It’s time to discover who the HTN Now Awards Finalists 2022 are in the category of Excellence in Remote Monitoring.
The use of self-monitoring and self-testing tools, virtual consultations, data dashboards et al has surged over the last few years shows no signs of slowing.
Last year, this category provided us with a range of innovative ideas, projects and pathways that had helped healthcare workers to continue to provide services to patients during the height of the COVID-19 pandemic.
So, which remote monitoring work has been making a difference this year? Find out below…
Eleven Health’s remote monitoring has been enabling patients with sickle cell disease (SCD) to monitor and manage their own health outside of clinical settings, with the aims of improving outcomes and using community data to improve vaccine uptake within the SCD community and people who have ethnic minority backgrounds.
People with SCD spend a majority of their time outside of the hospital, yet most of their care exists solely in clinical settings, and Eleven believes the support should not stop outside of the hospital walls.
Eleven’s technology empowers SCD patients to monitor their own health and, through predictive analytics, take proactive steps to improve it. Using pain as a proxy for vaso-occlusive crises (VOCs), Eleven combines patient-reported pain scores and data gathered from wearable devices to predict upcoming VOCs with a minimum 85 per cent accuracy, three to seven days in advance. This enables patients to plan ahead or scale back their activity in the coming days to potentially reduce their risk of having a crisis.
Data gathered through Eleven can be collated into a shareable format for patients to take with them to appointments, giving healthcare providers a far deeper insight into the daily experience of SCD patients than ever before. While, through the Eleven Patient Wallet, members can easily share tracked data with their health team to give them in-depth insight into how they’ve been without the pressure of remembering and recounting everything in one appointment. This helps improve outcomes whilst simultaneously making patients feel more involved in – and in control of – their care.
Overall, Eleven aims to ensure better quality patient care and experience, through both the advancement of standards and speed of intervention. Through predictive technology integration and monitoring of relevant vitals, the goal is to provide the knowledge needed to shape the resulting treatment pathways and boost each patient’s understanding of their condition.
Medication Support Company
Developed by the Medication Support Company, PAMAN is a pharmacist-led telehealth service dedicated to improving health outcomes through remote medicines management.
The Medication Support Company was launched in 2019 to improve medication adherence and bridge the digital divide, and PAMAN was developed in collaboration with Liverpool City Council, to work across health and social care.
In collaboration with Brownlow Health, which runs four practices in Liverpool, they have developed a range of specialist services to support patients with complex problems – for example, mental health or substance misuse – that can impact on medication efficacy.
Impact and results include: 97 per cent of users take medicines correctly (compared to 55 per cent national average); 51 per cent fewer medication errors; reduced medicine wastage; reduced GP time resolving medication issues; new, enhanced sensory support services to allow patients with hearing or sight impairment to access medication support more easily; reduced isolation of patients, with a source of advice and comfort in times of need; fewer hospital admissions and DNAs.
The company says that, in 12 months, Liverpool City Council saved nearly £345,000 by using PAMAN. This included savings made by: the medication review process, improving hospital discharge and replacing home carer visits. Liverpool University Hospitals also successfully used PAMAN to facilitate discharge, saving up to 10 bed days per patient.
Spirit Health’s mission is to make health easy through innovative thinking and service transformation. Its platform, CliniTouch Vie, digitises clinical pathways – providing remote monitoring, self-management, and education for thousands of patients across the UK. The platform is configurable for any condition, for any patient at any time.
CliniTouch Vie supports patients and clinical teams by implementing ‘proactive, preventative’ care. It works by providing clinically-validated health question sets, tailored to specific conditions, to gather qualitative and quantitative data on patients’ health. Combined with vital sign readings, this information is automatically given a risk score using the system’s unique algorithms.
In real-time, clinicians can view prioritised patient caseloads as red, amber and green, indicating which patients need urgent attention. The red alerts and health trends enable clinicians to spot early signs of deterioration and intervene sooner to prevent health emergencies.
The platform also includes video call and messaging functionality, educational resources, and a local air quality portal. The air portal lets respiratory patients know when and where it’s safe to exercise outdoors to minimise the risk of a symptom flare-up.
Spirit Health’s patient survey found that 90 per cent of patients said that the technology helped them self-manage their condition, while 70 per cent of patients said CliniTouch Vie helped them not to visit their GP.
The company has also collaborated with healthcare professionals to produce an education suite, including written materials, demonstration videos and audio files to help patients lead a healthier lifestyle. This aids in the prevention of health emergencies and slows down deterioration. Education can be freely accessed by patients, or specific materials can be prescribed by clinical teams.
Spirit Health deployed CliniTouch Vie in Leicestershire Partnership NHS Trust (LPT) to help them manage two significant surges in COVID-19 infections and unscheduled admissions. They quickly built and implemented a new virtual ward to help with patient flow and system capacity. The platform enabled COVID-19 patients in the early stages of recovery to be safely discharged into the community, and to be remotely monitored by their clinical team. The service achieved results including 288 hospital beds days saved from O2 weaned patients, while the average length of stay was reduced by 40.3 per cent (Swift et al, 2021).
Lewisham Health and Care Partners and HN provide services for diabetes and respiratory patients with their Virtual Ward. Patients are supported by a qualified nurse acting as clinical coach and the service has so far delivered up to 79 per cent reductions in unplanned care events.
To help address inequality and improve diabetes and respiratory outcomes amid the pandemic, Lewisham Health and Care Partners and HN created a service to support early discharge and release acute capacity. Patients are referred by the local diabetes and respiratory services, monitored via an app, and build a relationship with a qualified nurse working as a clinical coach. The coach checks-in-on, educates, and motivates the patient to take control of their health.
Addressing digital inequality was to be a key element of the service. The technology has two levels of care available depending on the tech-literacy of the patient – one for those with a smartphone, allowing patients to input biomarkers into an app, and another with more frequent calls from the clinical coach to take the biomarker results and input them into the system. Every HN coach in Lewisham is a qualified registered nurse, trained through HN’s in-house training programme accredited by NHSE’s Personalised Care Institute.
In the Lewisham pilot service, HN took on 30 of the highest-consuming patients and helped them to avoid requiring NHS appointments. As a result, staff noticed a reduction in attendances from these patients, while being assured they are being monitored and cared for outside the normal service. Patients who were part of the service were also discharged in around four months, in comparison to six months, and saw improved health outcomes as demonstrated through the improved biomarkers – SPO2 readings stable, and positive impact (-6 per cent) on blood glucose readings and improved health outcomes based on PAM13 and SF12 (standardised forms measuring patient activation and wellbeing).
This has allowed the capacity of the virtual ward to be increased, enhancing capacity to support more patients in the intervention, reducing per patient costs from approximately £2,800 to £1,623 (as 80 per cent of the cost was due to staffing). Both HN and Lewisham are now investigating how they can integrate innovation to simplify the service and address digital inclusion.
In the thick of the pandemic, the Redmoor-ELC Partnership spread video group clinics (VGCs) as a cornerstone of outpatient transformation. The programme did not create a new digital product. Instead, it harnessed the potential of existing platforms. The Welsh Government (WG) and Redmoor ELC delivered a comprehensive programme of support and introduced VGCs as part of the Welsh Outpatient Transformation Programme.
The partnership set out to deliver, via Microsoft Teams, a ‘business as usual’ clinic model that assures safe VGC practice by developing a comprehensive, nationally approved process toolkit. The company also set out to put in place robust information governance processes, develop and train 30 pioneer teams to generate best practice, embed data collection and reporting systems, and evaluate VGC impact on clinic efficiency, patient and clinician experience.
Whilst outpatient VGCs were new, Redmoor-ELC had recently completed a VGC spread programme across primary care in England, which had generated best practice insights on how to mobilise a national roll-out. This digital transformation programme provided teams with: basic VGC training for the whole team; intensive support and coaching to help plan the change, design the VGC model and set up digital clinic administrative processes; a dry run, which was observed and provided improvement feedback; and bespoke digital skills coaching if required.
Despite COVID-19, they engaged nearly 600 NHS Wales people through webinars and training, and provided intensive support to 25 teams across outpatients, primary and community services. Teams have trialed VGC models for: diabetes (primary care and dietetics led), rheumatology, dermatology, chronic pain, long COVID, stoma care, cancer (pre-chemotherapy and chronic fatigue), people living with lower limb amputations, virtual joint (surgery) school and pre-habilitation support, ophthalmology and children’s services (physiotherapy and CAMHS).
Outcomes included; clinicians conducting VGCs with six people in 30-45 minutes, compared to 25 – 45 minutes for one-to-one remote telephone or video consultations, improved quality of care, reduced social isolation, and improved experience of care through convenience – especially for those with mobility issues and working people, and workforce development.
With the onset of COVID-19, Inhealthcare worked in collaboration with Wessex AHSN [Academic Health Science Network] to swiftly develop and deploy a fully digitised-enabled Oximetry@Home (O@H) service. The service is now being expanded to include other conditions, including respiratory and hypertension (BP@H), using the same digital health infrastructure.
Supported by NHXS funding, the fully digitised-enabled Oximetry@Home pathway for the remote monitoring of people with confirmed or suspected COVID, was widely available to patients in primary and community care settings and was supported by Oxford and Kent Surrey Sussex AHSNs.
Since the service was rolled out, it has been adapted to include other care pathways for monitoring more long-term conditions using the same digital health infrastructure, including hypertension. Following a successful pilot, Inhealthcare has helped Surrey Heartlands ICS (Integrated Care System) to launch a remote monitoring service for patients to manage high blood pressure at home. Inhealthcare is also rolling out virtual wards to monitor patients with respiratory disease in early 2022.
“The introduction of the new technology allowed us to scale up remote monitoring at pace…while this was implemented as an emergency response to COVID-19, there is clearly now an opportunity to embed technology-enabled remote care as a core part of the health and care offer in future. That’s incredibly exciting,” said Claire Parker, Head of Digital, Hampshire, Southampton & Isle of Wight CCG.
Both the O@H and the BP@H services link directly to NHS Spine, simplifying registration for NHS staff. For COVID patients, identifying ‘silent hypoxia’ helps clinicians identify early signs of deterioration and intervene to improve outcomes. The O@H patient uses a pulse oximeter to monitor oxygen levels, answers a series of questions and provides vital signs readings requested by the Inhealthcare platform.
Hypertension patients, meanwhile, use a simple device to record their blood pressure and heart readings on a twice-daily basis for four consecutive days. Patients report their readings alongside other vital signs on a regular basis to healthcare teams. Patient records are automatically updated via integration with the EMIS and SystmOne GP systems using SNOMED codes, showing changes in their health and the amount of time spent on the virtual ward. Secondary care electronic patient record systems are also updated where applicable.
Outcomes have so far included:
• More than 6,000 people have benefited from the Inhealthcare Oximetry@Home service.
• Research shared by Dr Matt Inada-Kim, National Clinical Director for deterioration at NHSE, showed hospital length of stay was reduced by an average of 6.3 days for CO@H patients, in comparison to non-CO@H patients. Only 3.6 per cent of CO@H patients were admitted to ICU compared with 8.2 per cent for non-CO@H, and 5.8 per cent of CO@H patients died within 30 days compared to 20.5 per cent of non-CO@H patients.
• For BP@Home, a local trial involving patients in Surrey Heartlands found the service helped 53 per cent of users move from high to normal threshold blood pressure within five months.
NHS Coventry and Warwickshire CCG has worked with Docobo to roll out the company’s remote monitoring solution, DOC@HOME to practices and care homes across the county, receiving excellent feedback and results and demonstrating real impact in care homes and GP surgeries. The project has also been rolled out to at-home COPD patients who have been affected by COVID-19.
Docobo’s DOC@HOME is a Digital telehealth platform allowing care home teams to record residents’ observations and symptoms, using a tablet or CAREPORTAL® and a structured set of questions, designed specifically for residential care. When a resident starts to become unwell, instead of contacting their GP surgery, the care home staff use DOC@HOME® to record a structured set of observations and symptoms about the resident which are then electronically transmitted to a secure clinical database ready for clinical triage to ensure the right intervention and support is provided to residents.
The COVID-19 pandemic meant that physical visits from GPs to residential homes were radically reduced and care homes wanted to benefit from a remote monitoring scheme in order to maintain continuity of care with their GPs, while not necessarily being in the same location. Over the last 12 months, adopting this new technology has demonstrated so many benefits for GPs and practice managers, as well as for Care Home residents and staff. The roll out of Docobo’s remote monitoring happened smoothly across the care homes, with a mixture of online and in person training, where appropriate.
Benefits include GP surgeries saving an average of 19 hours of GP time per month, while care homes have fed back on the ease of use, the quality of clinical response and the speed of response of the system, and the fact that it leads to a reduction in GP call outs to care homes.
Annie Frost, Deputy Manager of St Joseph’s Care Home, says: “The staff have picked up the system far quicker than we expected, possibly because we are all used to using a tablet, which makes it much less daunting. The software is very self-explanatory, the system is really easy to use, and the teams are now very familiar with it. We are really pleased with the results and the ongoing project!”
The project is now rolling out further across Coventry and Warwickshire and is being used to support remote monitoring for those with COPD and heart failure and learning disabilities.
Royal Papworth Hospital
The Royal Papworth Hospital NHS Trust cardiology team can remotely monitor patients through implanted devices from a single platform, improving treatment strategy. Using DataLinQ, the cardiology team increased capacity in just one year, remotely reviewing patients and scaling its service from 1,000 to 7,000 patients. They can analyse heart performance, usage, longevity and reduce physical patient interventions to provide a care experience without walls.
Royal Papworth Hospital is a tertiary centre which manages over 7,000 pacemaker (PPM), implantable defibrillator (ICD) and biventricular (CRT-P and CRT-D) patients each year, from implants to follow-ups, revisions, and extractions for the region. During the COVID pandemic the cardiac devices service was rapidly re-structured to allow safe follow-up of patients with minimal face to face (F2F) appointments (appts), as many were shielding (average age of 75 years).
A process was developed by the physiology team to triage patients into low, medium, and high-risk groups, selecting only the highest risk patients to attend F2F appts for detailed assessment or programming changes. In parallel with this, they embarked on a programme of enrolling selected patients into RFU (Remote Follow-up) by posting RFU boxes and offering telephone virtual appointments. Patients not suitable for RFU had appts deferred when appropriate. There was also a specialist group of physiologists and cardiologists assessing any possible early generator replacements.
When a patient comes to the hospital for a check-up of his or her pacemaker or ICD, all data are entered automatically into one database with DataLinQ. Information is sent to the DataLinQ CRM software or an EMR with just one click of the mouse. All data from the pacemaker, ICD, ICM and remote follow-up are bundled in one location. The new workflow is fully automated. DataLinQ exports data from a pacemaker programmer automatically and links the data to the EMR.
DataLinQ helps cardiac physiologists and their team to monitor their patients both remote and in clinic. This way they can keep track on patient follow ups and trends in therapies given and the status of the implantable devices. By doing this, patients can receive more accurate interventions and individual therapies. In addition, Royal Papworth has increased its efficiency, as the system provides one workflow independent of the device vendor. As the system enables a complete automated workflow, the amount of accidental human errors is minimised, and time can be saved as manual transfer of data is no longer required.