Health Tech Digital Magazine | June 2019 by HealthTechDigital

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MAGAZINE COVER STORY:

MediViewer™ The electronic document management solution built specifically for healthcare

- p28

World-leading technology innovations to help 700,000 patients on the NHS - p14 Establishing The UK As A Life Sciences Powerhouse - p5

The UK’s essential Digital Health resource

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WELCOME

n this issue of Health Tech Digital Magazine we cover industry news and hot topics from the month of May/June providing you with a full month view of the sector in the UK as a whole.

Nicola Blackwood speaks at the ABPI Annual Conference & Dinner 2019: Enhancing a Life Sciences Powerhouse in a Post-Brexit World. At the Reform Health Conference on 5 June 2019, NHS Chief Simon Stevens announced that as part of becoming the world leader in machine learning and artificial intelligence, the NHS need the help of tech firms. The Government backs new digital innovation hubs to give scientists a way to access health data so that they can pioneer new, faster and effective treatments for patients. We write about several different implementation approaches to be considered if you are thinking about embarking on a Hospital-wide Electronic Document Management System (EDMS) programme, how to make your digital services excel in an Outstanding NHS trust and staying true to your vision in the face of financial uncertainty. We cover three intuitive healthcare technologies in our “Technology in the spotlight section”. MediViewer™ a leading EDM solution transforming patient records, Verto: Supporting Integrated Care Systems by providing a structured approach to establishing and managing a project and the DrugStars app - making it meaningful for patients to take their medication. I had a fantastic morning at the flagship event of London Tech Week: TechXLR8 as Chairperson for the LeadersIn Healthcare TechXLR8 Industry Summit. Sam Shah, Director of Digital Development, NHS England; Hector Minto, Senior Technology Evangelist (Accessibility), Microsoft; Dr. James Somauroo, Founding Partner, HS. and Neha Gupta, Clinical Product Manager, Medopad delivered excellent presentations to the audience. All in all it has been another lightening fast month for healthcare technology in the UK and prepare for it to get even faster as hospitals and healthcare establishments assess and continue to digitalise our healthcare system. Tracy Williams, Editor and Marketing Director

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here are many ways for you to get involved with Health Tech Digital. Health Tech TV, our new YouTube channel is where we will be sharing healthcare technology information on key topics relevant to the digital transformation of the UK healthcare sector. If you are a healthcare professional and you would like us to film your talk about the digital transformation of your trust or if you are a professional who has knowledge on a particular aspect of digital health, we would like to hear from you. If you are a healthcare technology company, we are always interested to hear any news you may have or a solution overview and case study. Contact us today if you would like to get involved. Email: info@healthtechdigital.com Website: www.HealthTechDigital.com

CONTENTS INDUSTRY NEWS

Establishing The UK As A Life Sciences Powerhouse

11.

NHS Organisations To Receive Fibre Optic Internet

NHS Chief calls on tech firms to help become a world leader in the use of AI and machine learning

12.

United Lincolnshire Hospitals Trust dramatically reduces ‘did not attend’ rate

Government Backing New Digital Innovation Hubs

13.

Thousands of hospital visits avoided because of NHS “Skype Doctors”

NHS Digital data monitoring and analytics available to NHS organisations

14.

World-leading technology innovations to help 700,000 patients on the NHS

INTERESTING TOPICS

16.

Safeguarding Healthcare against cyber threats

22.

NHS Trusts: stay true to your vision in the face of financial uncertainty

19.

How to make your digital services excel in an Outstanding NHS trust

23.

Why the NHS needs to seek a state of sustainable cyber resilience

20.

EDMS Implementation Approaches: Evaluating your EDMS Deployment Options

24.

New study sheds light on how blood vessel damage from high glucose concentrations unfolds

TECHNOLOGY IN THE SPOTLIGHT

IMMJ SYSTEMS MediViewer™

EVENTS

34. 4

Digital Health Events

TMI SYSTEMS Verto

DRUGSTARS DrugStars app

Establishing the UK as a Life Sciences Powerhouse

icola Blackwood speaks at the ABPI Annual Conference & Dinner 2019: Enhancing a Life Sciences Powerhouse in a Post-Brexit World.

At the ABPI Annual Conference & Dinner 2019, the Health Minister, Nicola Blackwood, gave a speech about how the UK can deliver one of the best health innovation systems in the world. Firstly, Nicola began her speech by establishing the reasons why the UK is seen as a health leader across the globe as well as a powerhouse for life sciences. For example, the UK is in the top five countries that exports pharmaceutical products. Furthermore, 25% of the most-used medicines in the world were developed in the UK, and the UK receives the most foreign investment for life sciences projects across the whole of Europe. Nicola gives thanks to the achievement for all of the people and collaborations that make it possible which include the NHS and its patients, UK charities as well as government and industry. Thanks to the Industrial Strategy, several successful projects are running which are improving the life sciences ecosystem which include the Test Beds programme. The Test Beds programme brings together industry partners and the NHS in a bid to test combinations of digital technologies in real-world settings. However, in order for the UK to continue to be at the forefront of life sciences, there are challenges ahead that need addressing. Some of the roadblocks that may hinder the UK’s progress include the need for a

regulatory system that can evolve alongside AI and digital health technologies. Other hurdles include ensuring staff are up to speed with new technologies through training as well as making sure data is more accessible but still retains the trust of patients and clinicians. One of the main issues that Nicola addresses in her speech is the fact that the UK can be slow to adopt new innovations. Nicola calls on further collaborations between government and industry through more Sector Deals which can help to develop innovations such as genomics. Nicola says; “For diagnostics, the Sector Deal announced £79 million to establish the world’s first cohort of up to 5 million healthy participants to support research, prevention and treatment across major chronic diseases, including cancer, dementia, heart disease and mental health disorders.” As well as collaboration another aspect that needs addressing is the regulatory framework of the UK. For progress to continue, regulations need to be easy to navigate. This means developing a clear regulatory pathway for several life sciences areas such as genomic medicines and testing advanced therapies. As a result of improving regulatory framework and collaboration across the UK, it is hoped that the UK can continue to have a strong, competitive and world-leading innovation ecosystem. An ecosystem where clinicians can access tailored innovations and patients can benefit from the innovations that improve prevention, diagnosis and treatment times. As well as this, the NHS can shift their attention from resources to clinical priorities.

NHS Chief calls on tech firms to help become a world leader in the use of AI and machine learning

t the Reform Health Conference on 5 June 2019, NHS Chief Simon Stevens announced that as part of becoming the world leader in machine learning and artificial intelligence, the NHS need the help of tech firms. Stevens requested that staff of the NHS also be invited to be part of the process by sharing new ideas that will help make the payment systems more user-friendly. He also called for evidence to be brought forward by technologists to demonstrate how the NHS can use incentives to target the use of AI across the NHS from April 2020 and beyond. Outpatient services will be revolutionised by this technology, as diseases like cancer will be diagnosed at an earlier stage which will save lives and make the healthcare system more convenient to use. Stevens challenged tech innovators to propose ways the NHS can implement solutions to minimise the time patients have to wait for test results. Reimbursement reforms are an integral part of the plan to incentivise the NHS tariff and alternative payment systems to ensure the safe and timely adoption of the new healthcare tech across the NHS. The recent popularity and effectiveness of AI technology will enable the Long Term Plan to save over £1 billion by making 30 million outpatients appointments unnecessary. These savings will then be used to improve front line care which will not only help the patients, but over-worked staff as well.

Simon Stevens, NHS Chief Executive, said: “As part of the NHS Long Term Plan we are going to be using new

technologies and treatments to improve patient care and save more lives. “We are seeing an artificial intelligence revolution that will be a big part of our future over the next five years, with technologies that can cut the time patients wait for scan results and ease the burden on hard working staff. “We want the NHS to be first out of the blocks, so from April next year we propose to change the way we fund care so that NHS organisations who invest in this worldleading technology will be properly rewarded for doing so. “We’re therefore kicking off a global ‘call for evidence’ for NHS staff and technology innovators to come forward with their best ideas for how we should adjust our financial frameworks to best incentivise the use of safe and evidence-based AI and machine learning technologies across the NHS.” Diagnostic tests are being implemented and used more than ever before, with 530, 000 CT scans and 315,000 MRI scans executed in March alone. That is a 20% and 33% increase in scans since 2016 respectively. The Royal College of Radiologists have reported that two million mammography screenings are being done annually through the NHS, with two clinicians each reviewing the test results. There are currently over 100 million outpatient appointments being provided by NHS hospitals in England. The testing of machine learning technology and AI has exhibited its potential to not only lift the workload on the staff, but also give them more time for other tasks.

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Government Backing New Digital Innovation Hubs

he government is backing plans of a £37 million investment from the Industrial Strategy in a bid to transform the way innovators and researchers can access NHS data. The new digital innovation hubs hope to give scientists a way to access health data so that they can pioneer new, faster and effective treatments for patients. With the digital innovation hubs, it is hoped that the data can help to speed up drug development, find cures and treatment for cancer, diabetes and other diseases and improve the time to diagnosis. These hubs will be set up across the UK so that innovators can access data from the NHS, social care network and universities. The primary benefit of these centres is that all of the data will be in one place. This means that researchers will be able to spot and understand data trends which could be crucial for finding cures. To help protect confidentiality, the data will run through both an encryption process and a de-identification process. The new centres will be chosen through a competition scheme, and there are plans to establish these digital innovation hubs by the end of the year. The £37

“IT IS ABSOLUTELY CRUCIAL THAT RESEARCHERS ARE ABLE TO ACCESS THE NHS’S WORLD-LEADING ANONYMISED DATA SO THEY CAN DEVELOP CUTTING-EDGE TREATMENTS AND SOLUTIONS TO SOME OF HEALTHCARE’S BIGGEST CHALLENGES.”

million investment comes from a broader government £210 million investment from the Industrial Strategy. The funding will come from the project, Data to Early Diagnosis and Precision Medicine Challenge. Greg Clark, the Business Secretary, says: “The Digital Innovation Hubs, backed by over £37 million of Industrial Strategy investment, will ensure researchers, innovators and clinicians can access a large quantity of anonymised data responsibly and ethically – allowing them to pioneer new medicines and treatments.” The Health Minister, Nicola Blackwood adds; “It is absolutely crucial that researchers are able to access the NHS’s world-leading anonymised data so they can develop cutting-edge treatments and solutions to some of healthcare’s biggest challenges.” Professor Andrew Morris who is the Director of Health Data Research UK says; “Working closely with UK Research and Innovation, our focus in delivering these new centres of excellence is first and foremost on ensuring that patients reap the rewards and are reassured that all data are used ethically and responsibly.”

NHS Digital data monitoring and analytics available to NHS organisations

HS can now make better use of machinegenerated information with NHS Digital.

NHS Digital is enabling NHS organisations to have access to a data monitoring, and analytics platform that will help them to make better use of machine-generated data. This comes as NHS Digital and Splunk Enterprise have agreed on a deal that allows local organisations to access the data through their analytic system. With this new framework, local organisations can access real-time data, reduce the risk of service issues and is a more cost-effective approach to obtaining insight from machine data. It is hoped this scheme can also provide better protection against cyber threats too. The new deal will help to reduce system incidents by up to 45% and can help with the detection of security

threats by up to 90%. Currently, Splunk Enterprise works across the NHS in other initiatives such as NHS 111, Care Identity System, NHS Spine and e-Referral Service. Splunk Enterprise also offers training sessions, events and scenario-based learning to improve its use and functionality within the NHS. Vice President of Splunk Enterprise explains; “Our priority is always ensuring customer success, and with this new framework in place to purchase Splunk Enterprise and become trained to use it, we look forward to working with more NHS Trusts on their digital transformations.” The Associate Director for Platforms and Infrastructure at NHS Digital says; “Splunk Enterprise has been a key strategic product for NHS Digital for several years and has had a real benefit to ensuring the systems and platforms that the NHS rely on are monitored and available to support patient care.”

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This data can then be used â&#x20AC;&#x201C; anonymously of course â&#x20AC;&#x201C; in new scientific studies. Pharmaceutical companies can also purchase this data on real-world experiences to use as a basis for better decision-making and for creating more user-friendly products. DrugStars uses the revenue from the sale of this anonymous data to pay for the donations made by the patients using the app. We call it Giving by Taking.

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NHS Organisations To Receive Fibre Optic Internet

he Health Secretary, Matt Hancock, is hoping to improve the quality of digital healthcare services by upgrading the internet at hospitals, GP surgeries and community care services. All of these NHS organisations will have their internet upgraded to the fastest broadband, full fibre connectivity. Research shows that around 40% of NHS organisations are relying on the internet through copper lines which can make the internet slow and undependable. As a result, it can restrict the number and quality of digital services available for patients. The upgrade to fibre optic broadband falls under the NHS Long Term Plan which hopes to improve the number of digital services available to patients. The New Long Term Plan promises to increase the digital offering for patients including giving patients the

right to chose a ‘digital first’ approach. This could include video consultations or online appointments. Better broadband will help to facilitate these consultations and provide high definition images quickly. Improved digital services will also include storing patient records on the cloud so that clinicians are able to access the right medical information from anywhere in the country. This can improve treatment time, patient safety and speed up appointments too. Matt Hancock believes the NHS is being let down by the use of unreliable technology such as outdated internet connectivity. Speaking of the announcement he says; “Faster broadband connections can help us deliver these dramatic improvements – we need clinicians and other healthcare professionals to feel confident they can access fast, reliable broadband so they can provide patients with the best possible care.”

United Lincolnshire Hospitals Trust dramatically reduces ‘did not attend’ rate

new patient communications project has cut the number of patients who did not attend (DNA) their appointments to just 4.1 per cent – one of the lowest in the country – potentially saving the Trust hundreds of thousands of pounds each year. United Lincolnshire Hospitals NHS Trust introduced a new digital communication portal which enabled patients to manage their appointments with one click from their smartphone. Pioneered by Healthcare Communications, the digital portal is replacing a resource-heavy system that relied on traditional letters to communicate with patients and incurred high costs. Since the portal’s launch in outpatients, the DNA rate has dropped from 5.8 per cent in September 2018 to 4.1 per cent in January 2019, compared to the national rate of 8.9% Through the portal, patients receive appointment letters straight to their smartphone and can accept, cancel or rebook their appointment in real time, freeing up cancelled slots for other patients. The digital content converts to 99 languages in just two clicks, and the font can be increased and highlighted to improve patient accessibility to hospital communications. Rural patients benefit from the instant delivery of their appointment, instead of waiting for it to arrive in the post. They can respond at their own convenience and not spend time and effort rescheduling via the telephone.

Patient feedback has included comments such as: “‘I [previously] lost an appointment because the letter didn’t arrive until 3 weeks after the date of the appointment. I like

the fact that I can have all the information I need digitally and with sufficient notice of future appointments” “It meant that I had all the information to hand when I went to the hospital, and it was also quicker than waiting for the mail to arrive” “Time saving, cost saving and less harm to the environment”. The portal has also led to cost savings. The NHS currently spends £100 million a year sending outpatient appointment letters, but the portal has already seen postal letters reduced by 23,000 year-on-year while the ROI from September to December 2018 was 57 per cent. There will also be a reduction in future capital costs as folding machines will no longer need to be replaced. The potential income gain is more than £2 million per year. Kelly Wymer, ICT Project Manager from United Lincolnshire Hospitals NHS Trust said: “In the space of only a few months, we have seen incredible results from the portal. Patient feedback has been excellent with many keen to use it and support a more digital NHS. “By relying on traditional letters alone to communicate with patients, we were using a lot of resource and incurring high costs. The portal has resulted in better performance across the entire patient pathway, so we can focus on patient care.” Kenny Bloxham, director of Healthcare Communications, which has been working with the NHS for 18 years said: “Switching to a multi-channel, digital-first contact approach means patients can be reached in a way that best suits them. It’s great to see the way both patients and staff have embraced the secure digital portal – with patients able to cancel appointments in real time, so appointments can be used by other patients.”

Thousands of hospital visits avoided because of NHS “Skype Doctors”

mbulance call-outs and hospital visits have been drastically reduced with the help of NHS doctors and nurses who are using Skype to help nursing home staff, wardens and carers to treat and help elderly people in their homes. 8000 Skype calls are received by the on-call Skype NHS team annually, and NHS Skype consultations have already prevented 3000 unnecessary A&E visits, as well as 2000 GP visits in the last 2 years alone. Ambulance call-outs have been drastically reduced, not only avoiding the distress of an emergency trip to the hospital, but also freeing up resources for other emergency situations. £1.3m and hundreds of hours have been freed up by using this technology as part of the NHS Long Term Plan in Tameside, in the Greater Manchester. The NHS also plan to implement the programme of integrated services across the UK. The technology is helping to improve the work load of NHS staff, and is also providing quicker and more efficient help to patients with urgent needs. The NHS Long Term Plan commits to using the scheme to provide improved, more convenient care to residents at home and providing quality support to health and social services using the digital technology. Prof Stephen Powis, NHS England Medical Director, said: “Putting every person’s individual care needs at the centre of joined-up services, supported by smart technology, is the heart of our Long Term Plan for the NHS. “What matters most to every patient and their family is that they get the right treatment, at the

right time, so integrating services – across communities and between councils, carers and hospitals – is not only good for the people we care for but a more efficient use of NHS resources.” Peter Grace, a registered nurse who works taking calls in the digital centre, said: “By setting up a direct link between services and the doctors and nurses at the hospital’s digital health team, we were able to offer guidance, advice and reassurance as well as being able to see the patient on Skype. “Extending this to housing wardens, working with the council, has taken the project to the next level as now we can also help with issues in sheltered accommodation such as falls. Working together with local groups, carers and patients, and also utilizing the last 3 years NHS and local council budget, Tameside as part of the Greater Manchester’s health and care approach, are developing solutions to health care issues more effectively. 14 areas across the country have Integrated Care Systems (ICS) which marry local government systems and NHS, simplifying systems between councils, GPs and hospitals. Jon Rouse, Chief Officer of the Greater Manchester Health and Social Care Partnership, said: “Tameside’s pioneering work is an example of what happens when you bring together teams from the NHS, local authorities and care home providers and give them the freedom and resources to develop new ways of doing things. “Greater Manchester has a long history of collaboration between the 10 council areas. It is that focus on working across organisational boundaries to best serve the needs of ordinary people that will help them to live independently as long as possible and receive care when they need it.”

World-leading technology innovations to help 700,000 patients on the NHS

n the 5th June 2019, at the Reform digital health conference in London, NHS England Chief Executive Simon Stevens announced that new tests, treatments and procedures will be implemented by the NHC which will benefit over 400,000 patients in 2019 alone. 300,000 patients have already been positively affected by various new healthcare innovations and technology, which are all part of the Long Term Plan. The latest breakthrough tests and procedures include a specialized blood test called a “High sensitivity troponin test”, which allows doctors to detect a heart attack within 3 hours, preventing people from being admitted to hospitals. Cluster headache patients can be treated with a handheld device called a “Gamacore” which uses electrical currents applied to the vagus nerve, reducing the pain caused by cluster headaches. The NHS’ Innovation and Technology Payment programme are delivering these new tests so that they can speed up the implementation of these ground-breaking procedures and treatments, building on progress which has already been achieved over the last couple of years

The NHS’ Innovation and Technology Payment programme will also be making funding available for a 3D heart modelling computer programme which diagnoses coronary heart disease. Another ground-breaking treatment will use a hydrogel called “SpaceOAR” which will reduce complications when radiation is used for the treatment of prostate cancer. Various other tests and treatments will also be funded and implemented by the NHS, which will change the way patients are diagnosed and treated.

Pregnant women will be able to access a Placental growth factor (PIGF) based blood test that detects pre-eclampsia. This test will prevent unnecessary hospital visits, enabling pregnant women to be treated faster and also prevent any labour complications which may possibly arise. Simon Stevens, Chief Executive of NHS England, said: “From improving care for pregnant women to using digital modelling to assess heart conditions and new tests to prevent unnecessary hospitalisations for suspected heart attacks, the NHS is taking action to ensure patients have access to the very best modern technologies. It’s heartening to see the NHS grasping with both hands these rapidly advancing medical innovations.” The Accelerated Access Collaborative (AAC) which is overseeing the acceleration of these cutting-edge treatments, along with the government and NHS, are striving to make the NHS the world’s best and most innovative health care system by implementing these treatments. The NHS’ 15 Academic Health Science Networks across England, will be responsible for overseeing the implementation in their various areas. The NHS will introduce a new funding mandate which has been set out in the Long Term Plan. The funding will be used to introduce and implement proven health tech products which will be used by the NHS in the near future. Lord Darzi, chair of the Accelerated Access Collaborative, said: “As Chair of the AAC, I am delighted that four of the seven technology areas currently receiving AAC support have been selected for this NHS programme. “This is a vital step in helping patients receive rapid access to the best, proven innovations being developed in our world-class health system.”

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Safeguarding Healthcare against cyber threats

n healthcare, cyber security is critical. Ram Vaidhyanathan, IT Security and Cyber Risk Analyst, ManageEngine, explores the impact of cyber threats on the healthcare industry and shares his tips for better protection According to the International Monetary Fund, the global GDP was close to £66 trillion at the end of 2018. Assuming that 10 percent of this value was spent on healthcare, as it was in 2015, that would make the world’s healthcare market worth £6.6 trillion. And assuming a three percent spend rate on this figure, the healthcare industry likely spent around £198 billion on IT in 2018.

IT spending in healthcare will grow at a fairly fast clip in the years to come as investments in value-based care, patient engagement services, connected medical devices, multi-cloud environments, data analytics, and mobile applications gain ground. And as emphasis is given to preventive healthcare on top of treatment, IT spending will likely increase

even faster to keep up with the growing list of services healthcare organisations provide. All of this means increased personalisation for each patient and better productivity among healthcare staff. But at the same time, these improvements will increase the attack surface for healthcare organisations and the potential risk of cyber attacks. Why would cyber criminals want to target healthcare? In 2017 the NHS fell victim to the devastating WannaCry ransomware attack which shut down hundreds of thousands of computers across the organisation, demanding payment for decrypting seized data. A third of hospital trusts and 8 percent of GP practices were affected and 19,000 patient appointments were cancelled. Beyond disruptions to service and the cost of the clean-up operations and IT security upgrades, healthcare organisations must also consider the risk to patients’ personal data. Electronic health records (EHRs) are thought to be more valuable than stolen financial data on the dark web. This is because each EHR may contain rich information including the patient’s name, gender, medical history, progress notes, prescription details, test results, radiology images, and insurance data. A cyber criminal could use this information to commit identity theft, buy medical equipment or drugs, or file fictional insurance claims.

A typical cyberattack at a hospital A hacker could use numerous techniques to intrude into a hospital’s network. However, it might be useful to look at a scenario that follows a typical hacker’s modus operandi. A front-end employee at a hospital gets a spear phishing email from a cyber criminal disguised as the hospital’s head of operations. The email demands that the employee open an attached Word document, fill out some details about patient profiles, and send it back urgently. The employee yields to this without thinking twice as everything looks legitimate. However, the moment the employee opens the Word document, malware starts downloading onto the employee’s machine without their knowledge. The malware allows the attackers to obtain this employee’s account credentials, through which they can access all the applications this employee has access to. From there, the attacker can lurk and move laterally in the network. They can sniff out particular servers, including domain controllers, that store all authentication information; many cyber criminals do this using a port-scanning technique, which lets them know which applications run on a machine. Finally, the attacker gains privileged access to the EHR database. Or imagine a scenario in which a criminal is disguised as a janitor with a fake ID, gains the trust of security staff over a week, and then simply has one of the security guards let them into the chief of medicine’s room which “needs to be cleaned” at 12:30am, when the chief is usually not around. Once inside, the hacker gains access to the complete EHR database by logging on to the network using the chief’s password, which was obtained via dictionary attack from a remote location. By using the chief’s office, the hacker makes the database access appear legitimate rather than criminal. A similar incident was depicted in the 1993 movie The Fugitive, but it’s not that far-fetched, even in 2019. How to stop cyber attacks in healthcare Here are five ways healthcare organisations can defend against cyber crime: 1. Educate employees about cyber security: All healthcare staff, including doctors, should frequently be trained on cyber security best practices. The weak links during any attack are often employees, and it’s usually through them that criminals gain an initial foothold. Hosting a training program at least

once every six months will go a long way in protecting the entire organisation from cyber crime. 2. Implement an identity and access management (IAM) program: An effective IAM program would require the IT team to look closely at the different roles and job descriptions in HR’s employee database, figure out which employees need access to what information, and follow the principle of least privilege. For example, a radiologist would never need access to the list of patients for whom prosthetics were fitted. 3. Perform comprehensive risk assessments: A risk assessment will help the healthcare institution identify all valuable data assets, prioritise them, and determine the business impact of a breach for every data asset. Using this information, IT can plug any vulnerabilities. 4. Monitor threshold-based alerts: Threshold-based alerting lets security personnel know as soon as certain conditions are met. For example, did someone with a doctor’s user account attempt to log in to a server and fail five consecutive times in one minute? Did this account then gain access on the sixth attempt? This could be a potential brute-force attack. 5. Look for anomalies: To better protect against threats, companies need to adopt user behaviour analytics (UBA), which looks at patterns of human behaviour and then applies algorithms to detect meaningful anomalies in those patterns. A UBA engine creates a dynamic baseline based on each user’s activity and will monitor for anomalies. This baseline may be updated every day based on the user’s activity. For example, the chief of medicine may usually log on to the network between 9am and 6pm, and the system would learn that this is their “normal” behaviour. If this user logs on to the network at 12:30am, it would then be treated as an anomaly and an immediate alert would be sent to security personnel. What can we expect 10 years from now? Within the next 10 years, doctors may start using artificial intelligence (AI) in every sphere of their work. AI-assisted robotic surgeries, virtual nursing assistants, and precision medicine might become commonplace. It will also become essential for healthcare institutions to invest in cyber security tools that employ general AI and machine learning to protect against cyber crime. While precision medicine predicts how likely it is for a patient to suffer from a particular ailment based on their genetic information, precision cyber security may predict how likely it is for a hospital to suffer from a data breach.

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How to make your digital services excel in an Outstanding NHS trust

making digital changes without a change in culture. Staff must know what to do in the face of a power outage, equipment failure, unexpected hiccups. Many organisations in the NHS, through lack of investment, do not run smoothly in these instances and struggle with introducing digital – they can be too busy trying to keep the lights on to begin the change. Reacting to disaster

is not enough; we must be proactive in our digital approach as ithin healthcare, we are seeing a rapid race towards

trusts. With targets, cuts, and a whole host of other stressors,

digital, with NHS trusts and organisations leaving

it’s easy to bow under the pressure and reject the notion of pre-

paper, pull cords and legacy systems behind one

emptive, pro-active approaches. We have started to be successful

by one. What we must remember, however, is that

at transforming on a small scale, but there is something to be

going digital is not that simple, and it costs. Being fully digital

learned from what we have been able to do here – something that

does not mean that it leads to becoming an Outstanding NHS

can be applied to larger organisations.

trust but it does help along the journey. A cultural foundation for change The pace of technological change in recent years has been

Now that we have a cultural foundation for change, our plans for

frantic. Creating a health service that responds to these changes

2019 are large but achievable with help from the magic ingredients

and stays ahead of them can at times seem impossible. Yet, in

of investment and resilience. In no way are we perfect, and we are

the face of budget constraints and a set of pressures unique

always striving to improve, with several ambitious projects in the

to every trust, the NHS is making a continuous effort to do so.

pipeline for the coming year. Advancing our home-grown EPR

When I came to work at The Christie, I saw it as my chance to

is a priority, as it will lead to many other positive changes within

get a digital service right. Of course, The Christie is a trust with

The Christie. Improvement in the EPR gives us a platform to

its own individual challenges, so how will it be possible to achieve

conduct more research as an organisation, as a specialist cancer

digital excellence? One reason is its smaller size than some other

centre. It will help advance the beginnings of a project that will

trusts, serving 3.2 million people across Great Manchester and

gather patients’ reported outcomes and patient experiences, and

Cheshire; around 25% of our patients are referred from other

combine them with the EPR to compile a complete picture of a

parts of the country. Another is its specialist organisation for

person’s treatment and how they are coping with it. This will help

cancer care. As I discussed at the recent Healthcare Partnership

us respond better to other patients about to embark on the same

Network, transforming the culture of the organisation can be

treatments, while working with pharma to improve treatments.

equally important as transforming the technology. Digital change

Beyond this, we are looking to construct a research centre adjacent

alters the way that staff interact with patients, alters the way they

to the hospital, in collaboration with Cancer Research UK and the

work as clinicians, and this shift can be intimidating. A trust must

University of Manchester. This will allow researchers and our

unite the staff body in its working methods, putting every person

clinicians to have the opportunity to work together under the same

on the same page.

roof. These are all steps towards being able to improve research data for clinical trials. In addition to being a leading cancer centre

Operational resilience

in the UK, these strides will help The Christie to stand at the side of

In recognition of this, it has been of utmost importance to me to

other world-leading cancer centres.

build the operational resilience within my teams. Much of the time, money will get thrown at a digital transformation, to be delivered

This is an incredibly exciting time for The Christie, and these things

by the IT department without forethought. A certain amount of

could not happen without the precise focus on cultural change

time and investment needs to be put into training and developing

before complete digital transformation. Our ambition as a trust is

the culture within the staff body as well as revolutionising the

to become completely digital. The crux of some of the projects

way we work. At the same time, the digital service itself needs to

we are working up at The Christie is setting as many fires alight

consider everyone involved – from the patients to their families,

as we can, and then seeing which ones will burn the brightest. It

from the clinicians, nurses to the administrators. The will, the

is essential for a trust to get the basics right, to make the building

recognition that investment is needed, and the ambition must all

blocks that can then create a world-class digital service to go

be there for a transformation to work. At The Christie, we have

alongside a world-class clinical service. As a trust, you simply need

taken strides towards achieving a digital trust, and my hope is that

the will to do so. The most recent Healthcare Partnership Network

eventually we may be used as a blueprint for other organisations.

took place on 12th and 13th March 2019 at Oulton Hall in Leeds. The next event is on 16th & 17th July 2019 – register to book your

Preparing for the power outage

place. By Eileen Jessop, CIO of The Christie NHS Foundation

One aspect a trust must be careful of is assessing the risk of

Trust, speaking at the Healthcare Partnership Network event

EDMS Implementation Approaches: Evaluating your EDMS Deployment Options

f you are considering embarking on a Hospital-wide Electronic Document Management System (EDMS) programme there are several different implementation approaches to be considered. Most organisations recognise that continuing with paper case notes is unsustainable and may be struggling to meet service demands. Some may have run out of physical space or are looking to realise cash releasing benefits through the closure of a record library. Regardless of the strategic drivers which may be significantly different between organisations, the overriding consideration will be to ensure that the EDMS will: • identify and deliver the efficiency savings at departmental level that support the ROI objectives; • provide measurable improvements to patient safety and clinical efficiency – allowing clinicians to mine information easily from scanned case notes and associate documentation with patient encounters; • be deployed without having a detrimental impact on departmental operations. It is important to consider the relative advantages and disadvantages of each of the options, evaluate and make recommendations on the best approach for your organisation – taking into consideration your own business drivers, organisational capability and infrastructure and affordability. Your EDMS programme can be split into two sub projects, albeit with strong inter-dependencies: • Deployment of an EDMS for accessing patient records in a clinical context; • Implementation of a scanning service to digitise existing patient case notes and ongoing capture of new patient documentation. Deployment approaches for EDMS: Option 1: Do Nothing Do not implement EDMS

Advantages • No requirement for additional investment in the short term (or until additional physical library capacity is needed);

• Challenges associated with managing organisational change will not be faced. Disadvantages • Fails to address the needs of clinicians. Immediate access will still not be available to essential patient information when & where needed; • Continued risk to security and confidentiality; • Physical space constraints will remain at the health records library; • Still gives rise to fire and health and safety risks; • Not a cost-effective option – resource time is being spent ‘firefighting’ rather than being using efficiently; • No significant opportunity to realise benefits with regard to Patient Safety Clinical/Information Governance, Health Records department or across the administrative establishment; • Fails to address any recommendations of the NHS Information Strategy, Connecting for Health initiatives or meet the Trusts strategic ICT aims; • Contrary to the concept of the modern NHS and 2023 paper-less target. Option 2: Phased deployment Deploy EDMS on a speciality by speciality basis using outpatient clinics as the trigger for scanning. IMMJ Systems have extensive experience of deploying EDMS on a speciality by speciality basis, initially using outpatient clinics as the trigger for scanning. Once the back and forward scanning functions are proven to be stabilised and clinicians across all specialities have been trained and exposed to digital patient’s records, a scan on discharge approach will then also be adopted. A phased deployment would be IMMJ Systems recommended approach to deploying an EDMS, as it allows for continued verification of operational and scanning processes to ensure SLA’s are being met and in the event of any concerns, the subsequent clinics go-live could be paused until resolution. This implementation approach has proven successful as it has ensured that the EDMS deployment is focused on continually supporting individual clinicians with the transition which has been key for establishing and maintaining clinical engagement throughout the project lifecycle. The pace of the phased implementation from initial go-live will be largely dependent upon the following factors: • Availability of Trust training resources. IMMJ Systems

will provide floorwalkers; to ensure that adequate support is provided to clinicians during go-live; • The scanning supplier can continue to meet agreed SLAs as the volume of records scanned increases in line with the phased speciality roll-out plan; • Forward scanned documentation is being processed in a timely manner; • IT equipment (new PCs, mobile devices, additional networking etc.) is installed in clinical areas. Advantages • A phased deployment allows the organisation to be flexible to ensure scanning services can meet agreed Service Level Agreements (SLAs). Specialities can go live one after the other or a few at a time depending on scanning and transformation capacity. In the event of any concerns, pulling for the next set of clinics can be paused; • Clinical engagement and transformation activities are focused at speciality level enabling concerns to be identified and addressed; • Process changes are tested, proven and embedded prior to introducing them in another speciality; • Fewer resources are required simultaneously to implement/support a phased deployment; • It is still recommended that transformation activities take place across all specialities ahead of go live to understand the impact of taking physical notes out of circulation. Disadvantages • The deployment time (between first and last speciality go live) is greater than with a big bang approach; • It may take longer to realise all the associated benefits with a phased deployment; • Patient records scanned whilst attending a live clinic will need additional floorwalking support if the patient attends a non-live speciality. Option 3: Big bang approach Deploy the EDMS across all clinics in all specialities from the agreed go live date. A ‘big bang’ approach enables EDMS to be deployed across all clinics in all specialities from the go-live date. Sufficient time will need to be allocated prior to go-live for transformation activities, and a speciality should be identified as an early adopter in order to verify new processes before deploying hospital wide. The success of a big bang implementation will be largely dependent on the following factors: • Having sufficient transformation and support resources

to cope with this approach; • Ensuring that all transformation activities have taken place across all services to understand the impact of taking physical notes out of circulation; • Understanding that the scanning throughput for on demand and forward scanning will be vast from go-live, therefore SLA’s will need to be closely monitored. If the scanning team fall behind, there is a risk that patients could be referred on or followed up without key information being available to clinicians. Advantages • Enables a rapid deployment if the transformation and support resources are in place to cope with simultaneous demands on implementation, training, scanning and IT support activities; • Benefits can be realised sooner than with a phased deployment; • All users will be familiar with the EDMS Solution from go live. This will result in a reduced support requirement if scanned patients move between specialities. Disadvantages • There is a concentrated resource requirement to support a big bang deployment; • The scanning throughput for forward scanning could be significant from go-live, SLA’s will need to be closely monitored; • If either scanning team (back and forward scanning) fail to meet SLAs, patients could be seen, referred on or followed up without key information being available to This could cause significant patient safety issues; As a big bang deployment is not confined to a particular speciality it is more difficult to pause the on-demand scanning in the event of any issues. This could have a detrimental impact on clinical acceptance and result in loss of confidence in the programme. We hope that this brief introductory guide will help you to evaluate the optimum approach for your organisation. IMMJ Systems has helped many healthcare organisations to navigate the many complex issues and can recommend a solution to fit most budgets and would be happy to facilitate a discovery workshop at your own premises. For more details, please contact us to arrange a demonstration: Call: 0203 790 7901 Email: info@immjsystems.com Website: www.immjsystems.com

NHS Trusts: stay true to your vision in the face of financial uncertainty

e can’t allow ourselves to normalise poor performance, says James Devine, Chief Executive of Medway NHS Foundation Trust, speaking at the recent Healthcare Partnership Network event.

transparent about what you’re doing. It’s important that we connect to the population, especially considering struggles such as poverty and unemployment. Trusts with a similar demographic must adapt continuously and show people evidential proof of change.

The ease with which NHS Trusts can be focussed only on targets, tables, and tightening purse strings has been at the forefront of my mind for the past few years I have spent at Medway. That said, hardship within an organisation can bring about incredible changes. Here at Medway, we have seen ourselves overwhelmed by judgement of performance, and then go from strength to strength under a new financial and cultural regime. Special measures became, in a way, a driver towards success. This is something that many NHS Trusts are experiencing.

Defeating organisational debt Of course, with all the work we undergo to make sure we improve, there is always the overhead cloud of finances. What we do is try to see this challenge as a driver, not a limiter, to what we have set out to achieve. The fact we have smashed through our savings target this year, to me, really sets the tone of the next two years to come. This debt is something that leadership teams of days gone by have grappled with and not delivered on, and I have belief that yes, we can clear our organisational debt with our current vision.

In 2013, we were placed in Special Measures, staying that way until March 2017 in one of the lengthiest stays of NHS Trusts in the country. It meant a complete change in the organisation. We are currently in year two of our three-year improvement plan, implementing a number of measures to propel Medway towards success. Coming out of Special Measures in March 2017 was massive. We were autonomously able to set out what was realistic to achieve, rather than being told what to do. It brought back a sense of control that is lost when you go under that intense period of external and internal scrutiny. Pressing the ‘reset’ button So how do you reset the bar of expectation in an organisation that has had these kinds of issues? How do you reset the culture bar? How do you reset the behaviour bar? Last year, we launched our cultural program called ‘You are the difference’, supported by some external partners who have done a lot of good work within the commercial sector, turning around retail brands. This marked the start of our cultural transformation, which will be the focus of my speech at next week’s Healthcare Partnership Network.

Turning around the culture is largely about behaviour. It’s about people feeling like they can, and should, go the extra mile for our patients. Of the 1700 staff members who have gone through that program, the results are great. We have notices all around our buildings showing that staff have signed a commitment to improve, so patients and visitors will know that we are serious about making tangible steps towards excellence. I have seen a fair few visitors stopping to look at these notices, and I believe it is crucial to be

This debt has not held us back. The senior leadership has regular dialogue with staff; feedback is of utmost importance to me, alongside clear communication and a common goal in mind. In the beginning, we saw people blaming our financial situation for the things they could not do. We have stopped normalising that sense of malaise, the sense that we can’t do anything to improve. One of the things I would like to improve, and something that more Trusts should be focusing on, is their engagement with staff. Staff in many organisations can be forgiven for their sense of apathy towards a constantly changing senior leadership team. We must show staff that we are present, that we mean business and that we are here to support and value them. That takes time, because people need to believe you. And the only way to make them believe you is to show them and be consistent. Poor patient experience shouldn’t be normalised. Preoccupation with money shouldn’t be normalised. We aren’t about ignoring the data sets and targets completely, but what Trusts must realise is that behind the endless lists of numbers, are the patients. Trusts that experience difficulty need to design a plan, and stick to it. Hold your nerve when under scrutiny, and have confidence in your vision as a Trust. The most recent Healthcare Partnership Network took place on 12th and 13th March 2019 at Oulton Hall in Leeds. The next event is on 16th & 17th July 2019 – register to book your place.

Why the NHS needs to seek a state of sustainable cyber resilience

he UK national infrastructure is particularly susceptible to cyberattacks. Critical organisations – such as hospitals, powerplants and water services – are high-profile, attractive targets to those seeking to breach their cybersecurity and who therefore must become resilient to attacks that can have massively damaging and ongoing effects. The health sector – the NHS in particular – is tempting prey for hackers who are after the vast amounts of sensitive data that can be extremely valuable, being used for the likes of identity theft and to take advantage of expensive medical services. But the health sector is a way behind in being resilient to such threats. WannaCry highlighted NHS vulnerabilities The 2017 WannaCry attack was a massive wakeup call for the NHS which was vastly unprepared to protect itself and the huge amount of valuable data on its books. There was no long-term solution in place on how to combat such incidents and a significant amount of vulnerable technology in use. Along with suffering a £92 million fallout cost, issues of accountability and effectiveness of its IT management were also brought into question. Whilst some lessons have been learned and solutions put in place, such as a new package deal with Microsoft, supposedly worth £200 million, there is still a lot of work to be done in order to make the NHS cyber resilient, especially as every one of the 200 NHS trusts assessed for cybersecurity vulnerabilities last year failed to meet the standards required. As cyberattacks continue to rise in number and grow ever more sophisticated, this resilience is particularly vital.

Cyber resilience is key The NHS will always be one step behind hackers if it continues to implement a reactive, purely threat-oriented approach to IT security. Instead, looking towards a proactive strategy to thwart cyberattacks before they happen, namely through sustainable cyber resilience, is the key to futureproofing. Whilst establishing sustainable cyber resilience in the health sector may seem and can be challenging – a range of technology and regulations causing security gaps and inadequacies – it is achievable through a continuous resilience process that identifies vulnerabilities in good time. Managing vulnerabilities is an essential component of sustainable resilience. This process involves identifying, classifying, prioritising and remediating the critical vulnerabilities in an IT infrastructure and acting on them swiftly, where business functions are endangered. This tactic strengthens a provider’s ability to resist attacks and enables it to continue to function during an attack. To achieve this, it is essential to reduce the number of targets available to hackers, resulting in a more stable foundation. This means identifying vulnerabilities that hackers could take advantage of early on. The NHS and the UK health sector in general need to look towards a pre-emptive and preventative approach to cybersecurity through securing a sustainable and resilient cyber foundation that will enable them to be one step ahead of attacks at all times. By: Dirk Schrader, Cyber resilience architect Greenbone Networks

New study sheds light on how blood vessel damage from high glucose concentrations unfolds

mechanism in the cells that line our blood vessels that helps them to process glucose becomes uncontrolled in diabetes, and could be linked to the formation of blood clots and inflammation according to researchers from the University of Warwick. • Scientists from University of Warwick modelled effects of high blood glucose on cells that line blood vessels. • The study improves understanding of how blood vessels are damaged in diabetes. • Future research could potentially lead to new approaches to prevent organ damage in diabetes. Reported in a new study in Scientific Reports led by Dr Naila Rabbani from Warwick Medical School, with further research the results could help to identify new ways to prevent organ damage from complications in diabetes. The research examines the impact of normal and high concentrations of the sugar glucose on human endothelial cells, which form the lining of our blood vessels. By increasing the concentration of glucose in the culture medium the researchers modelled the effects of hyperglycemia on this type of cell. Hyperglycemia is the condition in which an individual’s blood glucose is abnormally high and is commonly caused by diabetes. The researchers confirmed that glucose metabolism in endothelial cells is increased in high concentrations of glucose. They showed for the first time that this occurs because an enzyme that metabolises glucose in these cells, called hexokinase-2 (HK2), degrades more slowly in high glucose concentration and thereby metabolises more glucose than normal. Increased glucose metabolism is the driver of metabolic dysfunction of endothelial cells in model hyperglycemia.

They were able to correct this effect using a novel dietary supplement previously developed by the research team called a glyoxalase 1 inducer or Glo1 inducer. They also found that the HK2 effect was the major mechanism increasing formation of a reactive glucose-derived substance called methylglyoxal

(MG), known to be increased in diabetes and linked to damage to blood cells, kidneys, retina and nerves in arms and legs in diabetes – so-called vascular complication of diabetes. MG binds and modifies proteins, causing them to become misfolded. In this study the researchers identified 222 proteins susceptible to MG modification and this activates a protein quality surveillance system called the unfolded protein response, which removes damaged proteins. When the unfolded protein response is overworked with a high level of misfolded protein substrate it causes an inflammatory response and there is an increased risk of blood clot formation. These processes contribute to blood vessel damage involved in the development of vascular complication of diabetes. Dr Naila Rabbani, from Warwick Medical School, said: “Mechanisms of organ sensitivity to damage by high glucose concentrations in diabetes are still poorly understood and urgent improvement in treatment of diabetic complication is needed. Our study provides a step advance in understanding these mechanisms. “Our research has identified a likely key step, increased HK2, in the initiation of development of damage to the blood vessels in hyperglycemia linked to vascular complications of diabetes, such as kidney disease, damage to the retina in eyes and nerves in the arms and legs, and increased risk of heart disease – the major cause of premature death in diabetes. Importantly, we showed how a new type of treatment, Glo1 inducer, can correct this and deserves consideration in the search for improved treatments for diabetic complications.” The research was conducted in collaboration with Professor Paul Thornalley, now Director of the Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU) in Qatar. The research team are now working to confirm and develop this research, to develop further evidence for the importance of HK2 and MG in cell dysfunction and organ damage in diabetes and the benefits of Glo1 inducer treatment for diabetes and diabetic complications. The research was supported by funding from Taif University, Saudi Arabia; University of Warwick, U.K.; and QBRI, HBKU, part of the Qatar Foundation, Qatar. ‘Activation of the unfolded protein response in high glucose treated endothelial cells is mediated by methylglyoxal’ is published in Scientific Reports, DOI: 10.1038/s41598-01944358-1

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TECHNOLOGY IN THE SPOTLIGHT DIGITAL HEALTHCARE Each month we cover healthcare technology that is revolutionising the healthcare sector. This month we cover three intuitive technologies for healthcare: MediViewerâ&#x201E;˘ a leading EDM solution transforming patient records, Verto: Supporting Integrated Care Systems by providing a structured approach to establishing and managing a project and the DrugStars app which is actively engaging in the pharmaceutical conversation â&#x20AC;&#x201C; amplifying the voice of the patients around the world.

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UNLOCK THE SECRET INGREDIENT HIDING INSIDE YOUR MEDICATION 27

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Features MediViewer™ from IMMJ Systems anFast Secureisand electronic document management (EDM) solution built specifically for healthcare

MediViewer™ is extremely fast and intuitively easy to use, the need

for patient privacy is fully observed and supported by a

comprehensive security model.

Mobile Enabled Hospitals can scan, index and archive paper medical records and

he business case for investment in an EDMS solution is compelling, with the potential for significant improvements in operational efficiency, associated cash-releasing benefits as well as improving clinical decision making. IMMJ Systems are the provider of MediViewer™, which has been designed and built on the collective experience of their senior management team following many years in healthcare, supporting and delivering clinical systems. Having been involved at the ‘sharp end’ of delivering

access them quickly through an intuitive fully mobile, touchscreen enabled usersolutions interface ready to usethe on any device. of patient healthcare involving digitising records, we have acquired extensive knowledge and SmartIndex™ Technology understanding of the operational challenges facing NHS MediViewer™ makes sense of all your clinical information with our organisations who are beginning their paperless journey. built in document classification engine. Applying logic and

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milestone. The Isle of Man Department of Health MediViewer™ has been built specifically for healthcare and Social Care set a target to achieve the removal of providers and designed around the needs of healthcare paper records. The programme – which formed part professionals. MediViewer™ provides a device agnostic of the Government-wide Digital Strategy - was a major web-based platform for a true clinical mobile working commitment, building on the work already undertaken experience. This intuitive EDRM solution provides niche across many parts of their hospital. functionality to support BS10008 compliance and a highly advanced document classification engine to make “MediViewer™ is intuitively easy to use and its speed sense of large historic paper based medical records. means response time between pages is almost It can also fully integrate with your EPR and provide a designed speciﬁcally for healthcare to deliver Using a paperless NHS. instantaneous. MediViewer™ enables me to complete view of a patient’s health record. MediViewer™ quickly surface the exact clinical information I need at provides a best of breed eforms and workflow the point of care and has definitely made my job much application as well as utilising a completely open product easier!“ Dr Gregor Peden MBChB AMBCS, Chief Clinical architecture and API’s to support integration with other Information Officer (CCIO), DHSC Digital, Isle of Man clinical applications including the MESH and the MIG to receive and export information (for example discharge The project enabled faster access to patient information, summaries) into the primary care setting with ease. resulting in massive time savings and better care, a reduction in the space used to store paper notes by IMMJ Systems provides complete end to end digital to see MediViewer™ 100%, enabling multiple healthcare workers to view transformation, consultancy and implementation different records from almost any web-enabled device support services and operates as an agile business simultaneously and eliminating more than 16 million with the ability to adapt precisely to customer needs, sheets of paper. allocating the resources each project requires. The IMMJ Systems delivery team is comprised of experienced If you need help or advice on replacing or upgrading your NHS clinical and IT professionals who can respond existing EDMS solution we would be happy to advise. quickly to customer needs and the rapid achievement Take advantage of our complimentary options appraisal of healthcare policy targets. One of the reasons IMMJ now by contacting us. Systems deployments are so successful is the in-depth experience of the impact and challenges associated with To arrange a demonstration or for further information delivering an EDMS to the NHS. please contact us on the details below: Thanks to our implementation methodology and new Call: +44 (0) 203 790 7901 intuitive technology called MediViewer™, the Isle of Email: info@immjsystems.com Man is well on track to achieving its paperless digital

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Features Secure and Fast MediViewer™ is extremely fast and intuitively easy to use, the need for patient privacy is fully observed and supported by a comprehensive security model.

Mobile Enabled Hospitals can scan, index and archive paper medical records and access them quickly through an intuitive fully mobile, touchscreen enabled user interface ready to use on any device.

CALL US: +44 (0) 203 790 7901

Website: www.immjsystems.com | Email: info@immjsystems.com

Verto: Supporting Integrated Care Systems

HS Eastern Cheshire Clinical Commissioning Group (CCG) is one of 195 CCGs across England responsible for the commissioning of healthcare services for its local area and is a key partner in the Cheshire East Integrated Care Partnership which is joining up the area’s health and social care services. What NHS Eastern Cheshire CCG wanted to achieve The backdrop to NHS Eastern Cheshire CCG’s operations was a challenging if not unusual one. Its financial Plan forecast an annual deficit of approximately £15m and, to balance the budget, there was a strong drive to deliver Quality, Innovation, Productivity and Prevention (QIPP) schemes to achieve £9.4m of savings. The CCG identified that its Programme Management Office (PMO) approach required redesigning as projects had previously been managed using a combination of Microsoft Project, Word and Excel. Version control was problematic and, even though there was a shared drive in use, there was no visibility on who was working on which version. Similarly, reporting was laborious and, although the CCG had developed an in-house database, it still required manual data collation from multiple sources in order to produce the reporting required, which was hugely time consuming. The CCG recognised that it needed a cloud-based approach for its programme delivery which would offer:

• Ease of use • Collaborative working • Version control and visibility of updates • Easy and accurate reporting to enable planning with confidence and deliver efficiency savings. Importantly, Eastern Cheshire wanted a tool that allowed it to get the most out of its collaborative PMO working across all four CCGs in Cheshire on proposals to establish a single commissioner and two Integrated Care Partnerships (ICP). Verto as the solution Verto was built in line with how the CCG works, mirroring its workflow and processes, and able to see all its project data and documentation in one place. Once the CCG build was complete, we undertook the second stage of joining up Eastern Cheshire with its neighbouring CCGs: South Cheshire, Vale Royal and West Cheshire using the powerful functionality of VertoGrid. This created a Cheshire-wide network of CCGs, providing each CCG with a customised version of Verto. Joint projects can now be shared and, for the first time, all the project information across multiple sites can be aggregated into a single report. “Working with the Verto team has been brilliant – they have such a great ‘can do’ attitude. They are so responsive, listening to our ideas and challenges and finding solutions so the system really works for us. In the early stages we spoke to NHS West Cheshire CCG who were very impressed with the system and support. We could see how using VertoGrid would enable us to run programmes and reports cross-organisationally whilst retaining all the individual configuration of our own system. For us this was the best of both worlds and, combined with its ease of use and depth of functionality, it wasn’t a difficult decision”. Adam McClure, PMO Manager for NHS Eastern Cheshire CCG

The Benefits Verto provides a structured approach to establishing and managing a project, making it easy for people to follow project management best practice.

“One of the mainstays of Verto is its ease of use. For us, the user interface was a major selling point – we just found it so easy to navigate around”

Eastern Cheshire particularly liked the fact that Verto was simple to use, with a clear dashboard that made it easy to see all its project information in one place.

Adam McClure, PMO Manager for NHS Eastern Cheshire CCG

The CCG had instant visibility of its project performance and the ability to generate high-quality reports, including its Board Assurance Framework, with one click of a button. The Cloud-based system, coupled with the VertoGo App, gives CCG staff and stakeholders ‘on the go’ access to their data, supporting collaboration and flexible working. Verto also gives individual commissioning managers and the PMO a bird’s-eye view of their projects meaning they can manage risk, and monitor and report on projects in a much more robust way.

The time saving benefit to the PMO has been significant: reporting processes that used to take more than a week are now completed in less than a day, and having all their project information in one place has produced a noticeable saving in time spent on PMO admin. The PMO is now working on integrating Verto as a ‘business as usual’ tool across the wider organisation, and the information coming out of the system is enabling it to plan and track savings and benefits more accurately. Verto gives the PMO reliable and current data, one system to plan, track and manage the delivery of QIPP projects and to enable future planning with confidence.

The DrugStars app is actively engaging in the pharmaceutical conversation – amplifying the voice of the patients around the world.

laus Møldrup, a former professor at the University of Copenhagen, and his 12-person strong team have created and launched a scientifically validated app that actually makes it meaningful for patients to take their medication (1). Patients are rewarded with the opportunity to donate money to patient charities for free. All they have to do is take their meds as recommended by their HCP and share their experiences and opinion of their meds it the app. This collected data is then utilised – in anonymous form – in scientific studies. Pharmaceutical companies can also purchase this anonymous real-world data, enabling them to help them create better and more user-friendly products. DrugStars uses the revenue from the sale of this anonymous information to pay for the donations made by the patients.

“The goal for DrugStars is to transform the taking of medication, from being a necessary evil into a necessary good. For many people, having to take medication remains a daily challenge that most would prefer to be free of. So we thought, why not reward patients for this challenge? Why are most patients only shown the stick and not the carrot?” asks Claus Møldrup, DrugStars CEO and founder.

The award-winning app DrugStars is expected to reach 1 million patient medication reviews in 2019. DrugStars has already attracted over 200,000 active users, donating more than £200,000 to more than 70 patient charities – including 20 charities in the UK. DrugStars is transforming the everyday experience of taking meditation into a more meaningful, purpose-filled and fun task for patients across Scandinavia, the Baltics, the US and, especially, the UK, where the app if currently focusing its efforts.

“Much of what I did at the university was about improving patients’ treatments based on insights from their experiences with their meds. It’s nice to be academic about it, but my ambitions were to be able to make a real difference for patients and their experiences with medication.” Ans so DrugStars was born.

DrugStars is an example of a new trend in the digital economy, where the ethical monetization of information is integral to the business model, with users being actively rewarded for sharing their information – in this case the reward is in the form of free donations.

Patient insights Claus Møldrup was previously a Professor of Social Pharmacy at the University of Copenhagen , and it was his research into – and knowledge of – patients’ behavioural patterns and motivation in relation to taking medications that gave him the idea to start DrugStars back in 2016.

Claus Møldrup explains that the initial focus of the DrugStars app was on helping patients who forget to take their medication. Once again, the data was clear, with only 30 percent of non-adherence problems actually the result of the patient forgetfulness. The remaining 70 percent were due to some form of negative experience the patients had with their medication. It quickly became clear that the DrugStars app would need to address both of these adherence issues in order to truly help patients.

And to do this, it was necessary to collect data – realworld data (RWD) generated every day for every medication and in every country around the world. Today, DrugStars generates very strong RWD sets from real users, and with their full acceptance. This RWD includes whether the patient has faith in their treatment, whether they feel it is even necessary for them to be taking the medication. Whether they are troubled by any side effects. And whether they have complied and taken the medication as prescribed. This information is modelled around the medicine at a brand level, allowing DrugStars to broker and sell insights – in an anonymous form – back to the pharmaceutical companies. Similarly, j pharmaceutical companies can also purchase the anonymous user assessments of their competitor’s drugs, and thus increase their real-world knowledge. “DrugStars deliver real-world experiences and real-world evidence and outcomes in the form of data on specific drugs in an anonymous, aggregated format, allowing companies to utilise them to improve their offerings and ultimately benefit patients.” A voice for patients around the world With the high volume of drug reviews, DrugStars aims to offer patient reviews of all medications – like a Trustpilot for medicines, explains Claus Møldrup. “We hope to see DrugStars develop into a voice for patients around the world. In price negotiations between

pharma companies and the paying authorities, we envision our data on user acceptance of a drug being used as an essential and valuable parameter. Pharma companies’ clinical studies and health economics analyses currently don’t reflect anything regarding the patient’s acceptance of their medicine, for instance whether the tablet is difficult to swallow, whether they give up on their prescribed course of treatment and so forth. This type of data is clearly missing today. But DrugStars can deliver it, making us a growing factor in the pharmaceutical conversation between Payers, Providers, Patients and Pharma,” says Claus Møldrup, adding that the data clearly shows a direct correlation between a patient’s acceptance of a product and their compliance with the prescribed treatment. A tool at the pharmacy and at the GP’s office According to Claus Møldrup, it makes perfect sense for pharmacy staff to utilise DrugStars as a dialogue tool with their customers. “Patients who use the DrugStars app would be able to show their GP and their pharmacist exactly how they are doing with their medication. For example, pharmacy staff would be able to see when a patient isn’t comfortable with their current treatment, and they would be able to ask more informed questions, bringing everyone closer to a solution that benefits all parties. Now this dialogue tool is here in the form of our app,” says Claus Møldrup proudly.

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