Health Tech Trends

Reflections from across the NHS: Primary care access, patient portals, EPRs, optimisation, data, emerging tech, digital inclusion and more…

As we approach the end of 2023, we’re taking a look back on the year’s progress and achievements by asking NHS professionals: reflecting on 2023, what digital projects and programmes are you most proud of?

Morgan Daly, digital strategy transformation lead for One Care, the GP federation that represents and supports practices across Bristol, North Somerset and South Gloucestershire ICS, shared that in 2023, they initiated an extensive requirements gathering process with general practice and system partners to take stock of their requirements of the electronic patient record. “We’re proud of the way in which so many general practice and other system partner views have helped inform planning for the future, and will lead to greater interoperability of health and care systems,” Morgan said.

One Care also launched an emerging tech support process for GPs: “Any GP can identify a tech innovation that could help improve efficiency and quality of support for patients, and One Care (in partnership with ICB and other system partners) will assess the information governance and digital safety of the product. We’ll also develop recommendations for how the product can be safely implemented and whether case studies exist from other places to illustrate that it works for GPs. In 2023, we broke new ground by supporting a Bristol-based GP to launch robotic process automation for the first time in our ICS, with more innovations to come in 2024.”

Richard Pratt from Three Spires Medical Practice said: “One word that has been on everyone’s minds in primary care in 2023 is access. The health tech sector is at its best when it turns its attention to the real world problems in primary care. For years the focus has been on delivering a high quality service – rightly so, but a high quality service has neither impact nor benefit if patients can’t gain access.

“The drive to create a digital front door to access primary care has come from two directions: NHSE and patients. NHSE’s publishing of the Recovering Access to Primary Care demonstrated their commitment and the growing uptake by patients for tools like online or SMS consultations shows their readiness too.

“This year, health tech has launched and progressed a myriad ways to address access challenges – from triage tools to online consultations. These offer no single solution to address the yawning chasm between need and provision but can at their best, offer a multiplier effect. Effectively creating more of our scarcest resource – clinician time.

“Rather than a single game-changing tech solution, we’ve realised a suite of tools will be crucial in meeting the access challenges. Many are intended to liberate our time. Whether it be pump-priming conversations with patients by asking for details of their illness before picking up a phone or using voice-to-text dictation solutions to speed up consultation entry, they are rapidly becoming central and uptake wide spread, crucial in shoring up the primary care upon which we all depend as a nation over 330 million times each year. ”

Pam Pahal, digital transformation lead at Midlands Partnership University NHS Foundation Trust, said that the delivery of a patient portal for adult mental health service users stands out as a key achievement from 2023. The portal “enables service users to access their mental health care plan, appointments, letters, patient reported outcome measures and a suite of self-care tools at their fingertips,” said Pam. “The patient portal is fully integrated with the NHS App, making it accessible and easy to use through one front door which is familiar to our service users.

“This portal works with our core EPR, which means information that service users input into the portal can flow into our EPR for our clinical staff to view. This means Patient Reported Outcome Measures can be completed outside of appointments (if the patient chooses to do so). This will help facilitate better conversations to take place during the consultation. There is a healthy lifestyle questionnaire which enables patients to think about the choices they are making and promote self-care change behaviours. The portal has enabled patients to have a choice to access their health records via a digital app or web portal.

“For adult mental health service users, and MSK service users we have piloted an AI powered virtual assistant. This enables patient to access their appointment information using the trust’s website, this is accessible 24/7 enabling patients to view and cancel appointments. This provides choice to our service users, and the accessibility of out of hours was showcased by 40 percent of service users using the VA out of office hours.

“These are the digital projects we are most proud of because of the innovation enabling patients to have a choice in the way they access their healthcare information. The designs were developed alongside service users, clinical staff, digital and transformation staff in collaboration. They have provided a different route for service users to manage their own health.”

Corrina Hulkes, chief nursing, midwifery & AHP information officer at London North West University Healthcare NHS Trust shared: “2023 has been a very busy year for London North West Healthcare Trust digitally and also operationally, as we went live with a Cerner EPR in August of this year. One of the most exciting parts of this is that we joined a sector wide domain and across North West London we now have one shared EPR for the Acute Provider Collaborative, which include 4 organisations and 12 acute hospitals. This was a mammoth task and was over two years in the design planning. There are challenges in ensuring no variance and any new build or changes need agreeing by all the four organisations, but this has brought opportunities in challenging existing build and ensuring evidence based practice that is standardised in the sector and reflects national and in some cases international recommendations.

“We have a very good and inclusive governance structure that ensures that there is good discussion and agreement and each organisation has an equal voice, and one shared change board with also a separate governance meeting with membership from both clinical and non clinical digital leads from each organisation.”

From The Dudley Group NHS Foundation Trust, emergency department consultant Dr Ashish Singal said that a source of pride is the development of a “departmental app that provides all the relevant and up to date information at the clinicians’ fingertips and at the patients bedside.” Ashish explained how the app contains “guidelines, policies and procedures, directory with direct dial facility to any extension in the hospital, alert functionality and push notifications, ability to fill in forms ie annual leave requests, sickness reporting, training and CPD section, links to rotas, over 300 patient information leaflets, online induction and mandatory training. Since implementation two years ago, the app has had over 500,000 hits.”

We heard from Rob Birkett, chief digital and information officer at Calderdale and Huddersfield NHS Foundation Trust/The Health Informatics Service: “2023 has been a great year for both delivery and foundation building for digital here at Calderdale and Huddersfield NHS Foundation Trust and The Health Informatics Service (THIS). Our digital roadmap was developed alongside senior clinical and operational colleagues ensuring the developments we delivered were directly linked to improving patient care, reducing health inequalities and supporting the current pressures the NHS is facing. These developments included some first of types such as Electronic Controlled Drug Register (eCDR) and an EPR Same Day Emergency Care (SDEC) module.

“We also had a successful rollout of our NICU EPR, integrated diagnostic results into our maternity system and implemented 4AT dementia screening which is now being used in multiple trusts.

“In terms of our approach to data science, we had some great success around identifying high risk adult cohorts linked to our length-of-stay as well as using a data-led approach to waiting list validation supporting our aim to reduce health inequalities, especially around learning disabilities. One of our biggest successes in 2023 was a nurse/AHP/midwife-led complete redesign of our nursing documentation within our Oracle Cerner system – a joint implementation across two, soon to be three, trusts, with benefits for both colleagues and patients.”

Rob continued: “We have worked on a number of initiatives this year that will take us further forward throughout 2024 and beyond. One of these was a joint initiative with the University of Huddersfield developing a digital specific nursing placement focusing on digital in a modern nursing environment including virtual wards, e-observations, e-prescribing, point-of-care testing, virtual consultations and the importance of data/good use of an EPR. This has been very well received and we are looking forward to our third cohort in the spring.”

Lincoln Gombedza, practice educator facilitator for the practice education team at Harplands Hospital, North Staffordshire Combined Healthcare Trust, shared five key “noteworthy advancements and projects that stand out”.

The first is AI and machine learning. “There was significant progress in AI, particularly in natural language processing and understanding. This led to more sophisticated and user-friendly chatbots and virtual assistants, aiding in various sectors from customer service to mental health support,” said Lincoln.

Secondly, Lincoln raised telemedicine and digital health. “2023 also witnessed a surge in telemedicine, driven by the ongoing needs from the pandemic. Digital health platforms became more integrated, offering seamless experiences for both patients and healthcare providers.”

The third project revolved around remote work technology, with Lincoln raising how the enhancement of these technologies continued “with better collaboration tools and virtual meeting platforms, making remote work more efficient and accessible.”

Fourthly, Lincoln pointed to a “strong focus on developing more sustainable and energy-efficient technology, reflecting the growing awareness of climate change.”

Lincoln’s final point was around cybersecurity, explaining: “Given the increase in digital activities, there was a considerable emphasis on improving cybersecurity measures to protect data and privacy.”

Jill Watson, senior IT project manager at The Newcastle upon Tyne Hospitals NHS Foundation Trust shared how the Great North Care Record (GNCR) has “continued to grow from strength to strength in all aspects, including technical delivery, digital maturity, adoption and usage and true regional collaborative working.  The programme has achieved some real progress with onboarding new connected partners including local authorities, hospices, 0-19 services, child information services and maternity services.

“In parallel to the onboarding, the programme has also successfully completed developments to be able to retrieve data from BadgerNet, maternity services EPR, Tees Esk & Wears Valleys FT new EPR, Cito, and GP Connect, both HTM and structured data, which is the strategic vision of the national programme.”

Jill added: “The proudest element to GNCR is the people, the partnership working across health and social care, spanning across over 64 organisations, who are all driven to make it succeed, despite other work pressures.  The NENC region truly aim to deliver better patient care and as a programme playing a part in that, there is nothing more rewarding. GNCR has become an established platform for health and social care professionals in our region and is reaching consistently just under 580,000 per month and growing.”

Dr Amar Ahmed, partner & GP trainer at Wilmslow Health Centre, said that “by far the most significant challenge to primary care locally this year” was challenges with IT infrastructure. “Days of productivity were lost due to IT systems, in particular our electronic patient record. It can’t be right that so many hard-pressed practices across the UK were brought to a standstill by IT outages… We look forward to having more choice of EPR providers in the coming months so that we improve our practice’s productivity and reduce frustrations felt by all members of our team.

“In house, we have developed an award winning triage system which has been adopted by many practices across the country. The Wilmslow Triage System improves patient access and goes some way to help practices meet the BMA’s safer working guidance. The practice was proud to have had its endeavours recognised in receiving an international award.”

From Saddlers Health Centre, practice manager Catherine Murphy described how from 2023 various changes were made in regards to digital transformation, including the registering of a patient online service. This “has worked very well for our surgery,” Catherine said. “We have seen an increase in patients registrations from signing up to this service. We also signed up for the text message confirmation to the patient once the registration had been completed; this too has saved our reception staff time. The online registration forms have all the relevant information we require to register the patient. Other information can then be noted and added once the patient has had a new patient health check. It is much easier for staff to add the registration to the system, saving time.”

Additionally, Catherine shared how Saddlers Health Centre promoted online access to all patients via text message, letting them know how to access the service via a link. “We have found an increase in patient using this service which has freed up time spent on the phone lines,” she confirmed.

“We changed our website provider which has been an enormous help.  The information displayed on the website is now up-to-date, informative not only with services at the surgery but community services in and around the Walsall area. We have recently completed an audit on this, and have patient benefit results from this work. Not only can patients register for the surgery on the website, they have information regarding NHS App and patient access app, booking of appointments, ordering prescriptions, contacting the surgery on line and so on.”

Additionally, the surgery has completed the electronic records uploading to their clinical system. Catherine called this “a major help when copying medical notes for patients/third parties as all the information is in one format and one place. This also freed up space in our surgery as we no longer have paper notes to file.”

Finally, Catherine shared how the centre has improved their star rating on NHS Choices by sending out texts with online links to questionnaires asking for feedback, noting that they have received “fantastic reviews” from this.

From Nottingham, Digital Notts’ programme director Alexis Farrow highlighted that the digital transformation team for Nottingham and Nottinghamshire ICS “continues to have a positive impact across our local healthcare ecosystem. We’ve recently reviewed our digital strategy until 2028, with five priority areas underpinning our work, including public facing digital services, digital and social inclusion, and interoperability.”

Also from Digital Notts, project and business change manager for technology-enabled care and digital inclusion, Rosie Atkin said: “We’ve made great steps in addressing digital inclusion across our ICS throughout 2023. From embedding our innovative digital inclusion coordinators across our PCN, digital champions training with local partner organisations, through to our nationally recognised asthma and peak flow digital self-management project, our focus on continually evolving our technological offering is making a difference to the citizens of Nottingham and Nottinghamshire ICS.”

Charlotte Brown, communications specialist at University Hospitals Birmingham NHS Foundation Trust, said: “Our electronic healthcare record, PICS, has now successfully been rolled out across all our adult inpatient and outpatient clinics, including the Birmingham Chest Clinic. This means PICS is now being used for more than 3,000 beds across our four hospitals and community settings. PICS, a system developed by UHB and the Wolfson Computer Laboratory, is the largest single in-patient EHR deployment in England, a massive achievement for us here at UHB.

“Since the rollout began in November 2020, the digital health team have worked tirelessly throughout the pandemic to train over 18,000 staff, deliver 1,240 laptops and computers on wheels, create 107 archives and launch 15 go-live dates.

“Colleagues across the trust are now reaping the benefits of the successful implementation of PICS, with the system being widely used across clinical services. In one year alone, the system saw over 67 million results reported, over three million prescriptions issued, and 119 million observations recorded.”

From Midlands Partnership University NHS Foundation Trust, we heard from Shaun Allcock, head of health and social care systems: “In alignment with the Digital Capability Framework, we have put together a comprehensive programme comprising approximately 30 projects ready for delivery over the next two years. These projects are made to elevate the digital maturity of our primary electronic patient record and its associated services. A key focus of these projects is the harmonisation of different systems to facilitate the creation of a unified and shared patient record wherever feasible. Our goal is to seamlessly integrate these projects to enhance the efficiency and coherence of our infrastructure.

“A milestone in our recent projects is the implementation of a patient portal. This portal is now operational, playing a role in supporting our mental health framework. It is a platform which allows patients to have access to their health information, making healthcare more accessible.”

Christopher Matthews, head of digital education and simulation for the Education Directorate, Horizon Centre at Torbay Hospital shared: “During 2023, from a digital education perspective we have seen considerably more requests both from internal and external sources for 360 VR training packages, as the access to immersive equipment becomes more readily available. We’re proud of this content and have produced a range of passive and interactive VR experiences such as an ODP orientation and a falls deterioration experience for care homes.

“A collaboration between the digital and simulation teams has been fruitful in the development of mixed reality training experiences that provided broader opportunities for community staff to engage with simulated training without having to travel to the sim suites at the Hospital. Through the setup of a green screen inside our sim van we can run simulation training anywhere the van can visit. Through the use of passthrough technology we are able to incorporate real subjects and objects into the virtual environments that we have developed in house.

“There has been a flurry of excitement around the possibilities of AI and though we are still in the early stages, we have begun to use text to speech in many of our learning packages and creative output.”

From Wirral University Teaching Hospital NHS Foundation Trust, implementation programme manager Nickee Smyth commented: “The digital healthcare team has been working tirelessly in 2023 to deliver an extensive list of requirements across the healthcare landscape. From multi-year ICS initiatives to system upgrades and EPR optimisations, the team has successfully integrated technologies and implemented digital enablers for large capital programmes, ensuring the best possible outcomes for patients. One of our greatest successes was our contribution to the Cheshire and Merseyside Surgical Centre, which received Getting it Right First Time accreditation. The team has been recognised with feedback stating that we are an exemplar hub, that is well led and full of innovation, specifically detailing the highly effective data sharing solution, which we implemented and that has become a blueprint for Cheshire & Merseyside.

“We are also in the final stages of completing a significant network upgrade, which has included re-patching cables and migrating over 10,000 ports over 50 network locations across multiple sites, which has been extremely challenging. However, the team managed to complete this with minimal impact to end users, again resulting in the best possible outcomes for our staff and patients. Towards the latter end of the year, we completed the roll out of our digital CTG Solution. Close working with our clinical staff in maternity services proved vital for the success of the project which ensures that our services are delivered safely and effectively for all expecting parents.”

From South Yorkshire Primary Care Workforce & Training Hub, an organisation providing training support for local practices and coordinating regional workforce and training schemes on behalf of NHS England, project manager, greener NHS champion and NHS England clinical entrepreneur Liz Leggott highlighted their work testing digital learning tools and their effectiveness and appropriateness for primary care staff training. “We trialled about six suppliers, some had ready-made solutions to buy off the shelf, some were collaborations and some were created in partnership with suppliers from scratch,” Liz shared.

“We found that actually some of the ready-made solutions were not fit for primary care, we couldn’t suspend belief enough to make them work for us and they were quite expensive. We also found that actually smaller companies who were looking for customers were very happy to offer a partnership approach and made us realise that actually we could potentially create an income down the line for the output, and we got something bespoke. Equally we found that with a bit of guidance and someone who knows their way around a 360 camera and Matterport, we could easily create something for not a lot of money that would do a great deal for us.”

A key learning was that “we had to use the technology as part of a face to face teaching session to get any engagement. Offering open access to a tool to people who don’t have capacity for anything other than seeing patients, meant that there was very little uptake. It had to be a part of a planned session. So we did just that. We have now started to deliver training bolstered by the use of the Pico headsets and BodySwaps software and the use of our 360vr platform for induction and introduction to the general practice team and environment.

“The reason for the testing was in part to see what tools we could adopt in the Training Hub but it was also to build up a business case for an Innovative technology led training and simulation centre, to prove the concept and to offer recommendations going forward. That business case and evaluation is now complete.”

Didi Craze, specialist communications midwife, shared insights from University Hospitals Sussex NHS Foundation Trust. “We have four maternity units in our fairly newly merged trust (University Hospitals Sussex – which covers seven hospital sites in total), which serves over 10, 000 pregnant women and people and their babies. We have implemented maternity digital notes in our Chichester and Worthing sites this year, bringing them in line with Brighton and Haywards Heath sites, and there has been so much work by the maternity teams to join all our maternity services up and make them visible and accessible to parents.

“Part of my role, I organise and promote our regular staff listening events on Teams – a chance for staff from all four sites to drop in – even just for five mins with a cuppa and on their phone – meet staff from other work areas, get more familiar with the senior managers, hear updates on our services and key priorities as well as raise their own concerns and ask questions directly. This has helped break down the hierarchy barriers which can sometimes exist in large organisations as well as offering access to meetings to staff who may have struggled to travel or had childcare barriers to attendance.

“I have also been working on a project with the Director of Midwifery to implement a staff app which offers them a direct way to feedback their experiences on shift and their quality improvement project ideas.”

Aaron Atkinson, associate director of business intelligence at NHS Arden & GEM said: “Linking any datasets is not without its challenges but bringing together different health and social care datasets, at a system and national level, has historically proved particularly challenging due to a whole range of factors from data quality to information governance requirements. In 2023, we have seen our projects in this area really start to come to fruition.

“Nationally, the Adult Social Care Client Level Directions (ASCCLD) initiative now has 163 councils in England submitting mandatory data on a minimum quarterly basis, with 12 councils submitting monthly. This has already started to inform service delivery, for example managing patient flow through acute settings into community support, and provide new insights, such as understanding how unpaid carers can be better supported to prevent crises.

“At a system level, we have worked in partnership with Mid and South Essex ICS to develop and deploy a system-wide strategic data and analytics platform. Athena brings together national and local data flows, including primary, secondary and social care, to enable patient-facing services to be planned and delivered in a completely different way. As well as enabling users from different organisations across the system to have simple and secure access to dashboards, analysts are encouraged to work collaboratively to develop and publish their own content. The Athena platform has now been implemented in four further ICSs and made available to all local authorities across the country. These are just two examples of what is possible with data when you establish a clear vision, use fresh approaches to engagement and utilise high quality programme management support.”

The digital health team at Isle of Wight NHS Trust shared that over the past 18 months, they have “revitalised the ageing infrastructure within our trust through significant capital investment secured as part of the Our Investing in Our Future programme. This comprehensive update ensures that our systems are not only easily managed but also resilient and fault-tolerant.”

Key improvements include network enhancement, with replacement of core network infrastructure and wireless access points; dual fibre connections to all data centre rooms for network resiliency; and assurance of a quicker, fault-tolerant, and more secure network.

Work has gone into back-up and storage solutions, a telephony system upgrade, firewall upgrade and WAN and HSCN enhancement. There has also been implementation of a new clinical virtual desktop infrastructure with single sign-on, a data centre refresh and real-time location tracking for medical devices and assets.

“All these enhancements collectively improve the patient and end-user experience, laying the groundwork for future improvements,” said the Isle of Wight team.

They added that the integration of SystmOne into the community division “has been met with enthusiasm from community services, and our overall experience has been very positive.

“The implementation of our new methodology for transformative clinical systems projects has proven to be a triumph. This approach has enabled us to comprehensively grasp service requirements through structured workstreams. The introduction of these new systems has not only showcased increased capacity but has also alleviated pressures on services and waiting lists. Furthermore, it has fostered a culture of division-wide collaboration, promoting unified ways of working across various services within the division. As a result, there has been a significant enhancement in information sharing throughout island-based services.”

Many thanks to all who contributed, and HTN wishes everyone a happy Christmas and new year!