HTN was joined by a panel of digital leaders for a HTN Now session exploring how independent providers are using digital. We discussed digital pathways and how data and analytics are informing improvements, as well as hearing examples from our panel on how digital is supporting their services, clinical teams and patients. Panellists included Penny Kechagioglou, CCIO and consultant clinical oncologist at University Hospitals Coventry and Warwickshire and medical director for ICON UK; Dan Bunstone, clinical director at Cheshire and Merseyside ICB; and Tessa Mattier, customer experience manager at Radar Healthcare.
Each of our panel started out with a brief introduction, with Penny explaining ICON UK’s remit as an integrated care provider operating in London with a view to expanding the growth of radiotherapy services across the UK. Tessa shared her background as a registered nurse prior to working for Radar Healthcare; and Dan told us about his work as a GP, clinical director, as well as with Vor, an AI-powered workout generation platform, and Asterix, focusing on a modern workforce solution for healthcare.
Examples from the past 12 months
Penny talked about her experience and main focuses over the last 12 months with ICON. “It will come as no surprise to anybody that the challenges I face as a clinician in the NHS are similar to those we tackle in the private sector,” she said. “We are also rolling out AI and AI scribes to support our clinicians, driven by the same goals of seeing and treating more patients.” Digital tools help ensure connectivity with clinicians and delivering on partnerships with the NHS and other providers, she continued, “because as a global company, a patient getting a CT scan in the UK could have the actual plan for radiotherapy completed overnight from Australia with the right digital tools”.
That use of digital and connectivity offers huge benefits for patients, not only in terms of reduced waiting times, but also from a long-term outcomes perspective when looking at the cancer pathway, Penny shared. “We’re also working on a remote supportive oncology app and a digital exercise medicine model, digital nutrition, and psycho-oncology service. That’s designed as an all-encompassing care model that can be done remotely with patients so they don’t need to physically come to the unit, giving them a self-management tool during their treatment.”
Dan’s focus has similarly been on AI and ambient scribe, as the tools offering “massive impact” for the future. “For me, proactive care is the only way we’re going to truly get the NHS out of the cycle we’re in at the moment – we have to try to get to a healthier nation where there’s less demand by design – with that in mind we focused on patients with hypertension, aiming to proactively reach out and let them know what’s going on with their care,” he said. Feedback was positive and patients appreciated the contact, rather than having to struggle to get an appointment, and the project likely prevented a number of heart attacks and strokes that would have happened in the next 2-3 years. “You have to have that element of investing for the future – you plant the acorns now to harvest oak trees later,” he added.
As a quality management system covering risks, incidents, complaints, and audits, Radar Healthcare has to make sure to stay up-to-date, Tessa explained, so it can harness AI to bring together powerful information inputted into healthcare systems and reduce the labour intensive aspect of triangulating that data. “We work in true partnership with our customers, so it’s important to get that voice from the frontline to let us know what is needed from our platform, and how we can best support,” she noted.
The role of digital and data in supporting against key metrics
For private providers, the accuracy and the safety of treatment are key metrics, Penny told us. “Radiotherapy is a very complex treatment, and we provide this at scale, globally, so having solutions like our AI solution incorporated to check the dose is right, or to help clinicians identify where a change needs to be made in the dose for more personalised radiotherapy treatment, is paramount.” This use of technology aligns with the 10-Year Plan’s focus on personalised medicine and genomics, she went on, “and I would say AI within radiotherapy treatment allows us to have that focus on patient safety, personalised medicine, and accuracy in treatment”.
“I think the foundation of this is developing a safety system within different technologies and processes,” Tessa agreed, “in terms of the structures, processes, behaviours, and culture behind everything, where we can work together to identify risks, prevent harm, learn from incidents, and continuously improve patient safety and outcomes.” Bringing the information together isn’t enough, she said, “and in developing our dashboards we’ve had conversations with our partners about how we look at that, how we slice it, and how we can customise it while also allowing for an element of standardisation”. Doing that in the right way helps identify potential risk or the need for a clinical audit, helping to prevent harm.
Data is integral to the proactive care piece, and in demonstrating impact, particularly when requiring an investment now for a return that might not be realised until three years’ time, Dan said. “There’s lots and lots of data, and it’s being produced from things like smart watches. It’s how we use that data and put it together to make something meaningful. There’s so much out there in terms of NHS data, and if you start to blend that with the harder to access data, you can create something really rich that becomes very bespoke to the individual.”
“I couldn’t agree more,” Penny said. “It’s time we bring those dots together, and while there is so much data in the NHS, it’s important to look at what we have in the private sector as well with wearables, engaging with our patients, and how we can create those really strong datasets that can drive clinical decision-making. That will ultimately help us understand demand in both the NHS and independent sectors, and how we can share capacity.” Allowing patients access to their data and empowering them to improve their health through self-management, is another key element, she added.
Opportunities for AI
AI is a huge area for exploration, Tessa considered, and can be particularly useful when looking to build a narrative around available data. “It’s about picking up on what the data is telling us – it might be that hand hygiene audits completed toward the end of the month tend to have worse scores than those completed at the beginning – as humans, we might not pick up on that, we might just see that people are passing. AI can give us that additional layer of understanding.”
The power of AI is in its ability to look at complex datasets and patient journeys, Penny offered. “If I take one of my oncology patients, it can be very complex, and they might move from one provider to another with disparate datasets sitting in different places. Tumour boards should bring that data together, and AI can help – it leads to meaningful conversations about patient care, and meaningful outcomes – that’s a huge opportunity, and it’s exciting.”
“When you look at primary care notes, for example, that is the single source of information for much of a patient’s health record,” said Dan. “Trawling through those can be difficult, and it’s like trying to find a diamond on the coalface. If you’re trying to look for certain things that might lead toward a suspicious diagnosis, or even a safeguarding issue, being able to extract those subtle pieces of data as a human would take an exorbitant amount of time.” AI can help look for keywords or themes, attendance rates, to offer a clearer picture and some context, improving accuracy and saving time. “Yes there are data risks, but there are risks if we delay, too, in terms of adverse outcomes – doing nothing also has a consequence we don’t often spot quite so easily.”
Examples in practice
Moving on to look at some examples in practice, Penny told us about some of her work on remote pathways for cancer care, highlighting the important role of communication alongside technology in the patient journey. “These are long, complex pathways,” she shared, “and technology can help link the right expertise across the globe, make treatment planning faster, and bring data together to speed up the quality assurance process.” For patients, that means the pathway from coming in for preparation of radiotherapy to actually receiving it, can be completed in one week, rather than several.
Dan shared details of a project looking at hypertension, using protocol-based software to search the primary care database for patients that were then risk stratified into categories from high to low risk. Patients were given access to an app to use to input their blood pressure readings, he explained, so both they and their clinical team could have a record of that data. “They were then supported by a clinical team, who were all remote, and much of the advice given was about compliance, medication taking, and so on. It made a real impact, and patients loved it, they felt empowered, and appreciated we reached out to them rather than the other way around.”
Tessa spoke about seeing a lot of collaboration across the independent sector, with Radar Healthcare supporting a user group that meets once a month to go over what is working well and any challenges. “A really good example of collaboration is with our Learning From Patient Safety Events, which has been around for a couple of years, but with independent providers wasn’t always clear right from the start. Our partners and customers could come together and compare data and what they were seeing, to see where they could learn from each other.”
“For us, our global clinician network is what drives patient outcomes, so we need to connect them,” Penny agreed. “Part of my role as medical director is to bring clinical communities of best practise together and link them, looking at how to share clinical information safely so we can make decisions quicker and get patients to treatment faster.” Engaging with patient communities is also important, she said, which makes patient-reported outcome and experience measures key. Digital can help remotely collect that sort of data and enable services to be adapted in line with patient needs.
With Asterix, a focus on helping tackle demand in primary care is prompting the interrogation of data on things like patient attendances, time of consultation, and number of blood tests being ordered, Dan shared. One of the things that has come out of that is that the top 20 percent of attenders consume about 80 percent of appointments, he told us, meaning that dealing with that cohort in a more proactive way could help free-up some of that capacity. “Context is huge – due to the amount of information in the primary care record, you wouldn’t necessarily go back three or four years, but being able to do that brings up really informative trends. Maybe something happens every November that nobody’s spotted because it’s infrequent, but that’s the sort of thing we can look at now with our data.”
“What we’ve started looking at with one of our partners is how to overlap that data we’re collecting on incidents, risks, audits, complaints, and so on, with things like consultations, visits, activity, and everything that sits outside of that quality management system,” Tessa noted.
Accelerating proactive care and prevention
Dan talked about stresses around funding and current funding cycles, which often don’t support longer term returns. “To get proactive care off the ground you have to do a joint project,” he said, “so with hypertension you could combine with something like COPD where you can prove in-year savings through avoided admissions, and bolt your work on hypertension onto that.” Going back with the results in terms of money saved and then asking to reinvest that money is then how to work on that with the system, he continued, “but we have to do this stuff now, because if we’re still having these conversations in ten years time, the situation will be 100 times worse”.
“We know that screening rates for cancer are not where they need to be, and that goes hand-in-hand with digital literacy, as we are also aware people from disadvantaged populations are less likely to attend for those appointments,” Penny highlighted. “That increases the likelihood of cancer being diagnosed at a later stage, making it less likely to be curable – there is a lot of work on improvement in this space, but if we take digital literacy seriously and try to reduce those health inequalities in access to information, and as clinicians navigate that information with our patients, we can empower them to play their part in prevention. That will help us diagnose cancer earlier.”
Tessa gave us an example of work done with Radar Healthcare and Genesis, exploring how being able to visualise data on different forms of cancer treatment and specifics between different roles or competencies in cancer care has helped increase visibility and enhance compliance. “That has been helping improve safety and ensure patients are receiving fantastic care,” she added.
Future focuses
Considering plans for the future and priorities for the next 12 months, Dan told us he will continue to focus on neighbourhoods and drilling down into more granular level data. “It’s great we have that for areas or roads, or sometimes even houses, but I’d like to get to what I call bedroom level data, where it’s actually dad or daughter that needs attention, rather than that household,” he explained.
“Neighbourhood health is going to prevail,” Penny stated, “and we as independent providers need to play a role – there’s a huge opportunity we are working on at the moment to identify with the NHS what patients would benefit from chemotherapy, for example, closer to home. How can we help, as independent providers, with our digital tools and connectivity, to offload some of that demand from acute trusts, because it’s not going to go away.”
For Radar Healthcare, the priority is supporting customers and partners with their ambitions, Tessa outlined, and making sure safety systems are established and maintained to support safe patient care. “We’ve got a solid roadmap for the next 12 months with AI at the centre,” she added, “and with our product advisory panel offering insights from key strategic leaders on how we can meet needs and keep on top of evolving technologies.”
Key learnings and takeaways
“A key learning for me from my work in the independent sector has been that we might need more staff, but actually if we work a bit differently and use the right technology, we can be efficient and deliver what we need to with what we have,” Penny considered. “In my case, it’s about understanding where the bottlenecks are in the patient pathway, and working with staff to see how we can do things differently or incorporate technology.”
“We all have many of the same problems, and there’s more we can do in having those conversations with each other and being open about that,” Tessa said. “It might be that we can look at those problems we’re trying to solve and learn from what has worked in other cases, or how other providers have tackled them, rather than starting from scratch over and over again.”
“The difference between the independent sector and the NHS is probably the ability to start projects off and get things going,” Dan noted. “I think the NHS has a bit of fear around spending taxpayer’s money, so doesn’t want to waste it, but by delaying, bad things still happen. It doesn’t have to be perfect in the first iteration, and sometimes we need to let things breathe – achieving success in six weeks or three months is pretty difficult.”
We’d like to thank our panellists for taking the time to share these insights with us.
