It’s time for the second part of our latest industry view feature, focusing on technology within integrated care systems.
In this edition, we pose the question of where, within an ICS, technology will have the biggest impact.
Without further ado, here’s what our respondents had to say…
Nick Weston, Chief Commercial Officer for Intelligent Lilli, said that technology has the ability to “deliver the biggest impact through preventing admissions to hospitals and stemming the flow of patients through the system” which will “alleviate the pressure on ambulances, hospitals, community care, GPs and social care providers.” However, he noted, the challenge for ICSs is to understand “what technology can be deployed and in what setting to have the greatest impact. Our insight and feedback firmly points towards using non clinical measures to create a preventative culture. Observational data and insight that highlights need is where ICSs need to be investing. Using technology in frailty for example to slow down and stop those who score 3 on Clinical Frailty Index from progressing to a 5 or higher.”
Technology has a major role to play in “resolving many of the workforce challenges currently plaguing ICSs,” said Dr Kit Latham, co-founder and CEO of Credentially. “From recruitment to credential checking and onboarding, existing workforce processes in use across healthcare are disjointed, frustrating for employees and costly to employers. By introducing new technologies specifically built to get new staff into their roles as quickly as possible, whilst ensuring that regulations are consistently adhered to, staff gaps can be filled and colleagues better supported to perform their roles in a sustainable way. Ultimately, this will improve morale across the ICS and drive up standards of service delivery.”
Stef Lunn, Adult Social Care Practice Lead for OLM Systems, commented: “This question almost answers itself; Integrated Care Systems need integrated information systems. Multiple organisations can better serve their shared population when they understand its assets and needs. Modern technology solutions ensure that relevant, person-centred information is available to the right people at the right time.
Using the power of cloud hosted software, commissioners and providers can share information in real time, Stef noted. “This is especially important for people who are in touch with multiple health and social care organisations, who would rather tell their story just once. The boundaries of information sharing can now be set by the person, rather than organisational infrastructure.”
“One of the primary aims of an Integrated Care System is to tackle inequalities in outcomes and access to care,” commented Brian Boys, Managing Director of public sector IT specialists Kingsfield. “This is where the impact of technology is most apparent. Improving connectivity within the healthcare sector increases the quality of care as communication between staff and patients alike is enhanced.
“When it comes to access to care, the option of self-care is available to patients via the use of technology. Wearable devices like an Apple watch allow patients to monitor their own care from home, meaning they no longer need to wait for in-person appointments. This also alleviates pressure on healthcare providers who may be struggling to see every patient in a timely manner.”
Mark Burton, Health & Social Lead, Virgin Media O2 Business suggested that the biggest impact technology will have on the future of care will be “to move more of this care from the traditional in-patient care environment back to ‘at home’ care environment.”
“There are lots of obvious beneficial impacts around shared care records, joining things up, increased visibility of the patient within the system,” said Matthew Riley, Head of Informatics at Here. “What is perhaps more interesting are the things that an ICS could enable that don’t currently exist. An example is much better use of analytics to support decision making, such as measurement of health outcomes and linking these to patient interactions across the entire system; so that we understand where we are delivering the greatest benefit and what really matters to patients.
“It’s tempting to see this a call for ‘big data’ solutions and centralised resources, however in our experience it’s much better to keep the analytics close to the coal face (where people understand the connection between the data and the care delivered), and for the ICS to act as mentor and supporter.”
Over time, the impact of technology within an ICS will be “underlined by clinicians being able to better manage and increase access for patients,” noted Dr Noel O’Kelly, Medical Director at Spirit Health. “The key to this is showing ambition. ICSs should be steadfast in their commitment to technology, and adopting it as widely as they can in order drive a sustainable, positive impact for patients and clinicians that can accrue over time.”
Clare Morris, CEO of Rethink Partners, suggested that with technology we should “start anywhere – take a single team or service, but do the full tech wraparound as a test environment and don’t be scared to prototype, test the impact and then roll out on a bigger scale. The NHS loves a big bang roll out of a single system or product and this makes it more manageable. Create a small, but fully enabled digital service or team – with good culture/change support and service redesign. Learn the lessons, make it work and then replicate and scale.”
“Technology will have the greatest impact in ICSs in two key ways,” said Robert Miller, CEO of Wellbeing Software. “Improving movement of data across the system and identifying ways to improve technical workflow efficiency. As we head into winter, finding efficiencies in time, resources and costs will be critical for every ICS organisation.”
He added: “The NHS is experiencing seemingly insurmountable appointment backlogs and referral times, driven by significant capacity pressures. While only a small part of the solution, technology that facilitates cross and inter-organisational interoperability supports better information sharing, reducing the time it takes to access important data like test results and patient information held across different systems. Consequently, clinicians will spend less time manually entering and re-entering data in numerous systems, freeing up more time for patient care.”
Since the mid-1990s the NHS structure in England has “persisted with an organisational structure built on concepts of market choice and competition,” stated Andy Kinnear, Partnerships Director at Ethical Healthcare Consulting. “This has created a culture where organisations have felt the need to compete, including on the design and delivery of technology architecture and solutions. At times that has led to inefficient design, duplicated technologies, poor user experience, inability to share key data and a poor use of limited investment.”
The ICS initiative offers a chance to “drive a collaborative approach to healthcare across a geography and will create an opportunity for a more efficient technology programme,” Andy shared. “The impact should be everywhere from better networks, more joined up clinical systems, cheaper back-office services, better data access and analysis – all of which ultimately delivers better clinician experience, faster and safer care and higher morale for our frontline professionals facing the most difficult of circumstances right now.”
Vaish Khullar, Founding Data Scientist at Monitor Analytics, said that from a data lens “(good) technology allows us to collect, store and manage data effectively. This paves the way for a future of significant innovation, and just enabling access to good-quality data is sufficient to start the process off.”
In the present situation, “the biggest impact will be helping to address capacity challenges,” noted Alan Payne, Director, The Access Group. “Namely delayed discharge – there are innovative ways to manage supply and demand to enable a faster, more efficient and appropriate step down from acute to community care, akin to an Air-BnB model of mapping capacity/availability.”
He added: “And with a renewed commitment from government to tackle the problem, as announced in the autumn statement, now is the opportune time for ICSs to capitalise on these solutions.”
Paula Ridd, General Manager for Altera Digital Health UK, commented that in her view technology’s biggest impact will be in helping ICS organisations to share information more effectively, so that they have a full picture of a patient and their care. She said: “However, simply deploying technology will not have the impact we need. How it is implemented and joined up is just as important. Data sharing holds huge potential to drive transformation, create efficiencies in care delivery and improve patient experiences of care. However, interoperability between systems and across care settings is a prerequisite for making this a reality.”
Successful use of technology within ICSs will “provide an opportunity for patients to receive more streamlined care and improve their health outcomes. We’re seeing this begin to happen at organisations like Gloucestershire Hospitals NHS Foundation Trust, which has developed an ICS dashboard which is facilitating faster discharge and joining up processes across the region.”
She added that interoperability is essential if projects like this are to be scaled and for the whole ICS to benefit from technology deployments. “There is a lot for us to learn from countries with more digitally mature health systems who are already benefiting from this, such as in Israel, which nationally shares and uses health data. An important step will be to ensure that the data and interoperability standards being created for the NHS are extended to all ICS organisations, or data will stay siloed and joined up care will always remain an ambition.”
As these programmes mature, “the biggest impact will be felt most significantly by empowering people to have input into their own care, through contributing to their own records,” said Matt Cox, Managing Director UK and Ireland at Better. “Previously people have not always had a voice, which has made truly personalised care something that is often spoken about, but not always delivered. Providing the ability for people to make a contribution to their care brings together various settings, making it possible for genuine holistic, connected care to be provided.”
Paul Landau, CEO of Careology, commented that he sees tech as having the biggest impact on the entire cancer care pathway, “particularly at the point where patients begin the daunting process of learning about their specific cancer. Technology which adds a more personalised experience would help to eliminate people researching the wrong information at the wrong time and becoming more anxious.”
Tech enables people living with cancer to “keep on top of their numerous appointments and understand the side effects of their treatment, preventing many requiring more acute care. With a rapidly growing cancer population a blended care service which empowers patients will have a compounding impact across ICSs. Combining digital and physical care will help ICSs to harness cancer resources and healthcare teams will benefit from operational efficiencies.”
Craig Oates, Managing Director, Doctrin UK, noted that if we begin “with the end in mind, as Stephen Covey advised, some of the biggest benefits that technology can enable are increasing efficiency and capacity across ICS services to provide safer care for patients, while reducing pressure on the workforce.”
In practical terms, an ICS will get the greatest impact from “integrated care navigation platforms and population health management. We’ve seen how the first-generation online consultation and triage solutions can impact and support care delivery in primary care. And taking that a step further to the second generation, we’ve seen customers reduce an average five-week wait for non-urgent appointments to two days and frequent attenders by 39%. This is a game changer for any GP practice, trust or community service, and will reduce pressure elsewhere in the system.”
He added: “Likewise, identifying those technologies most likely to have high impact or enable regular targeted interventions earlier in the patient journey, and providing a whole-person care plan using PHM, will have a significant downstream impact on those individuals’ lives and their need for longer term care across the system.”
For Mark England, CEO at HN, primary care is at the heart of sustainable health and care systems. He commented: “By arming primary care networks with data and prediction tools we can begin to manage health and care in a completely different way. Using data, we can see who the individuals are with rising health risks and identify the right patients for proactive support, such as health coaching. This moves away from a purely reactive model and has the potential for more person-centred care.
“Health coaching empowers people with long-term conditions to be active participants in their own care and prevents them from needing to use congested unplanned care pathways.In the face of rising demand, primary care is where this will have the biggest impact. Tech has the potential to enable a streamlined and integrated urgent care system will be fundamental in creating lasting change.”
Andy Meiner, Chief Revenue Officer for ReStart, stated how he is confident that new ICS structures will “force CIOs and boards to take a step back in order to focus on how information can be best utilised across a geographic region to meet the challenges presented as virtual wards, integrated clinical pathways, system convergence and trusts merge over the coming years.
“For example, remote monitoring should result in better outcomes for patients that don’t need to come to hospital and patient engagement platforms will empower the citizen to take direct control of their own care and reduce the need for hospitalisation. Data will ultimately provide insights that allow an ICS to focus on wellness rather than illness.”
Whether served by a single EHR or an ecosystem, “when working within the operational boundaries of the organisation frequently the EHR meets the needs of users adequately,” noted Dr Richard Pratt, Clinical Director at Eva Health Technologies. He continued: “Though there may be opportunities to refine the functionality or user interface, they are good enough. But patients move around the system. When we they do, these transitions often expose any weaknesses in the software that are so critical to provision of care.
“So it is at these boundaries between services where the greatest opportunity for improvement lies both in quality and efficiency. “Say it once” should be our driving principle. A reimagined system would mean critical information is gathered and shared effectively, such that patients and clinicians only ever need to say it once…”
David Kwo, Healthcare Consultant commented that “when EPRs are shared between GPs and hospitals, which is only a matter of time, because it is in the interest of the patient. For instance, GPs and hospitals using the same EPMA module will remove the need for medications reconciliation and documenting care on the same record will remove discharge summary transmissions and delays.”
Many thanks to all respondents for taking the time to share their thoughts.
