For a recent HTN Now panel discussion, we were joined by a panel of experts from across the health sector to talk about approaches to streamlining patient care, including strategies to reduce follow-ups and increase clinical productivity with targeted technology deployments.
Panellists included Damien Yeo, consultant paediatric ophthalmologist at Alder Hey Children’s Hospital NHS Trust; Rachael Robinson, consultant dermatologist and clinical lead for dermatology at Harrogate and District NHS Foundation Trust; Peter Hansell, CEO and co-founder of Isla Health; and Leila Brown, associate director of digital transformation at Alder Hey Children’s Hospital NHS Trust.
Damien started off our round of introductions, sharing some details about his role as a paediatric ophthalmologist at Alder Hey. “We get referrals from GPs, clinicians and optometrists,” he said, “and we see about 70,000 – 80,000 patients per year in our clinics.” Increasingly, that activity is being moved over to virtual settings, he added, “and ophthalmology is very outpatient heavy, so we’re trying to increase the capacity of patients we can see in existing clinics and also to tackle backlogs of patients on waiting lists”. Optimising clinical decision-making time has been key to that, he went on, “and Isla Health’s solution has given us more digital arms to multitask better and to move consults to a more asynchronous style, which offers flexibility, allows working from home, and enables us to receive information about patients at any time, rather than just in the traditional model of the clinic which is based around one patient at a time”.
Alder Hey is “increasingly digitising a lot of data collection”, according to Damien, “trying to move things onto the EPR, and structuring things that were previously not structured to bring into Isla, like photographs and forms about a patient’s clinical progression”. Historically, the traditional method of relying on contact with a patient to ask how they’ve been doing and note that down hasn’t been that reliable, he told us, “but with Isla, because you’re getting patients to collect data for you at home, without the need for a clinician, you save a lot of time and manpower”. There is regular oversight from clinicians on waiting lists, he said, “and if we require information that can be requested and collected spontaneously, without the need to bring patients into clinics”.
Rachael gave us an introduction to her role as a consultant dermatologist and clinical lead, before detailing how a few years ago she was tasked with improving the department’s image collection process. “As you can imagine, dermatology is a hugely visual specialty,” she said, “and back in those days we were taking images with a normal camera, printing out each one, and then sticking it in the paper notes with some sellotape, so some of those would fall out or get lost, and they weren’t great quality, so I looked at what we could do instead.” Talking about how Isla’s solution offered “exactly what was needed”, she noted its benefits in keeping track of patients, saying: “When patients come to clinic, we take a picture of their skin lesion, which helps us identify the correct site surgery, because we can mark-up the images.”
The realisation came about, however, that Isla’s solution could also be used to communicate with patients, Rachael said, “and this is where things have really improved – whereas patients used to call to say they had concerns about their wound, and we’d tell them to come and see us; now when they call us we can send them a link via text inviting them to send us a picture of their wound, which is then automatically uploaded to the system and linked with our EPR. A nurse can have a look at that, and call them back to let them know everything is fine and not to worry, or to ask them to come in if there looks to be a problem.” That has the effect of streamlining that clinic, she continued, “and it’s especially made a difference for our elderly patients, who do get worried about wounds, because we can offer them that reassurance”.
Another thing Rachael’s team have looked at is automation, she went on, which has been effective in their two-week-wait clinic, as patients can be sent a link prior to their appointment to upload an image of their skin lesion, along with a form to be filled in that has been designed to cover all of the information needed to inform their care. “That has meant the clinic can run quicker,” she shared, “and when they come in we already know what it is we’re looking at, and a bit about the history.” It has also allowed the department to increase its capacity, according to Rachael, “because we can easily see ten percent more patients, and we’re looking to increase that even more”. She also shared that feedback from registrars has been positive, and that the solution has helped facilitate MDT working by allowing images uploaded to the system to be shared during MDT meetings. “The automation for our two-week-waits has worked so well that we’re now looking to move that into our acne clinics,” she concluded.
We also heard from Leila, who shared with us some of her insights into the use of the Isla platform at Alder Hey from a digital transformation perspective. “I look after the projects and programmes team, as well as the systems team,” she said, “so we do a lot around keeping the lights on and keeping our current systems going, but also trying to introduce new technologies to bring benefits to our staff, our patients, and our families.” Taking us through a slightly different use case to those already talked about by Rachael and Damien, Leila shared details of an ongoing project at Alder Hey focusing on waiting lists. “We’re contacting people on our waiting lists, and validating through Isla whether they still need an appointment,” she said, “which helps us fulfil the requirement to contact patients every twelve weeks.”
Alder Hey also worked with Isla on a pilot within surgery, Leila went on, “to do this validation work, to reach out to patients and families on the waiting list to check whether they still needed their appointment, and we’ve seen really positive results”. According to the latest data, she shared, “we had over 200 families get in touch to say their appointments were no longer needed, and that worked the other way as well, as we had those who stressed their need for an appointment, so it helped us prioritise”. Along with benefits in clinical time saving from the released appointments, Leila also pointed to the benefits for patients and families, in not having to travel to unnecessary appointments. “It’s been a really positive pilot so far, and is now being replicated across surgery, with tongue tie being next on the list; being brave with that has been necessary to help us get to where we need to be in terms of national targets,” she finished.
And finally, we heard from Peter, who talked to us about Isla Health’s development and the technology perspective, as well as where the company started, and its motivations in the health and care space. “I’m an engineer by training,” he said, “but I find working to improve the health system much more personally fulfilling, so I’ve spent the majority of my career in various roles covering tech and transformation across the NHS.” Five years ago he founded Isla, Peter went on, “with the intention of optimising the way we receive information from patients, preventing them having to keep coming in for appointments to track their conditions, and to pick up on deteriorations earlier”. The overarching aim, he shared, “is we want to modernise this process and move to a system where we have much more regular input from patients in to the clinical team, and offer that empowerment and ownership for patients to submit information about their condition”.
Applying that model to a large cohort of patients highlights that some will require much more regular follow-up than others, Peter continued, and also some who won’t require as much face-to-face input with a clinician. “The key thing is to understand who those people are in both categories,” he considered, “and the real key value is that through the information we collect in images, videos, sound recordings, and PROMs; we can go a long way toward providing quite a complete summary of how a patient’s condition is changing.” Starting in dermatology made sense, as so much of that relies on visuals, he said, “so if we can create a longitudinal understanding of the way something is visually changing, that can help in making the right clinical decisions”.
Key outcomes: patient outcomes, feedback, impact, and more
Peter shared details from other case studies where Isla has been making an observable impact, including work with burns teams in Nottingham University Hospitals and Chelsea and Westminster. “Chelsea and Westminster is a regional burns centre, so they cover quite a large area,” he said, “and an external evaluation there showed a decrease in average waiting times from 67 days to 24 days post-implementation.”
“We’re seeing patients quicker,” Damien agreed, “and there are many benefits to that – families have important lives, kids have to go to school; the less disruptive we can be to that, the better.” In general, feedback has been that families find the technology relatively easy to use, he said, “and where they have any difficulties or where they’re not comfortable, we have an easy way to revert back to the traditional model, so it’s very forgiving”. Whilst finding a solution which can meet the needs of different specialties can often be difficult, he continued, “Isla is very fluid and very open to change – you can create bespoke functions, and the forms are all customised based on your specialty, so the experience has been very good with regard to the families”.
Looking to clinical outcomes, Damien talked about Isla’s potential to help make improvements to the triaging process, ensuring patients are seen in the right clinic, at the right time. “Before Isla, patients would sit on a waiting list before coming into clinic, and at that point we’d realise maybe they had a squint that we’d missed. With Isla, we can use a photograph to differentiate between patients that have a real squint versus those who don’t – the picture makes that easy to identify, so we can bring those who need it to clinic much sooner.” Referrals from other consultants or departments can also be dealt with faster, he said, “because we can get lots of information about a patient in a very quick manner, in order to triage them properly”.
Overcoming misconceptions and concerns around clinical safety
“I think user resistance is always a concern,” Leila told us, “because there’s always the danger that you’ll roll something out and people won’t want to use it, or they will rebel against it. If you get it right in terms of starting small and proving the concept, showcasing the benefits and assessing that against the impact it’ll have on people day-to-day, that helps.” Although resistance hasn’t directly been an issue with the Isla solution, “you’ve got to be mindful”, she said, “and I think it comes back to integration – we prioritised our integration with the community EPR, working closely with Isla to get our inpatient EPR integrated too”. In general, “people can see what it can do for patients and staff”, she went on, “so with Isla it’s been more about those who can’t onboard onto the platform”.
Having that problem identified first, and then demonstrating how Isla can help to overcome that has been central to the project’s success, Leila observed, “rather than doing it the other way around and finding that solution first before looking for problems it could solve”. Ensuring things like the PROMs questionnaires are clinically-led has also been important, she went on, “and at the moment, we decide what we want those to look like, and then send them over to Isla for the Isla team to put that in place for us”. Having an “open and honest relationship” between the trust and the supplier has helped, she considered, “and the transparency around what the process has involved has helped keep our staff happy with the solution”.
Key learnings and takeaways
Leila talked about some of the lessons it’s been possible to take away from her experience of Isla’s implementation at Alder Hey. “There are a few things that I think made it a success,” she said, “like having the involvement of all of our MDT teams right from the beginning – clinical, digital, operational teams; buy-in from our execs, and so on. Doing it together and understanding what the benefits were together was so important, and we’ve all leant on each other and learned things along the way which will inform our future projects.” Leaning on those clinicians with enthusiasm for the project and relying on them to help identify any teething problems prior to taking it further is also important, she continued. “You need to go step-by-step, choosing specialties where it’s been proven in other organisations, working with clinicians who are good at this kind of thing or who want to be advocates for this kind of solution, getting your data and then presenting it to others in the organisation who might be more nervous about using this type of tool, so they can see that it works”.
The amount of enthusiasm amongst clinical teams for Isla once Alder Hey had done this engagement work “meant that everybody wanted it”, Leila shared, “and what we ended up doing was listening to whoever was loudest; what we could have done in hindsight was a bit more around where the real benefits are, and where we could see the biggest impact, so we could have started with those specialties first.” Now that the solution is “trust-wide” across “numerous specialties”, all of that has come together successfully, she considered, “but if we were to do that again, that’s probably what we’d do differently”.
In Harrogate, Rachael noted the time taken at the beginning, working through governance and making sure all of the functions required for the dermatology department are available within the solution. “We spent a lot of time discussing that, outlining potential benefits, and running through the governance piece,” Rachael said, “so we had weekly meetings, and it took several months to get everything set up, but it was very worth it when we did.” The team is now working on blueprinting for NHS England, she continued, “doing a blueprint-on-a-page for Isla in dermatology, which should be helpful for people to look at who might be wanting to implement the solution in their own trust”.
Damien shared his perspective, saying: “Adopting tech in healthcare can be very difficult and notoriously slow; the systems here do not like to be disrupted, and the NHS in general does not like disruption because it doesn’t like taking risks, essentially. It requires lots of information gathering, as well as enthusiastic individuals who can see the potential of a solution and the impact it could have on our patients.” Getting the buy-in from managers and administrative staff to support a project like this is key, he said, “but when patient and clinician experiences are good, the solution will naturally be taken on more and more”.
Damien also highlighted the Isla team’s ability to make changes rapidly and understand how to overcome challenges that might occur during implementation. “They have the talent and the skills to make rapid changes to systems to cater to the needs of different specialties,” he said, “and I think that fluidity has been really key in achieving success.”
The technical bit: Isla’s integration with clinical systems
Peter explained Isla’s integration with clinical systems, “typically it’s possible to have a bi-directional interface whereby we can pull all patients automatically into Isla, and push any information we collect about them back in”. There are also instances where Isla can be embedded into systems such as Cerner, “to avoid clinicians having to jump between different screens and platforms in order to get the information they need”. Referring to that as the “gold standard”, Peter said: “We’ve built those interfaces with SystmOne, EMIS, Cerner, MEDITECH; we’re working on that with Epic, and we’re integrating with Rio at the moment.”
From a supplier perspective, “the consequences of getting it wrong are significant for a lot of people”, Peter considered, “but I think the more we work with people like Damien, Rachael and Leila, the more our confidence grows to be able to challenge the underlying model and do this at an increasingly large scale – we’ve proven the concept works, and now we’re looking to deliver that fundamentally different model of care.”
We’d like to thank our panellists for taking the time to share these insights with us.
