Let's get digital What happens when forty researchers, patients, entrepreneurs and health and social care staff come together to discuss digital technologies and their impact on NHS sustainability and transformation? That was the experiment at the University of Southampton' s Web Sciences Institute on 16 January, at a workshop sponsored by the Institute, the CLAHRC and Wessex AHSN. And the result? A highly energetic and constructive exchange of views from the diverse stakeholders in the room. The take away messages: 1. The NHS has to embrace digital technologies to survive but precisely how it embraces these is critical; 2. successful adoption of digital technologies needs to take account of: • the political imperative of developing a compact between public services, service providers and citizens about how their data may be used; • the social processes involved in patient and workforce adaption to technologies and the substantial research base that already exists in this field *the technical challenges involved in ensuring that a proliferation of health data and digital devices develops in a way that supports integrated, patient-centred care rather than promoting fragmented data and digital silos; • developing the capacity to adapt to and exploit fundamentally disruptive innovation from within the NHS and from SMEs many of which have their origins in academic research or front-line clinical practice Next steps? How might we maintain and develop the coalition of interests that met in the workshop to underpin a research-driven, innovation-friendly digital technologies implementation plan for the NHS in Hampshire and the Isle of Wight. Watch this space.

1. Critical Engagement with Digital Health Technologies
for NHS Sustainability and Transformation

2. Transforming
health and
care
in Hampshire
and Isle of
Wight
Health and Academic Sector
Engagement
17 January 2017
Richard Samuel
Lead, Hampshire and Isle of
Wight Sustainability and
Transformation Plan

3. 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

4. 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
change
Health care today
is too reactive
Healthier lives, world class sustainable services, strong primary and community care

5. 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

6. 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

7. Questions?
Healthier lives, world class sustainable services, strong primary and community care

8. Critical Engagement with Digital Health Technologies
for NHS Sustainability and Transformation

9. User experiences of telehealth
and telecare: learning from
studies of LTCs adaption and
adoption
Anne Rogers,
Faculty of Health Sciences, University of Southampton UK

10. Telehealth interventions

11. 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.

12. 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/new
s/from_the_dh_pilots_update/december_2
009_wsd.html

13. 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

14. 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.

15. 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)

16. “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)

17. 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)

18. 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,)

19. 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)

20. : using new technology adaptations by
users
ID168, W, 77 yrs, COPD

21. 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)

22. 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)

23. 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)

24. Paradoxes
An 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 making
Paradox reliance acceptance of TC +creation of new
relationships and dependencies

25. 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

26. Critical Engagement with Digital Health Technologies
for NHS Sustainability and Transformation

27. Simon Bourne DM, FRCP (UK)
CEO my mhealth Limited
NHS NIA Fellow
Respiratory Consultant Portsmouth Hospitals NHS Trust
An evidence-based approach for
the design and delivery of
mHealth products for people with
long term conditions

28. Where are we with mhealth?

29. English subtitles for hard of hearing and
language translation
Polish
Punjabi
Urdu
Bengali
Gujarati
Arabic
French
Chinese
Portuguese
Spanish
Tamil
Turkish
Italian
Somali
Lithuanian
German
Persian
Farsi
Tagalog
Filipino
Romanian
(C) my mhealth limited 2016 - Not for distribution outside
agreements
2017
Reaching areas where current
clinical services struggle

30. Connectable
(C) my mhealth limited 2017 - Not for distribution outside
agreements
Next
Generation
POC
Diagnostics
Home Diagnostics
Biometric wearables
Cloud
Platform
Clinician
Software
New models of care

31. Clinical Studies

32. 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

33. Critical Engagement with Digital Health Technologies
for NHS Sustainability and Transformation

34. © xim ltd 2016

35. The self-care challenge

36. © 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

37. 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

38. Alignment with STP Characteristics
STP Lifelight™
Self-care Ease of use
Affordability
Adherence
Pro-active
Avoidable
admissions
Removal of
variation

39. Alignment with STP Characteristics
STP Lifelight™
Self-care Ease of use
Affordability
Adherence
Pro-active Early warning
via NEWS
Avoidable
admissions
Removal of
variation

40. Alignment with STP Characteristics
STP Lifelight™
Self-care Ease of use
Affordability
Adherence
Pro-active Early warning
via NEWS
Avoidable
admissions
Prevention by NEWS
Removal of
variation

41. Alignment with STP Characteristics
STP Lifelight™
Self-care Ease of use
Affordability
Adherence
Pro-active Early warning
via NEWS
Avoidable
admissions
Prevention by NEWS
Removal of
variation
Measure outcomes
with post-discharge
data

42. Challenges to adoption
• Pilots -> partnerships
• Building evidence base
• Culture change - spend to save

43. Other issues for digital self-care
Ease of use and ease of management
Design digital into new preventative care models
Consent, privacy and security
Data ownership
Primary and secondary care blurring lines
Open data
Hampshire Health Record and IoW integrated model
Analytics

44. Thank you
Laurence Pearce
Contact
@laurencepearce
laurence@xim.ai
XIM Ltd
Catalyst Centre, University of Southampton Science Park
www.xim.ai
© xim ltd 2017

45. Critical Engagement with Digital Health Technologies
for NHS Sustainability and Transformation

46. Health workforce
challenges and
opportunities in the
digital age
Jeremy Wyatt DM FRCP ACMI Fellow
Professor of Digital Healthcare & Director
Wessex Institute of Health & Research

47. Examples of digital health
innovations
GENIE – web tool to map personal support network,
identify community resources
Personal Health Records – eg. UHS Prostate service
Quantified Self movement; wearables
Body worn sensors for eg. blood sugar, alcohol
Self hacking movement – insulin pumps
Patients Like Me: online patient community running
“citizen science” studies
Patients Know Best: personal health record I control,
share with clinicians when I decide to
Google DeepMind Acute Kidney Injury app at RFH

48. Expected changes due to digital tools &
methods
In 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

49. 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

50. 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…

51. 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?

52. Conclusions
1. Digital is already changing the shape and practice of
healthcare, and will accelerate over next 5-10 years
2. This opens up welcome professional opportunities,
but also poses some challenges
3. We need facilities to train health professionals to
provide safe, effective “distance medicine” services
4. 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
J.C.Wyatt@soton.ac.uk

53. Critical Engagement with Digital Health Technologies
for NHS Sustainability and Transformation