As an example, Inhealthcare has found that, although they assumed younger, working age users would be more likely to take up their INR self-testing service, the biggest cohort was, in fact, the most recently retired, who wanted to be able to enjoy their retirement by getting out and about, and travelling.
Other areas, such as purpose-built services and agile design, and value of money through driving efficiencies and savings, were also considered in the webcast, with Jamie sharing that taking on too many different technology partners and offering a number of different services could actually add to cost and workload.
Integration was another “hot topic” according to Jamie, who provided a checklist to help score service providers against, to ensure they meet requirements. This included whether systems use NHS numbers, have spine validation and open APIs, and if they can offer integration with NHS login, MESH and a master clinical record.
Data insight was another area raised, with Jamie noting that, “from my experience this is an area that’s really challenging, because it is often an afterthought”. He recommended that organisations identify what data items they want to record, how they will access them, whether they want a dashboard or to work raw data, early on.
Finally, he considered data security and compliance, with another checklist to make sure suppliers are meeting the latest national requirements and have a roadmap for compliance with new medical device legislation.
Jamie then went on to discuss the power of collaboration, highlighting Health Call – a partnership between Inhealthcare and seven NHS trusts in the North East and North Cumbria, which provides digital health and remote monitoring services to around three million people. By bringing together their expertise and solutions, he shared, the region no longer consumes resources by repeating tasks multiple times and can save money by procuring systems as a group.
“Health Call is a fantastic example of how organisations can collaborate to bring together their expertise and share this for the benefit of all organisations in the region,” he said. “By collaborating and sharing ideas and innovations, the organisations in the region can achieve economies of scale and ensure that services are designed to meet regional priorities.”
Due to the mix of urban and rural areas within Health Call’s North East and North Cumbria remit, Jamie added, “you get a real mix of patients and different challenges across the different organisations.”
This section included a case study on Inhealthcare’s work around INR self-testing and undernutrition services with Country Durham and Darlington Foundation Trust (CDDFT), which he used to highlight the benefits of collaboration.
About the two examples, initially developed within the Health Call region, Jamie explained: “These services were initially developed with County Durham and Darlington Foundation Trust but, following their successful deployment within that organisation, they’ve been scaled up across other healthcare providers across that region and [have] also been adopted by other organisations in the UK who use the Inhealthcare platform.”
On the undernutrition service, which allows dieticians to monitor patients remotely, keeping tabs on their weight, appetite and compliance with nutritional supplements, Jamie said that the CDDFT pilot achieved impressive results, including increasing the capacity of the dietetic clinic by up to 100 per cent, reducing wait times from six weeks to two weeks and the average treatment time from 40 weeks to 12 weeks, and also cutting the cost of supplements. This was also mirrored in by health board outcomes in Northern Ireland, which saw a 90 per cent reduction in domiciliary visits.
By supporting dieticians with the Inhealthcare platform, which gathers observations and data from patients and calculates their risk of undernutrition, they were able to “give healthcare professionals up-to-date information on the status of their patients”, Jamie noted.
The second example, INR self-testing, which was designed by an anticoagulation clinic to avoid unnecessary visits, Jamie called “a fantastic example of person-centred design”.
“They had 300 patients coming in to a two-hour appointment slot, and they felt that they weren’t giving the best service to those patients,” he explained, adding that they wanted to allow some patients to self-test, while still providing the same level of service and safety that is available at a face-to-face appointment.
“What we did,” explained Jamie, “is we worked with them on designing a digital service that would replicate what they did in clinic – gathering the same information, asking the same questions that they would face-to-face, and bringing that all into their dosing software that they use within the clinics. This meant that the clinics were then able to operate really efficiently.”
Results from this service included a reduction in dosage time for those remote patients, from three minutes to 30 seconds on average, as well as the ability to spend more time with patients in the clinic. Unintended consequences were, Jamie stated, that patients become more self-aware of how to manage their condition, more compliant with medication, and mindful of the impact of their diet and lifestyle.
The service is now being deployed across clinics in a range of areas – from Newcastle to Bradford and Hull, and is an example of how solutions and best practice can be scaled and shared, effectively.
As his last example of collaboration, Jamie also spoke of Inhealthcare’s work with the City Health Care Partnership Hull (CHCP), specifically commenting on its child immunisation programme.
“[We] have a really strong relationship – they started using the INR self-testing service…and since then we’ve worked with teams to develop and pilot new innovations and scale those across the organisation,” he stated.
Before the partnership, CHCP’s childhood immunisation service had relied heavily on paper and manual transcription and data entry, with posting letters and paper forms leading to low completion rates.
To help solve the inefficiencies in this area, Inhealthcare developed a fully digital service to allow patients to register and provide consent online. In addition, it allowed staff to improve triage and ask health questions in advance. “We also wanted to provide a digital service on the day of vaccination,” Jamie continued, “so that individuals providing the clinics could enter all their information into an app, or an online portal, to avoid the need for manual transcription back into their clinical system later on.”
A real-time dashboard, providing information on uptake rates, was also implemented to allow views across different areas and even individual schools, which enabled the redeployment of resources.
Other benefits included an increase in vaccine uptake, a reduction in Do Not Attends due to reminder notifications, and a 50 per cent reduction of time spent in schools for the immunisations programmes, due to improved efficiencies.
“It’s a really good example of where we’ve worked with an organisation on a service for one area, and then how it has scaled across others,” Jamie concluded, noting that the service was originally for childhood influenza vaccines in schools, before expanding its reach to other vaccines and cohorts.
Catch up on the full session in the video below: