For our December innovation series, we spoke to Open Medical’s Director of Innovation and practising orthopaedic surgeon Piyush Mahapatra on clinical digital innovation.
Piyush discussed what clinical digital innovation means to him, its benefits and challenges, some of the innovative programmes he himself has been involved in, and more.
Clinical digital innovation is…
Clinical innovation is really around clinician-led co-design. There is a lot of technology out there in the industry and a lot of it is designed with different user groups in mind. Ultimately, the innovations that have proved to have the most value and demonstrated the most benefits are the ones that have significant clinician involvement all the way through from the early concept through to scale and adoption.
These innovations tend to solve real problems. They’re not just chasing the headlines. You hear a lot about artificial intelligence and other technologies; there are some pockets of very good practice in those areas with heavy clinical involvement, tackling problems that people are facing on the floor.
Clinicians recognise the importance of patient choice, advocacy and shared decision making, and this is often represented in their innovations. At Open Medical, for example, we have a patient and public engagement coordinator who works to ensure that the patient voice is captured within any innovations that we provide, because the solutions are designed for their benefit.
Benefits of clinically led innovation
One of the real benefits is that these innovations have been thought through operationally. People design them in such a way that they can be utilised effectively within a clinical environment. They focus on how an innovation works in practice, rather than a notional idea of how it could work or theoretical benefits.
Often, theoretical benefits don’t survive the challenge of the real world clinical pressures. Everyone knows the current state of healthcare systems. It’s not just the UK, it’s global – there’s an understanding that healthcare is extremely pressured and the innovations really have to fit within that environment.
The other benefits are really around adoption, which can be a major challenge in healthcare and in healthcare technology. It’s reasonably straightforward to get something piloted once. It’s very challenging to get it scaled and adopted across entire healthcare systems. Again, this challenge is often solved if the innovation is clinically-led because the leadership and design team behind that innovation really understand the end user. If you provide tools that the clinicians can utilise efficiently and safely and it makes their day-to-day work easier, then they will naturally adopt it and you’ll release a lot of those benefits in a much more defined way.
I think we’ve seen difficulties in this area with earlier technologies that we have implemented in healthcare, with things like the electronic patient record systems – there are some cases where the value hasn’t yet been realised because they don’t have that very strong clinical focus behind them.
Giving clinical digital innovation the best chance of success
To give them the best chance of success, it’s important to make sure that these innovations aren’t stifled, and they need to be encouraged.
The landscape is changing for the better. I’ve had a very fortunate personal experience, in that I was supported a lot throughout my innovation journey alongside my medical training. There are fantastic programmes like the Clinical Entrepreneur Programme that really provide a framework for NHS entrepreneurs. I’ve heard of stories from a few years ago where people were asked to choose whether to continue with their innovation or their medical training and it was effectively an ultimatum. With that, you lose a lot of your expertise out of the healthcare environment.
The best innovations come from people with a diverse portfolio because they can draw inspiration from different sectors, whether that be technology or finance, and apply it into healthcare and vice versa. The understanding of that has improved a lot. National structures to support this are now realising its worth. For example, the Royal College of Surgeons is due to set up an innovation hub to encourage this within surgery.
Locally, there is considerable variation between organisations but the direction is certainly changing. My local trust (West Hertfordshire Teaching Hospitals NHS Trust) is promoting innovation very strongly, all the way from board level downwards. They’ve recently created divisional digital innovation leads with the aim to encourage clinician involvement in the digital innovation environment within hospitals. This needs to be fostered but not too rigid – there is a risk with innovation that if you provide too many rules and structures, it can stifle the innovation.
There are a few national programmes that are trying to move towards integrated innovation training, so that would mean it is part and parcel of your medical career. I recently attended the Future Surgery conference and you could tell there was a huge appetite for this amongst our future surgical workforce. Ultimately, all of this will benefit the NHS massively, particularly given the ongoing concerns around workforce recruitment and retention. Giving people that extra avenue to explore and pursue their passions is certainly something that should be promoted.
Challenges and solutions
The challenge, early on, is always around getting your innovation utilised. Depending on what your innovation is, there is quite rightly a very high regulatory threshold. You need to make sure that your innovation reaches that level in terms of information governance, security principles and so on. It can be a challenge, particularly as that pathway is not necessarily easily defined. I’m involved in a pilot programme to look at creating a roadmap for this – regulation should absolutely be there, but it should be clear how people can achieve this threshold rather than it being a learning exercise to identify what those steps are. It should help those that follow tremendously.
The other resistance is often found where there is divergence from strategy. Technology is moving at such a fast pace and strategic agendas tend to be set on a slower cycle, especially in regards to technology and innovation. Often, a new innovation appears which may conflict with the agenda in the short term, that can lead to people not understanding the value that the innovation can offer. Again, tackling that is around encouraging and fostering the environment where innovation can flourish rather than stifling it due to the underlying long-term strategic agenda. That really only gets solved from exec level down. I’m very fortunate in my trust – they’re very forward looking and it feeds down from the leadership.
Looking at ways to tackle the challenges, I think persistence certainly helps. If you are a clinician working in this area you will understand the daily problems and the magnitude of what you are facing. It’s unlikely that those problems are going to go away if they’ve caused you an issue to the point where you’ve tried to develop a solution to solve them.
Things do move and change; I think if you are persistent and confident that your innovation is correct, then continue. Early on, that’s what got us through at Open Medical. We also have a significant amount of technical expertise and that has really helped us thrive in that environment, so I’d encourage people to look for a strong technical partner, unless you have sufficient technical expertise yourself.
Experience with innovation projects and programmes
We are involved in quite a number of large-scale innovation projects across multiple geographies and the NHS has done a fantastic job supporting these through initiatives like the Small Business Research Initiative.
A particularly exciting project we are working on is around skin cancer – it’s one that really fits in with the direction the NHS is headed towards with integrated care systems and community diagnostic centres, and we’re being supported by the NHS England cancer teams on this.
Rather than healthcare providers operating in individual compartments, we’re providing a whole pathway-based transformation tackling the acute issue in dermatology, specifically with skin cancer. It aims to really optimise the patient journey and bring some of those care elements closer to home, increasing the skills and capability of our existing workforce and utilising them more effectively. Ultimately, we want to help patients to get diagnosed and treated faster, which should save quite a few lives. We’re about halfway through now with some very promising early results which we’ll be able to share in due course, and we’re looking to scale that across significant parts of the country.
Another project is around some of our sustainability and net zero work. We’re looking to see how we can make surgery in the NHS more sustainable, both in terms of environmental sustainability and operational sustainability. We all know the pressures that the NHS is facing at the moment with waiting lists – this project is about considering ways to use digital technologies to deliver surgical care more effectively and sustainably. Once again, we’re taking a whole pathway-based transformation approach to that.
In terms of what makes our projects truly innovative is that we are looking at end-to-end solutions from community care all the way through to cure or long -term remote monitoring, and everything in between.
We’re working on the South East London telederm project; that’s looking at an integrated teledermatology service across three major providers in the area. We’re operating a very interesting model there whereby clinical histories are taken directly from the patient, medical photographers conduct high quality imaging, and then patients are assessed by a dermatologist with a triage decision being made. Often the patients are diagnosed there and then. Some patients who require further investigations are then booked in for those immediately.
The aim is to show significant pathway efficiencies: how can you see the highest number of patients possible as efficiently as possible and give them the best care that you can? There are also opportunities to help even out peaks and troughs in demand so that you can utilise staff more effectively across three sites, and again, it’s an opportunity to address those backlogs.
Another interesting project we are working on is with the Royal National Orthopedic Hospital. It’s an end-to-end pathway transformation across all of their care, including both acute and elective care. We are currently managing all their referrals with our cloud-based platform, whether those be emergency referrals or planned referrals through the electronic-Referral Service. We’re providing a triage capability and moving towards complex work around post-operative outcomes. It’s an exciting project because it’s a true end-to-end innovation across a whole enterprise or ICS, and they will hopefully help transform the way care is delivered at surgical hubs.
Innovation in the health tech industry at present
My overall feeling is that things are changing for the positive. Clinical leadership within innovation really needs to be encouraged. There are good examples of that, such as the Entrepreneur Programme and the National Innovation Accelerator which are trying to provide some structured training for individuals. We need to encourage that.
There are some fantastic examples in other countries as well. The Republic of Ireland has the Stay Left Shift Left Initiative, which aims to encourage more community-based and at-home care, and to deliver that on an ongoing basis with a significant step change driven through digital innovation.
In terms of looking for other opportunities, there is a lot around culture change. There are opportunities to introduce integrated innovation training, to have it form part of people’s portfolio if that’s something that they are interested in. Hopefully, that will feed through organisations to better their understanding that change will happen, it needs to happen, and how to learn from it. Ultimately, we need to point change in the right direction, so that it continues to drive benefits and improvement.
Advice to people looking to launch innovative projects in their own organisations
First and foremost, if you believe in it, be persistent. It can take some time to get things through.
Listen to feedback that you get because that’s how you learn. You might improve your offering based on that.
If people are telling you no, initially, try to understand why. Ask them for the solution – what would make them say yes?
The other thing that I think people sometimes miss is asking for the counterfactuals. By that, I mean asking what happens if we don’t use that innovation. Sometimes, particularly with large innovations, there is a sense of inertia and it can be difficult to instigate change. The cost or implication of not taking the innovation on is often overlooked so it’s probably worth trying to identify that. It will help you in your own proposition, because you’ll be able to take that forward and state the benefits.
Many thanks to Piyush for joining us. To read more from Piyush, you can find a previous interview with HTN on cloud technology here.