On 3 August, our digital primary care event will be headlined by Generated Health.
Generated Health is a technology organisation providing psychology-based, two-way health messaging that engages patients continuously to change their behaviours and create better, sustained outcomes, along with supporting its customers to create solutions based on real-life learning and data-led insights.
Ahead of the event, we arranged a chat with Generated Health’s Chief Medical Officer, Doctor Jonathan Serjeant.
Jonathan joined us to share more about Generated Health projects and approach in primary care and across the healthcare system, and their patient engagement platform Florence – Intelligent Health Messaging.
Can you give us an overview of your organisation?
In June 2022, psHEALTH was renamed to Generated Health and will adopt Florence – Intelligent Health Messaging as the global brand.
Generated Health builds healthcare technologies that improve clinical outcomes and drive productivity. I’ve known the company for a good 15 years because they used to do some work for me in my previous business.
We have one tool that’s all about referral management called ART (Intelligent Referral Management) , but the main tool and focus is Florence – Intelligent Health Messaging. It’s is a digital health solution that engages patients via personalised text messaging, supporting them to self-manage and allowing clinicians to monitor remotely.
Florence has been around for about ten years; Generated Health purchased it about a year and a half ago, and we’re focused on investing in it so that we can drive behavioural health. It’s about empowering people to manage their care through behavioural activation and giving people a really good structure across the year around long-term conditions and vulnerabilities.
Florence – Intelligent Health Messaging really is the front of our business. What’s beautiful about Florence is that it started life as a super simple idea; how could text messaging activate people’s behaviour, engage them and help live healthier lives. What’s amazing about it is how much engagement we get from clinical leaders to drive the algorithm development. It now has over 20 million patient interactions, plus an enormous amount of evidence underneath it, much of it independently evaluated, publications in good journals, and it’s got over 120 validated algorithms that drive specific outcomes in patient experience, clinical outcomes, workload reduction and return investment to the system on a PCN level.
We’ve got teams in America and here in the UK, and we also have some contracts in Australia.
What’s your role? Can you tell us a bit about your background?
I’ve been a GP for 25 years and a GP Partner for about 16 years. I’ve always had a portfolio career – always looking at the problems in front of me and try to work with other improve care. I’ve got a bit of an entrepreneurial background; I’ve founded four companies with two of them going on to become successful medium-sized businesses, one in diagnostics and onc called Here (Care Unbound) which is all about improving care around people’s needs. It runs a lot of healthcare services in partnership with the NHS, third sector and independent sector e.g musculoskeletal, dermatology and IAPT (Improving Access to Psychological Therapies). We built a start-up within that one called Practice Unbound, which focused on driving productivity and efficiency of general practice in terms of new roles and technology. Over three years, we implemented new ways of working and technology to about 35 percent of all GP practices in the UK.
I also have a particular passion around supporting people to be the best leaders that they can be. I co-founded a leadership network called NHS Collaborate across the UK – it’s built around 700 new primary care leaders. The most important part is about building relationships; helping people share vulnerability, helping them to build tighter relationships together so that they can take more risks together and maintain resilience.
What are some of the projects that you’re currently working on?
One of the current UK priorities is hypertension identification and control– we’ve heard lots of things about checking your blood pressure at home, how we can find the people who are under-diagnosed, which populations are not getting that kind of healthcare? On the back of the COVID vaccination programmes, we’ve found that we can get to people if we think differently. I think there’s going to be a real focus in the next two to three years around blood pressure because it affects so many different diseases.
We have some really established protocols around this. One is doing remote blood pressure management, picking up people’s blood pressure across seven days. We also have a protocol that holds you if you have hypertension in your year of care, nudges you to ensure that you are taking the right medicines which is critical to blood pressure management. It also engages you in wider information that supports better living – smoking, exercise, weight loss, et cetera.
I think the area in which we differentiate from the market is that we activate behaviour change to empower people to self-manage. There’s no point picking up loads of data and doing lots of remote management and remote data collection – it just drives workload into primary care and community trusts. Our intelligent health messaging platform analyses the remote monitoring data and plays it back to the patient, so that they do something with it. We are able to titrate people’s medicines, always in partnership with a clinician, so that you really minimise the amount of times people have to come into a practice. We also give people small amounts of educational information around their illness so that they can be more informed and make better decisions about their health.
These protocols have been in practice across NHS Scotland for about eight years now, all driven from a solid evidence base of what makes a difference to people’s behaviour.
Another interesting project is in Northern Ireland, we provided a 12-week weight management reduction programme that’s text message based. It was offered to all NHS staff and about 5,000 people signed up. We can not only drive health care efficiencies for patients, we can also make staff feel cared for.
In terms of future projects, we’re looking at virtual wards – how can we support people to have their own agency around their own healthcare as they come out of hospital?
Our focus is on long-term conditions in the broadest sense – BP, COPD, Asthma, Diabetes but also anxiety, depression, or pain management. In that sense, we can make a big difference to things like the waiting list backlog. Whilst people are waiting, how can they help themselves manage their health so that when they turn up for their intervention, they’ve got the best chance of the best outcome.
Can you talk about some of the challenges you’ve faced, and how you’ve tackled them?
Let’s talk about people first – digital inclusivity is fundamental. COVID has shocked all of us, woken us up, and we need to hold onto what we learnt through the pandemic so that it doesn’t disappear. It highlighted the health inequalities that are created by the design of systems, along with all the social factors that we create in our society, it isn’t acceptable. If we’re going to implement new technologies, we’ve got to pay attention to health inequalities. At a minimum, we’ve got to make sure that new technology doesn’t worsen inequalities, it should start to narrow the gap.
Communication can be a challenge with people. Everyone talks about health apps, and there’s really clever stuff, but what I like about Generated Health is that it’s just simple text messaging with a level of intelligence. You don’t need a smart phone, most people have a text messaging capability. Interestingly, for healthcare purposes like ours, text messaging is well taken up by young people, but also in the elderly and with carers. So it’s really inclusive from an age perspective. Obviously, you need to have extra types of solutions to support people where they can’t see, for example, so we can augment that with some automated telephone messaging services.
To overcome engagement issues with people, we get them to help contribute content for our algorithms. For example, we worked with some Romanian gypsies, to try to get them into a weight management programme. They didn’t respond initially, so we got members of the group to write the language themselves, to engage their community. It made a big difference to the amount of people who engaged in the programme.
Another challenge is time to engage, think and plan as a clinical team. We have to be pretty adaptable to make sure that we capture people’s attention at the right time and then be really focused around working with people to understand the problems that they have. We build our algorithms from real world, ground-up problems, which is why I think over time Florence engages real clinical champions all over the country. I think the key is to work with people to be really clear about the population that they want to make a difference to. That’s our main focus when we talk to them at the beginning of our implementation process. If you get that right at the beginning, then writing and building the algorithms and using them to change people’s behaviour is a lot simpler, and people see a return on investment rapidly after implementation.
Can you tell us a bit about your partners – who are you working with, and in what capacity?
As Generated Health has been around for a decade, we are in acute trusts, community trusts, mental health trusts, primary care networks and general practice. We’re right across care pathways and Florence has the ability to be a whole system technology. To get it to that stage is a big step, and it takes time.
For example, we’ve had a long-term contract with Nottingham ICS and they use us all across the system – they have an ICS contract with us, and they’re able to make impact within the hospital and particularly with their mental health services. At the same time, we can do long-term condition at primary care level in Nottingham. People can really bespoke it depending on the different populations that are being served around Nottingham.
We’re doing some very interesting work in Sussex, where we are focused on blood pressure management and health inequalities. We’re working across three primary care networks and comparing the three of them, looking at how to identify people who haven’t been diagnosed and identifying people whose blood pressure is out of control, to bring them back under control with our titration algorithms. Critically, we’re looking at who is not engaging. They’ve invested in extra workforce time so that they can really focus on how to reach those people who haven’t traditionally engaged in their care.
Can you summarise some of the outcomes from your projects?
It’s all about focusing on the outcome you’re trying to achieve. We’re very clear about the need to try and pigeonhole it into one of the four quadruple aims.
With improving patient care, we’ve had fantastic feedback from patients around feeling cared for, even though they know that it’s a computer solution, they feel cared for by the organisation that is looking after them.
In terms of clinical outcomes, we’ve got a whole list of examples – two examples are the fact that we’ve reduced hospital admissions through COPD management, and more people are achieving blood pressure targets if Florence is used.
Workload reduction is critical. You’ve got to have a workload and life balance in practice teams. In Sussex, for example, they are going to use Florence to make thousands of admin process efficiencies in the initial phase, and then they will work on clinical time in the next phase.
Then there’s the return on investment, which I’ve touched on briefly already. If you bring down someone’s blood pressure by 10mg of mercury, you reduce heart attacks and strokes by 20 percent. If you use Florence, you reduce blood pressure by 5mg, more than if you didn’t use it, so we’re halfway there. That’s what drives all of us in the team, making a difference to peoples lives together.
Many thanks to Jonathan for sharing his time and thoughts – remember to join us on 3 August for our digital primary care event, at which Jonathan will be speaking. Click here to register for your ticket.