For our HTN Now: Citizen Transformation event we were joined by Ben Panton, Senior Digital Partnership Manager for NHS Arden and GEM Commissioning Support Unit, for a discussion on developments in home diagnostics, with focus on the latest trial plans and patient reactions and perceptions around remote diagnostics and artificial intelligence.
Ben began by establishing some background information on NHS Arden and GEM CSU, explaining that they work with over 90 organisations across health and care systems such as local authorities, ICBs, trusts and primary care services.
“I’m particularly focused on the digital transformation side of things,” he said. “I’ve been in post for around six months now, working with colleagues across our digital and IT teams. Our particular focus within digital transformation service redesign has been working with potential partners such as the ICBs, to really understand their digital priorities and challenges, and how digital solutions can potentially mitigate some of the challenges that are being faced by the NHS, social care, and local authorities.”
Ben brought the discussion to focus on two elements that he and his team have been working on: remote monitoring, working to support timely discharge or monitoring patients once they have been discharged to support them at home, and remote diagnostics, working towards enabling early interventions and getting diagnostics closer to home.
“A key element to this, and the focus of a lot of work we have been doing with partners, is that foundational block around connectivity,” Ben said. “It’s important to recognise that you can’t run before you can work. Sometimes we’ll be working with partners who maybe don’t have that baseline connectivity in place to allow us to enable a lot of solutions, and other times we work with partners who’ve got 5G and satellite capability which means we can explore the potential power of that.”
He added: “Obviously the other element there is patient engagement. Arden and GEM do a lot of work on different methods of communicating with patients to really get their feedback on technologies and how digital solutions can potentially help them with the challenges that they face.”
The diagnostic challenge
Ben provided some statistics which showcase the backlog of referrals for patients awaiting endoscopies in the UK, reaching 435,000 as of January 2022.
Ben acknowledged that in recent years, there has been a media focus on bowel cancer with the deaths of high-profile celebrities such as Chadwick Boseman and Dame Deborah James, which has prompted a keener awareness of the disease and the importance of early diagnosis.
He said: “The key point to emphasise is that early intervention is critical. If we can catch it in stage one or two, there is a much better outcome”.
Ben pointed out that innovation in pathways and technologies, such as moving diagnostic capacity into the community, can help to tackle these challenges and give citizens greater control and choice over care.
He noted that an option is to “take the actual diagnosis, the methods for early identification of conditions, and pilot different pathways for patients. Obviously, this involves a lot of effective triaging of patients so it’s not going to be suitable for everybody. But we can work with clinical colleagues to explore where this is potentially of benefit to certain cohorts of patients, and we can explore the potential impact of that. Can it reduce some of the demand pressures that are directly on the main acute trusts at the moment, can it release pressure on clinical time and facilities?”
For context, Ben commented that adoption of these new community-focused pathways has perhaps been a little slow in England, comparing it to some work he has seen in rural areas of Scotland where “there has been a real focus on exploring community methods of both service delivery and diagnosis. I’d say that this is gradually starting to transition and pick up patients in England as well.”
IntelliGI
Next, Ben moved on to discuss a pilot project bringing together partners with clinical, transformation and technical expertise: Arden &GEM CSU, CorporateHealth, University Hospitals Coventry and Warwickshire NHS Trust (UHCW) and West Midlands 5G. The project has seen the introduction of at-home diagnostics enabled by connectivity improvements, an increase in home testing and changing mindsets around self-care and patient control.
Ben said: “Firstly the project focused on the method for actually delivering a colon capsule and the supporting requirements around it out into the community. The team effectively developed and trialled what we refer to as a smart box, and essentially it’s got all the kit you need – the capsule itself, what you need for bowel preparation, medical guidance. It gives the patient the ability to self-administer and work their way through the process.
“Alongside that, we had to develop standard operating protocols (SOPs). That involves working out the actual pathway, from that virtual appointment where a nurse will interact with a patient and explain the requirements of what they need to do and what they need to take when, to being there when they physically swallow the capsule and go through the process. That brings me back to the importance of connectivity, as that is based on having underlying connectivity in place within the patient’s home.”
At the moment, Ben shared, they are working with UHCW to pilot the procedure on around 40 patients to collect their feedback on the progress and test the delivery and set-up process. “Hopefully, we can build on that and scale it around the coming months,” he said.
Capsule endoscopy delivery at scale through enhanced AI analysis
“The second element of colon capsule delivery is all around the analysis of results and the images that are being collected,” Ben said. “There’s a recognition at the moment that it is a critical part of the process but it is a significant time burden for the clinical colleagues who are having to read and review those images.”
As part of this, Ben shared how Universitat de Barcelona has reviewed around 1.3 million images from colon capsules and colonoscopies to build an algorithm capable of identifying suspicious items that potentially need further examination.
To analyse the results of their project, the CSU is working with partners taking a lead on different factors: UHCW is taking clinical lead, Universitat de Barcelona is focusing on the AI side, and CorporateHealth is the project lead. 674 patients within the UHCW area are having their images analysed by the algorithm.
“Whilst this is being developed, the images are going through both the traditional pathway of that standard clinical analysis along with the new AI approach,” Ben said. “The outcomes of this project will be a comparison of those pathways to see how they can potentially benefit clinical colleagues and reduce some of the time pressures that they face in reviewing these images.”
Patient reception and reaction
At this point, Ben moved on to discuss some work Arden and GEM did with NHS Innovation in an earlier project around patient engagement.
“We ran some focus groups to get feedback on patient perceptions around both colon capsules and more broadly artificial intelligence and the reading of images,” Ben said. “The feedback we got showed that around 75 percent of participants said that they would prefer capsules, though I must caveat that and point out that there was a lot of discussion around the need for ongoing evidence and reassurance to patients; they felt that further work needs to be done around conveying the evidence that they are as effective as a standard colonoscopy.
“80 percent of participants were very positive about the use of artificial intelligence in image reading,” Ben continued. “There was a lot of talk around what is actually meant by artificial intelligence – one of the broad messages that came back was that patients felt that something like ‘computer learning’ might be better terminology. I think that clarity of language is very important in the digital sphere, making it as straightforward and clear as it can be for patients. They need to know what’s actually happening – for example, is a human still involved in reading the images as well, what is the AI part of the process actually doing?”
Ben noted that bowel preparation is “part of the process that some patients obviously do find a challenge… it was critical that they had interaction and support from the nursing team, to help them in working their way through that process.”
On patient experience, Ben said that obvious benefits were raised such as reducing the amount of travel time, saving on parking costs and supporting patients in being more proactively involved in their own care. “They felt it was working in partnership with the clinical teams rather than having something done to them,” he commented.
In addition, Ben noted that there were discussions in the focus groups around how this work won’t be suitable for all patients, and the need to work with clinical teams to identify the cohorts where this pathway can be of most benefit.
Scaling innovation in endoscopy
Finally, Ben shared some general thoughts on how the project can be taken forward over the next few months.
A key element is “building the evidence base,” he said, “working through, taking these pilots forward and collecting information and analysis from them, along with patient feedback around their involvement in the process and whether the pathways work for them.”
Clinical engagement is critical, Ben pointed out. “It’s great to have UHCW in this instance overseeing the clinical oversights and acting as clinical champions for how this can be taken forward.”
Ben took questions from the audience from 20:37; click on the video below to watch his webinar in full.
Many thanks to Ben for taking the time to join us.
