We recently spoke to Dr Jonathan Serjeant and Matthew Davies on the partnership between Generated Health and Bedfordshire, Luton and Milton Keynes ICB, with focus on the implementation of Generated Health’s intelligent messaging platform Florence.
Firstly, we spoke to Jonathan to get an overview of Florence, how the platform works, and some of the benefits. Here’s what Jonathan shared with HTN…
I’m the chief medical officer of Generated Health. I’m a GP by background for around 20 years and I’ve always worked in organisations that focus on how to redesign the way in which people experience their healthcare services.
Generated Health runs the Florence platform, an intelligent messaging platform which is there to support people to self-manage their care and support clinical teams to reduce their workload in their normal daily routine. We know that managing a long-term condition can be quite complex, particularly when you develop conditions such as diabetes or hypertension. There’s a lot for patients to learn and Florence delivers the prompts, nudges, reminders and education required for patients to break bad habits and form healthy new ones.
How does it work?
The key to adopting new technology is inclusivity. We want to reach as many people as possible with the simplest form of communication. Our platform uses SMS text messaging, as it’s well evidenced that this is the best form of communication for patients if you’re wanting to include as many people as possible, because you don’t need a smartphone to make it happen.
Using text messaging, Florence creates a connection between that individual and the clinical team, wherever they are, and maintains communication with them. You can learn more about your disease and send updates to Florence so that the clinical team know how you are getting on. It’s all about helping people to not feel alone in their care.
Florence can help you structure your management of the condition and implement a behavioural change towards a better and healthier life. For example, It can support you with changing eating habits or taking your medications appropriately. Patients love it too – we have really good take-up of our algorithms and we also have good completion rates to illustrate this.
Working with customers
We have a lot of time for our customers. We pay a lot of attention particularly to new customers who are wanting to innovate new things – we spend a lot of time with them from the beginning to understand what the problem is that they want to solve and to identify the population that we can make a difference to.
We can then look at our library of protocols and pick out different aspects to really focus on the behavioural change that the customer wants to achieve, and the efficiency that they want to achieve.
Generated Health has customers in the UK, and also in the USA and Australia. We learn a lot from the different places in terms of what works best for different teams and different patient cohorts.
We also place an emphasis on creating a community amongst our customer bases. We bring them together around specific problems to learn they might be facing. Early 2023 has seen us hold four community events, for example, where people can come and share what they are doing, how it’s going, how they are overcoming any challenges and so on. It helps people from across the country to really make strides together and use the full capability that the Florence platform offers.
Benefits and outcomes
The platform can have an impact on key priority areas for the NHS. Hypertension is one of the areas identified in the Core20PLUS5 approach as a key priority, and Florence has been helping NHS Scotland with hypertension for over eight years. It’s providing support around identification of high BP in the population, diagnosis, automatic monitoring and supporting people to manage their own results. We’ve also created and developed algorithms to allow us to titrate people to best tolerated treatments.
Blood pressure is measured in millimetres of mercury and when you’ve got hypertension, you want to reduce that number. We’ve got independent evaluation demonstrating that using Florence reduces it by just under five millimetres of mercury. A 10-millimetre reduction in your blood pressure results in a 20 percent reduction to your risk of having a heart attack or stroke, so it’s a really significant health benefit.
What’s innovative?
There’s been a huge explosion of remote monitoring off the back of the COVID-19 pandemic, but Florence is different in the sense that we focus on behavioural change. We have behavioural scientists in the team who focus on developing our communications – the language we use, how it is styled, the regularity – to reach as many people as possible, with the aim of activating their behaviour to achieve better health. That’s what effective self-management is – it’s not just about collecting data.
If you just collect lots of data – for example, a thousand blood pressure checks – that information comes into your clinical team and needs processing. Research indicates that this takes six to eight weeks on average. With Florence, 60 to 70 percent of that data collection is managed by the patient.
Looking to the future, we’re working on innovative ways to make sure our messaging is personalised for the right cohorts. People will receive different types of communication and we will be able to assess their effectiveness during randomised control trials which will give us a better sense of the types of messages which work for different patient groups. It’s part of looking at how we can address health inequalities, because we might be able to change the format or content so that our messaging becomes much more personalised.
Matt Davies on how Florence has helped Bedfordshire, Luton, and Milton Keynes ICB
I’m a clinical pharmacist working for the medicines optimisation tea within Bedfordshire, Luton, and Milton Keynes (BLMK) ICB. We work within the BLMK Integrated Care System (ICS), which covers a population of over 1 million, with around 140 thousand people diagnosed with hypertension.
My background is in cardiovascular disease (CVD) management. Prior to my move to the ICB, I was the CVD and stroke lead pharmacist at an acute trust. Since joining the ICB, I have worked closely with our CVD long-term condition group supporting with CVD project implementation. Working on an acute cardiac unit and stroke unit, I’ve seen the devastating impact that heart attacks and strokes have on people and the people around them. I’m very passionate about the primary prevention of CVD and improving the management of our hypertensive population.
How did the partnership with Generated Health begin?
We have been working with Generated Health for around nine months to implement Florence. When we started looking at hypertension and using digital technology there were three key areas that we wanted to improve in our hypertension pathway. We wanted to improve the efficiency of the process of the annual blood pressure (BP) check to reduce the workload for practices, so that they can focus on managing those that need blood pressure optimisation; empower people with BP to manage their hypertension; and streamline the management of people with newly diagnosed hypertension, reducing HCP contacts and reducing the time they take to reach their BP target.
When we looked at the available products, Florence was the technology that would allow us to achieve our aims. We have launched Florence across one PCN and two additional practices, focusing initially on the diagnosis and annual review pathways.
Collaboration
We have worked closely with the team from Generated Health, GPs, and staff within the practices as well as our local AHSN to map out the bp diagnosis and review processes for practices. Using the knowledge and experience of the Generated Health team, we have been able to build a clear pathway for hypertension diagnosis and annual review which requires minimal intervention from the practice. Once set up, all the data we need is collected and it keeps the patient informed and motivated while they are being monitored.
We are in contact with the team from Generated Health on a regular basis, to update and modify the protocols to meet the needs of the practice as we learn more about Flo. We have also recently implemented bulk uploads to Florence so that patients don’t need to be added on to the Flo dashboard individually. This is saved a huge amount of time meaning that we can now add 100 patients on to Flo in less than 10 minutes.
Benefits and outcomes at the ICB
In our experience at BLMK ICB, the main benefit is the reduction of time, for health professionals and administration staff within the practice. If we can bulk upload 100, 200 or 300 patients to Florence, that reduces the administration time of printing and posting letters. Data comes back into a dashboard so we can see what stage the patient is at within the hypertension pathways. This also allows us to identify people who are not engaging with the pathway and why they haven’t submitted their BP to us, reducing the risk of someone being lost to follow-up, this will be particularly beneficial for our medicine’s titration pathway.
It supports the patient to self-manage their condition by giving them reassurance, so they know that they are managing their condition correctly. It can also give them reassurance that they need to make the change that is part of their hypertension plan, or contact the surgery if their condition isn’t being managed. Positive messages within Flo can motivate the patient and let them know they are doing the right things.
For patients there are the additional safety aspects – if there is a red flag such as a very high BP, for example, it will ask them to repeat the BP. If the figure is still high, it will tell them to contact their GP or out-of-hours support. It will also flag this on the the Flo dashboard so a clinician is aware and can intervene
For patients, the text-based system doesn’t exclude people who don’t have a smartphone or anyone who would struggle to utilise that sort of technology. The text messages are free so there is no need for internet access or mobile data.
What’s innovative about Florence?
I’d say the innovation comes from the fact that Florence is a persona-based smart messaging tool – it’s intelligent messaging. We’re not just asking for information from the patient, we’re also getting the patient to act appropriately on the information, whether that means contacting the surgery or out-of-hours if there is a red flag or if they need to do something differently. We can personalise the protocols to work with local pathways and to suit the pathways and processes for individual practices.
Plans and hopes for the future
We want to roll out to more practices for the annual review and diagnosis, but in the next financial year we also want to focus on promoting our new pathways those newly diagnosed patients. Flo really works well with our new pathway and we have built a medication titration protocol, so we would like to offer Florence to as many practices as possible to support with implementation of the new guidelines.
I know that Generation Health are putting a huge amount of work into behavioural change and evaluating the date from FLO on the best ways to influence people and patients to make positive changes, recognise their conditions and improve adherence to medications and other treatments. We want to build on that knowledge and work to build behavioural change into future protocols.
Many thanks to Jonathan and Matt for taking the time to join us. To find out more about Generated Health’s work, join Dr Gemma Donovan at the April edition of HTN Now, our live webinar series through which we share thought leadership, best practice and learnings for the health tech industry. Gemma will be discussing how Generated Health take a behavioural approach to tackle the Core20PLUS5 framework on 19 April at 9am. Keep an eye out for more information here.
