Patient-facing tech: exploring the NHS App, electronic comms and remote monitoring

In our latest feature we cover some of the recent developments in patient-facing tech, and how they are impacting service delivery, patient engagement, patient-provider relationships and equitable access in the realms of health and care.

Earlier this month at London Tech Week, Lord Markham shared planned updates for the NHS App, including the introduction of the first mental health and musculoskeletal products which are to become available through the app later this year, “allowing 24/7 access to suit lifestyle factors without the need for a clinician referral.”

In May, we heard how NHS England will be offering patients a shortlist of at least five care providers to choose from through the NHS App, when referred by a GP; this move “aims to provide patients with more choice and control over their own care, providing a patient with providers to choose from based on their preferred selection criteria, such as waiting time or distance.” As part of this programme, NHS England updated ERS functionality in March 2023, creating a single menu of service options to support referrers to see the options in one place. Patients will be able to view this information using the NHS App or website following discussion with their GP.

In April, we explored a study focusing on uptake of the NHS App and patient portals, in which researchers used electronic practice-level metadata recorded usage to assess population uptake along with examining the sociodemographic characteristics associated with reduced uptake. The study found two of the most socioeconomically deprived quintiles was associated with reduced activation of the app, versus the least deprived quintile, which was associated with greater uptake. Other factors associated with reduced level of uptake included age, level of urbanity and some long-term conditions including dementia and mental health.

Last week, we spoke with Hertfordshire and West Essex ICS’s director of digital transformation Adam Lavington, who said that he is looking forward to “the level of patient empowerment in the next three to five years.” On the push towards further integration between the NHS App and trust patient portals, Adam said: “Soon, as well as booking your primary care appointments, ordering your repeat prescriptions and looking at your medical history, patients will be able to see outpatient letters, manage secondary care appointments online and receive questions and surveys to facilitate two-way communication between patients and NHS trusts. This is a massive step in making it more of a partnership between patients and secondary care providers.”

We’re hearing more about that integration in practice; earlier this year when we spoke to Lisa Emery, NHS Sussex’s chief transformation, innovation and digital officer, she discussed how “a really big piece of work for the digital team” has been to “further join up systems, so that the virtual care that patients are receiving connects directly into their care records. Clinicians can see that data from wherever they are, and patients can see what’s happening through our patient app, My Health and Care Record, which is integrated into the NHS App.” On that note, Lisa added, “we’ve had a real drive through the winter period around adoption of the NHS App and My Health and Care Record.”

In March, Newcastle Hospitals NHS Foundation Trust announced that it had gone live with MyHealthCall integration with the NHS App. The trust’s chief information officer Graham King said that the move would “greatly improve the digital patient journey for those being cared for by the trust, and we will be rapidly expanding its use across our patient services”, whilst NHS Health Call’s managing director Ian Dove said: “We believe that this integration will revolutionise how outpatient care is delivered for our NHS, and integration into the NHS App is only the very beginning. We plan to release further features which will help clinicians streamline care and reduce administrative burden while providing exceptional service for patients.”

On the current uptake of the NHS App, NHS England’s website announced in January 2023, said that the NHS App now has over 30 million registered users; this follows January 2022’s announcement that the app had reached 22 million users.

Electronic patient communication and messaging services

Studies have highlighted the role of patient-provider relationships in patients’ experiences of care. In an article entitled “Patient care experiences and perceptions of the patient-provider relationship: A mixed method study“, authors found that communication is a key factor in establishing relationships with care providers, and that communication with clinic practices also had a positive impact on patient engagement. For example, sending digital reminders between visits increased the likelihood of patients making, and keeping, appointments.

NHS England backs up how a greater focus on electronic communications can reduce patient non attendance, noting in guidance released in February that text messages have the potential to reduce patient non-attendance by up to 25 percent. NHSE also pointed out that GP practices in East Lancashire were estimated to have saved £767,844 in a single year by using text message reminders to reduce non-attendance, along with a further £813,495 saved in postage costs when using SMS, email and voice calls to invite patients for annual reviews.

Another benefit revolves around increasing positive patient behaviours; in a study entitled “Exploring the use and challenges of implementing virtual visits during COVID-19 in primary care and lessons for sustained use“, the authors report on a randomised trial using text messaging as a means of improving adherence to cardiovascular disease preventive treatment. Findings indicated a significant improvement in medication adherence from participants in the group which received text messaging reminders. The research showed how 8 percent of the group receiving texts stopped taking medication completely or took it on fewer days than they had been instructed over the course of the study, compared to 25 percent of the patients in the group receiving no electronic reminder.

    Remote monitoring

    A study entitled “Providing ‘the bigger picture’: benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study” by Austin, et al., successfully used a specifically-designed smartphone app to allow patients to record their daily symptoms, before integrating this into the electronic health record. The study reported excellent outcomes in terms of participant engagement and satisfaction with the smartphone app, and also revealed significant evidence that this approach could be used in the future to improve outcomes for patients with rheumatoid arthritis.

    “Specifically,” the authors state, “it demonstrated that patients benefitted from consultations being focused around their own data, making consultations more personal. Furthermore, the summary of daily symptoms revealed disease patterns that would have been missed, including flares and long-term trends that would otherwise be hidden within the day-to-day fluctuation of symptoms.”

    In a similar study, remote monitoring of 95 MS patients for one year using accelerometers – devices capable of measuring levels of vibration – found positive benefits for targeting interventions and for ongoing monitoring of patient condition. Titled “Association of Continuous Assessment of Step Count by Remote Monitoring With Disability Progression Among Adults With Multiple Sclerosis“, the article states that continuous remote activity monitoring for this condition “appears to be feasible”, with results showing that a decreasing average daily step count during the one-year period was “associated with worsening of standard ambulatory measures but could also occur even when traditional disability measures remained stable.” As such, the researchers continue, the results “appear to support the prospect of using the average daily step count as a sensitive longitudinal outcome measure in MS and as a clinically relevant metric for targeted intervention.”

    As well known in the industry, remote monitoring attracted increased attention during the COVID-19 pandemic. A study entitled “Novel Use of Home Pulse Oximetry Monitoring in COVID-19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization” demonstrates the positive impact that patient-facing technology can have supporting patients to take charge of their own conditions through self-monitoring, with benefits including providing reassurance to the patients themselves, avoiding unnecessary hospital visits and saving clinician time. In the study, 209 patients from an emergency department and outpatient testing centres were given home pulse oximeters and told to record their SpO2 every eight hours. They were told to return to hospital if they noted their recording dropping beneath a certain level or if they felt they needed urgent medical attention. The authors concluded that the remote monitoring was capable of identifying the need for hospitalisation and as such reduced unnecessary emergency department visits.