critical engagement with digital health technologies for nhs stps
TRANSCRIPT
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Critical Engagement with Digital Health Technologiesfor NHS Sustainability and Transformation
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Transforming
health and care
in Hampshire and Isle of
Wight
Health and Academic Sector Engagement
17 January 2017
Richard SamuelLead, Hampshire and Isle of Wight Sustainability and Transformation Plan
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Goal
Meeting the many opportunities and challenges facing the local health and care system around the need to empower people to stay well and to provide safe, high quality, consistent and affordable health and care to everyone.
Healthier lives, world class sustainable services, strong primary and community care
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The case for change
Health and care funding is
increasingly outstripped by
increasing demand
Workforce pressures
Accessing care, information and support is often complicated and
confusing
Too much variation in outcomes
across the area
Increasing pace of technological
changeHealth care today
is too reactive
Healthier lives, world class sustainable services, strong primary and community care
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Focus for transformation
Healthier lives, world class sustainable services, strong primary and community care
Prevention at scale
New models of care
Effective Patient Flow and Discharge
Acute Physical Alliance
North & Mid Hampshire configuration
Mental Health Alliance
Digital transformation
Workforce
Estates
Commissioning
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Shape of Transformation
Healthier lives, world class sustainable services, strong primary and community care
Do Things Better (2.5%) AND Do Better Things
3 points of recognition:
- there is a burden of care- there are outcomes worse than death- there is predictability in much that we do
Break / Fix model to Proactive Population Health Management:- Reversing the specialisation trend- Capability in Behavioural insights- Founded on Predictive analytics using connected data- Channel shift and Care coordination - Actuarial and risk modelling
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Questions?
Healthier lives, world class sustainable services, strong primary and community care
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Critical Engagement with Digital Health Technologiesfor NHS Sustainability and Transformation
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User experiences of telehealth and telecare: learning from studies of
LTCs adaption and adoptionAnne Rogers,
Faculty of Health Sciences, University of Southampton UK
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Telehealth interventions
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Aspirations
•A means of making services more responsive, equitable, cost and clinically-effective
• Able to play a central part in mediating between service users, professionals, and service providers.
•Potential for Self care agenda policy vision of independent responsible self-managers.
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Warning shot for aspirations•“Our assumption that all those who were eligible would want the technology proved to be the biggest challenge in the recruitment process.” (Martin Scarfe, Project Director Newham) http://www.wsdactionnetwork.org.uk/news/from_the_dh_pilots_update/december_2009_wsd.html
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Key themes for patient implementation
•Technology Design•Perceptions of health, self-care and dependency
•Views on technology and operational factors
•Expectations and experiences of changes in service provision and use
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Three Principles for designing effective tele-health progs for LTCs
•Need to help people living with conditions to:• Build effective relationships with doctors, nurses and others.
•Be a good fit between the technology and everyday routine of the patient
•Provide a clear visual record of health results, such as blood glucose readings.
• Vassilev I, Rowsell A, Pope C et al. Assessing the implementability of telehealth interventions for self-management support: a realist review. Implement Sci.
2015;10:59.
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self-care• Interventions improve motivation to improve self-care
This has helped since I've had the graphs going, that I know that day I had a drink, or extra piece of cake, so I make sure now that once I've had my dinner I don't take nothing else (ID78, M, 75yrs, diab)
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“That big one, when it's gone up to eleven... which isn’t too bad? That was my birthday when I had a curry night and the kids came around and gave me about four Baileys” (ID78)
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BUT Monitoring could also undermine self-care strategies
I think you feel like you're not in control of your life… from how he explained it, you tended to have to do your blood test every single day… I try to be a bit more relaxed and… I just felt it, it did put a bit more pressure on me…” (ID31, W, 61 yrs, Diab)
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Threats to health and independence IF not targeted appropriately
I'd feel more crippled… As long as I can get out, that's all I am worried about…We see these old people... hobbling along, like, you know, and we're walking.. (ID28, M, 84 yrs, HF,)
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Perceptions of technology• Concerns about technical competency
The older you get the more forgetful you get… younger people obviously are computer wise… when you are not used to it you need to read the manual every time. (Wife of ID33 M, 66yrs, COPD)
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: using new technology adaptations by users
ID168, W, 77 yrs, COPD
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experience of service change• Valued new relationships with staff
...my sugar level was high and one of the nurses called to see if I was alright… So I feel quite relieved because, if things did [go] wrong, I know there's somebody watching. (ID77, W, 59 yrs, diab)
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experience of service change• Increased security
If there's anything wrong, they phone you up…Someone’s at the end all the time. I call them the angels (ID70, M, 66 yrs, diab)
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Introduced into set expectations of services• Concern that good services would be undermined or taken away
They put things in your home don't they. You don't have to go to the doctors…Too complicated for me…I like things plain and simple. I'd sooner go over to the doctor. (ID27, W, 79 yrs, diab)
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ParadoxesAn adequate substitution for traditional services & added benefits (minimising travel, reassurances of regular external surveillance)BUT Limited patient work low level rather than requiring higher level interpretation of readings and decision makingParadox reliance acceptance of TC +creation of new relationships and dependencies
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A balancing act: Key Points •Facilitates & inhibits self management•Creates new relationships and dependencies•Participants may be active or more passively engaged
• Interventions may be perceived as threats to identity and independence
•Expectations and perceived technical competence are important
• Interaction/ communication is important for integration
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Critical Engagement with Digital Health Technologiesfor NHS Sustainability and Transformation
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Simon Bourne DM, FRCP (UK)CEO my mhealth Limited
NHS NIA FellowRespiratory Consultant Portsmouth Hospitals NHS Trust
An evidence-based approach for the design and delivery of
mHealth products for people with long term conditions
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Where are we with mhealth?
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English subtitles for hard of hearing and language translation
PolishPunjabiUrduBengaliGujaratiArabic French ChinesePortugueseSpanishTamilTurkishItalianSomaliLithuanianGermanPersianFarsiTagalogFilipinoRomanian
(C) my mhealth limited 2016 - Not for distribution outside agreements
2017
Reaching areas where current clinical services struggle
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Connectable
(C) my mhealth limited 2017 - Not for distribution outside agreements
Next Generation
POC Diagnostics
Home DiagnosticsBiometric wearables
Cloud Platform
ClinicianSoftware
New models of care
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Clinical Studies
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New pathways….....ementation
Touch points Advantages
• Whole system communication• Enhances reach and impact of
current PR services• Proven inhaler education• 24/7 resource for patients• Helps with delivering the COPD
BPT• Assists with COPD patient
review• Predictive analytics
Digital hub
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Critical Engagement with Digital Health Technologiesfor NHS Sustainability and Transformation
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© xim ltd 2016
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The self-care challenge
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© Xim Ltd 2016
Standard smartphone camera: No custom hardware. No wearables.No contact. No wires.
Predict heart attack or other critical event 24 hours ahead. Before it’s too late.
Prediction for prevention
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Use cases
• Self-care monitoring– Simplicity– Low cost– Adherence– NEWS/MEWS capture– Track deterioration
• Triage vitals in 30secs– Paramedic– Over a 111 call– GP reception– NEWS/MEWS capture– No training required
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Alignment with STP Characteristics
STP Lifelight™Self-care Ease of use
AffordabilityAdherence
Pro-active
Avoidable admissions
Removal of variation
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Alignment with STP Characteristics
STP Lifelight™Self-care Ease of use
AffordabilityAdherence
Pro-active Early warningvia NEWS
Avoidable admissions
Removal of variation
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Alignment with STP Characteristics
STP Lifelight™Self-care Ease of use
AffordabilityAdherence
Pro-active Early warningvia NEWS
Avoidable admissions
Prevention by NEWS
Removal of variation
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Alignment with STP Characteristics
STP Lifelight™Self-care Ease of use
AffordabilityAdherence
Pro-active Early warningvia NEWS
Avoidable admissions
Prevention by NEWS
Removal of variation
Measure outcomes with post-discharge data
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Challenges to adoption
• Pilots -> partnerships• Building evidence base• Culture change - spend to save
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Other issues for digital self-care
Ease of use and ease of managementDesign digital into new preventative care modelsConsent, privacy and securityData ownership
Primary and secondary care blurring linesOpen data
Hampshire Health Record and IoW integrated model Analytics
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Thank you
Laurence Pearce
Contact@[email protected]
XIM Ltd Catalyst Centre, University of Southampton Science Parkwww.xim.ai
© xim ltd 2017
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Critical Engagement with Digital Health Technologiesfor NHS Sustainability and Transformation
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Health workforce challenges and opportunities in the digital age
Jeremy Wyatt DM FRCP ACMI FellowProfessor of Digital Healthcare & DirectorWessex Institute of Health & Research
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Examples of digital health innovationsGENIE – web tool to map personal support network, identify community resourcesPersonal Health Records – eg. UHS Prostate serviceQuantified Self movement; wearablesBody worn sensors for eg. blood sugar, alcoholSelf hacking movement – insulin pumpsPatients Like Me: online patient community running “citizen science” studiesPatients Know Best: personal health record I control, share with clinicians when I decide toGoogle DeepMind Acute Kidney Injury app at RFH
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Expected changes due to digital tools & methodsIn professional practice:• Data tsunami due to self / remote monitoring• Automated data interpretation, triage• Remote video consultations, data capture• Greater sharing of data with patient, others in own organisation, other
organisations• Increasing health literacy & self care activity
In health systems:• Global health services compete with GP practice down the road• Citizen participation in health decision making• Citizen organised research• Learning Health System
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Some opportunities for staff• More flexible, mobile working (Skype clinic in Boston
after dinner?)• True partnership with patients via shared records• Active triage of patients – you only see the complex
or very sick patients• Rapid learning and feedback in LHS (cf. monthly /
annual clinical audit)• Future: don’t see patients at all – instead provide
professional EB updates to guidelines and other tools that manage patients
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Some challenges for staff• Need to ensure record easy for patients, other professionals to
understand • Avoid data tsunami from remote / self monitoring: nurse-run call
centres, artificial intelligence algorithms• Distinguishing “normal” from “special cause” variation in disease
indicators – SPC methods ?• Ensuring continuity of digital services – don’t use personal email
address• Managing patient expectations for more responsive clinical services• Learning how to remotely consult, build therapeutic relationship, escalate to a FTF visit…
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Training & other implications• Need for a “distance medicine” learning lab (role play
with digital tools in difficult scenarios); analogy is keyhole surgery training centres
• Need new codes of practice for carrying out & documenting remote consultations, computer assisted triage, etc.
• How to check quality of apps, decision support, triage algorithms etc. – look for CE mark; NICE / PHE work on apps
• How to check quality of digital services – CQC Key Lines of Enquiry for digital health services
• Will digital services attract and retain more staff, or not?
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Conclusions1. Digital is already changing the shape and practice of
healthcare, and will accelerate over next 5-10 years2. This opens up welcome professional opportunities, but
also poses some challenges3. We need facilities to train health professionals to provide
safe, effective “distance medicine” services4. Healthcare organisations and clinical services may soon be
competing on a global stage to provide health services to “their” population
5. Research is needed to understand these challenges, and how to overcome them
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Critical Engagement with Digital Health Technologiesfor NHS Sustainability and Transformation