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Special Report: Digital Patient – March 2017

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Digital Patient Services

Achieving a shift to digital patient services is a golden thread of STP plans, Claire Read examines how the landscape is shifting and attitudes are changing to the diverse range of new tools and services that place patients in control of their health, but the key challenge remains reaching scale. 

If, for your sins, you read through every one of the carefully crafted 44 local sustainability and transformation plans (STPs), you will frequently come across the word “digital”. In fact you will realise – as you gulp down two paracetamol for the splitting headache you’ve suddenly developed – that you saw that word in 43 out of the 44 proposals.

In many instances, it’s used in reference to the local digital roadmap, an exercise in jointly planning the digital direction of health and care communities, which has become somewhat swept up by the STP juggernaut. But it’s also frequently used in more general overviews of each area’s plans.

Which, you ask, is the one document which doesn’t use the word? Step forward Staffordshire and Stoke on Trent, who prefer to mention technology rather than digital.

Digital patient tools identified as key to NHS sustainability

But in suggesting that digital (sorry, technology) could help patients better manage their own long term conditions, this plan too echoes a theme which comes across in many of the STP proposals. The vast majority state that digital patient tools – be it apps, wearables, shared care records – will be critical to reducing dependence on healthcare services, so making them more sustainable.

Certainly the digital patient agenda has been increasingly prominent in recent months. Consider the announcement that a Babylon Health chatbot is to answer some NHS 111 calls in London; or the awards success of University Hospital Southampton Foundation Trust’s personal online health record My medical record; or the plans for a revamped NHS.uk.

But the challenge remains delivering these diverse range of digital patient services at sufficient scale to enable shifts to more sustainable models of care that enable large numbers of patients to take far greater direct control of their own health.

Reaching the dipping point on digital

As a self-confessed “geek, gadgeteer and gamer”, Dr Keith Grimes has always tried to combine his passion for technology with his practice of medicine. He feels “the water has now reached the highest mark thus far”.

A couple of weeks back, he hit a milestone: in a single consultation, he used both a smartphone connected ECG (Kardia, by AliveCor) and a smartphone connected otoscope (Cupris). He also uses a digital stethoscope several times a day.

For Dr Grimes, these digitally connected devices – and the ability to securely share the information they collect – are changing the way in which he practices care. “I can get an expert’s option without sending the patient to them,” he explains. “This is all about sending the information and not the patient. And that’s made a difference in terms of stopping people going to hospital to see ENT doctors or cardiologists.”

When ENT surgeon Jules Hamann first came up with Cupris, that was precisely the intention. “He was suffering from inefficient communication in the NHS and thinking that much of the time his patients could be treated remotely,” explains Helene Viatge, business development and project manager at Cupris. “With sharing of information he would be able to save patients time and save the GP time. So the idea was a secure communication platform to enable him to really easily discuss issues with patients and GPs.”

That platform supports better communication with patients as well as between healthcare professionals. When a patient does need a consultant appointment, he or she is able to complete an electronic questionnaire via the system to provide the necessary information.

The idea for a digitally connected otoscope followed quickly. “When you do a consultation, you don’t only ask for results, you also make a clinical examination – so if you really want to make remote consultation decisions, you also need to enable remote clinical examination,” says Viatge. “So we developed the otoscope. It’s a very simple device that you clip on the back of our smartphone, and which enables you to take clinical images of the ear and send it remotely.”

For now, Cupris is marketing the device to healthcare professionals rather than directly to patients. Not so for Kardia, the ECG device Dr Grimes also regularly uses. “The idea of the product is really to give individuals the same sort of information that would normally have been reserved for the medical institution or GP, and really change the power dynamic,” explains Francis White, VP sales and business development at AliveCor. “So it really is the digital patient, and the bulk of our market is to individuals who buy it for themselves online.”

“In most cases at the moment, we are still at the point where doctors, CCGs and the like are using it as a tool on patients,” reports White. “That’s still the dominant lens through which people see healthcare. We’re trying to get to the point where we say, actually, we could give this out and empower patients to do it on their own. That piece of the journey is what we’re trying to navigate at the moment, really.”

Positive early results for self-management tools

Ian Thompson, the strategic director at my mhealth, which runs online self-management programmes for those with long term conditions, tells a similar story. A recent research trial showed patients who went through pulmonary rehabilitation using the firm’s online tool actually did better than a control group who had face-to-face support. But Thompson fears the progress of the digital patient agenda is sometimes stymied because “healthcare professionals don’t always want to let go of their patients”.

“I think there can be this tendency to focus on the patients who can’t use digital technology or who won’t,” he reflects. “But then you’ll just continue in the way you currently are. Most of your patients are going to be able to do this – I mean, you don’t get any training in online banking but people are able to use it.”

How can STPs overcome barriers to digital patient shift

Could the STPs help change these types of mind-sets that weighs against digital? Viatge suspects it will depend on individual areas. “Some are really moving forward and really involved and really into the idea of translating this agenda into reality and into real projects. And some are a bit less active.”

There are encouraging signs that STPs can help. Viatge notes a recent workshop run by the East Midlands Academic Health Science Network (AHSN) which brought together five STP footprints. “They had identified four areas in which they needed solutions, and brainstormed with suppliers, trusts and CCGs. Out of that day they identified 12 specific areas in which suppliers like us should come out with a solution and they will move forward. For them, it was really how do we deploy solutions and not just about strategy.”

STPs and digital roadmaps have helped build shared commitment

Dr Grimes is optimistic that his local STP – Sussex and East Surrey – will help accelerate the digital patient agenda and help scale initiatives. “Having an agreed underpinning digital roadmap means that the innovations that take place in one component of the STP can rapidly be moved to the others,” he says.

“And so the innovations that we develop in our area could rapidly be cascaded to other members of the STP. Likewise what they develop could be brought back the other way as well; accelerating the pace of the change. That’s one of the things that I see as the benefit of the single STP and the roadmap.”

It is a view shared by Simon Merritt, acting head of commercial operations at Ieso Digital Health. The company provides cognitive behaviour therapy via a secure online platform – those with a mental health issue can ‘meet’ a real therapist on the platform, communicating via secure messages. It’s a method which has already been embraced by 35 CCGs, and Mr Merritt hopes the creation of STPs will now make it easier to implement across larger geographic footprints.

“I do feel like we’re approaching a tipping point really where our sort of service is no longer seen as part of the fringe, if you like,” he says. “We’re treating as many patients now as an average increasing access to psychological therapies service. We delivered 35,000 hours of therapy in 2016.”

Digital patient channel shift must become the norm

Thompson agrees that the digital patient agenda needs to become normalised, and that it must form a part of the NHS’s future. “With high street banks, footfall is less through the door since people can manage their finances themselves online,” he argues. “That’s what we want to do for the NHS.”