HTN Digital Week Day Two: Tuesday 21st January 2020
After a successful first day for HTN Digital Week, we are delighted to provide below a summary from day two. The presentations on day one provided exceptional content and insight; many thanks again to all who presented!
We expected the presentations on day two to be just as informative, fascinating and educational, and we were not disappointed.
Najum Khan – Command Centre at Northampton General Hospital
First to present today was Najum on a software package that amalgamates information from various sources to allow for comprehensive ward and A & E management, that is being used at Northampton General Hospital.
Najum said: “The solution provides dashboards to help us to reduce A&E breaches and improve bed management, and patient discharges. It pulls together information from several clinical systems to provide a highly visible patient record.”
“The focus of iBox is to plug into a multitude of systems and pull data from those systems to bring data to life.”
“The solution runs live data 24/7 on ED, it shows how many beds have been acquired, the demand in A & E currently, the capacity within A & E, how many people are almost at the 4 hours wait time deadline and other data. The program gives a site overview of all the core metrics without having to call A & E or consult spreadsheets. It gives patients a RAG rating to allow users to identify priority patients and core metrics are accessible on a mobile version also.”
“It shows hour by hour activity and flow, it can show a forecast of A & E attendance, it identifies themes and trends and impacts where something can be done differently to improve efficiency of service.”
“The program can check if the hospital has enough staff to cover a demand in services, with what staffing model is required for specific demands. It gives a really detailed view of A & E, hour by hour, day by day, week by week and month by month.”
“Each ward has its own performance dashboard – the detail within this is comprehensive and provides the user with an abundance of data and metrics, asking ‘how did we do on a ward?’ Moving up to ‘how did we do as a department?’ To ‘how did we do as a trust?’.”
“The program then offers a task summary; showing what tasks are outstanding for the patient, for example, does the patient need the consultant to come and review his/her status in order for a quicker discharge and thus improvement in patient flow. You can see where your easy wins are to support an earlier discharge.”
Session two: Dr Kathrin Cresswell, Sally Eason & Professor Robin Williams – NHS Arden & GEM CSU and the University of Edinburgh provided insights from their GDE programme evaluation
In the second presentation of the day, Professor Robin Williams talked about improving digital maturity and developing a learning ecosystem within the NHS.
Professor Williams discussed the background of the Global Digital Exemplar Programme (GDE), where lessons were learnt from the high-profile failure of centralised procurement through NPfiT. Stating that there were cost and interoperability issues with the local trusts.
“The GDE is a great attempt at making a learning ecosystem, where £10 million has been made available for digital exemplar hospitals, with £5 million for Fast Follower trusts linked to GDEs. The GDE has seen production of ‘best practice’ blueprints.”
“One of the learnings from the previous programme was to have real time evaluations of problems rather than wait until they arise” and “having an independent evaluation of the GDE programme.”
Professor Williams went on to discuss the three phases of the conceptual framework; firstly, to understand digital transformation. Secondly, how does knowledge flow from the GDE to Fast Follow sites. Thirdly, how to build a broader learning ecosystem.
One headline from the presentation was that “GDE has been very impactful and insightful and has allowed players to raise their sites from a number of drivers. It is not just a technology programme, but a digital transformation programme.” Adding, “GDE funding has been impactful for smaller sites, but is perhaps small change for the larger sites.”
Professor Williams, discussed some of the key values of the GDE programme:
“Firstly, raising priority of digital transformation. Secondly, improving scope and promoting wider learning. Thirdly, having greater leverage over the supplier. Fourthly, improved development of staff as well as retention of highly skilled staff; also, development of clinical digital leaders from original staff. Fifthly, some sites have integrated GDE work into digital transformation.”
“Another crucial element of the GDE programme mentioned by Professor Williams was the spread of learning after transformation. In order for spread of learning to be successful, there needs to be successful GDE collaborations, production of blueprints, ongoing blueprinting, blueprints acting as signposts – where blueprinting networking was highly successful in some contexts. It must also be considered how useful blueprints are more widely. The takeaway being “learning from failures as well as successes.”
The challenges in running a digital transformation programme, as mentioned by Professor Williams include making sure funds are available, renewing infrastructure takes years, ongoing issues with benefit realisations; as in over time, do the original intended benefits stay true as well as visions evolving over time. Finally, there is no end point of digital transformation.
The key questions going forward, how can successes be replicated? What resources needed to share knowledge? How can less digitally mature trusts learn and leap frog? How can change programmes in evolving contexts be managed? And how can the role of intermediaries facilitating exchange between trusts be promoted?
“The NHS has tried to produce a learning system in a digital health ecology – the GDE programme has shown what happens when you have to manage change on the hoof.”
Cara Afzal, Senior Programme Lead at Health Innovation Manchester presented the Smart Hearts programme, a digital transformation of the heart failure pathway in Greater Manchester
We listened in to a fantastic presentation by Cara Afzal, discussing implanted heart devices which enable users to monitor heart failure patients in order to prevent an episode way in advance of it happening.
“In terms of Greater Manchester, we have a great opportunity to do things different – it has devolution – we can ask ‘how do we get better outcomes for our population?'”
“In terms of policy and key drivers for change, the taking charge document has focused our attention and efforts on the life course of individuals – how they live well and how they age well. We ensure this by looking at various different priority areas implemented through a strategic plan.”
“What is our mission and purpose? – to improve the health and well-being of Manchester’s citizens first and foremost. Our vision is to be an international leader. Our purpose is to connect research academia and industry with the health and care system at an accelerated rate.”
“We are using health related data from implanted cardiac devices to monitor heart failure stability with our overall aims being to use data routinely from medical devices, increase the population in Greater Manchester who can benefit from these approaches, explore new ways of working with partners and with industry and to test a digitally enabled ‘high tech low labour’ transformation model to add rapid value to patients with heart failure.”
“Why did we select heart failure as the condition to be prevented from implanted devices? – we had patients with heart failure in Greater Manchester with cardiac devices already installed. We had a cardiac devices team and a heart failure team already and the impact of heart failure in Greater Manchester is striking; the numbers are stark. A 40% increase in 2014 of heart failure in this area.”
“Traditionally speaking, we usually intervene when an attack occurs, timely intervention is crucial; to act before an attack – to do this we monitor pressure changes, autonomic adaptation, impedance changes and weight changes, heart rate and other biometrics. Diagnostics pick up information from the device so that clinical teams can act on that data swiftly.”
The way information is transferred is from device to cloud servers and on to clinical teams, as a result, data is now accessible to the front line where it has not been previously.
“We need a way of lowering the burden even further – we can give a risk rating to be sure clinical teams are placing their best efforts where required where we have currently established what interventions need to be made and at which time. Predictive modelling helps with that and allows us to concentrate on the right individuals at the right time.”
“We are creating a new pathway for remote monitoring of heart failure stability in patients; data is now routinely viewed by clinical teams, and is brought together so it isn’t scattered over multiple hospitals and multiple systems.”
“To conclude, the information we collected is about remote monitoring.” Clinicians now have information on the action they need to take, this is actionable change. “We now have tens of thousands of patients with HFRS enabled devices.”
A patient now knows when they may have an episode due to the tech, way before the episode actually happens – they now know his heart is looked after ahead of time before it gets to the stage of an episode. Truly remarkable technology!
The last session of the day was live on Twitter (@health1tech), Andrew Dean, Head of Partnerships at NOVA presented the top 5 reasons for health tech start-up failure – and how to avoid them
To round off Day 2 of HTN Digital Week, we listened in to Andrew Dean, Head of Partnerships at NOVA on how to avoid failure at starting up a health technology company.
“NOVA is an organisation that helps tech start-ups across different sectors, particularly in health, to go from an idea to a first prototype. They do that by providing a team and the investment to run that team and become a technical cofounder with whoever was the original founder. We’ve come up with these top 5 reasons for failure through experience of dealing with start-up companies.”
- Building something nobody wants or no market need
- Poor hiring – not necessarily different to any other company, however, because tech start-ups are generally very small, poor hiring can have a huge impact
- Failing to execute sales and marketing
- Having the right cofounders
- Get a good investor
“If you’re dealing with a hospital, then the hospital becomes a customer and the patient becomes a user. It is important to build a user panel so you know exactly what the problem is you are trying to solve.”
“This is something we have heard time and time again from previous interviews – it is critical to understand your user’s needs.”
“You can talk to hospital departments before you have anything solid planned, where some start-ups state that they have spoken to the potential users, but not to the actual hospital department associated with the user. I can’t stress enough to have initial discussions and to understand your customers.”
“It is important to have someone in that domain to understand and have the subject knowledge of the problem you are trying to solve.”
“So, firstly, building something that nobody needs, is the number one killer for tech start-ups.”
“In a clinical setting, this sounds a little corporate, but you still have to convince one hospital, one trust or one set of doctors surgeries etc that this is the thing that they need to have.”
“Who are the key people who have the buying power in these organisations? Essentially, who holds the purse strings and is able to make the decision in buying your product.”
“Don’t be afraid to “hustle” – send multiple emails to get hold of who you want; you might land on that one email address which gives you the break you need.”
