NHS England has published a new case study entitled ‘Improving care home residents’ wellbeing through digital technology – South Devon and Torbay’, in which Digital Health Devon, a collaboration between the NHS, Torbay council and local Healthwatch; aimed to support care homes and their residents in making the best use of SMART technology.

Recognising the importance of residents keeping in touch with friends and family members who may live further away, the project looks to work with care home managers to ‘establish a network of champions in smart digital technology’ and introduce interactive solutions for residents.

Using an introductory pack from Digital Health Devon, which comprises of Amazon Alexa devices, a meta portal, mobile phones and Wi-Fi extenders; staff in care homes receive online training to help them to put this plan and tech in place for their residents.

In particular, the ability to use voice-controlled devices such as the Amazon Alexa , has helped residents with limited mobility regain some of their independence, as they are introduced to ways in which the device can help them to manage things like remembering medication, selecting preferred music, and calling their loved ones.

The project stresses the importance of the engagement of care home staff, iterating that as digital champions for the project, they are best placed to understand the needs of their residents and how these can be met using the digital technology made available to them.

The published article on the case study finishes with the following quote from Roz Wills, the Registered Manager of Mallands Residential Home: “The portal has been of huge benefit to the residents. Residents were able to speak to their loved ones and their friends. It has been better than using a phone, because they are able to see their loved ones. The loved ones are also able to see the residents, how they look, how they feel, particularly beneficial for residents with communication difficulties. Also, hugely beneficial to care staff.”

To view the case study, please click here.

A recent study published by BMC Primary Care examines the experiences and perceptions of introducing new information systems in primary care organisations, focusing on the use of a clinical decision support system (CDSS) to identify and diagnose malignant melanoma.

The qualitative study aims to explore the attitudes and belief systems of stakeholders from three different organisational levels in primary care, surrounding digital technology and how these views can significantly impact the role and implementation of new tools and systems.

Researcher Ann Frisinger conducted semi-structured interviews with a variety of primary care stakeholders, asking them the following research derived questions: what can be improved in current digital transformation efforts?; what are the success factors for deploying new technology?; and what is specific for healthcare?

For the application provider, the questions focused on the CDSS application functionality and value proposition. Whereas the other stakeholders were asked about their individual roles, digitisation and the CDSS application for malignant melanoma.

Many of the respondents believed that the initial time and effort required to implement new IT solutions created high levels of stress for professionals and that if the solution “does not provide direct value, it will not be used.”

Several respondents also noted that there is little time to learn about new technical solutions and are often viewed as “disturbing” – one interviewee said: “High workload – to learn a new way of working in parallel is disturbing and the new tool gets unused”.

Many participants expressed concerns regarding the change process, saying that if the solution was designed by people far away from the daily operation or lacking in medical experience and clinical knowledge, it would be highly likely that important requirements would be left out and prove unsuccessful for the end-user.

Scepticism was another defining determinant, with many participants discussing the need for proven evidence in order to convince medical staff of the efficacy of new systems and technology. One interviewee said: “Doctors can be very sceptical, they only trust science and well proven experiences.”

Another voice added that there is a lack of inspiration amongst medical professionals as they are more focusses on the medical issues themselves, rather than the opportunities modern technology can offer.

The conditions for enabling successful digital transformation were discussed by the participants, with motivation emerging as a key aspect of driving change.

Firstly, “motivation by stimulation” which provides initiatives to encourage practitioners to commit to the technology/system and mandatory application. One interviewee gave the example of the digital patient contacts that were implanted during the pandemic, explaining that there were no other options and so the need for the new technology was universally understood.

The interviews also highlighted that an accessible and user friendly interface is necessary in order to incentivise people to engage with technology on a sustainable level. In addition, the doctors being interviewed felt that patients would be more likely to accept the new solution if the procedure “was presented in a comprehensive and trustful way” by a doctor who was well-informed and confident of it.

Overall, the study revealed the complexities of introducing new technology in healthcare whilst offering insight into the positive factors which could help facilitate its wider adoption and implementation on a larger scale. It is hoped that the findings of this study will help healthcare to accelerate digitalisation.

As part of our latest case study feature, the digital mental health provider SilverCloud has shared the outcomes of its work with Greater Manchester Health and Social Care Partnership (GMHSCP), which revolved around bridging the silos in mental health resource to meet increasing demand.

Comprised of 10 CCGs, NHS trusts, social care providers and voluntary bodies, GMHSCP saw that its Greater Manchester’s Improving Access to Psychological Therapies (IAPT) programme was facing a number of acute challenges, brought about chiefly by the COVID-19 pandemic. These included cuts to staff resources, changes to delivery of care, and a move to phone-based therapy.

Against a backdrop of analysis by the Royal College of Psychiatrists, which showed that almost 400,000 children and young people and 2.2 million adults had sought mental health support during the pandemic (April 2021), as well as May 2021 figures from the Office for National Statistics that showed one in five (21 per cent) of adults experienced some form of depression in early 2021, the partnership decided to consider digital mental health therapies.

Greater Manchester selected SilverCloud to be its provider of these services, utilising the supplier’s ‘Space from COVID’ programme, which consists of a six-module online package that is designed to address the issues people have experienced due to the pandemic. Each module provides clinically-backed support for issues such as trouble sleeping, coping with stress, developing mindfulness, financial worries and experiencing grief and loss, and offers practical tools, tips and suggestions for managing mental health difficulties.

The programme was made available to everyone over the age of 16 within the organisations and CCGs comprising the Greater Manchester Health and Social Care partnership, and worked alongside pre-existing programmes which continued to support individuals if they required additional in-person therapy.

Deployed swiftly, the project – which would have typically taken 12 months to approve and implement, according to the IAPT system lead from the Great Manchester Health and Social Care Partnership – took just four weeks to successfully roll out.

Outcomes for patients and staff

Between 1 April 2020 and 31 January 2021, Space from COVID helped 12,700 people to achieve average recovery rates of 59 per cent, and a clinical significant improvement (CSI) rise from 54 per cent to 63 per cent, between 1 April 2020 and 1 March 2021.

Other patient outcomes included greater accessibility of treatment, decreases in wait times for face-to-face or phone appointments, and unlimited capacity of digital therapies. Meanwhile, the Greater Manchester Health and Social Care Partnership estimates that its psychological wellbeing practitioners have been made ‘three times more effective’ as a result of the programme, helping staff with prioritisation and allocation of resources. This is highlighted by 29,070 hours of therapist time being saved between 1 April 2020 and 31 January 2021.

Cost savings have also been considered. By using reference pricing and savings from NICE, GMHSCP has identified that, during a 12-month period, the net cost saving to GM by SilverCloud will be a minimum of £2,234,137, while 29,070 hours of therapist time has been saved using SilverCloud.

Further stats on impact, provided by SilverCloud, show:

• Waiting times improved over time with an 95 per cent 18-week target being met since March 2020 onwards, and the 80 per cent six-week target being met from August 2020 onwards.
• The programme has equated to 7,597 extra patients seen in standard treatment or 18,795 using SilverCloud.
• Patient satisfaction – the user satisfaction survey had 109,375 reviews in total and 1,839 patients who accessed COVID support programmes. The feedback shows 92 per cent of respondents found the programme supportive in making progress towards their goal, while 94 per cent of users found the modules interesting.

“I think it’s broken down into bite size chunks and is easier to understand, it’s not overwhelming and having videos to explain it rather than just reading it is more helpful to someone like me,” said one patient.

“The time management tool has been a real eye-opener and really helped me to prioritise things that are actually not important which I thought were. I am sure implementing this approach will help me in daily life,” added another testimonial.

Moving forwards

The key elements of the SilverCloud Space from COVID programme will remain in place in Greater Manchester, but there are also set to be further expansions into other areas of care across the Greater Manchester CCGs, with potential for take-up beyond the region.

The approach from this piece of work is also being used as a template for the development of new digital mental health therapy programmes, such as expanding the service into perinatal care and potentially also for long-term conditions like Long COVID, diabetes, respiratory, cardiac, and cancer.

As an independently commissioned report with Health Innovation Manchester noted, due to the programme’s ‘focus on preventing escalation and supporting individuals during times of crisis’ it is anticipated that many of the ‘core benefits’ relating to the sustainability of the investment will only be truly realised in the future.

To find out more about SilverCloud and its work, visit silvercloudhealth.com.

As part of our latest series of features and interviews focusing on digital mental health, HTN spoke to Lynsey Eland, the Children and Young People (CYP) Service Manager at Carlisle Eden Mind, to find out how the organisation has been utilising SilverCloud’s suite of online ‘Space from…’ products to complement its in-person support.

The aim for the charity was to increase the availability of mental health services to young people living in the area, through digital therapy.

After selecting the SilverCloud ‘Space from…’ suite, which includes programmes dedicated to helping young people with anxiety, depression, stress, positive body image, and resilience, as well as courses for adults on how to support anxious children and teenagers, the mental health support charity found that by using the online tools it had managed to reach three times as many service users.

Carlisle Eden Mind (CE Mind) has been supporting people with their mental health for around 25 years and had seen demand for children and young people’s services surge recently, including during the COVID pandemic.

Working directly with children and young people through its ‘Your Voice’ advocacy service, which encourages young people to use their voice to access support and understand their own mental health, CE Mind was facing several challenges and barriers to delivery – from geography, distance and communication, to stigma, capacity and funding.

The charity decided on including a complementary digital approach and settled on SilverCloud’s package, which contains seven individual programmes and can offer both supported and unsupported assistance to children. The suite also includes the option of online coaching and support from a CE Mind specialist and 24/7 access to digital tools and resources.

“We always felt digital could really offer something to young people”

Having worked at the CE Mind branch for 12 of its 25 years, Lynsey’s work now focuses on supporting therapy programmes and networks, as well as service users themselves. She explained to HTN how she added SilverCloud to the charity’s support kit. “It was constantly in our mind that we wanted to look at some kind of digital offer,” she said.

“The reason we were looking at that is because Cumbria is quite a rural landscape and quite spread out – and that brings quite a lot of challenges for delivering services with equality of any kind of description. This is due to poor public transport and all those things that go with living in a lovely area but a very widespread one. We always felt digital could really offer something to young people who find direct and face-to-face access too tricky. We’d looked at doing it ourselves and it was just too expensive for us as a charity.

“We then came across SilverCloud, who very kindly offered Mind a free period for staff during the lockdown. I initially tried the adult version and really liked it. A lot of the feedback we get from young people is that they don’t like jargon, gimmicks or being spoken down to, so what I really liked was that the adult version felt very comfortable in its use of language and just a nice space. It feels really calming in its design and layout,” she said.

Having engaged with the adult version, Lynsey then began to explore the CYP programmes. “SilverCloud shared the programmes so that we could have a look before we decided to go ahead, and we just felt it fit really well,” she continued.

“One of the big pluses was that it could be, what we call, a blended model where we offer individual sessions alongside it, so that it’s not all online. For some young people, that’s still not what they’re looking for – despite what society may think about young people wanting everything online. It means that we offer it to them alongside face-to-face work as well, where in between our sessions they’re using the app to dip in and out and to help them with some things that they might be finding tricky when they’re not in sessions with us, or just as expanded learning.”

Before using SilverCloud, CE Mind was supporting ‘around 30 young people at any one time’, but that number has now increased to around 90 people, on a rolling and ongoing basis.

On how adding SilverCloud’s online resources to its mental health toolkit has helped with capacity, Lynsey added: “If we’re to see a young person in a particular part of Cumbria, that could take us over two-and-a-half hours for one appointment because of the travel time involved. If it is suitable to offer that [digital] service [instead], that’s cutting our time down hugely and, in that time, we could be seeing a number of young people. That’s not [intended] to take away that time from that individual though, it’s still on offer.”

In some cases, the charity says, using SilverCloud has cut the support time for a review session from two-and-a-half hours to 15 minutes.

“It’s almost a way to navigate around the young person until they are ready to come forward”

Of the challenges and learnings, she experienced while adding a digital offering to the traditionally face-to-face services, Lynsey highlighted that it was important to “re-align expectations” around rates of engagement, expect that it won’t necessarily work for everyone and that “it is going to be different” in approach.

“It takes the young person to be really ready and able and wanting to engage and break down any barriers to make sure they’ve got the best chance of success,” she stated.

“The other learning is to make sure you’ve got really good communication with who your referrers are, so that they know how this service is best going to support. A brilliant part of SilverCloud is that you can send them a demo account and say to, for example, some of our heads of year in schools, ‘have a look, feel comfortable with it yourself and then you know what you are sharing’.”

As for the future of CE Mind’s digital services and utilisation of SilverCloud in particular, Lynsey says: “We’d very much like to continue with it. We are currently seeking funding to be able to do that. We would very much like to explore [working with] with parents.

“We did a mini pilot of a few sessions and they worked really well, for example with the ‘Supporting an Anxious Teen’ [programme]. We’d like to do that more as an offer. The feedback we’ve had from parents is that this is really good. As that can often be delivered un-supported, that’s a really great thing, as it doesn’t take a lot of staff time. It’s almost a way to navigate around the young person until they are ready to come forward and want some support.”

“We go into schools and deliver workshops on mental health and wellbeing to young people. And what to do if you feel like you need some support. That’s important but often then the next stage isn’t there for young people. So, when they put their hand up and go ‘oh, actually, I think maybe I do need a little bit of help’, there’s a bit of a gap. I think SilverCloud sits really well in that space,” she concluded.

Find out more about the topic of digital mental health in our dedicated feature channel. You can also discover more about the SilverCloud approach in our companion to this piece, a forthcoming interview with the company co-founder, Professor John Sharry.

The full case study information from Carlisle Eden Mind can also be found, here.

Feature by Liquidlogic

Hospital bed management and patient flow has always been a challenge, but COVID and the unpredictability of case surges has tested health and social care professionals to the limit. Now, both have a wary eye on the colder months ahead. There are concerns that the triple threat of COVID-19, flu, and respiratory syncytial virus (RSV) could put unprecedented amounts of pressure on the NHS this winter.

The Long Term NHS Plan has zeroed in on preventing unnecessary admissions to hospitals, as well as ensuring a timely transfer from hospital to home or community care, with the ambition of freeing up over one million hospital bed days over the next five years.

This has been followed by the government’s implementation of the Discharge to Assess model in March last year, which aims to support outcomes for people leaving hospital, improve communication between health and social care workers and ensure more individuals are discharged on the day they no longer require a bed.

Improving the efficiency of hospital discharge, supporting patients with the appropriate level of care after they leave, and doing as much as possible to avoid return visits, are vital pieces of the puzzle.

Harnessing technology to reduce bed blocking and accelerate transfer of care

Health and social care professionals will need to pull together to meet these challenges – and there is now a widely held consensus that data-driven technology will be one of the most important tools when it comes to supporting this interprofessional teamwork.

Lancashire County Council is one example of an authority that has emerged as a trailblazer, using digital solutions to dramatically reduce Delayed Transfer of Care percentages (DToC), improve integration with acute hospital partners, and strengthen the authority’s social care management tools.

In 2017, Lancashire ranked 124^th for total DToC bed days out of 151 authorities. By February 2020, they had climbed 14 places. This was achieved by dedicating significant senior resource from both health and social care partners to improving the county’s position, which included making an investment from the Better Care Fund for a number of initiatives.

One of these projects was their Digital Discharging for Social Care solution, which was first implemented at Lancashire Teaching Hospital in 2019, with the assistance of social care systems and software supplier, Liquidlogic. The system, which sends information directly into a local authority’s social care system ahead of the patient being discharged, using NHS Digital’s MESH standards, has helped Lancashire achieve numerous key objectives.

Benefits so far have included:

• A more rapid discharge process, leading to improved recovery rate, reduction in infection risk and a reduction in delayed days.
• Enhanced handover data from a health to a social care setting, enabling better focused care provision. This allows the data exchanged between both parties to be more transparent, structured and patient-focused.
• Improved levels of independence and confidence for individuals who have experienced a hospital stay.
• Better data quality and security, including building upon their shared care record across Lancashire and South Cumbria.

“The Digital Discharge project helped us establish effective systems to monitor patient flow across health and social care,” explains Lewis Mitchell, Project Manager at Lancashire County Council. “The transfer of this information electronically ensures that all information is sent safely, securely, lawfully and is transparent. This directly contributes to minimise unnecessary hospital stays and provide the best social care and support for people.

“It was a crucial component to strengthening local arrangements for integrated discharge teams, enabling timely exchange of information and patients and ensuring better flow of patients through and out of hospital.”

During COVID-19, Lancashire County Council and its acute partners continued to use the Digital Discharge functionality to manage hospital discharges. Given the value and effectiveness demonstrated before and during the pandemic, the council is now working with other Liquidlogic customers, and NHS Digital, to further develop the Assessment, Discharge and Withdrawal (ADW) standard for use within the new Discharge to Assess model.

The project has also enabled the council to utilise regional technical developments already in place to share data digitally – and has provided a use case for the wider NHS Lancashire Patient Record Exchange Service (LPRES).

Scaling up with Pathfinder

Since 2016, all health and social care teams at partners across Lancashire and South Cumbria have had a shared local digital roadmap (LDR). As part of this, several approaches and agreements around health and social care digitisation have been agreed. This has provided Lancashire County Council with the opportunity to scale up the Digital Discharge solution, following its successful implementation, and widen it to their partners across the Lancashire and South Cumbria footprint.

Pathfinder, which is currently a work in progress, will connect three acute and community trusts; University Hospitals of Morecambe Trust, East Lancashire Hospitals Trust and Blackpool Teaching Hospitals Trust. Lancashire County Council is also partnering with Lancashire’s two unitary authorities, Blackpool Council and Blackburn with Darwen Council, who have their own relationships with these trusts.

“This collaborative programme will help us to further innovate across Lancashire, improving discharge processes and enhancing a single shared patient record solution which will allow multiple partners a single point to access relevant information in relation to a person who may come into their care,” explains Lewis Mitchell, Project Manager at Lancashire County Council.

“We are in the latter stages of development and extremely excited for the benefits and opportunities that this collaborative working will bring to the people of Lancashire.”

For more information on Digital Discharge, visit Liquidlogic.

There’s also been plenty of dialogue about how digital innovations and technologies can support ICSs with wider aims around collaboration, greater integration across all health services, and a reduction in health inequalities.

After a year in which digital tech enabled healthcare providers to work remotely and keep delivering vital services to patients across the course of the COVID-19 pandemic, ICSs can reap the rewards of the healthcare innovations that have been trialled during this period, to move forward.

In this feature, we’ll take a closer look at how change management technology can help to transform and support ICSs, and drive adoption through planning, strategy, communications and the construction of smart workplaces.

Change management is increasingly being driven by smart tools that can sit within an organisation’s structure, and act as an aid to help transform its people and their processes. This fits well with integrated care systems, which are themselves intended to propel a huge shift in terms of healthcare focus and approach.

For our expert comment in this piece, we spoke to Gupinder Syan, Healthcare Sector Lead at Hable, who is also a trained NHS pharmacist and prescriber – she offers the dual perspective of being a past adopter of solutions and someone who supports others to implement them. She also has previous experience of working in both primary and secondary care.

Gupinder currently helps NHS organisations across the UK with adoption of technologies and change management methodologies, specifically with Microsoft 365 and Teams. Use of the latter has rocketed within the NHS during the pandemic, becoming a key platform for staying connected.

“The pandemic sparked a massive transformation in IT in general. That’s actually how the sector was born at Hable – we ended up having several contracts with NHS organisations and decided that we needed somebody to help head that up,” she said.

Gupinder is currently working closely with ICSs across England, which are becoming a strong focus for Hable alongside other large healthcare organisations in the UK, such as NHS Scotland and NHS Wales.

Gupinder explained that for one ICS project, it is progressing in two phases. “The first phase is concentrating on just their CCG staff members within the ICS; the second phase is going to be working across primary care – so that’s including all 104 GP practices,” she said.

“After that, they’re looking at us supporting them with the wider ICS organisations as well – offering our services to other organisations such as local councils, social care organisations, community services and charities etc – it’s the start of a larger piece of work.”

“The ICSs that we are working with are really forward thinking, there aren’t a lot of organisations that invest in adoption and change management – so the ones that we are engaging with are innovative in wanting to change the mindset of their people. They talk a lot about changing hearts and minds, they’re really fully engaged, and I think that is key – we need advocacy from exec level to be able to implement a change across an organisation,” Gupinder said.

Technology as an enabler 

A common barrier to change is the human element, rather than the technology.

“It’s all about how technology can be an enabler to help people to work in new, more productive, and more efficient ways,” adds Gupinder, “but in order do that, you need to change the way that people think and the way they work. That’s the challenge.”

“As an organisation we’re Prosci Certified Change Practitioners. And, because I’m a clinician I understand deeply how frontline staff and clinicians work – the engagement with technology, what the pain points are in terms of how busy we are in our working days.”

“There are real opportunities and it’s just finding those little nuggets of information by talking to people and finding out how they are working, then coming up with a future state of working to improve it and increase the efficiencies – to save time and costs,” she said.

Solving problems

As part of their engagement with the ICS and some CCGs, Gupinder undertook ‘discovery work’ to understand the attitudes, ways of working and pain points, before setting goals and learning plans.

This meant taking the different types of roles and personas into account, whether that’s fixed office staff, flexible staff, frontline workers, or field workers who are on the move.

Focusing on roles, as well as how people were using the tech, meant that Gupinder could better understand the challenges they were facing.

In one CCG case study, Gupinder identified four key challenges that CCG workers faced:

1. People’s workload being led by their emails and the heavy workload associated with this,
2. People not being aware about the best ways to communicate and collaborate using O365 tools,
3. People using the tools inconsistently and in different ways, with this sporadic use of communication leading to issues like back-to-back meetings and a backlog of task lists.

“People weren’t able to get the work done, as they’re just being absorbed by their emails and meetings. Everything becomes urgent and you get that inability to prioritise tasks. All that leads to is an issue with wellbeing, people working until late at night when they weren’t before,” she said.

Gupinder and Hable used this to pinpoint how to solve or improve the issues – by driving staff away from email and pushing collaboration and communication over to Microsoft Teams. They also showed staff how they could create tasks from emails by using To Do and Planner to prioritise them.

“In terms of digital wellbeing,” she said, “it’s just making people aware of the features that are available on the platform. So that they know they should turn off their notifications when not working and understand how to manage their meetings and workload better. Meeting management, task management and email management; that’s what we had identified as the key areas where we could help them.”

On working in smarter ways, Gupinder elaborated, “time saved, and money saved – they’re the two biggest drivers in healthcare. If you’ve achieved that then you’ve achieved success. To do that you need to work smarter, using technology as an enabler.”

Monitoring she added, would be achieved by looking at the Office 365 dashboard tool usage figures, behavioural change and “just seeing the impact that that has on people’s working lives – on their wellbeing, productivity, and ultimately on patient care.

“If you’re doing all of those things right, you’ll be saving time and costs for the NHS, and enabling your frontline clinicians to have less administrative work to do, freeing them up to be able to see more patients and improve the quality of care that you can give.”

Identifying needs 

Delving further into how change management can support needs, Gupinder explained how two-week “floor-walking” stints – when workplace coaches and consultants embed into an office to support staff and log and address issues – helps every individual within an organisation to understand functionality and think about new ways of working with the technology.

Champions are also onboarded and recruited to advocate the change – these are trained on theme-based courses, such as how to lead virtual teams, how to collaborate on Teams, how to be champions of change, and how to support integrated care, all of which utilise Office 365.

“The plan,” Gupinder says, “is once we’ve trained them up, they can train their peers. Champions can have a huge impact on the digital transformation of an organisation, and this is underutilised in the NHS.”

In primary care, the biggest challenges are the vast number of users across multiple organisations, as well as the need to better communicate with other healthcare and social care organisations to provide seamless patient care. Hable focuses on phased roll-outs, instead, to account for greater capacity.

One area that they have identified, which could also be applicable for ICSs, is helping them with smart and effective MDTs – Multi-Disciplinary Team Meetings.

Due to COVID-19, these have typically moved to virtual settings, so the focus is on assisting organisations to do this effectively, by using Teams to reduce travel time and venue costs, and also to free up clinician time spent attending meetings that once upon a time could take up half a day to attend, hence allowing more patients to be seen.

Letting the outside in

In terms of ICSs and communicating and collaborating with external organisations, Gupinder says: “At the moment, we’re still finding that ICSs need to digitally mature further to enable two-way communication. At the moment there are a lot of barriers, in terms of outside organisations getting access to NHS tenancies. That’s something that needs to be resolved so that we can help train people up better. There’s so much opportunity with cloud-based technology to be able to do that a lot better.”

Planning for those barriers before undertaking transformation, she highlights, is crucial: “We also do governance workshops to help people understand the N365 tenancies, the restrictions, how they should get the security right – it’s helping them to create robust policies that protect the organisation and enable effective communication. As much as you need the security there, it can sometimes be a barrier, so it’s about getting that balance right.”

Gupinder concluded with some tips for those early in their ICS journey. “My advice is to recognise the importance of change management when trying to adopt new technologies. Don’t view it as secondary, embed it from the start. If you don’t, you’re chasing your tail. To create a successful change across an organisation you need good change management, good project management and good exec sponsorship – those three elements are critical.”

To find out more about Hable’s NHS case studies, visit hable.co.uk/healthcare.

For more expert comment and features on support for ICSs, visit HTN’s new dedicated channel.

Feature by ReStart

NHSX CEO Matthew Gould recently announced that all 42 Sustainability and Transformation Partnerships/Integrated Care Systems (STP/ICS) organisations must have a Minimum Viable Solution (MVS) shared record in place by September 2021. There are nine months left to achieve this goal.

Shared Care Record procurement and deployment has generally taken much longer in those areas that have one. Is there an approach that meets these timescales? We take a look.

The requirements of a ‘basic’ shared care record – the MVS

Like many technology projects, the programme team’s first query is: what are the intended requirements and deliverables? In November HTN reported that NHSX wanted a ‘basic’ level of record-sharing in place as set out by the Professional Record Standard Body in their Core Information Standard.

As well as general demographic information, this includes appointments, medications, care plans and more. The Core Information List includes over 1,500 data fields which might exist across hundreds of different IT systems. With NHSX wanting further interoperability of records to include NHS trusts, GPs and social care, organisations coming out to tender are shaping their own interpretation of what constitutes the MVS.

Integrated Care Systems and STPs are complex. Your ‘basic’ level of record sharing and your requirements, i.e. your MVS, will undoubtedly be different from another ICS/STP. How do you make sure you can design and deliver this interoperability for your teams’ requirements by September 2021?

Prioritise the objectives of your MVS

Keeping clear objectives at the forefront makes it easier to identify the indispensable critical elements needed for your shared care record.

What are your clinical priorities?

• Is GP data shared in the hospitals within your STP/ICS, especially in ICU?
• Do you need to manage repeat testing by sharing lab data across the community?
• Does the wider system have visibility of allergies and alerts?
• Do you need better transitions of care?

Flexibility: Start small and build incremental programmes

It is essential to manage scope and appreciate the interoperability capabilities within your organisation.  Start with the basics, add datasets incrementally and work at the pace your clinical teams can manage, between now and the end of Sept 2021.

Encourage clinical champions to support their communities through the change programme and adopt a common language to create a clear understanding of the proposed solution.

A measure of success will be the level of buy-in from your clinician teams; if they don’t believe it in, how can they endorse it?

What’s the end goal?

A shared care record enables any user across any care setting to view the same information about a patient in real-time.

Shared care records will pave the way to population health management, analytics and machine learning.

The fundamental requirements for your MVS shared record and any procurement are:

• A detailed health and care record – view everything in one place, including documents, medications, appointments, results, scans and care plans.
• Real-time data flow across care settings – update information once and share immediately.
• Role-based access – ensure users only see the information they need for their care setting and role.
• Integration across all health and care settings – build with Open Technology for complete interoperability with existing sources whilst allowing for future changes.
• Read and write capability – allow users from all care settings to collaborate seamlessly. 
• Single sign on authentication –enable users from all organisations to log in to the record using their existing credentials.
• Caseload lists – created by users and shared across care settings to promote collaborative working.
• An intuitive user interface – for users to quickly view patient information and activity from any care settings without the need for dedicated training.
• Cross-organisation search – allow users to find patients no matter which system they are registered with.

These fundamental requirements will give you the platform to enhance data sharing in the future and pursue a sustainable healthcare delivery model; as health services transform and patient participation increases.

A partnership approach to shared care records

When your supplier understands your needs and can design a shared care record with your users, with their workflows and patients in mind, it results in an interactive consultation. This improves collaboration and innovation and when professional needs are listened to efficiencies can be realised.

The discovery phase should not just be a technical audit, but an opportunity to understand each partner organisation’s local needs and their readiness to meet the project goals. Flexibility is key. The flexibility of the shared care record functionality must deliver a solution that meets the ICS objectives, tailored for each organisation to support a mixed pace and approach to local adoption. Only then can early benefits across all settings be recognised.

Suppose you and your shared care record supplier have an up-to-date view of the systems’ technical state and the clinical priorities. With this mutual understanding, you can plan and manage in a way that considers competing priorities and differences in system maturity, even where those priorities appear to conflict.

What technology do you need for shared care records?

Ask your supplier what type of technology they use to build, host and manage your shared care record. How will they integrate, and how will you have access to the care record? Will there be any dependencies on your local infrastructure? Will your supplier be able to add or remove user components, functionality and features without any downtime?

We at ReStart believe our interoperability solution, the IMX Clinical Record, is the answer. It is not a constraining, pre-defined product but instead is designed with your input specifically for your region and to address your immediate concerns. STP/ICSs can build their own MVS or ‘basic’ care records according to their users’ needs and current working practices.

IMX-CR can provide the MVS shared care record in as little as 12 weeks. The care record doesn’t require a large data repository and is developed using a modular approach to save a considerable amount of time. The incremental programme approach makes it very cost-effective as you never pay for functionality you haven’t asked for and don’t need. IMX-CR is fully interoperable and can integrate any system or embed within it.

We’re here to break down your silos of data from legacy or current systems. We work with clinicians to present a single source of real-time information, that enables better-informed decisions about patient care and a view of data you want, right from the start.

IMX-CR is hosted in the AWS (Amazon Web Services) cloud, and offered as a fully managed service with built-in data replication. Barring some access to, and integration with, local trust integration platforms, there are no dependencies on trust infrastructure. IMX-CR has micro-service architecture so we can update the system safely, without downtime, which is essential for a 24/7 NHS. Find out more in our latest blog ‘Why microservices are the answer for shared care records’.

Get the ball rolling today

The NHS has confirmed funding will be available to help STP/ICSs meet the 2021 target. We recommend getting the project underway as soon as you can before suppliers are fully booked, and you are at the end of the queue.

With IMX we challenge the 2021 naysayers and Mr Gould himself, “I do not want to put a timescale on deeper interoperability and getting away from the legacy estate and extraordinarily patchwork system that we start with, because it is complex and hard to pin down as a job.”

We don’t need to get away from existing technology at all. It is far more efficient for shared care records to embrace the complex patchwork already existing and capture it for re-presenting in a user-friendly way. We believe it’s the most effective method to deliver flexible shared records necessary for the regional NHS landscape. With the IMX Clinical Record, you can think big, start small, scale fast and deliver your MVS by September 2021.

Find out more

For more information, view the following:

• IMX Clinical Record product overview video
  Four-minute product overview to see a glimpse of the powerful functionality of IMX-CR.
• IMX Clinical Record booklet
  Downloadable PDF showcasing testimonials from our current customer base.
• Bedfordshire NHS Foundation Trust Interoperability case study
  Case study on how Bedford Hospital uses IMX to gain immediate access to patient information.
• IMX-CR website overview page
  Webpage for an overview of IMX-CR, including user testimonials and where healthcare organisations use our interoperable clinical record.

To discover more about how IMX can solve your shared care record challenge talk to an expert on 01392 363888 or email hello@restartconsulting.com.

The challenge

Walsall Healthcare NHS Trust’s existing tracking system for its Portering Department had begun to experience failures, and as an older system it no longer received full technical support. Jobs were mostly logged via wards and departments and sent to porters via pagers. Porters then needed to go to a hospital phone to pick up tasks and also report completion or delays. There was no real time visibility on the location of porters, or activity. Upgrading the existing system would have involved significant additional investment in infrastructure and devices and considerable disruption during installation. Many wards said they were finding it impossible to use the system; reverting to manual management which resulted in delays to patient and item movements and its reporting system was difficult to use.

The solution

Portering provides a vital function within hospitals – without which clinical and non-clinical service cannot operate effectively.

When looking to replace its existing system, the trust examined a number of options before deciding MyPorter was best suited to its needs. MyPorter was developed by porter managers, for porter managers, with GlobalView Systems gaining insight from more than 100 NHS Trusts before developing the unique solution.

Each system is configured to the individual needs of the hospital. For Walsall Healthcare NHS Trust, the MyPorter software provides dashboards at ward level.  And where the wards request a porter, the porter supervisor can allocate tasks to porters. Each porter uses a robust Motorola radio, which receives text messages with details of their tasks. This reduction in voice communication ensures clarity on tasks, reduces background noise and enhances the privacy of patients. As the porter carries the radio with them, it also improves efficiency as they no longer have to go to a hospital phone to manage their tasks.

The system is currently being expanded to automatically allocate tasks to the next available porter/team, without requiring management by a supervisor or helpdesk.

Results and benefits

MyPorter has delivered a wide range of benefits to the trust:

• Efficient
  Productivity has increased as porters no longer have to phone into the system, saving time. These improved response times have in turn improved patient flow. The system gives real time alerts on porter location and status and the dashboard colour codes priorities and alerts, enabling tasks to be resourced accordingly, e.g. sepsis patients can be given priority and appointments for CT/MRI scans scheduled into the system in advance.
• Easy to use
  As the NHS continues to move away from paper-based systems, MyPorter provides an advanced solution that is simple to work with. Staff very quickly understood how to use the system for communication, management, and reporting, with minimal training.
• Insightful
  MyPorter enables data to be exported into excel, word, rich text format, pdf and straight into charts, enabling trusts to design and produce a wide range of reports, bespoke to their needs e.g. data on specific wards, moves or timeframes. In addition to measuring Key Performance Indicators, the intuitive software can identify trends and deliver insight, such as predicted peaks in demand – improving the efficiency and therefore financial management of the department.
• Reliable
  MyPorter has proven its reliability in other trusts throughout the UK. The radio handsets used are purpose-built for critical communications with a long battery life and encrypted data. The system also has a built in back up system using radio communication, which means in the event of a system failure or an emergency situation, management can communicate with the porters directly. MyPorter has the option to operate over WiFi where a robust network is in place to provide full coverage, providing a future-proof platform for service delivery.
• Scaleable
  Should the needs of the hospital change, the MyPorter system can be quickly and easily expanded without the need for major investment. Users with relevant access permissions can easily add new staff and areas and manage passwords and security.
• Supported
  MyPorter is a UK solution, offering prompt after sales and technical support. Any updates and upgrades to the software are automatically supplied at no extra cost, ensuring users are always operating on the most advanced software version.

Natalie Morgan, Porter Supervisor, said: “MyPorter has given us better use of resources and improved patient movement. The team at MyPorter worked closely with us, and it shows that they really understand portering and the needs of our team, environment and patients.”

Find out more at myporterlogistics.com

Feature by Global View Systems 

Read the full case study here.

The East London Health & Care Partnership (formerly North East London STP) had the greatest IAPT access rate increase within London as a result of changes in the prevalence rate. Five of their CCGs were ranked in the top six most affected in London. It’s anticipated the growth will be at a rate of 60% over the next four years.

The partnership wanted to address a number of challenges, including how to achieve cost effective growth, against an increase in demand, and how to address greater complexity.

A pilot has started with SilverCloud to demonstrate the use of online therapy programmes to address these challenges.

To date online therapies now account for approximately 10% of the IAPT work across ELHCP with leading areas such as City and Hackney achieving 15%.

Dan Burningham, mental health programme director, NHS City and Hackney CCG, said: “This is an exciting pilot which has demonstrated the applicability of programmes previously only applied to people with mild to moderate mental health problems, to people with more severe and complex mental health issues.”

“It is also an important part of our overall approach for this patient group, which focuses on empowering people to manage their own wellbeing supported by online resources, which connect to professional oversight.”

Use cases include:

• Home Treatment Team – The home treatment team provide patients with access to unsupported, self-help programmes, such as sleep and stress. Patients receive approximately 3 weeks of intensive care and progress through the programmes is discussed as part of their usual follow-up.
• Early Intervention in Psychosis – Use SilverCloud online therapy with people at risk of developing psychosis or those experiencing a first episode. Programmes help with the identification and self management of symptoms.
• Recovery Team – The recovery team use SilverCloud programmes as self-help for relapse prevention for people with serious and long-term mental illness. Programmes help to identify early warning signs, and create a plan for dealing with difficult situations.
• Enhanced Primary Care – Preventing people from needing in-patient support. As part of their treatment patients use SilverCloud programmes as self-help over 12-months with monthly check-ins.

Read the case study here.

Wirral University Teaching Hospital NHS Foundation Trust has worked with health integration specialist Enovacom, a subsidiary of Orange Business Services, to integrate data generated by medical devices to their hospital information system.

The Patient Connect solution integrates any data generated by medical devices to any hospital information system, from patient vitals to alarms. It enables automated data collection and removes manually process such as writing vital signs information in the EMRs.

The Trust decided to begin with the connection of their ventilators to their EMR.

The Trust’s ITU Manager, Christine Jones said “Before the Enovacom software was in place, members of our ICU team were double-documenting and manually transcribing patient data, meaning there was an increased risk of transcription errors. The knock-on effect for this process was that it reduced the amount time we could spend with patients.”

Paul Charnley, Director of IT and Information “ENOVACOM Patient Connect was the only solution we could find that was flexible enough to allow us to get all the granular data we needed out of the ventilators and in the right format to go into the EPR.”

“This project was an important part of our journey towards digitising patient records through care pathways and paperless working. We have deployed a strategic integration tool that supports our ICU nurses first and foremost, but which can also be scaled to other areas of the Trust to release more interoperability benefits in the future.”

In this case study, you’ll discover how Wirral’s nurses are benefiting from medical device integration for a safer and more productive care, as well as how the organisation is working hard to develop workflows and blueprints for other providers to learn from their experiences around connecting mobile devices and becoming paperless.

Download the case study here.