HTN was joined by an expert panel to discuss digital in community care innovation, taking a deep dive into best practice, approaches, challenges, and the 10-Year Plan. Our panel included Sheikh Mateen Ellahi (Mateen), GP partner, clinical director, and clinical safety officer at Elm Tree Medical Centre and Antonia Frost, CNIO at Sussex Community NHS Foundation Trust.
Antonia shared her background in district nursing, working for community trusts since qualifying around 15 years ago. “As CNIO, my team includes digital clinical safety, user-centred design, and digital skills and training,” she explained. “I’m leading on an awful lot of digital projects in the community, and looking forward to talking about some of them today.”
“Along with my role as a GP Partner at Elm Tree Medical Centre, I hold several board positions, and a lead position at ICB level as a peer ambassador,” Mateen shared. “I’m also lead for the PCN on teaching and training, and do a lot of consulting for GP practices across the country, helping them with digital transformation.”
Innovation in community care
On what innovation actually means for community care, Antonia suggested: “There’s a tendency to think of it like a shiny new thing or invention, but I think it’s about working differently, using tools differently, and changing the way that services work. In community settings in particular, they really need to be practical, useful, and connected into systems we already use; otherwise, they’re just going to add a layer of difficulty into the already challenging working lives of our community staff.”
At Sussex Community, recent successes have included virtual consultations for community nursing, Antonia told us. “A patient will call and let us know their wound dressing is falling off, for example, and the triage nurse will do a virtual consultation first, carry out some level of assessment, and then that can prevent a late night visit as an emergency when it doesn’t need to be.” The trust has recently completed a pilot of ambient voice technology, she continued, which ran across paediatrics, the falls team, and the children’s speech and language team. “That resulted in about 600 scribes, and was a fantastic opportunity to see whether it can work in community settings, showing us we can save loads of clinical time even in just a three-month pilot, with better results expected as the tech improves, but also as our clinicians get more confident with using it,” she added.
“It’s great to hear Antonia’s perspective,” Mateen said, “and it’s good to see that AVT is being adopted. I think the focus isn’t the technology, it’s the people – analysing patient outcomes and clinician outcomes, time saved, and so on. In a GP practice, it’s the administrative burden that takes up a lot of clinician time.” Finding out what the actual issue is, and speaking to clinicians to find out what their pain points or burdens are is key, he shared. “We did that, and along with the usual admin burden, we found more niche things, like filing blood tests or letters – that was taking clinicians over an hour at the end of clinics every single day, and often people were taking their laptop home to do it.”
Having the specific problem to address, his team looked to the market to find out what was available to help to resolve these challenges, according to Mateen. This led to identifying the auto review feature in the existing SystmOne EHR, something that allows clinicians to set their own criteria for blood test filing, so they can be filed automatically within two minutes. “We were able to generate several different protocols, meaning we can now file up to 60 percent of blood tests in two minutes – that has a substantial effect on patient care, speeding up the process, and making life easier for clinicians. My point is, there is tech already out there – it’s how we can use that, rather than using a new shiny tool that might perform two percent better and cost us significantly more.”
Overcoming challenges
One of the challenges her team encountered was when piloting in children’s speech and language services, when the AVT tended to try and figure out what should have been said, rather than recording what was actually said verbatim, Antonia reflected. Another challenge was when trying to record conversations happening in busy environments, she said, “but it broadly worked really well”. The NHS T.E.S.T. Framework was useful in performing a rigorous evaluation prior to the pilot, she went on, “and we’ve just finished our evaluation, but overall people liked it, acceptability was improving, it saved time, and confidence with using it was growing”.
The single biggest thing that would make the tech even better, would be its ability to integrate with the trust’s EPR system, Antonia considered. “At the moment, we’re having to ask clinicians to copy and paste from individual fields into other individual fields, and that takes a lot of time.”
Mateen noted that although his team conducted a smaller scale pilot that did yield some positive results, the tech has much more potential for the future. “AVT is a segue to a new stratosphere of future primary care,” he highlighted, “because it will provide integration into lots of different things across clinical and administrative work. Some of those trialling it at our practice stopped because they felt the time it was taking them to review the documentation was a little bit more than they would usually use to do typing or doing auto consultations – we’re still having conversations about adoption.”
“Just on the future of AVT, I see it not just doing our documentation for us – hopefully for community nurses going out and seeing patients, it will be able to listen in and do the documentation, send onward referrals, order the equipment you’ve mentioned,” Antonia noted. “We need to help support staff who might not be natural adopters of technology to show them the benefits, and it should be a very low barrier to entry, because you just click the button and it does the listening for you.”Being able to personalise the technology works better in practice, she continued, sharing what is required for documentation, and working on improving templates.
The 10-Year Plan
Moving forward, the biggest thing that needs to be tackled to advance innovation in community care is interoperability, Antonia stated. “We can’t work in neighbourhood teams across organisations without being able to access each other’s records and care plans, and that’s our biggest barrier at the moment. I’ve been doing some training with a big group of clinicians today, and one of the questions was about how all of that is going to work.” Rather than being a big decision, this shift is likely to be made up of a series of smaller decisions about how to share the most important pieces of information, until that becomes part of everyday consideration.
“Improving interoperability would improve patient safety, decreasing time lag and making things more efficient,” said Mateen. “When we look at things like discharge letters, patients might come to us asking for a medication they agreed with the hospital to be started on at discharge, but we still don’t know anything about it, two or three days later – that negatively impacts patient experience.”
Looking to the prevention piece, Antonia voiced her thoughts about the potential to use AI and predictive modelling to understand which patients are likely to become unwell, informing preventative measures. At the moment, data isn’t good enough to enable this, she considered. “We’ve got lots of it, but we all use it different ways, or code it differently, and AI might be able to help us make sense of that in a way we can’t do ourselves, allowing us to do much better risk stratification.” Remote monitoring in people’s homes is starting to move in that direction, she noted, trying to identify deterioration early and offer intervention via virtual wards or other services. Aligning the codes used by different organisations at a national level would be a great way of moving toward data standardisation.
Mateen shared that his practice is using a Johns Hopkins tool for risk stratification that has been a “game changer”, with a significant reduction in patients admitted from the practice for things like asthma and COPD exacerbations. “We looked at the most vulnerable patients for chronic diseases, and tried to do their medication reviews for long-term conditions in Summer, bringing in the most at-risk patients first, making sure they were on the right medication prior to Winter months,” he explained. “That’s not only reduced admissions, but it’s decreased the number of appointments – I think that can be done remotely quite easily in the future for heart failure, COPD, hypertension, diabetes, or even frailty.”
A survey conducted by Sussex Community identified that 27 percent of those who responded felt that they didn’t have the skills and confidence to use the digital tools or systems they needed to use for their role, Antonia highlighted. “That is a worry, because if people can’t use the EPR safely, or work with remote monitoring tools, that can be a safety problem. We’re taking it very seriously right now, and trying to create a whole digital skills framework along with support and training – it’s key to find those people that need support and bring them with us, but at the same time not over-train people who are already confident.”
The future of innovation in community care
When considering what community care might look like in the future, Mateen predicted that the kind of technology that will be needed will be able to overcome interoperability challenges, or sift through patient records and summarise them in a clear and concise way. “I think community, primary, and secondary care teams will operate much more cohesively, with AI helping to join up patient journeys, and supporting the move to proactive care,” he stated. “The question shouldn’t be about how we deploy AI; it should be about how we can help patients stay well, stay independent, and the role of AI in that.”
“We don’t have a technology problem; we have a scaling problem,” Antonia concluded. “We keep piloting things and we don’t share them across organisations. We don’t need to pilot everywhere if we can use each other’s learnings – we need to be sharing more and trusting other organisations so we can scale-up quickly for our clinical staff.”
We’d like to thank our panellists for taking the time to share these insights with us.
