On the third day of HTN Digital Week June 2020 we hosted five live sessions. The first session we were joined by Alfresco discussing Content Services for the NHS, Delivering Positive Patient Outcomes in a Pandemic.
Jeff Nott started by highlighting their customer projects; George Eliot Hospital NHS Trust and Leeds Teaching Hospitals NHS Trust: “George Eliot wanted to move to a paperless solution across the trust, they needed a system that was agile but an electronic form solution that would streamline the process.”
The trust was looking to save financially but also have forms and processes that didn’t rely on printed formats.
Jeff said “On implementing Alfresco, the forms can now be created much more quickly, and the system has been really well received with a lot of positive feedback.”
At Northampton, Jeff explains that the CIO there was focused on moving away from paper records: “What he wanted to do was digitise the records to make information more available and make the hospital a more information led environment.”
To offer better patient care, Northampton General Hospital NHS Trust chose Alfresco to improve the management of patient data. This gave healthcare professionals a better overview of patient information and to meet the NHS paperless mandate.
“The idea was to automate the back-office functions to free up time for the doctors and nurses to spend on patient care.”
Jeff then proceeded to talk about Leeds Teaching Hospitals and how they wanted to modernise and manage patient records better.
To drastically improve their information sharing efficiency, Leeds Teaching Hospitals chose Alfresco’s open source Content Services enabling clinical staff to view healthcare information across multiple care providers and between different systems in real-time.
“The first key statement in Leeds’ digital compendium, is that the Leeds digital way is going to enable everyone to have safe integrated care in Leeds and beyond.”
Leeds have turned paper files stored in a giant warehouse to digital files. What the trust needed was an opensource solution that could integrate with their existing solution.
Alfresco was chosen due to its ability to integrate with the existing patient pathway and the ability to configure it out of the box.
Our second presentation of the day saw Henrietta Mbeah-Bankas, Head of Blended Learning and Digital Literacy Workstream Lead at Health Education England discuss digital literacy, digital capabilities, engagement as well as sharing her insights.
Henrietta took us through building a digitally literate workforce, how to develop capabilities in digital literacy, engagement and what works.
“HEE in 2018 defined digital literacy as ‘those capabilities that fit someone for living, working, learning, participating and thriving in a digital society.”
Henrietta explains the importance of this definition as our generation of so called ‘digital natives’ are not necessarily digitally literate.
Covid-19 has pushed digital communications over the past three months but clinicians have had to use it with very little training. “The scale of change is rapid”, she said.
“Health is the area where we most need complex digital skills; we will need our workforce to be digitally skilled in the 21st century.”
Henrietta showed us a graph of the speed of change in digital technology progression where humans are not keeping up with the development of such technology in terms of adapting to the increasingly complex nature of tech.
“Digital ready means to be digitally willing and digitally able.”
Essentially, people need to both possess the skills to wield digital tech but also be willing to do so from the outset.
The challenges with people are to provide them with the necessary skills; in order to do that we need to engage with people who are digitally negative, digitally ambivalent and digitally excluded.
Henrietta explains that culture plays a large part in digital engagement and there is currently a shift in culture change towards digital tech which has undoubtedly been pushed by Covid-19.
“Local policies can prevent the implementation of digital tech; not to provide challenges, but to improve the process.”
The challenges according to Henrietta surround design; is it user centric, ethics, and keeping the tech up-to-date: “we should bring users to help design technology that is fit for purpose.”
Also Henrietta said “decision making tools; who’s responsibility is it if the algorithm gets it wrong.”
Interventions in digital literacies include now having a developed health and care digital capabilities framework, a sign-posting tool to digital skills resources, commissioned an independent evaluation of five digital championship models and learning for experts and leaders.
“We are continuing to ensure we are working with colleagues in all sectors to make sure learning outcomes in terms of digital literacies are being met. We need to think about digital organisations to support the implementation and planning for the future.”
“We need openness and experimentation” in order to engage everyone in the implementation of digital literacies.
Our third presentation of the day saw Terry Murphy and Molly Kent of Radar Healthcare discuss a data driven approach to safe care.
Terry started the presentation by taking us through the fundamentals of a digital system and telling us what a system like Radar provides: “when these healthcare organisations flourish, we will all benefit from better care as a result.”
Terry took us through how Radar supported ERS Medical where they required a digital system to be implemented. Radar improved transparency by supported ERS to plan and manage issues, digital transformed ERS systems and provided continuous improvement to ERS following system implementation.
Molly then took over to discuss what the foreseeable future holds in response to Covid-19. She said: “We need to have watertight tech in place. We shift the focus from reactive to proactive for organisations we work with. A system needs to be configured to look at all data within an organisation to then go on and action solutions based on that data.”
During the webinar, Terry and Molly discussed how data can support your organisation to make decisions and drive change.
Radar allows access to real-time operational data, to provide control and visibility to enable steps to be taken in improving quality of care.
The webinar helped the audience understand how data can influence service improvement and create a safer care environment.
Also, Terry and Molly discussed the importance of centralising any incidents and risks which involve patient harm, reputational damage or financial loss as well as how to create a standardised approach to quality and compliance.
Finally, the presentation ended with how adopting a digital system to manage operational processes and procedures have huge efficiency and financial benefits.
Our penultimate presentation saw Dr Pauline Whelan of Greater Manchester Mental Health NHS Foundation Trust & University of Manchester talk to us about CAMHS.Digital – developing digital (mental) health platforms with children and young people.
Pauline took us through the co-design and co-production of CAMHS.Digital.
The goal of CAMHS was to enable Children and Young People (CYP) to drive the digital research agenda for CYP mental health. The co-design and co-production of CAMHs.Digital is a two-way process where work is conducted with researchers and technical teams.
One of the products CAMHS has been involved in, mSootheBox is an augmented reality app for managing self-harm behaviours.
“The rates of self-harm amongst CYP are increasing.”
Where services are overstretched and support is often needed out of hours, the augmented reality program is where interactive elements are overlaid on real-life settings and can be accessed any time on demand.
Pauline also informed us of the MANC Project where the aims of the project are to “embed low cost, scalable, innovative digital mental wellbeing tools for children in school.” This came on the back of schools, teachers and parents in the region becoming increasingly concerned about the mental health and wellbeing of their students and children.
Our final presentation of the day surrounded how digital health products are changing behavioural change outcomes.
Catherine Dale, Programme Director for Patient Safety and Patient Experience at the Health Innovation Network, hosted Dr David Crane of Smoke Free App, Shaun Azam Co-Founder of Sweatcoin and Mark Jenkins from Oviva in a discussion on behavioural change theory and how digital products on the market today are empowering people to manage their own health better.
David began his presentation discussing the smoke free app that he has developed.
“The most effective type of support is behavioural in conjunction with medications. People do not use behavioural support as much as they should to really benefit from it.”
“The problem we face as behavioural scientists, is how do we get people to maintain behavioural change?”
For the long term, David explains two psychological theories to change behaviour:
Prime theory: “we can have the best intentions to go running, but we won’t go running unless we still want to. We need to help people in the moment they are attempt to go back to that behaviour”
Rothmans theory: “We will only maintain this behaviour if the outcomes to that change are seen as being worthwhile in the short term.”
“People will not change unless encouraged in the moment; how can we predict when people might attempt to smoke.”
The reflection is key as well as appreciating the gains from quitting negative behaviour; people need to be able to reflect and see the gains from habit change.
Next up, is Shaun Azam Co-Founder of Sweatcoin.
“Our mission is to make the world more physically activate.”
Some of the tools out there already are things like gym memberships, exercise machines and Fitbits.
“We wanted to know what they did well and what they didn’t do well.”
“The average life of a Fitbit is 42 days, and we know that people quit the gym shortly after or during January. The fear of stigmatization also puts people off going to the gym.”
Shaun has made a free to use app to convert behaviours into reward coins to redeem for products on the company’s market place.
“People want to come on to our app and come back and see steps taken, points earned and what they can redeem. Our users walked 20% more each day even after 6 months; sustained behaviour change.”
To end the presentation, Mark Jenkins Medical Director and Co-Founder of Oviva talked to us about medical change behaviour programs that Oviva has implemented.
“Dietetics is a clinical speciality focused on nutritional balance although over the last 20 to 30 years with the growth in obesity and diabetes, dietetics has become a specialism in itself.”
“It makes sense for dietetics to digitise as there is no physical contact with the patient.”
There are 7 million people with type 3 diabetes with only 4,500 dieticians in the NHS. Oviva has built an app for behaviour change plus a dietician to guide the patient through the program.
The behaviour change is conducted through cognitive behavioural theory.
“We are combining humans with technology to drive change.”
The outcomes from Oviva research is that the outcomes are the same as with face to face services but the uptake and completion rate of treatment is much higher.
“We are available in 20 STPs across the NHS and have supported 20,000 people in the UK.”
Purely digital solutions do not have any significant benefit according to the research where Oviva is keeping a human balance to their treatment.
