Feature Content, Interview

“All of those stars are aligning to make this the right time to solve this challenge” John Kosobucki of OX.DH on providing a secure, integrated and intuitive solution

Our latest interview features John Kosobucki, CEO and founder of Oxford Digital Health (oxdh.health).

John shared the story behind OX.DH, what they aim to bring to the healthcare industry, and the key themes that underpin their work: security, integration, and providing a modern, intuitive user experience for patients and clinicians.

Hi John, can you tell me about yourself and OX.DH?

As you can probably tell by my accent, I’m originally from the USA, but have made the UK my home and have lived here for more than 20 years. I’ve worked in technology for over 30 years now and I’ve worked closely with the University of Oxford.

A couple of my close friends are medical practitioners who shared their frustration with the systems they work with. In 2018 along with my co-founders, I decided to launch a digital healthcare company with the aim of giving patients and practitioners a modern digital healthcare experience that would take away the frustration, and improve patient care and clinical outcomes.

One of our founders specialises in fertility and women’s health, so we started off in the assisted reproduction pathway. OX.ar digitises the pathway and introduces portal access which helps patients to become more engaged in their healthcare – they can fill in documentation online, manage appointments and access results. This reduces the administrative burden for staff and it also helps staff locate all the information they need in one place, as well as providing the ability to digitally audit activity. We now work with a number of fertility clinics here in the UK as well as internationally, in Australia.

Thanks John, that makes good sense. Can you explain the platform and the technology for me?

OX.DH provides modern, intuitive cloud-native solutions built on Microsoft cloud, which means our solutions are secure by design and by default – that is one of the core aspects of our work. We are cloud-native; we haven’t taken a legacy software with technology debt and moved it onto the cloud, our service is actually built and developed on the cloud. Moving an existing software over to the cloud is more of a  ‘lift and shift’, and it doesn’t deliver all the benefits of cloud-native deployment – namely the configurability and security.

We align ourselves with the integrated care agenda and we utilise industry standard options for integration with the broader healthcare system. Ultimately, we have a passion for improving healthcare-related IT infrastructure and outcomes, by using design, resilience and service provision ethos that have already been refined to high standards in other industries.

Along with our various components, OX.DH is also built on Microsoft Azure. We have a long history of working with Microsoft, and we’ve chosen them as a partner because of their experience and pedigree with running infrastructure within organisations as well as their leadership in provision of cloud technology. Microsoft isn’t a data company that has moved into providing cloud infrastructure, it is an infrastructure company first and foremost that took its experiences and built out cloud capabilities from there. When you combine that with the NHS’s commitment to Microsoft through the national tenant, there is a huge opportunity to leverage the existing investment and accelerate digital transformation.

You mentioned the assisted reproduction pathway. Presumably you have other supported pathways?

The lessons we have learned in assisted reproduction can be applied to other healthcare pathways, so we’ve also split our solution down into components so that it can be used for horizontal micro-services to address specific healthcare requirements.

Those different components include OX.virtual pharmacy, OX.waiting room, OX.clinical pharmacy, OX.patient referral and OX.patient consent, and they can all be used for different things. For example, OX.waiting room can be used to help manage patient engagement, online and virtual consultation process, or vaccination consent-gathering can be handled with OX.patient consent. On a bigger level, we can then assemble these solutions into verticals workstreams, such as OX.general practice or OX.virtual clinic.

Looking at those examples in a bit more detail; our online and virtual consultation capabilities are built as Microsoft Teams plug-ins, which means that patients can directly connect from any device on a browser without having to download the Teams app or any other app. The clinician can connect with the patient from within their native Teams environment. As of right now, we’re confident that this is a unique capability that we can offer.

OX.general practice assembles our various components to provide everything needed for running a GP’s office. One of the challenges in the industry at the moment is lack of flexibility available within primary care. The NHS is encouraging new entrants to the market to provide more choice for organisations and ultimately help organisations pick the solution best placed to help them and support their patient outcomes. On that note, we are currently being onboarded to the Tech Innovation Framework, which the NHS describes as ‘designed to encourage innovation and new ways of working’. It’s there to support the development of the next generation of GP digital infrastructure.

Healthcare IT professionals often have much to say about integration challenges. How have you tackled that problem?

I think they are similar to the challenges we are seeing in other industries, like finance and retail. We have disjointed islands of data and systems that don’t talk to each other. Historically, we have seen approaches with large monolithic systems, but the reality is, to provide the best care possible, there has to be API-based integration to access information from different sources and consolidate it so that the patient and the clinician can have a holistic view of what’s happening. We are focused on being an API company – we’re open to allow people to integrate with us and we embrace integration with the broader healthcare ecosystem.

The other key challenge here is security. I think people tend to be quite happy to share information online in terms of their personal life, they’ll participate with online banking and online shopping, but when it comes to healthcare there’s a tendency to be more reserved. They want to know that their data is absolutely secure. That’s one of the things that we have built in by design and by default from the very beginning. We’ve made sure that all data is kept securely, and that we are essentially the data processors, with the healthcare organisation as the data controller. It’s really key that patients have the confidence that our solutions will keep their data secure.

Digitalisation of healthcare is attracting a lot of attention worldwide. How does OX.DH create a unique healthcare consumer experience?

We differentiate ourselves by engaging and listening to medical practitioners, practice managers and patients, in order to understand what they really need and want. We’ve built technology that is flexible and can be easily configured. By harvesting the golddust of feedback, we can quickly and continuously improve our pathways, functionality, and of course our user interface.

In the past, companies have tended to provide infrastructure and then it’s up to the organisation to take it and run with it. Our approach has been very different. We’ve built the core fundamentals and pathways as a framework, and through feedback – with patients, clinicians and user groups – we’ve enabled it to be an experience and a solution that people want to use, rather than something that is just being forced upon them. In essence, we provide a pre-configured solution with capabilities that address their needs today, but it also gives them the flexibility to adapt and configure that as pathway requirements evolve.

Do you think the interoperability challenge in healthcare will be solved?

Absolutely. COVID was extremely challenging, and a tragedy for many people affected by it. Some of the long-term repercussions include a focus in people’s minds on examining how technology can really move forward on the interoperability side. The COVID pandemic put digital at the centre of the NHS agenda going forward.

The maturity of the cloud technology we’re seeing now, the APIs, and the commitment within integrated care boards to start bringing together shared infrastructure. All of those stars are aligning to make this the right time to solve this challenge.

We don’t expect the organisations to overhaul all of their legacy infrastructure at once; that is too big an ask and it’s important to be realistic. But what we’ve done as an API company is enable integration with those legacy systems, so that over time organisations can move on from them. It’s about making changes in bitesize chunks rather than trying to undertake a massive change all at once. We’re saying: we can integrate with what you’ve got, you don’t have to do anything huge, you just have to learn a new interface – and we’ve done lots of that already, just look at how everyone has got familiar with using Teams since the pandemic.

Doing it in this way makes it more intuitive for patients and staff to use. Then you can build on that infrastructure. You might want video consultations now and digital consenting in six months’ time. It provides organisations with the opportunity to build the solutions that they need for their current requirements.

Ultimately, we all want a frictionless healthcare solution with the patient at the centre of it. That’s the endgame. Over time, healthcare has accumulated a lot of duplication and separate solutions, and at the moment we are seeing integrated care boards and trusts revisiting the platforms that they have in place and trying to rationalise them to use a common shared infrastructure. That’s where we come in. Enabling the integration with these legacy systems is a tactical step along the path to bring us that bit closer to our shared goal of modernisation, simplification, and better patient outcomes.

Looking to the future, what are you excited about?

I’m excited about the ability to provide better care to patients, and to reduce workloads for clinicians. We want to give people an intuitive experience; when you’re dealing with healthcare, it’s often a stressful time. People shouldn’t have to be burdened with complex technologies, or by difficulties in engaging with their clinicians, or struggling to find the information they need because it is spread across multiple systems.

The implementation of a new system in the NHS can be really hard, particularly on frontline staff, when resources are so limited and people are under so much pressure to deliver clinical care. Sometimes things end up getting pushed to the back of people’s minds because they’ve got too much on and it’s too complicated to think about. By providing an intuitive new system, we want people to not have to think about it – like picking up a tablet and browsing the web. You just know what to do with it after picking it up, without an instruction book, or a training manual.

We’ve seen how frontline staff in the NHS have to battle technology sometimes. It’s not efficient, it just adds to their stress. If we can alleviate some of that and improve staff experience, they are more likely to pass that positive experience onto patients. It’s important to remember that at some point, we are all going to be patients as well. You have to think about it from both sides.

Many thanks to John for sharing his time and thoughts.

In March, we heard how Barnsley Hospital NHS Foundation Trust has leveraged the Microsoft national tenant using technology from OX.DH for their virtual consultations. Click here to find out more.