HTN Awards 2023: Best Use of Digital in Primary Care

Here we take a look at all of the entries for the Health Tech Awards 2023 category of ‘Best Use of Digital in Primary Care’.

Inhealthcare Limited

Overview: Blood Pressure@Home enables patients to monitor their blood pressure from the comfort of their own home, without the need to visit their GP practice. They send in BP readings digitally to a team who support them in managing their condition.

Why? Surrey Heartland’s Digital Primary Care team is working with Inhealthcare to target and support around 125,900 people estimated to be living with poorly-controlled diagnosed or undiagnosed hypertension.

What happened? Building on a successful pilot in 2021, the service with Inhealthcare is led by clinical pharmacists and care coordinators working alongside GPs and other specialists. This approach, interlinked with strong patient engagement, maximises resources as the service prioritises people according to clinical need. Patients most at risk of hospitalisation or stroke, according to a risk stratification pyramid, are actively monitored by the service using the Inhealthcare platform. The patient uses a monitor to take their BP reading and submit it to the service via a channel of their choice – an app, email, text message, or phone call – to the long-term conditions digital care coordinator, whose post, along with Inhealthcare licenses and blood pressure monitors, has been supported through NHS England funding. Findings to June 2023 show 3,161 patients from high-risk cohorts engaged with the BP@Home service and progressed through 4,031 cycles of monitoring; 12 patients with critically high blood pressure readings in the red RAG rating were identified and through intervention by the clinical pharmacists now have readings in the green or normal threshold; 46 percent have been treated to target with their blood pressure readings now in the normal threshold; a further 33 percent patients showed improvement, with either systolic or diastolic readings showing green ratings; and a further 50,500 responses have been submitted by patients using SMS whose blood pressure wasn’t  previously known.

Looking ahead. Inhealthcare looks to continue to scale-up the service ICS-wide, to serve a population of approximately 125,900 people living with poorly-controlled or undiagnosed hypertension.

Pogo Digital Healthcare

Overview: Tailored Talks is digital platform with a patient facing area and app (MyTailoredTalks), offering personalised support for people living with  long COVID.

Why?Long COVID has affected millions and GPs had limited options when it came to offering referrals. Care for people with the condition has been difficult to provide, due to issues within the NHS such as increased waiting lists caused by the COVID-19 backlog, as well as a general lack of information and understanding of the condition

What happened? MyTailoredTalks features a self-assessment questionnaire, which upon completion triggers the system to share personalised multimedia presentations containing information relevant to the patient’s answers. The presentations contain information on the most common symptoms of long COVID, such as breathlessness and fatigue, as well as other information on practical topics such as returning to work and financial support. It is thus designed to personalise information for patients, allowing them to better understand their condition and the support available to them, while simultaneously saving time and resources for clinicians. The platform includes an option for patients to receive a call-back from the Chest Heart & Stroke Scotland (CHSS)  Adviceline, allowing them to speak to a professional who can help to guide them through recovery. Patients can refer back to MyTailoredTalks  at any time, track their symptoms and request information on new concerns throughout their recovery. The solution was developed and rolled out in NHS Lothian, in partnership with both CHSS and NHS Lothian. Phase one of the project, which began in the summer of 2021, constituted the design and creation of the pathway, which involved cooperation across sectors and organisations. Phase two  involved the pilot stage, which took place in NHS Lothian and ran from March 2022 to November 2022 and phase 3 a full roll-out across NHS Lothian. 15 patient interviews conducted following the pilot found patients were positive about using a digital support service and found it effective; and that they felt the service could help them cope with long COVID. Quantitative feedback from the roll-out so far has shown a significant decrease in patients’ level of concern for breathlessness on climbing stairs, breathlessness on dressing, depression, and daily activities.

Looking ahead. Following the initial pilot, phase three is underway, which involves a wider roll-out, with a target of integrating Tailored Talks into health boards across Scotland. The current goal is to onboard 80 percent of long COVID patients in Lothian and make the system accessible to 95 percent by December 2023.

Sunderland GP Alliance and Iatro

Overview: Sunderland GP Alliance (SGPA) and Iatro aim to improve digital access to primary care services in Sunderland by creating a digital front door to reduce GP and administrative workload, promote self-care, and standardise website quality to reduce inequalities in patient experience.

Why? Consultations with a range of stakeholders including GP’s, patients, practice managers and social prescribers, revealed that GP practice websites were inconsistent and of poor quality with low accessibility, which resulted in limited adoption of digital tools by patients.

What happened? The success of the project was measured through monitoring website traffic, adoption of digital tools, standardisation of practice websites, and reduction of disparities in patient experience. The second key stream of the project was to uplift the GP practices in Sunderland to a new website platform that would ensure consistency and high-quality accessibility across all practices in the region. To ensure a seamless transition for the GP practice websites, the project was split into 4 phases and involved all 38 practices across Sunderland. The practices were moved over to Iatro’s Practice 365 website platform over a period of 6 months, with completion in February 2023. The website provides information on a range of services, including social prescribing and self-care options, and allows patients to access their own health data, promoting digital tools such as online appointments and medical record access through the NHS App, via a secure and easy-to-use platform. The project has already provided patients with better quality websites, increased access to digital services, and raised awareness and referrals to other services such as social prescribing and self-care options. A website audit was completed to gauge the accessibility of the practice websites before and after the Practice365 solution was installed. Prior to the new installations, nine different website providers were used across the region, and only 16 percent were compliant with modern accessibility guidelines. After the new websites were implemented, all websites achieved 100 percent accessibility compliance. Since migrating to the new GP practice website platform, 375 self-referrals for social prescribing have been completed through the new digitised form in websites.

Looking ahead. Learning and outcomes are being shared with NHS England transformation team as part of national research, and the project team is working on scaling up the project to improve access to digital primary care services across the wider region.

Hint Health

Overview: Hint Health is an operating system for direct primary care (DPC) providers. Built to reduce administrative inefficiencies and empower clinicians to focus on patient health, Hint’s software, education, and nationwide clinician network supports the growth of the direct care movement.

Why? Modern healthcare faces challenges including long waiting times for appointments, overworked clinicians, and little time during appointments for patients to voice their concerns.

What happened? Through a DPC model, patients or their employers pay a primary care provider directly through a transparent, monthly membership fee instead of paying through an insurance company. The realignment of incentives in this model is shifting the healthcare industry towards one that prioritises health and well-being over profit. To support this growing form of primary care, Hint Health offers a comprehensive solution for the DPC industry through its two distinct platforms. Hint Core, the software component, caters specifically to DPC clinicians by streamlining billing and administrative tasks. Meanwhile, Hint Connect focuses on connecting clinicians with other stakeholders, such as employers, third-party administrators, benefits advisors, and plan sponsors. By separating these services, Hint Health ensures optimised support for both DPC practitioners and those seeking access to innovative healthcare options. Hint Connect launched in 2022 because the company’s research found that DPC practices joining a network experienced 548 percent growth in members after three years, compared to 255 percent growth among non-affiliated practices. Hint aims to encourage this growth among its customers. By focusing on health and well-being over profit, Hint Health is leading the charge toward a healthcare system that prioritises patients. Through its dedication to restoring the patient-provider relationship, empowering DPC professionals, and fostering a healthy and engaged team, Hint Health is leading the healthcare industry towards a brighter and more compassionate future one patient at a time.

Looking ahead. In future, Hint Health hopes to continue to restore patient-provider relationships by powering direct primary care and enabling the prioritisation of health and wellbeing over profit.

X-on Health

Overview: Surgery Connect is X-on Health’s multi-award winning, flagship cloud-telephony system; designed and developed specifically to meet the evolving needs of NHS general practice.

Why? Surgery Connect can deliver key improvements mentioned in the Primary Care Plan. These include an end to busy tones for patients, and integration with critical GP record systems.

What happened? Surgery Connect supports communication via voice, SMS, and video, so GPs are equipped to reach patients via any channel required. It also incorporates a way of securely requesting photos from patients and storing them to the clinical system. Patient Callback means that patients can be automatically called back, instead of being left waiting in a queue. Self-serve features enable patients to conduct basic transactions themselves. Administration staff have visibility of call queues so they can re-route calls during busy times to other surgeries within a PCN. Real-time performance dashboards, regional statistics, improvement metrics, and the use of AI allows practice managers to assess volume and performance. There is also Phonebar, an app extension of Surgery Connect which consolidates GP telecoms and patient communications to a single application, which was initially launched to 54 surgeries in 2022 and is now used in 600 surgeries. Call recordings and SMS communications can be filed back to the GP record; creating a more seamless working environment for GPs and joined-up service for patients. Surgery Connect has an 99+ percent customer retention rate over a 10-year period.

Looking ahead. X-on Health wants to continue to develop Surgery Connect, and improve connectivity with the SystmOne version, which is set to be launched imminently.