Next up as part of our Digital ICS event line-up is Inhealthcare, a recognised leader of patient remote monitoring technologies who work closely with NHS organisations to deliver digital transformation at a strategic level.
For this edition of HTN Now, we explored a range of topics relating to the development and practice of digitised integrated care systems (ICSs). In this session, Jamie Innes, Product Director of Inhealthcare, joined us to discuss supporting the virtual ward agenda for ICSs.
Digital healthcare: the backdrop
To start, Jamie laid out the current state of play in the healthcare world with regards to digitisation:
- COVID-19 made remote monitoring in patients’ homes a necessity
- During the pandemic, health care teams across England increasingly used new technologies
- Digital services were essential rather than ‘nice to have’
- Clinicians embraced new ways of working with a can-do attitude
“As we start to exit from the pandemic, the NHS is faced with an unprecedented backlog of appointments and increasingly organisations are looking at how virtual ward technology can be deployed to support patients in different care settings,” Jamie said. “This introduction of new technology is going to allow NHS organisations to free up capacity and resources, supporting the demands of the backlog but also some of the more complex patients and caseloads that have developed over the pandemic.”
Noting that remote monitoring in patients’ homes has traditionally been used to support long-term conditions such as COPD and heart failure, Jamie explained that remote monitoring is now moving into other areas as a result of the successes experienced during the pandemic.
“We’re going to see the introduction of more remote patient monitoring technologies,” he said. “This is where continuous monitoring technologies are going to allow for the introduction of virtual wards that transform the way in which patients are discharged from hospital, even when they have complex care needs. There will be a greater emphasis on proactive monitoring and intervention to reduce the number of patients being admitted to hospital, or at least reducing the average length of stay for patients.”
Inhealthcare’s solution in practice
The identification of silent hypoxia (the presence of low blood oxygen levels) was one of the early breakthroughs in treating COVID-19.
Inhealthcare developed a solution called Oximetry@Home, through which patients with COVID-19 could be looked after at home by allowing health professionals to track vital signs. Inhealthcare launched the service across seven ICSs in southern England. Patients use a simple monitoring device called a pulse oximeter to monitor their oxygen saturation levels and answer a series of questions, with both sets of results reported back to their healthcare team to allow for intervention as necessary.
“As part of the programme we saw significant reductions in length of stay in hospitals,” Jamie shared, “and in addition, reductions of those admitted to intensive care when compared to patients not on the remote monitoring programme.”
One of the main benefits noted from feedback was the freedom that remote monitoring allowed patients. “Many patients liked the reduction in travel,” Jamie said, “so that they could continue to live their own independent lives.”
The Oximetry@Home programme has since expanded into respiratory areas, with Inhealthcare working with customers to develop solutions for conditions such as asthma and COPD. This pathway has given respiratory patients the opportunity to take control of their health at home.
ICS: the digital agenda
“ICSs and the new statutory body are taking on the responsibilities that CCGs held before them, but at a regional level,” Jamie stated. “This means that ICSs are going to be responsible for transforming patient services across a much larger population than ever before. This is going to present ICSs with a fantastic opportunity to make large-scale changes across a region.”
The introduction of virtual wards and the normalisation of video consultations supports the process of changing how patients receive care. “NHS providers will have to adapt to this new way of working,” Jamie said, “along with patient expectation in terms of how and when they will access services.”
The changes that we have already seen through the pandemic will inevitably lead to patients questioning methods of care, Jamie noted; if you have received satisfactory care through virtual methods during lockdown, why would you want to spend time and money travelling to in-person services if the virtual offer meets your expectations? “This in turn will create more pressure on NHS providers and ICSs to ensure that digital services are an option for patients who desire that flexibility and wish to receive care remotely.”
Virtual wards and virtual care
“NHS England has outlined two key definitions of virtual healthcare,” Jamie said; a virtual ward is a “safe and efficient alternative to bedded care that is enabled by technology… they support early discharge out of hospital and prevent avoidable admissions into hospital”, whilst virtual care “provides enhanced healthcare at home but not as an alternative to NHS bedded care.”
Jamie shared some examples of each. Frailty Hospital-at-Home is a virtual ward service that could support frailty conditions requiring multi-disciplinary team input and hospital-level care, whereas virtual care could provide support for stable patients monitoring chronic diseases or patients managing wounds post-operation.
“Over the next 20 months, NHS England expects ICSs to have completed the deployment of virtual wards to support between 40 and 50 beds per 100,000 population,” Jamie said. “If you take that number, this equates to the equivalent of 24,000 virtual ward beds across England.”
Next, Jamie outlined some of the challenges that virtual wards face, such as staffing requirements to maintain 24-hour patient safety, the necessity for patient records to be available for all those involved in a patient’s care regardless of which team or organisation within the ICS they have come from, and the fact that continuous monitoring will create vast volumes of confidential data to be stored and used securely.
“The key to delivering any virtual ward is to remember that technology is only a small part of the overall solution,” Jamie stated. “To be successful in redesigning pathways, it’s going to require a whole system approach to developing and running virtual wards.”
Building a digital-first ICS
ICSs are required to have smart digital and data foundations in place in order to meet NHSE’s targets and requirements, but Jamie noted that it is important to recognise that not all ICSs are starting from the same position, with different organisations within ICSs having varying levels of digital maturity.
Jamie ran through some of the essential requirements that need to be considered when designing a digital-first ICS:
- It must meet real needs. “It’s very easy for organisations to get carried away with technology, and for the scope of projects to creep. So having a real clear indication of what you want to achieve and either a set of problems or a mission statement that you can always refer back to is a really good way of designing and developing digital services.”
- It must be person-centred. “Not only should you provide patients with options as to how they interact with their digital service, but also ensure that the service meets that need for the patients and is better than their existing way of accessing the service.”
- It must be co-designed with input from clinicians, users and providers. “The best services that I’ve seen developed over the past decade have been where the technical and clinical teams have collaborated to design, develop and test the pathway at all stages.”
- It must be purpose-built to meet the needs of the population it serves. “Having services that are developed in collaboration is so important, as it allows service users to be able to shape the services to their requirements, their ways of working and their local population.”
- It must be digitally inclusive and accessible to all. “One of the common mistakes that I see people making when they are designing their digital services is that patients are often thought of as using smartphones… there are staggering statistics that show the digital divide which exist in the UK at the moment, with many users of NHS services not having access to the internet.” Figures from Ofcom Online Nation 2020 show that nearly 1 in 10 households with children are without computers. 13% of adults do not use the internet, with that number rising to 51% for over 75s.
- Integration is key. “Whenever you are designing a digital service and the topic of integration comes up, I’d always look to define a set of goals for the integration in terms of what data items, what systems and how it will be achieved.”
- Don’t overlook data insight. “From my experience, this is an area that can be very challenging because it’s often an afterthought. Many projects fail to identify early on the data items that are key to demonstrating their effectiveness. My recommendation is to identify early in your project what data items you want to record, and how you’re going to access them and deliver them to your service users.”
- Ensure that the digital service complies with data security standards. Jamie recommended checking suppliers against the following list: ISO 27001, ISO 9001, ISB 129, Cyber Essentials Plus, Data Security and Protection Toolkit, Medical Device and ISO 13485.
Jamie finished off his session with a question an answer session with webinar attendees, available to watch from 30:19 on the video below.
Many thanks to Jamie for sharing his time and thoughts.
You can watch the webinar in full here:
