Interview Series: Professor Anthony Rowbottom, Lancashire and South Cumbria HCP

As HTN continues to focus on Integrated Care Systems (ICSs), and how technologies will play their part in shaping services and collaboration, we spoke to the Lancashire and South Cumbria Health and Care Partnership (HCP) to find out more about its digital transformation case study with BridgeHead Software.

Professor Anthony Rowbottom MBE, Clinical Director for Lancashire and South Cumbria’s pathology service, sat down with us to share his learnings from both the project and the partnership. Below, he explains how BridgeHead’s HiPRES solution can support ICSs with recording, storing, protecting, sharing, and analysing test results – as well as how it can be harnessed across a variety of other care pathways.

Hi Anthony, tell us about yourself and your role at the HCP

I’ve got a few hats – my primary ‘hat’ at the moment is Clinical Director for Lancashire and South Cumbria HCP’s pathology service. I’m also a professor of clinical immunology at the University of Central Lancashire (UCLAN), and I have recently been appointed as North West Regional Clinical Lead for Pathology by NHS England.

I’ve been in pathology for about 40 years, and I’ve seen how it’s evolved considerably over the years. By training, I’m a consultant immunologist and we provide a regional service to the North West, as well as beyond, offering diagnostic tests. I have a particular interest in digital and I see the benefits and value that it can offer – and that’s not only in advancing technologies but also in the use of data.

We were probably one of the first departments in the country to have an NHS-funded scientific trainee in health informatics. The skills and understanding they’ve brought to data is really impressive. I would like us to use data to move away from retrospective reporting and towards prospective modelling – so that we start to understand the needs of a diagnostic service based on what is coming through the front door of a hospital and use that information to provide the requisite resources.

I’m also interested in how we develop technologies across the healthcare ecosystem, moving from primary and secondary to tertiary care, with everybody having access to results.

How do you see technology playing a part in the future success of ICSs?

Technology is going to be front and centre. We’re seeing it in the world around us through the use of applications, the use of wearables, etc., and I can only see that expanding. I think it’s a key element of how we advance healthcare.

I recognise that pathology contributes to about 80 per cent of diagnoses, so we play a central role in providing healthcare for individuals at the point of illness – but also with monitoring chronic disease and health conditions.

The data management and reporting aspects of digital are vital in addressing strategies for ICSs. We have been working in partnership with BridgeHead on the HiPRES mobile workflow and data management solution – which has the potential to significantly improve the way we are able to manage the capture and flow of data across a number of care pathways for Lancashire and South Cumbria HCP. But we also believe HiPRES will resonate with other ICSs who are following a similar direction of travel as ourselves.

What’s your view on the part that data plays – how important is it in the formation of ICSs?

Data is key. In our department, we gather around 80 million parts of data throughout the year – a significant proportion.

How we use that data is probably not as efficient as it could be. Quite often we use it to look back retrospectively – to understand what’s happened to the service and how much money we’ve spent. We need to move from that retrospective performance analysis to a more prospective description, and towards information gathering around what the needs of the service are.

Our aim is to leverage the combined information gathered from healthcare, social care and economics for patients. We know that all of those have a significant impact on outcomes, so I would really like us to get to a position where a clinician is sitting in front of a patient and they’re having an informed discussion about their care based on important, aggregated, real-time data. Access to this kind of information can really help clinicians better understand potential outcomes, with some of the key elements considered against the impact on the survival curve, such as treatments, drugs, responses to antibiotics, etc.

Another important data consideration, I would say, is regarding public health management. Gathering and connecting data from across communities can make a huge impact. Take, for example, areas like microbial resistance management. We use a lot of antibiotics across the ICS, but we don’t really have a heat-map of who is using what and where…so we’re not able to fully understand how we deploy particular antibiotics and what their reaction might be in particular communities.

There’s also risk stratification – whilst we might all have similar DNA, we know that environmental factors imprint on outcome. By being able to use data to ‘drill down’ to an individual, perhaps by using their DNA sequence or mutational analysis, we may be able to create a risk stratification for that individual, which helps them to understand their disease, lifestyle and any environmental changes or potential treatments.

Tell us about the HiPRES project – how did the partnership with BridgeHead come about?

I was sitting in my office, considering the impact of COVID. One of the elements I was mulling over was that, within a short period, I expected that we would be required to provide testing to a large cohort.

Lateral flow testing (LFT) was going to be one of our pieces of armour – we had laboratory testing and near-patient testing, but we wanted to give the patient the opportunity to test in their own home. However, the result would only be visible to them. We also wanted to capture certain data points concerning tests, such as lot number, batch number, and whether the test was done properly.

There were many testing entrants coming into the patch; and we had questions about variations in how the test was performed, the quality of the test, how it linked in with the laboratory results, etc. That’s where the concept of HiPRES came about.

We wanted a solution that everybody had access to, available on a mobile phone or tablet that would enable us to record test results and link them directly to an individual via their NHS number. The solution would guide users through a logical process in performing the test while allowing us to record information such as consent.

Once the test was performed, we also wanted to capture it in an image format that would link directly to patient records, and which would then be viewable across the whole health economy. With HiPRES, we would then be able to start using the data to understand the quality of one lateral flow test against another. That was how it all started.

But soon after, we were tasked with providing LAMP [saliva] testing to the NHS staff across our region – where we would send results back to individuals, as well as their line managers. We also needed to be able to use those results to inform external agencies, integrate them into our healthcare IT systems, and use that data in a way that would be meaningful for the ICS and beyond.

There were lots of strands to the HiPRES project with BridgeHead – key to all of them was being able to work within a Cloud environment. BridgeHead were very responsive to our requests, quickly understanding our needs, and worked collaboratively with us to deliver the solution in quite tight timescales; particularly as there was some pressure to get this out into the system as quickly as possible.

BridgeHead were also tasked with building into the system a test routing component, i.e. where we send the tests – we now have the ability to record where the samples were collected from, where they were sent, where the individual [who was tested] sat in the organisation and their role, which all helped with highlighting potential cross-contamination and hotspots in the hospital.

We had a clear idea and strategy of what success looked like; this enabled BridgeHead to underpin HiPRES with its data management solution. The first care pathway implemented with HiPRES began with COVID testing and LFT pathways, but we were very quickly able to use the solution for the LAMP pathway. HiPRES has made a significant difference for the ICS, with LAMP test results being delivered back to staff to determine whether they had to stay home or return to work. It made a huge impact to be able to drive efficiencies in managing this process.

How was testing done before COVID – and why is it different now?

Working in the NHS, we do have systems and processes in place, though they can be restrictive. Digital is no different. We already have data connectivity and messaging between organisations. But what COVID highlighted was that this was probably not sufficient for our requirements. What we needed was an agile connectivity platform, while still retaining our traditional routes and processes.

With BridgeHead’s HiPRES, we have developed an app that an individual could use to record results that would then be viewable across the patch. We didn’t need to have a hardwire, dial into a computer and link to the electronic patient record to report through traditional mechanisms. The HiPRES project has allowed us to completely revolutionise how we work.

HiPRES is intuitive to the user, which was key in making sure it got adopted very quickly – from the use of the app, all the way through to the reporting.

There is a move in healthcare towards individuals and patients taking control of their records. This is one of the first steps towards that by promoting point-of-care-testing through a phone app and allowing people to receive information back, which may then direct what they do next.

Could HiPRES be used as part of other clinical pathways, beyond COVID testing?

The vision was around agile connectivity and using technology that is currently available, while keeping an eye on future technologies.

There’s a lot of NHS pressure around cost control and efficiency, so the notion was that the HiPRES solution could be adapted for opportunities to support other care pathways outside of COVID testing. That was always part of the vision and, as a result, built into the architecture – that we would be able to take component parts and utilise them for other areas across the ICS. HiPRES is not only sustainable but integrated with the technology we already have in place, so it’s a common platform to build upon.

At the moment, we have a whole raft of ideas, at the concept stage, on how we can use HiPRES across the ICS. Some we are currently looking at quite closely, include: image capture analysis and low-level artificial intelligence, primarily focused on skin cancer but maybe widened to skin lesions and linked with biopsy taking; working with the North West Ambulance Service to transfer and view information through a central repository; supporting rapid responses for phlebotomy, with access to blood takers set to be an ongoing limitation for ICSs; new phone app additions such as heat-mapping of inflammation – to speed up access to secondary care for those who may have sepsis; capturing and sharing images of potential allergic reactions to help with capacity; connectivity with wearables such as glucose monitors; and also exploring where HiPRES could be used in community diagnostic centres.

At Lancashire and South Cumbria, we’ve also just put a bid in for drone technology. How I see this working is as a ‘click and collect’ system, potentially using HiPRES. We are looking at drones that will move test samples from hospital A to hospital B. We’re considering bringing the two projects together and using HiPRES to track where things are in the system. It could help reduce the carbon footprint and ensure we are not restricted by traffic in places like London.

HiPRES can receive and manage data in any way, regardless of the source or the target – whether the information needs to go to a trust, individual GP service or a patient record.

What learnings will you take away from the partnership with BridgeHead?

Together, we have made great strides and introduced some great innovations –working on COVID and LAMP testing was a really good experience. We gained a lot of learnings from each other and don’t want to lose those going forwards. I also want to start thinking about other ways we can work together in the future, in areas such as decision tools.

I think we need to be mindful of funding opportunities – having collaboration between a commercial partner, academics and clinicians makes for a really powerful environment. For me, working with BridgeHead is really important in order to support future projects and develop products that may attract funding.

There are a lot of technology vendors out there and a lot of healthcare providers – but those delivering care are not always the best people to evolve a technology solution, and the technology vendors are not always the best people to create a solution that is fit-for-purpose in a care setting. The beauty of this partnership is bringing both of those skillsets together.

For more BridgeHead-related content, HTN also recently chatted to the team about cyber security in the NHS, following the company’s live webcast and panel discussion on the topic, earlier this month. You can catch up on both the write-up and the video session here.