For our latest panel discussion, on the topic of patient engagement and communication, we welcomed a group of healthcare professionals including Dr Penny Kechagioglou, chief clinical information officer and deputy chief medical officer at University Hospitals Coventry and Warwickshire; Dr A Raj Kumar, GP, deputy chief medical information officer at NHS England and chair for the NHS Clinical Leaders Network; Nina Crump, primary care digital programme manager for Surrey Heartlands ICS; and John Kosobucki, CEO and founder of Oxford Digital Health.
To begin, our panel provided some context on what’s happening within their organisations in relation to patient-facing tech.
Nina: I’ve been working in digital transformation in Surrey since 2018 and over quite some time I’ve been working on engaging with our patients and understanding how they would like to access our services digitally, predominantly general practice.
Penny: In Coventry and Warwickshire we’re doing a lot of innovative projects such as looking at citizen engagement and patients who are on the elective waiting list – how can we engage with them better? We’re focusing on better understanding our patients along with how we can use tech to cater for patient needs in the diverse population we are living in.
Raj: I’ve delivered and supported projects such as electronic booking from the early days, which was key to patient engagement and communication – it was the only digital link that the NHS has with patients to start with. From there on, we’ve delivered Spine and everything else that we as frontline clinicians use.
John: I’m a lifelong technologist who came to healthcare in 2018, in partnership with Microsoft at the University of Oxford. We are bringing the lessons learned from other industries to healthcare and putting patients at the centre of everything we do utilising technology to deliver better outcomes.
How can digital enable patient engagement?
Penny: We saw during the pandemic the huge role that digital played in sustaining our interactions with our patients. We’ve built a lot on that since then in terms of remote monitoring and interactions through portals.
Recently with our industry partners we’ve been looking at how to better engage with patients who are on the elective waiting list, because we know how anxiety-inducing that period can be and often patients do not know where they are in that journey. We’ve been trying to understand how we can use digital technology such as chatbots and automation to answer frequently asked questions but also enable them to see where they are in the journey and change their appointment if they need to. It’s about making the whole process cleaner and more visible, with a better patient experience.
We’ve been testing out the chatbot and patient feedback has been extremely valuable and very positive. It’s also made a difference to staff which is key because we have to look at it from a holistic viewpoint. We’re looking at further developing that function moving forward, understanding how patients interact; who is using the technology; who isn’t using it and why; and catering for individual patient needs.
Nina: About 10% of our practices at the start of the pandemic already had a new digital channel, but like the rest of the country, we did a rapid roll-out of online consulting. The take-up was positive; we’d already been engaging with patients and we’d done some research with a citizen panel that operates in Surrey to understand usage and barriers. It resonated with the points Penny made – the anxiety about knowing where they were in the journey and where follow-up would be coming from. I think that applies broadly across healthcare.
I think this work is also very much about digital’s role as an enabler and a support. Patients need to be able to choose how they access their healthcare services and that’s been very much at the heart of the work that we’ve been doing – enabling the practices with triaging and flowing patients, whether they chose to present digitally or via the phone or in person. The people who aren’t as confident in engaging with us digitally should be able to access our services in a way that is equal and fair. We’re passionate about that channel-agnostic approach.
We’ve been really focusing on that user experience when it comes to procuring services and having a consistent approach to that digital front door, and from our take-up we can see that we are building trust and people are growing in confidence about engaging with us digitally.
Raj: Digital really did leave healthcare behind to begin with, especially in comparison to other industries like banking. As Penny and Nina have said, the pandemic, though awful, pressed fast-forward on digital in this area. A key consideration for me in this area was how to replicate the frontline face-to-face contact through digital means – and one area of that means creating the digital reception window that we needed.
Similarly, our trusts and GP practices moved at speed to ensure that their digital front windows were accessible. That starts with the initial contacting of the NHS – instead of walking into a practice and picking up a form, patients would start logging on and taking an interest in communicating digitally. Digital consultations started becoming the norm very quickly. 10 years ago, if I started to put forward a project relating to digital consultations, the uptake would have been two or three percent. It’s about the cultural change. People are getting used to it – I did a surgery yesterday where about two thirds of my consultations were digital.
There’s the technical side of it too, in terms of making it easier. So many people have phones with cameras now.
What’s really exciting about digital patient engagement is that a lot of the work we did at NHS Digital, as it was, was around digital care pathways and algorithms. In this way, we don’t need to utilise a person to provide a response to a question about a common medical condition. That is evolving into a space where we can develop artificial intelligence to engage with patients in a very effective manner.
I think this is just the tip of the iceberg – these are really exciting times.
John: The common theme is that the population is very familiar with digital experiences in other parts of their lives – from travel, banking, shopping, insurances, etc. They often want it in healthcare as well. Everyone has different needs, and not everyone is comfortable with pure digital but overall, the appetite is there and adoption is increasing.
I think when we came to the pandemic, there was a ‘make do and mend’ attitude when it came to engaging with patients. Since then, as the other panel members have said, a great deal has happened to iron out the wrinkles and make patient experiences better.
As an example, the NHS has launched the Tech Innovation Framework to bring new technology into primary care, and I am pleased to say my company is a part of this. We’re using all those great modern APIs that are accessible for things like e-prescribing and e-referrals to industrialise the patient pathways from primary to secondary. For me, good is when the patient experience is as seamless as buying a book from an online retailer and being able to track it from order to delivery.
The panel then discussed how to drive adoption, what approaches have worked and what other considerations should be thought about.
Nina: In terms of building the case, we started with insights and building our knowledge base of local needs and patient preferences. We’ve done a mix of qualitative and quantitative research before embarking on procurement processes to make sure that we really understand what services are the most important to people and what the main barriers are. Is it usability of platforms, complexity of language, ease of navigation? Ultimately, it’s about designing for usability, and easy user experience.
As we moved forward and looked to identify platforms moving forward, our focus has been on engaging with patients throughout the process. We had a co-design approach, involving patients in the development of our procurement specification and in the evaluation. As we’re building templates and moving forwards, it’s about continuing that process, and making sure that we keep a focus on people who might be finding it harder to access digital services; for example, people with English as a second language or people with learning disabilities. We need to try and identify barriers and reduce them. Then, when you’re at implementation stage, you’re then in a better position to try and engage with patients about their experiences; because you won’t get everything right and there are always challenges.
Of course, it’s also important to take a holistic view and to engage with the providers – our digital team work very closely with the primary care team, and we spend a lot of time out engaging with our practices, training staff and making sure that practice teams have the tools to engage with patients in turn.
Penny: We are doing a lot of work at the moment on processing our outpatient data to understand, for example, who are the patients who do not attend and why, how can we enable people to attend, how can we streamline processes such as booking appointments or supporting patients to make reasonable adjustments? It’s important that every single encounter matters, and it’s about understanding our population and their needs to make those encounters matter. We need to align all these things to make a patient’s journey run as it should in the first instance, so that people get value out of their appointments and it’s more efficient.
The other side of things which I am very passionate about is using the time when people are waiting for appointments in a smart manner to optimise their health and wellbeing. How can we use technology to interact, and perhaps to apply behavioural change approaches? At the same time we need to keep an eye on those patients and make sure that they still want the service and ensure that we know what matters to them.
John: From the technology side, we are often part of a change programme and rolling out new solutions to potentially thousands of people who have been used to legacy solutions and hard copies requires an element of winning hearts and minds. Stopping is never an option and so our change programme has to work along side legacy for a time.
The good news is that the change programme is all about the end user, in this case the patient and clinician, experience and outcome. We work with our clients and Microsoft to deliver solutions that are modern, easy to use, with minimal learning curve. An example of this is a project at Barnsley through which we collected feedback from patients on their use of our solution. That turned into a very quick feedback loop where minor changes deployed quickly in the cloud, gave people what they asked for.
It’s key to note that people love to be asked for their opinions and they love to help and be involved. When they see that their feedback has been listened to and acted upon quickly, they feel like they are making a difference, something that frustrated them in the past.
The NHS’s commitment to Microsoft means that it’s a huge asset to be leveraged and we are proud of our partnership with them.
Raj: Patient engagement has always been key to the success of projects. In the early days with the national programme for IT we learned that lesson through facing multiple challenges and looking back at what could be done differently or better, and we realised that there’s no point pumping money into projects that are led by technology firms, without ensuring that they are fit for purpose.
For any large-scale change process, especially digital, there are a few key principles that we need to remember. It needs to mimic the current process to start with, for it to be adopted. If we can replicate the one little action of a patient ringing up a GP surgery to talk to someone and provide a digital front door instead, that’s a great start. Then you move on to allowing the patient to book a digital appointment. I think sometimes in people’s enthusiasm for making change happen, they can forget how important it is to start with step one rather than skipping ahead. But doing that can put patients off, and then they won’t engage.
User research is key. When you’ve got a patient in front of you in your practice, you can ask them how they made their appointment – was it digital? And at the end of every digital interaction, it’s important to try and get feedback on how the patient found it. That sort of data is invaluable.
Another consideration is the difference between the public and patients. Penny, for example, will be seeing a lot of patients in the hospital as an oncologist. As GPs, we’re often seeing more of the public, who may only come in now and then with an intermittent problem. A key understanding of patient engagement is that you need to make sure that the public isn’t left out. All of us, as members of the public, will eventually become a patient in some capacity. So, we need to start the digital process by engaging with the wider public too and not just patients. This can be an issue with user research, because it can miss out the public all together.
If you speak to seasoned clinicians, they will say that 80 percent of services are used by 20 percent of the population, and that’s true. But the other 80 percent of the population will catch up over time. In terms of research and focusing our attention on engagement, we need to be equally engaged with both groups.
We also need to create processes that support proper empowerment of the patient. When patients attend a healthcare appointment in person, they always have a choice whereby they could just turn around and walk out or say no to whatever service is being offered. We need to ensure that through our digital tools we offer the same level of empowerment and not just take them through a single algorithm that gives them a one-way process. I think people can forget that, but it’s a key enabler in helping to support patient engagement. If patients think that a digital tool further empowers them, that using it will provide them with the choices that they have if they are attending a session physically, then you will find that patient engagement is more likely to be consistent.
That word is key – consistent. In addition, whatever we create must be robust, because if we launch tools that are not robust, patients will just drop out. It must be tested and clinically safe, and only then should it be put out. I see a lot of people dabbling in projects here and there with the live population, and some of these projects aren’t necessarily clinically accredited. It’s so important to ensure that from a patient safety perspective that these standards are always followed.
Penny: This year, we launched an integrative oncology app that has been developed out of a clinically unmet need, which is a very important way of understanding what the problem is and how we can help through digital means. The app is for people with cancer in any stage of the journey. The unmet need is these patients don’t always have access to educational materials on how to look after themselves, and also may not be offered resources to support holistic care wrapped around mental and physical health – what kind of physical activity might benefit them when they are undergoing treatment, for example, or dietary support. A colleague and I saw this problem on a daily basis so we put the app together to provide evidence-based resources for people undergoing treatment and beyond, into survivorship. It lets them track things like outcomes and quality of life, and they can also link in data from wearables.
It’s important that it is delivered by clinicians in a language that patients understand. They have been involved in the co-creation too, we have a patient advisory group as well as a medical advisory group. It’s a free app which is also very important.
Lastly, the panel was asked if this was 10 years in the future, what does ‘good’ look like for healthcare technology?
Nina: It comes back to a point Raj mentioned earlier – empowerment. Moving forwards, we want technology to help people in self-serving and having control and ownership of their health in a proactive way. It should also help in interacting with healthcare teams and accessing support and advice in a holistic, seamless way.
Accessibility is also a key point here. There’s still a way to go in terms of integration between systems; things like the difference in messaging from primary or secondary care teams through the NHS App. But having everything in one place to help people access it is really important.
Digital shouldn’t be just the tool that patients or clinicians are using, it’s about digital as an enabler. Good also needs to look like healthcare services recognising patient choice.
I think it’s quite difficult to know exactly what the future will look like from this moment, due to the advancements that we are seeing in things like AI and robotic process automation. It’s going to impact our lives generally, but in terms of healthcare I think it will be quite profound. We’re already seeing benefits; it’s about building efficiencies and supporting our teams to do the work that is the most valuable.
Raj: 10 years down the road, good would be ensuring that we have a good balance with universal patient coverage in relation to digital, regardless of background or barriers such as language. The vast majority – 95 to 97 percent – of bank account holders are digitally connected; if we can reach that level, to start with, I think that’s amazing. It means you’ve got that level of access to that digital front window of the NHS.
The NHS App holds great promise. As Nina mentioned, there have been challenges around integration – often with our own protective elements, such as NHS firewalls. However, going back to the pandemic, that enabled us to take a step back and change our view a little, look at things – and risks – in a different way. There’s been a lot of progress there, with the NHS now allowing integration with multiple programmes and pieces of software.
Also, one size can’t fit all. Interoperability can often get overlooked by the commercial sector, as their focus tends to be on their product. But if we can set the right interoperability standards – we’re only a small nation. If we can set nationally accepted interoperability standards, and nothing is procured outside those standards, you’ve got a utopian scenario where the sky is the limit. In ten years’ time, if we can get even two thirds of the way towards that, then we would have a digitally enabled system which would be the envy of the world. And I do think it’s possible, thanks to the NHS and to technology that already exists.
John: This is something I have thought long and hard about. We have an opportunity to lead the way with healthcare interoperability in a way that will not just be good for the UK but potentially internationally. Many parts of the world already consider the NHS to be a benchmark and I believe with digital transformation the UK can lead the way.
There is already a growing familiarity with generative AI tools such as ChatGPT and within Microsoft Copilot. I am excited about where this will take us in healthcare. We already see AI making an impact in diagnostic imaging and in the future, I am confident that it will act as a trusted assistant to clinicians to direct the patient journey to achieve the best possible outcome. Technology in support of sound judgement.
Thinking about what good looks like from the patient perspective, it’s always going to be starting with primary care entry point. They should have available all the information relevant to them in a way they can understand with appropriate signposting as well as details on appointments, test results, contact information, integration with wearables and an easy and secure way to communicate with primary and secondary care teams. It will make it so much more efficient, reduce stress levels, not to mention administrative burden.
I’m really excited about what the next ten years will bring.
Penny: From the patient perspective, good should look like personalised interactions with the healthcare system. It needs to be a seamless way for patients to book and manage appointments, exercising their choices.
But also, there’s the question of how we educate or coach our public to how to use digital tools, how they will enable them, how digital can support their healthcare. We’ve still got a way to go in terms of bridging that digital divide and making it smaller. There’s also the element around educating or coaching the healthcare professionals too; we are using lots more tools now and we need to change our curriculum and make sure that the new generation of clinicians are aware of what digital can do and how to share it with their patients.
Many thanks to Penny, Nina, Raj and John for joining us.
