For HTN Now we welcomed a group of experts for a discussion on how digital tools are transforming community care delivery and expanding workforce capacity. Panellists included Peter Cumpstone, head of digital clinical systems, safety and transformation at Sirona care & health; Sara Lowe, CHS business and transformation clinical team lead at Leicestershire Partnership NHS Trust; and Gabi Cohen, director of delivery at Isla Health.
Our panel shared real-world projects, including waitlist validation pathways, self-managed care models, and community-based digital practices. They also highlighted practical insights into how technology is being used to streamline workflows, reduce pressure on staff, and improve patient outcomes.
Sirona care & health
Peter, a physiotherapist by trade, told us how he’d transitioned into a clinical informatics role after recognising the direction of travel toward digital for the whole of the NHS. “I moved to Sirona care & health, a community interest company, which is not officially a trust, but we work very closely with our primary and secondary care partners. We deliver a wide range of services across bedded units, district nursing, integrated neighbourhood teams, and place-based urgent care.”
Speaking on the topic of increasing demand, Peter said: “In the NHS we operate in a world of ever-growing demand, limited resources, and immense responsibility. Every minute counts, every decision matters; yet in the drive to be efficient, we must never lose sight of what defines us, and that’s compassion, care, and clinical excellence.” Using digital tools is not a means of rushing patients through the system, but freeing up time to truly see them, he considered. “It’s about making every second safer, and every process smarter.”
Isla Health was introduced at Sirona to support secure storage and processing of confidential clinical images and videos, according to Peter. Since that time, it has supported more than 9,280 patients, and been used to store more than 31,300 entries across images, videos, digital forms, and more. “Waiting list validation is a huge thing for us,” he said, “and we’ve saved 224 hours of clinical and admin time in under 4 months, seeing the reduction in waiting time from 12 weeks to five days from receiving referral.”
Describing the implementation of the waiting list validation tool as “straightforward and low burden”, Peter shared how a simple text message is sent to individuals on the waiting list to ask whether an appointment is still required. “The results are huge numbers, and it isn’t just about reducing lists; it’s about supporting people to wait well – we can signpost to self-management, resources, and community support.” The team at Sirona is now looking to roll this out across additional services.
“With any technology we introduce, we must ensure we’re not simply shifting the burden elsewhere,” Peter told us. “Too often, we see solutions deployed before the actual problem is fully understood, and as a result clinicians and administrative teams are left carrying additional workloads.” In this case, feedback from teams on the rollout has been “entirely positive”, he added.
Leicestershire Partnership
Sara talked about her background in nursing in both inpatient and community roles, before moving on to discuss Leicestershire Partnership’s experience of implementing digital tools to support clinical pathways. “We’ve been using Isla for two years and it’s been really successful for us,” she said. “We’re sending resources via Isla to reduce admin time, postage costs, and so on, and we’re using it at the point of triage, so when a referral comes in we can request photos or videos from patients, depending on the service.”
Isla is also used at the trust for appointment amendments, to prevent patients having to ring the call centre, Sara told us. “We’re using it for video to inform hospital discharge and our falls prevention service; the voice note functionality is used in speech and language therapy; and it’s been really useful in improving information sharing between healthcare professionals and promoting self-care with patients.” Healthcare assistants noticing a deterioration can contact the person triaging back in the hub, send a photo straight away, and get advice or treatment started, “rather than delay”, she noted.
Picking up on the title of the webinar, Sara shared that efficiency without compromise in the context of frontline care looks like “continuing to deliver high standards of patient care using different methods, such as technology, to support elements of the patient pathway, without reducing quality, mutually benefitting patients and clinicians”. The team are also testing the waiting list functionality with the hopes of realising results similar to those demonstrated by Peter at Sirona.
The Isla perspective
Gabi shared her perspective as Isla’s director of delivery, where her team is responsible for implementation and evaluation. “We work collaboratively with both clinical and operational teams,” she said, “and we’re currently working with more than 30 NHS trusts in both community and acute settings, with around 200 clinical pathways.” That involves leveraging data to move patients along pathways more effectively, supporting care journeys, and seeing around 2,000,000 submissions to the platform per year.
Gabi also talked about how Isla is currently on a journey toward global expansion with deployments in Trinidad and Tobago and Ireland, is proud to be B Corp certified, and is focused on driving forward businesses in a way that promotes sustainability and efficiency. “We see our digital pathway platform as a way to move patients through their care pathways as effectively as possible, using patient-submitted and clinician-captured data, events and information from the EPR to understand exactly when and how we should be requesting information from patients. We also look at how that should be surfaced to best support clinical teams.”
Part of this is identifying clinical and administrative tasks that can be automated, Gabi told us, as well as ensuring the right data is being surfaced at the right time. “We do a lot of referral management, advice & guidance, and waiting lists, supporting patients on waiting lists to self-manage. Patients sending in images and wound assessments helps identify risk levels and support workforce planning.” Results have shown increased productivity, with a 75 percent deescalation of demand from SOS to planned intervention, 15 percent of contacts shifted to virtual contacts, and a 3.8 times faster response in terms of getting specialist input due to the MDT view of data available in Isla.
Alleviating pressures with digital tools
When talking about his experience of where digital tools have been most effective in alleviating pressures, Peter noted Sirona’s recent transition to EMIS Mobile. “Contemporaneous records, how people are recording things, and where people are recording things are all huge challenges for us – we’re out at people’s houses, we’re not based in wards and clinics. We’re up to about 50 users at the moment, so just the ability to have things on phones, the ability to put clinical records in clinicians hands where they need it, and having the right information at the right time, is essential.”
This move has been inspired by listening to clinicians and understanding their needs, Peter elaborated. “They were telling us they struggled to load laptops in patients homes or in their cars, so we introduced this solution. It’s listening and bridging that gap between IT and clinical, because we are ultimately all trying to do the same thing.” For already-stretched staff, it’s about not adding a burden, but making their lives easier, he summarised.
Sara agreed about the value of digital tools in helping with demand on services, supporting clinicians with triaging and granting them the ability to perform a bit more of an in-depth assessment ahead of time. “The other example I’d use is that healthcare assistants in patient’s homes can use Isla there, get a response, and do that treatment quicker for the patient,” she continued. “As Peter said, you need to listen to staff and what they need. It needs to be easy for them to use, and the beauty of Isla is that it’s very straightforward.”
Whilst her team has had challenges implementing technology in community nursing in the past, “Isla has been one of our biggest successes”, Sara told us, “and our teams love it – they’re coming up with new ways that it can be used, and we’ve had a lot of ideas on how it could support self-care pathways and triage”. It has been rolled out slowly across community nursing on a hub-by-hub basis, she shared, “we’ve also had great support, and patients haven’t been constantly asking how to use it or download it, which means staff aren’t spending their time with patients trying to support them with that”.
Isla has integrations with EMIS and SystmOne, Gabi shared, with both pulling patients into Isla automatically as a patient is booked in or added to a waiting list. “We also push data captured through Isla back in to EMIS and SystmOne, so we still have a consolidated patient record which is the single source of truth. There’s no manual upload, which was a challenge we experienced previously, having to capture that on a mobile phone and upload when you get internet connection.”
Anything captured through Isla goes straight into its cloud-based environment and straight into the EPR, meaning nothing is stored locally on devices, Gabi explained, “so you don’t have mobile phones with lots of sensitive patient data”. Sara’s team are also trialling offline access, she went on, “which allows us to have improved coverage over all of these areas”.
It’s vital to ensure patient safety when utilising digital tools in health and care, Peter considered, “and that’s based on what we record, how we record it, and the systems have to be safe in which we do that”. Whilst there’s a lot of work done with suppliers, the reality is that often a lot more time is spent working with clinicians to find out about “on the ground” problems, before those are raised with suppliers to find a solution, he said. “As our solutions evolve, it’s our job to check they’re evolving safely – that’s the efficiency without compromise. It’s symbiotic, there’s a lot of partnership working, and there’s a fine balance to be struck.”
Approaches to implementation and ensuring buy-in
Gabi highlighted the importance of robustness and rigorousness in implementations, considering the downstream and upstream impact on everything from integrations and the technical ecosystem, to the effect for those on the frontline. “Pathway mapping, understanding the problem we’re trying to solve, understanding who is involved, who owns different parts of that, and what it looks like in practice, is key,” she said. “The second thing is making the solution as simple as possible – if you can’t articulate your solution in one line of summary, you probably haven’t really got there in terms of the transformation, and you get a lot of buy-in by doing that.”
“There are two clinical staff within my team, as well as admin staff,” Sara told us, “and one of the clinical staff was identified as the lead – she delivered training to staff but was also there for troubleshooting guidance if needed.” That approach has definitely helped, she considered. “It’s a little resource-heavy, but it has benefits in the long run, and it’s been fully implemented across community nursing, embedded within practice. We could have done it by providing resources and doing it remotely, but I think it would have taken longer, and I don’t think we would have had the same success.”
The team at Leicester Partnership started out wanting to look at wound photography, Sara noted. “We scoped out the various options, and Isla was our preferred option. We did a pilot in community nursing, our community hospital ward, podiatry, and lymphedema, the outcomes of which we used to put a proposal forward to have this substantively in our directorate.” The pilot itself was “brilliant”, she went on, “and you don’t need lots of time to roll it out, we did it over six weeks, and we got fantastic results that could be seen across the trust”.
Peter referred to something his CDIO said about “a bronze solution implemented well, being better than a gold solution implemented poorly”, adding: “I’m not referring to Isla as a bronze solution, but the point is the implementation – you can have the world’s best solution, but if you don’t bring your colleagues and patients along, make it fit their workflow, and make their lives easier, people will find every reason to walk away from it.” Digital and IT teams are bridges in relation to bringing those parts together, he added, “and having someone there to problem solve on the ground makes things stick so much more easily”.
Describing Sirona’s approach as more of an iterative one, Peter shared how working with the team at Isla meant identifying issues and finding solutions on the ground. “Generally we do start with one team,” he said, “and as soon as we start demonstrating the benefits to one team, other teams want to get involved. It drives adoption of tech when people see it working and recognise how it could help them. If the system is simple and the training is minimal, that’s what works.”
Technical details
Responding to questions from our live audience, Gabi explained a few of the technical details around Isla’s implementation, beginning with how long the process takes when implementing Isla with a new EPR. “That’s a key part of my team’s role, sitting down with organisations to understand what the technical, operational, and clinical requirements are and doing that interoperability mapping,” she told us. “Where we don’t have existing integrations like with EMIS or SystmOne, we’ll leverage things like HL7 or FHIR, and we also have our own API that we’ve designed that partners can plug into to interoperate with us.”
In some instances, Isla will go directly to an EPR provider and work with them to deliver the solution, Gabi continued. “Those tend to take a bit longer – I think the most recent one we’ve done took about three months. If a trust already has HL7 capabilities or has connected via a trust interface engine, for example, that can be as little as two weeks.” The purpose of the delivery team is to act as an enabler for implementation, and a large component of that is pathway and process mapping, along with the KPIs or indicators expected to be impacted as part of the change. “What that exercise does is help us understand where blind spots are in the service – you might realise you didn’t fully understand what was happening at certain points of the pathway,” she considered.
What that process also does is that it helps the team create a blueprint of when and why data is to be requested, Gabi shared. “We don’t want to have a barrage of information or photos every day if they’re not useful for clinical teams, so it’s about making sure we know what we’re asking for, why we’re asking for it, and how to surface that back to clinicians.” Keeping the process iterative is also important, according to Gabi. “We might see that there’s an additional data point needed, or we might get feedback, and tweak those pathways. The team continues to work with our partners to make sure we’re iterating effectively and getting to something that is as efficient as possible in an ever-changing environment.”
Whilst the Isla platform itself is designed to be “off-the-shelf”, it is configured and designed around the challenges of a specific pathway or the local requirements of an organisation, Gabi said. “There’s tons of local configuration available, and we work hard to make sure it serves the accessibility needs or specific requirements of the local population.”
Looking ahead
Considering where the greatest opportunities lie for the use of digital in community care, Peter focused on the need for a better shared care record, where the right information is available at the right time. “A summary of people’s requirements from different areas would be a superb start,” he noted, “and I know that’s not particularly digital or modern, but it is enabled by the solutions we have.” Often, information is available, but requires clinicians to log into multiple different systems to access it, he stated. “We need to challenge our digital leaders and our local authorities to share that information and not be scared, to get a better picture of our patients and deliver better clinically-led and patient-focused care.”
Sara pointed to the waiting list validation work and the self-care work being done at Leicester. “There are so many opportunities for self-care, and I don’t think we do that very well, or very consistently. That’s something that has come out of the pilot we’ve been doing with Isla, and it’s something we definitely need to explore for patients.” Listening to your staff is integral, she noted, “and clinical staff have some amazing ideas, thoughts, and things that can be changed in the process – they’re the people delivering the care every day, so engaging with them is vital”.
“Something we’ve learned from all of the different projects we’ve worked on and teams we’ve worked with, is that having members of the team who really feel empowered within each of their remits to push something forward is fundamental,” Gabi shared. “When we’re thinking about who needs to sit on that team, it’s worth thinking about what they have to be able to do, and then giving them the space and opportunity to actually do that. That’s when we see teams excel.”
We’d like to thank our panel for sharing these insights with us.
