Feature Content, Interview

Interview Series: Noel O’Kelly, Clinical Director, Spirit Health

Noel O’Kelly, Clinical Director of Spirit Health, recently sat down for a chat with HTN about all things remote monitoring and the future of digital health.

Hi Noel, tell us about your role and career background

I’ve been Clinical Director at Spirit for about a year-and-a-half. Previously I was a GP, a GP with Special Interest in Respiratory, a GP commissioner and an Associate Medical Director of a large community and mental health NHS trust. For most of my career I have been involved in service re-design for long-term conditions.

I’m very passionate about using digital tools to improve clinical pathways and patient outcomes, so working as the Clinical Director at Spirit Health was an opportunity that I could not miss.

My role as a Clinical Director involves helping to facilitate the clinical content that we host within our CliniTouch Vie platform and working to develop that with clinicians, commissioners, providers, and clinical leads. I support them with looking at their clinical pathways and try to help with the decision of where the technology would fit best. I am also involved in helping to design the evaluation of our technology within pathways. Other roles I have include leading on clinical governance and advising internally on clinical matters, as well as working closely with clinicians in the NHS.

What are the benefits of remote monitoring from a Spirit Health perspective?

Spirit has been involved in remote patient monitoring for around 10 years. We are now on the fourth iteration of our system, CliniTouch Vie, a remote patient monitoring platform. The platform is both content and device agnostic, so fully adaptable to patient and clinician needs. Through our platform we can help connect patients, carers, and clinicians in their care and management. Our system features a clinician dashboard which provides longitudinal clinical data for patients, which helps inform them of what the best clinical decisions for that patient might be. From a patient perspective, they feel more connected and are able to better self-manage their conditions.

We have a system of intelligent branching clinical algorithms which are specific to disease areas. Within these ‘question sets’ patients also record their clinical observations. The system has a prioritisation process embedded within it that RAG rates patients (i.e., red, amber, and green), which helps clinicians to identify patients most at-risk and the priority of who they need to interact with first. There is also an education model within the platform where textual or video information can be sent and viewed by the patient. For example, within our virtual pulmonary rehabilitation programme, patients can be prescribed and monitored on their access to education and exercises on an individual basis.

Most of our previous work was focused on long-term conditions – COPD and heart failure. We have published a number of peer-reviewed evaluations demonstrating improved outcomes when using digital technology. One was based in a rural setting (Leicestershire County and Rutland), and another in an urban setting (Leicester), This was targeted at people with severe COPD. We showed a two-thirds reduction of admissions in that cohort of patients. The studies also showed an improvement in quality of life, with the COPD Assessment Test (CAT) score improving on average by 4.2. We also showed a large health economic benefit – saving money.

We also worked previously with St Mark’s [Hospital], in London, a tertiary centre for complex gastro-intestinal (GI) surgery. They used our platform to monitor patients after discharge from GI surgery, with good outcomes demonstrated from this pathway. We have also demonstrated a reduction in face-to-face appointments with the services we have worked with.

The platform also allows texting to patients and video consultations – so it’s a complete package for remote monitoring a patient. Of course, when you get the data, you still need a clinician at the end of it.

Do you have any other real-world examples or case studies to share?

When the pandemic hit, we continued working in Leicestershire with the heart failure and COPD teams in the community. Like so many hospitals, there was a real concern over capacity due to a rise in admissions for patients with COVID-19. So, we helped to set up a COVID-19 virtual ward, enabling people to get out of hospital quicker and freeing up beds.

We’ve just had our report on the first 65 patients published in the British Journal of Healthcare Management. Results from the virtual ward showed a halving in the readmission rates and over 40% reduction in the average length of stay, with patients remaining in the virtual ward for about 14 days after being discharged from hospital. Looking at the cost of admission versus the cost of the virtual ward, there were cost savings of over £1,000 per patient. We’ve now had 350 patients go through the virtual ward in Leicester, and in early January this year, we also went live with a respiratory virtual ward in North West Anglia NHS Foundation Trust. The expanded roll-out of virtual wards is key for the NHS, so we’re keen to support with our platform wherever we can.

Other areas we are interested in are in the management of frailty and mental health in care homes. We’re working with Joined Up Care Derbyshire, the shadow Integrated Care System (ICS), and numerous care homes to look at monitoring their patients with frailty – both for ongoing care and helping to deliver appropriate escalation pathways. The programme in undergoing an evaluation with the University of Lincoln.

We have recently presented an abstract at the Hospital at Home Conference in Australia on the work we have done on frailty in general practice. This entailed supporting a GP practice in managing patients within a care home. The abstract detailed the improved outcomes for patients and clinicians within a reduced cost.

We’re also doing a lot of work with Lincolnshire health system. One of the things we’re really excited about is how with people with frailty can be supported within their own homes, working together with care agencies. That’s been running now for about six or seven months and we’re looking to extend that. In Wales, we’re going to start supporting a ‘mental health for older people’ in-reach team, for a care home in Swansea.

There are lots of examples of where we’re working in the NHS, including supporting a large project at ICS level which will be starting soon. That looks at a system-wide approach for how to use digital technology through CliniTouch Vie – linking primary care, community care, secondary care, so helping with the present issues with elective care.

We hope this project will promote better flow through the system – getting people out of hospital quicker and getting patients optimising clinically and physically with their long-term conditions. So, when they do turn up at hospital for a procedure, they’re in a better position. The evidence is that if you do ‘prehab’ and improve people’s mental and physical health before they go to hospital, you get better outcomes, improved lengths of stays, and less cancellations of procedures.

What have your learnings been so far?

People feel more connected to the clinicians and less anxious if people are monitoring them. An important thing to understand, when you’re looking at a digital tool, is that it’s not just about the tool but where it fits best within the pathway. Sometimes you can have unintended consequences when you bring something new into a clinical pathway. It is important when frontline clinical services are re-designed and new technology is embedded within a pathway that the whole pathway is viewed and its potential impact across that is scoped out.

Whenever you bring in new ways of doing things, some clinicians can feel a little bit sceptical or worried about it. But what we have found is, when they get used to it, they’re more likely to adopt it further. For example, Leicester, Leicestershire and Rutland (LLR) health community was successful in 2020 in becoming one of the ‘Ageing Well accelerator’ sites. When the pandemic struck, they had to consider how the specialist community teams could manage patients with heart failure, COPD and respiratory conditions. So, they decided to extend their remote monitoring offer, to reduce face-to-face consultations and keep their services running effectively and safely.

Because of their experience at that period of time – they came back to us and said, “we’ve got to restart cardiopulmonary rehabilitation, can you help us?” We helped to support that through our digital tool. After that they then asked us to help them to develop and support their COVID-19 virtual ward. Now they’re asking us to further expand on their virtual ward to get more people out of hospital. I think that shows the journey people must sometimes take in adopting new technology within their working environment.

When I was a GP, I was seeing a patient every three months or six months for 10 minutes. With remote patient monitoring, patients can enter their clinical data on a longitudinal basis, so providing the clinician with more of an idea of how their condition is affecting them. This provides the clinician of a wealth of clinical information that helps them to make better clinical decisions in the care of their patients.

What tips do you have for implementing remote monitoring within pathways?

There are lots of healthcare apps out there. We must be aware of user fatigue that patients can get when using these. Therefore, there is a need to look at what features of the technology will make a difference to their lives and wellbeing and keep them engaged. Making it simple to use will also help with continuing engagement.

Sometimes clinicians think patients can’t handle the technology when, in my experience, often they can. We’ve had the average age of people using our technology at around 77 – I think the oldest patient we’ve had use CliniTouch Vie is 91.

Also, we have had a person who was blind and have aided them in being able been able to participate in digital remote monitoring. Another of our patients had never used a smartphone before but [after being on the COVID virtual ward] he got his family to buy him an iPad, so that he could connect through social media with them. I think we have this idea that people, especially older people, can’t use the technology and really in most cases that’s just not true.

The financing of digital technology, especially remote patient monitoring, can be a challenge. Without sorting out ongoing specific funding for RPM it will be challenging to further develop digital clinical pathways. The NHS mainly works from fiscal year to fiscal year. Often funding becomes available at the end of the year and must be spent before the next accounting year begins. This causes all sorts of problems for NHS provider organisations. Often the funding has to be spent on capital purchases and can’t be used for revenue, which makes it hard for the continuation of technology within their services.

Funding for digital technology needs to become an integral part of the strategic plans of ICSs, aiding in services becoming sustainable and resilient. I believe that this has now been recognised centrally so I am looking forward to a more structured and transparent approach to ongoing funding for technology.

I really cannot see – with the workforce issues that we have [in the NHS] – any other solution for the NHS, unless they adopt digital technology. However, at a local level it is so important to get clinical leads to buy into it and identify champions within services to drive things forward. They will be the ones who are going to get the more sceptical people to adopt it. We as suppliers also need to be listening to clinicians, explain the benefits and be flexible in our approaches. If we get too focused on the product and not the pathway, it’s easy to lose our way.

The pandemic has been a real game-changer. It’s made people look at different ways of doing things. We need to make sure that we keep the work going and continue to improve, to benefit the NHS.

To find out more, visit spirit-digital.co.uk.