HTN Festival: Inhealthcare on getting down to business with virtual wards

On Monday, we kicked off our HTN Festival of health tech content with the first live session from Inhealthcare, in which they discussed how to roll out a virtual ward, including lessons learnt from the pandemic and how these can be applied, complete with a virtual ward demo to show our audience how they work.

The session was led by Jamie Innes, Product Director, with a demo provided by Amy Frith, Senior Account Manager at Inhealthcare.

“Today we’re going to be discussing the reality of virtual wards, and how NHS organisations can deploy them within their region,” began Jamie. “As part of today’s session we’re going to be covering quite a broad agenda – discussing the reasons why virtual wards are so important following the COVID-19 pandemic, what the pandemic has validated about remote monitoring services and some real world examples of what our services have delivered, and the impact that digital health can have for patients.

“Then we’ll go into more detail on the delivery of virtual wards and key criteria that providers need to have in place to deliver virtual wards. We’ll look at an example of a virtual ward pathway and what it looks like, and finally go into a demonstration in real time of what that virtual ward pathway looks like for an organisation that we’ve recently worked with.”

Jamie provided some background to Inhealthcare. “We’re a provider of digital health solutions across the UK,” he shared, “and support over two and a half million patients using our digital health platform. We support over 50 NHS trusts in England, the five health and social care trusts in Northern Ireland, and we also have a national agreement with National Services Scotland to deliver remote monitoring services across the 14 health boards in Scotland.”

Then Jamie turned to the impact of the pandemic upon digital health technology. “It sped up the process of digitisation that was already taking place,” he commented. “Two years ago, almost overnight, the NHS was faced with the challenge of how to support its existing caseload of patients without face-to-face contact, and digital became the de-facto approach.”

A statistic was shared from Bryn Sage, Inhealthcare’s Chief Executive: “In November 2019, the number of episodes of [virtual] care was 50,000. By the end of the pandemic we’d got to 2.5 million.”

The presentation noted that the government and NHS England have set an ambition to eliminate all waits of more than one year by March 2025, adding: “We need to think radically about how we deliver healthcare and design remote health ways.”

Turning to how virtual wards and remote monitoring can support this ambition, Jamie said: “The successes of remote monitoring during the pandemic is now supporting the expansion of the technology into new areas such as cardiovascular and respiratory. This is really just the tip of the iceberg. To support some of the challenges that the NHS is facing in reducing that backlog and managing that increased caseload of patients, we’re going to have to see the introduction of more remote patient monitoring technologies and allow greater numbers of patients to be cared for within their own homes and in environments such as care homes.

“The continuous monitoring technologies allow for the introduction of virtual wards, and they will transform the way in which patients are discharged from hospital, even when they have complex care needs. There’s a greater emphasis on proactive monitoring and intervention to reduce readmissions and, at the very least, reduce the average length of stay for patients in hospitals.”

The idea behind the technology, Jamie continued, is to “free up that capacity and resource, to support the demand for the backlog, and support those complex patients and caseloads that need a bit more face-to-face attention.”

Here, the presentation moved on to the example of Inhealthcare’s Oximetry@Home programme. Jamie shared the challenge as it existed during the start of the pandemic. Silent hypoxia, or the presence of low blood oxygen, was identified in patients who with COVID-19 who might not otherwise seem unwell, but who required close monitoring in case they required urgent medical attention. Inhealthcare’s Oximetry@Home service was launched across seven ICSs in southern England, facilitated and managed by the Wessex AHSN, and allowed health professionals to track patients’ vital signs remotely. The patient would use a pulse oximeter to monitor their oxygen saturation levels and answer a series of questions, with both sets of results reported back to the healthcare professionals, who could then pick up on early signs of deterioration.

Jamie provided some more examples of Inhealthcare developing digital services across the UK, from a COPD and heart failure service in Norfolk that saw an 88 percent reduction in bed days and an 89 percent reduction in A&E admissions, to a blood pressure monitoring service in Surrey that has been deployed to 19 primary care networks in the region, with initial results showing that 53 percent of users moved from high to normal threshold blood pressure within five months.

“There are lots of benefits to providers of virtual wards,” Jamie said. “What we also need to consider is the patient. If there’s nothing in it for the patients, then they won’t adopt the digital technology and will revert to previous ways.

“One of the main benefits of remote technology for patients, typically, is that it provides them with freedom. Prior to the pandemic, one of the main benefits that patients reported was that it gives them the freedom from travel, to reduce face-to-face contact so that they can continue to live their own independent lives. In addition, patients have spoken about feelings of reassurance that remote monitoring technology can provide – the knowledge that healthcare professionals are spotting trends and intervening.”

Another key benefit, Jamie said, is that patients “start to take a more active role in the management of their own health. Virtual wards provide patients with some self-management tools that they can use over time to more effectively manage some of their own conditions without the need for intervention. Overall, this results in changes in behaviour and greater compliance from patients in following their prescribed treatments.”

Next, key learnings from the roll out of Oximetry@Home were shared, which are being taken forward into Inhealthcare’s virtual ward programme.

“The first thing I’d like to highlight is that you need to really keep it simple and easy for patients,” Jamie said. “You can’t assume that patients are familiar with technology and you need to ensure that it’s as easy as possible for them to provide information, or allow their carers to intervene.”

Inhealthcare provide multiple communication channels. “That’s the way that I would advise organisations to think about how they can promote their services,” Jamie commented, “ensuring that they’ve got methods for patients to use that aren’t reliant on a smartphone such as text messaging or automated phone calls, and finding ways to allow carers to provide information.

“Also, something else that you need to consider for your virtual ward programme is how many patients within the caseload are going to be in care homes. This is a significant area for virtual ward programmes going forward, and you need to make sure that the technology supports that.”

Another key learning revolved around integration. “Integration is king,” said Jamie. “Ensuring that data can be shared between different clinical systems and can get into the hands of healthcare professionals without manual entry is vital. Automated integration delivers massive efficiencies and ensures that data is available across the health system.”

Moving onto the expectations from NHS England for virtual wards, Jamie highlights that virtual wards will deliver care for patients at home who would otherwise have to be treated in hospital by enabling supported discharge and alternatives to admission. By December 2023, ICSs will have completed development towards a national ambition of 40-50 virtual beds per 100,000 population; and at a minimum, each ICS is expected to implement virtual wards for two pathways, acute respiratory infection and frailty, by December 2023, with one rolled out by winter 2022.

“Virtual wards are expected to make use of new technologies and have clear criteria for the step-up and step-down of patients in their caseload,” Jamie noted. “There’s a clear minimum dataset that NHS England have expressed within the virtual ward programme which includes the capture of a number of different vital sign measurements and observations that can be used to calculate a NEWS2 score.” Some of the measurements listed on the presentation include patient demographics such as date of birth and NHS number, and clinical observations that the patient or carer can input such as respiratory rate, pulse rate and oxygen saturation.

It’s important to remember that virtual wards are not a replacement for face-to-face services, Jamie pointed out, and some virtual wards “may require some face-to-face activities. But most importantly, virtual wards aspire to improve healthcare for all through equitable access, excellent experiences and optimal outcomes.”

Next, the presentation moved onto how technology can support the delivery of virtual ward programmes.

“We believe that there’s a number of different devices and options that providers need to have available in their armoury, and this is something that we’ve used throughout our experiences of delivering different health services,” Jamie continued. As an example, he highlighted how Inhealthcare partnered with MediBioSense for the use of Vitalpatch, a wearable patch that can continuously monitor vital signs or allow patients to take readings at regular intervals, or a combination of the two.

“As part of our virtual ward programme, we also support a number of different device options for patients,” Jamie added. “From experience, you need to have a range of different device options that allow for individuals who are using smartphones but also for those who might not be comfortable with technology… it’s advisable to have bluetooth and non-bluetooth options available for patients, and it also helps to keep costs down from a provider viewpoint.”

Jamie rounded up his section of the webinar by sharing Inhealthcare’s checklist which covers the factors providers need to review when it comes to virtual wards, and the things that need to be considered when choosing a new technology to implement. The checklist can be viewed at 20:31 on the video below.

“What’s really important is making sure that your technology can be adapted and scaled to support different monitoring models,” Jamie stressed, “and ensuring that your technology can also support changing requirements. Whilst the emphasis at the moment is on respiratory and frailty for virtual wards, that will change in the future and the technology needs to be able to adapt with that. Ensuring that your technology also supports integration with different clinical systems and different devices is also key.”

The presentation then moved on to real world examples of a respiratory virtual ward that Inhealthcare have been developing with an ICS.

“At a high level, I’ll provide you with some information on how the virtual ward service works,” said Jamie. “Firstly the patient is added from the NHS spine and we capture important information such as the patient’s registered GP practice, which can be used for integration later on. The patient is then referred onto the pathway and information is captured such as any bespoke patient thresholds and the method by which to contact those patients.

“The patients then receive onboarding messages from the system and they can receive notifications to input their information based on the frequency set in the pathway or against that individual patient. Once the patient inputs their results and the results are checked against the threshold and an algorithm such as NEWS2, that then determines whether alerts need to be raised for clinical teams to investigate. All the information is displayed in a dashboard so that it is immediately visible to the teams in the virtual ward. From here, patients go into a cycle until they are discharged from the pathway.”

The clinical dashboard is one of the key elements around a virtual ward, Jamie shared. “The idea is that you need to provide clear visibility of all the patients who are in the caseload,” he said, “but in addition, allow for that prioritisation and identification of those who need an urgent review.

“It’s more than just a clinical dashboard that you need to manage these patients,” Jamie continued. “That’s why you also need alerting and clinical workflows that are designed around these pathways. This process allows for alerts to be stratified and filtered to different teams, and workflows can be customised. That then kicks off additional processes such as making information available to different clinical systems for integration and sending additional information to patients or other clinical teams so that they can intervene.

“You also need to be able to manage the exceptions – what if patients don’t respond or what if they don’t provide their results after a number of attempts to communicate? This is really where those bespoke pathways and clinical workflows get built into the service.”

At this point, Jamie passed over to his colleague Amy Frith for more details on the respiratory virtual ward including a live demonstration of how the system works. You can watch this section of the webinar from 22:58.