Digital Health - Q1 2021 by Mediaplanet UK&IE

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Q1 / 2021

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How digital health is making science fiction a reality

A recent INsurvey THIS howed that before ISSUE COVID-19, just

12%

of patients in England

Advances in technology have revolutionised what we know about the human body and our ability to improve and save lives. Now digital health is set to accelerate progress further.

had received Patients’ needs and preferences must be the ealthcare virtually starting point for the use of digital technology. 1

Rachel Power, Chief Executive, The Patients Association and Chair, Patient Coalition for AI, Data and Digital Tech in Health

centure. Sustaining the growth of digital health. 2020. Available at: tps://www.accenture.com/gb-en/insights/health/england-patient-survey. Accessed: February 2021.

Technology has been instrumental in healthcare’s COVID-19 response by helping support patients and the NHS workforce.

WRITTEN BY Dean Russell Member of Parliament for Watford, Chair of Digital Health, APPG

Guy Boersma, Managing Director, Kent Surrey Sussex Academic Health Science Network

It is also important to tailor and personalise digital services and care as much as possible. Sean Duggan, Chief Executive for the Mental Health Network, NHS Confederation

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e are on the verge of further giant leaps in our ability to prevent illness and cure the human body, with the rise of digital health. In the world around us, what may once have been science fiction is fast becoming science fact. Shifting focus from cure to prevention One of the most notable benefits of many modern consumer-facing digital health devices is the shift from cure to prevention. The past two centuries of innovation have placed treatment at the centre of most healthcare innovations. Yet, with digital health in the public arena, there are incredible opportunities to put prevention at the centre of 21st-century healthcare. At the heart of this is the collection of evermore health data, yet this does not come without its challenges. As the devices grow in number, so do the ethical and societal challenges around what data is collected and shared from individuals. Hesitation around sharing data As a simple example, imagine collecting health data from every individual taking a particular drug; this could help form an ongoing living clinical trial. Yet, sadly, data is often a dirty word when discussing health. The general public may already be oversharing every detail of their lives via social media and Google, but it is still a big ask for them to share their personal and private health data, even if the request is for the greater good of curing cancer or dementia.

Still, it will be hard for the health industry to reach digital health’s full benefits without the right safeguards, security, and legal protections. The fear of sharing too much information with any government is a perennial issue. Still, it will be hard for the health industry to reach digital health’s full benefits without the right safeguards, security, and legal protections. In the public health arena, a move towards a single patient view for data could transform health outcomes for individuals. It could also increase efficiencies across the NHS and social care. A future with predicted health outcomes By ensuring we lay the safety, privacy and security foundations now, in the future we may reach a point where a doctor uses AI to predict health outcomes for a patient based upon the patient’s records and live data feeds from their digital health devices. With the rise of digital health, it isn’t too far-fetched to assume doctors may shift from prescribing tablets for patients to swallow, to increasingly prescribing patients to download health apps instead. Whatever the predictions we make for revolutionising healthcare in the future, their success lies firmly in the decisions we make in the present.

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How data is shaping the future of healthcare COVID-19 has propelled the rise of digitalisation - but how can our personal data help to improve patient outcomes today and shape the future of healthcare tomorrow?

T WRITTEN BY

Gaëtan Leblay Managing Director, Janssen UK & Ireland

he last year has seen a staggering 6,500% increase1 in the number of healthcare professionals recommending digital health tools to their patients; 99% of GP surgeries have moved to offer video consultations; and over four million people have downloaded the ZOE COVID Symptom Study app to actively share their symptoms in real time.2 Those who may have given little thought to the value of their own health data previously, are now seeing its power first-hand in the fight against COVID-19. This information has helped to identify patterns and trends, highlight at-risk populations and inform the Government’s response. As we look ahead, data is already establishing itself as a core driver in shaping the future of healthcare. While this rise in public awareness is hugely beneficial, there is still much to be done to help people understand why their personal health data is so vital and importantly, provide assurances regarding how it will be used and what safeguarding and governance measures are in place. Data security Arguably, there is no sector that better understands the need for transparency than the healthcare industry, where there are clear parallels between protecting patients and their data. Safety will always be our watchword; the challenge is therefore not so much in the doing, but in showing how and why it is being done. Digital literacy can be addressed through improved access and education, but trust is a far trickier commodity. It takes time to build confidence and this can only truly be achieved through transparent practices and consistent delivery. The way that we use health data is key– it must be unfailingly ethical and highly respectful of an individual’s privacy.

Those who may have given little thought to the value of their own health data previously, are now seeing its power first-hand in the fight against COVID-19. Paid for by Janssen

March 2021 | EM-55115 This article has been sponsored and developed by Janssen-Cilag Limited.

Connecting the data points While personal health apps, clinical studies and electronic health records (EHRs) are very useful, hurdles often lie in the lack of interoperability between the data holding systems, and the fact that data collection isn’t standardised. Nonetheless, these factors have not impaired the benefits

that data is already demonstrating in healthcare. We see a breadth of positive adaptations already appearing through personalisation, accessibility and immersive technologies aiding patient care. This should only increase with time and expand to positively impact patients, healthcare delivery and the economy as we follow this data movement. Last month the Government unveiled a project that will focus on more efficient and safe uses of health data for research and analysis.3 At Janssen, the Pharmaceutical Companies of Johnson & Johnson, we’re already partnering on programmes to help tackle this, including a Europe-wide collaboration with the Innovative Medicines Initiative, aiming to increase access to quality real-world data by finding ways to reduce the variables in study design and data analysis. We’re also leading on the European Health Data and Evidence Network project, which seeks to harmonise an impressive ~100 million EHRs into a large-scale useable network.

It is the responsibility of the Government and industry alike to nurture public trust in the value of health data and digitalisation. What’s next? COVID-19 has ignited a revolutionary approach to healthcare and provided opportunities to harness the value of data like never before. At Janssen, we are embarking on a digital transformation journey to accelerate our capabilities in this space. Building on our partnerships and expertise to ensure that the data patients entrust to us can be used to genuinely advance healthcare - from the development of innovative therapies to the delivery of patient care. That said, it is the responsibility of the Government and industry alike to nurture public trust in the value of health data and digitalisation. Only by doing so will we build towards a healthcare system that is resilient enough to meet our needs today and flexible enough to face tomorrow. References 1. COVID-19 Response. ORCHA. Available at: ORCHA - NHS Innovation Accelerator (nhsaccelerator.com) [last accessed March 2021] 2. ZOE. About the COVID Symptom Study. 2021. Available at: https://covid.joinzoe.com/ about [last accessed March 2021] 3. GOV.UK. Research and Innovation in health and social care. 2021. Available at: New review into use of health data for research and analysis - GOV.UK (www.gov.uk) [last accessed March 2021]

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Ensuring legislation works with innovation On 1st January 2021, the UK entered a six-month interim arrangement with the EU on data sharing, with a full decision on adequacy due within that period. This agreement, and presumably, largely unchanged UK Data Protection rules, will set the overall legislative context for UK data handling. However, there are many calling for flexibilities derived from Control of patient information (COPI) notices to be enshrined in new information

governance rules. Sarah Wilkinson, CEO of NHS Digital, has been quoted as saying “The current legislation is very labyrinthine and that makes it difficult to have a clear dialogue with a broad cross-section of people, even within the health and care system.” Any changes to legislation that enable a more streamlined flow of data across the NHS and helps build critical datasets would be welcome.

The UK needs to leverage its health assets to the widest possible benefit for its patients, citizens and economy. Ensuring faster access to care through data The ‘data economy’ in health is hugely prized and the UK has an opportunity to develop an open-data resource that could attract clinicians, academics and industry to help develop next generation solutions to critical health problems, stimulating economic growth and enabling UK health services to reduce the “bench to bedside” timeline. Some baulk at the idea of profit from health data but ‘health and wealth’ are two sides of the same coin. Healthcare performance is strongly dependent on the economy. Wealthier countries have healthier populations and it is a basic truth that poverty adversely affects life expectancy. The UK needs to leverage its health assets to the widest possible benefit for its patients, citizens and economy.

©Wavebreakmedia

hanges in access to healthcare were enabled by a common purpose, use of derogations in regulations and clarity of risk versus benefit. Not all of these circumstances will remain post-pandemic and new ways of working will need to be established to ensure we maintain these benefits. These may be legislative or cultural and some will inevitably require funding. It is of particular interest in how the pandemic will shape attitudes to sharing data, and in turn, influence legislation. It is widely accepted that data sharing is vital to aid efficient service delivery, support improved outcomes and provide insights for innovation. There are of course legitimate concerns over privacy.

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How to ensure digital health progress remains post-pandemic

OVID-19 proved the most profound accelerator in adoption of digital healthcare technologies. When it became impossible for patients to visit their clinicians, healthcare services adopted digital technology overnight. Antoine Valterio, Country Manager UK and Ireland of ResMed says: “People could see first-hand, how digital medicine had the ability to energise clinical care, enable systems to perform optimally and empower clinicians and patients alike.” Take the example of chronic obstructive pulmonary disease (COPD), a lung condition causing narrowing of airways and damage to the air sacs. As the impact of the virus swept through NHS services across the country, there was no way COPD patients, who experience serious air flow restriction in and out of the lungs, could attend

where needed. For patients, the technology was accompanied by personalised online tools providing feedback on their condition and personalised coaching tips on how to manage it better. “Digital health can be used to drive patient adherence. It also gives people the security of feeling constantly supported,” says Valterio. In addition, advanced analytics, machine learning, and artificial intelligence applied over large sets of health data create opportunities for improving the delivery of healthcare and outcomes. “‘Big data’ insights will allow us to understand which therapies work best for different patient groups and ultimately contribute to the holy grail of medicine - personalised care for every patient,” says Valterio.

‘Big data’ insights will allow us to understand which therapies work best for different patient groups and ultimately contribute to the holy grail of medicine - personalised care for every patient.

appointments for monitoring. Clinicians rapidly adopted remote monitoring of COPD patients through cloud-connected home non-invasive ventilation (HNIV) to ensure they continued to receive clinical support and treatment. A cellular chip embedded in the device allowed data to be transmitted directly to the cloud, enabling clinicians to remotely monitor the patient’s respiratory rates, blood oxygen levels and track changes in their condition. Helping patients to feel continuously supported “The data coming from the devices is viewed online through dashboards, which automatically triage patients into different groups according to clinical need, allowing doctors to immediately pinpoint who needs attention most,” explains Valterio, adding health staff can also adjust device settings remotely

INTERVIEW WITH

Antoine Valterio Country Manager UK and Ireland, ResMed

Written by: Janet Fricker

Funding remains a challenge Currently digital medicine stands “at cross roads”, where the technology is poised to go mainstream but in danger of being knocked back by inadequate funding. At the start of the pandemic, the usual NHS tariff system - the set price commissioners pay providers for different services - was suspended and an interim umbrella funding was put in place. The payment landscape, maintains Valterio, has not evolved in line with digital health technology. “While data-enabled medical equipment is provided through national procurement frameworks, the problem right now is that the NHS has no tariff codes in place to track and remunerate the work health care staff do when they access data to care for patients remotely. As far as tariffs are concerned, digital health just doesn’t exist.”

©ELENABS

In the COVID-19 pandemic, access to digital health technology has been catalysed, but can the momentum be sustained when life returns to normal?

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Levelling tariffs and incentives To continue the transformation of care with digital health, Valterio is calling for tariff codes to be introduced to ensure all activities that can be done remotely are equally valued, compared to the same activities done face to face. “This would send a strong signal to providers and payors that digital health should be adopted as the standard of care while ensuring patients retain choice,” Valterio says, adding he has taken inspiration from the 2019 German Digital Supply Act that introduced statutory reimbursement for digital health applications. Ultimately, the introduction of digital health has the potential to drastically reduce the backlog of waiting lists and ensure the NHS offers a sustainable model for ageing populations who will suffer from more and more chronic disease. “It will also overcome geographical health care disparities, getting rid of post code lotteries, so that the care people receive no longer depends on where they live,” says Valterio.

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COVID-19:

The importance of building citizen trust

WRITTEN BY Dr Charles Alessi Chief Clinical Officer, HIMSS

s clinicians and patients have embraced telehealth, the issues which have always acted as a barrier to mainstream adoption have not disappeared. However, their influence on the rapidly changing landscape is different from what we had got used to. Addressing the digital divide There is far less resistance to adopting telehealth in the clinical community. Partly because there is no real alternative in some cases, and it offers advantages to both parties in protecting them from nosocomial infections. There is a major workforce management transformation area of work still outstanding however, as many clinicians still have all the advantages of digital communication yet to discover. Citizens and patients have adopted these technologies quickly. Whilst there are still issues associated with the digital divide to address, people have welcomed the easier access and immediacy that digital communications offer. Does this mean that the debates around secondary use and trust have been resolved? This does not appear to be the case. Indeed, discussion around the balance between the right to privacy of the individual and their

duty to their fellow citizens have dominated conversations. The adoption of digital solutions around contact tracing is a case in point. Voluntary adoption has been challenging Adoption of novel technologies during the initial stages of the pandemic by populations who had the ability to exercise choice was disappointing. This was true in countries as diverse as the UK, Europe, and the Far East. The latest attempts to increase adoption seem to encompass increasing levels of mandating as a result. There is still lots to do. We need to reopen the examination about the advantages to citizens and data being shared and aggregated to gain insights. We need to ensure people have assurance that we will have the capability to safeguard their data from unwarranted data breaches, and also from unwarranted requests for access from a whole range of agencies, some private, some public and governmental. We need to engage with people now and at scale. It is possible these discussions will be contentious and in many respects that is to be expected, since levels of trust have inevitably been eroded by the pandemic - but engage we must, and with some urgency.

We need to ensure people have assurance that we will have the capability to safeguard their data from unwarranted data breaches.

©NATALYABUROVA

The pandemic continues to have significant effects upon digital transformation. It has accelerated its adoption, as digital modalities have become the choice for access to treatment in this age of contagion.

Why safety and equality are at the heart of AI in healthcare WRITTEN BY

Dr Indra Joshi Director of AI, NHSX

It’s not enough to just develop solutions using AI-driven technology in health and care, we need to carefully assess the impact.

eople working in healthcare are used to testing and adopting new ideas and there is huge enthusiasm about the challenge and opportunity of artificial intelligence. Now the challenge is in making sure we are confident that clinicians and patients in all communities will benefit equally. At Milton Keynes University Hospital, the stroke team is using mobile app technology that has both increased the speed of reading the brain image and improved the treatment pathway for stroke patients. Having scans on a mobile app has connected clinicians, accelerated decisions and facilitated working between hospital sites. When the need for expert diagnosis is recognised, that expert no longer needs to be on site to give feedback. All these improvements to efficiency, rate of diagnosis and treatment has led to some re-thinking of the process for patients. Perhaps pinch points in the system could be reduced such as wait times. So now patients can feel the benefits too.

equipped with both an understanding of how to adopt them, and the reassurance that they can be safely and ethically deployed. The use of AI, and machine learning in particular, in safe and ethical ways is not without its challenges. The potential for inequalities exists in the unintentional preference of programmers, racial bias in data sets used during development and in funding disparities for some health issues over others. Ensuring care equality The COVID-19 pandemic has unfortunately highlighted some of the existing inequalities of care for minority communities. The NHS AI Lab is starting a muchneeded national conversation to address AI’s potential impact on care inequality and the need for algorithmic impact assessments in AI developments. New research plans, in collaboration with the Health Foundation, are launching soon, aimed at exploring how UK based AI-driven technologies can be used to improve inequalities in healthcare. For AI to continue providing real change for public good, there is no point in technology for technology’s sake. We will keep working with health care professionals, innovators and commissioners to find and tackle the most impactful problems. As with all areas of the NHS, our mantra will continue to be: patients first.

For AI to continue providing real change for public good, there is no point in technology for technology’s sake.

Asking the ethical questions The NHS AI Award is funding technologies like this stroke example in order to boost AI deployment into hospitals and care settings. Now the responsibility lies in ensuring that frontline services are

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AI speech recognition helps with COVID-19 demands

INTERVIEW WITH

Dr Simon Wallace Chief Clinical Information Officer (CCIO), Nuance Communications

Written by: Mark Nicholls

ith growing evidence showing that admin is adding to workload and clinician burnout, speech recognition tools harnessing artificial intelligence (AI) are helping ease that burden. Dr Simon Wallace, Chief Clinical Information Officer with Nuance Communications, says: “Healthcare has become increasingly complex. That requires detailed documentation so that clinicians have an accurate record, not just for themselves but for other clinicians looking after patients.” Risk of burnout Yet it is an ever more time-consuming process. A survey by the company indicated clinicians were spending 11 hours a week creating their documentation. Other research has suggested using an Electronic Patient Record, adds a further 30-40 minutes to the clinician’s working day. Dr Wallace says: “This has resulted in doctors only spending an estimated 13% of their day with patients; they are overwhelmed by clinical documentation, adding to stress and issues of burnout.” COVID-19, inevitably, has added to that. Last September, Nuance surveyed 900 NHS clinicians and managers from primary and secondary care. A high proportion stated clinical administration had increased during the pandemic and that their worklife balance and stress at work had worsened. Significantly, 87% in primary care and 70% in secondary care thought the burden of clinical documentation had contributed to burnout.

Dragon Medical One has helped our staff pivot to remote working due to coronavirus. As a cloud-based solution it’s playing a vital role in supporting our doctors conducting clinics from home. ~Dr Paul Altmann, Chief Clinical Information Officer, Oxford University Hospitals NHS Foundation Trust

©INFOGRAPHIC PROVIDED BY NUANCE

AI-powered speech recognition is dramatically cutting the time clinicians spend doing their documentation, freeing them up to spend more time on patient care.

Nuance survey report published Oct 2020: www.nuance.com/burnout

Highly accurate speech recognition Speech recognition systems can be used anywhere that clinicians are typing or dictating documents. Sophisticated algorithms and deep learning, supported by a comprehensive medical dictionary, deliver “industrial strength” accuracy, with the system attuned to different accents and languages. Speech recognition is commonly used in radiology but is now being widely adopted in other clinical areas of the hospital, as well as in mental health, the community and primary care. In the hospital setting, major benefits in A&E and outpatient departments have been realised. Dr Wallace adds: “Some organisations were having high outsourced transcription costs, others had a shortage of secretaries and were relying on bank staff, and clinicians were staying late to get their admin done.” Admin burden reduced With speech recognition, the turnaround time of clinic letters dropped from two to three weeks to two to three days. “Clinicians felt their admin burden was reduced, transcription costs were significantly reduced and the burden on secretaries eased,” he continues. “That has been a real success in the outpatient department with hospitals getting a healthy return on investment.”

Dragon Medical One has had a big impact on the efficiency of getting our letters done for any clinic. Clinicians are now able to send letters within 24 hours—or even instantaneously if there are no blood results to be waited upon. This compares with the pre speech recognition era where letters took two weeks or even longer to be completed. ~ Dr Paul Altmann, Chief Clinical Information Officer, Oxford University Hospitals NHS Foundation Trust Clinic room of the future Looking ahead, AI speech recognition technology is a foundation for other solutions aiding clinician workflow and easing administrative burden. Using natural language processing (NLP), the quality of a clinical term can be improved, clinicians alerted to possible missing diagnoses and clinical terms coded (e.g. with SNOMED CT codes). The ultimate vision is the clinic room of the future using ‘ambient clinical intelligence’. The desktop computer is replaced with a ‘smart device’ on the wall that harnesses voice biometrics to diarise the whole conversation between the doctor and the patient. NLP works in the background to create a fully structured, coded clinical note without the clinician needing to touch the keyboard at all.

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The promise and challenges of imaging AI AI can read scans and improve hospital workflows, but what does the imaging AI landscape look like now for radiologists?

rom self-driving cars to facial recognition, artificial intelligence (AI) plays an increasing role in our daily lives. Within the highly regulated healthcare landscape, development has been slower in order to ensure patient safety. However, the clinical community is both optimistic and proactive when it comes to harnessing AI’s huge potential. How imaging AI can and will improve care There are many areas where AI can enhance hospital imaging. For example, automating the measurement of abnormalities will improve the speed and accuracy of disease staging and management. In future, algorithms may be able to integrate data such as blood test and genomic results with scan findings to give prognoses or recommend the best treatment regimen. One ongoing NCIMI AI project I’m involved with is a partnership between my trust and GE Healthcare to evaluate an algorithm for detecting collapsed lungs. AI will also have a big role in improving backroom radiology by flagging abnormal scans for urgent review and improving appointment scheduling.

WRITTEN BY Dr Sarim Ather The Royal College of Radiologists’ Radiology Informatics Committee AI Clinical Champion at the National Consortium of Intelligent Medical Imaging (NCIMI)

©OSKER14

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How the NHS coped with the surge of pandemic demand

the radiology community in training and understanding the use of AI, as well as supporting engagement with its development. It’s important the safety and efficacy of any new tool is proven prior to adoption, and that innovations lead to time efficiencies, rather than greater burden on a stretched NHS workforce.

A traumatic shock to an established system has destructive power, but it also has the power to transform and reinvigorate.

Overcoming hurdles to widespread adoption The UK has a thriving AI innovation ecosystem. However, the lack of AI integration with clinical workflow and poor efficacy evidence has been a barrier to widespread adoption. The RCR has taken a leading role in highlighting past lessons to the new wave of innovators, as well as engaging with industry to ensure new AI integrates with existing IT infrastructure. Work is also well underway from UK regulators to develop robust regulatory pathways to ensure AI is safe and can be rolled out quickly. Even with real-world evidence and clearing regulatory hurdles, the NHS can still be slow to up-scale innovation. Organisations like NHSX have a key role in supporting adoption at a national level, as do programmes such as NCIMI by bringing the right specialists together. Successful implementation of imaging AI depends on engaged staff, armed with the right tools. The radiology community needs AI champions to promote buy-in and pave the way, supported by the right NHS IT infrastructure.

However, the lack of AI integration with clinical workflow and poor efficacy evidence has been a barrier to widespread adoption.

We were sprinting to stay ahead of the surge of demand and, on more than one occasion, the waves hit us and we had to recover quickly. Responding to increased demand Clarity of requirements, radical acceleration of service design, product design and build phases, a near-elimination of bureaucracy and intense hard work were essential to meeting increased demand. Risks were taken that were well beyond those we would normally accept: systems went live without extensive testing, without a good understanding of how they would perform under scale and without automation of many of the service operations processes. Compromises were made. In the normal course of business, we consult extensively with all our stakeholders and the public on the use of patient data, whether for direct care, for planning or for clinical research. During a public health crisis there is little time for this and there is specific legislation that allows for the sharing of health data quickly, without consultation. This increases the speed with which we can react, but it also increases the responsibility to act on the behalf of all those constituents in ensuring all data use is appropriate, proportionate and secure. Maintaining this focus, amid the clamour for data, was one of the greatest challenges.

©METAMORWORKS

What imaging doctors need With a variety of AI solutions coming online, it’s important that radiologists understand the benefits and limitations of the algorithms at their disposal. The Royal College of Radiologists (RCR) has a unique role in supporting

WRITTEN BY Sarah Wilkinson Chief Executive, NHS Digital

hen the COVID-19 pandemic arrived last year, it was clear that digital and data services within the NHS would be critical to the response. In order to meet the demands of the crisis, we would need to transform numerous aspects of our approach. New services were required, and fast. These included systems for testing and tracing, for scanning the population for clinically extremely vulnerable individuals so they could be shielded, a digital infrastructure for vaccinations, data dashboards for multiple audiences and many more. Existing services had to be scaled, and dramatically. The peak utilisation of our 111 online services in March last year was 95 times its highest ever previous peak. We were sprinting to stay ahead of the surge in demand and, on more than one occasion, the waves hit us and we had to recover quickly.

From collaborations to partnerships Loose collaborations were forged into cast iron partnerships. Unity of purpose, the intensity of interactions and a dense history of heart-felt problems and victories written throughout this last year have created new trusted pathways within the complex network of the NHS. Mean reversion is strong in large bureaucratic systems. The challenge ahead is to rethink how we deliver digital and data services, based on our pandemic-era experience.

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Unlocking the power of digital health

INTERVIEW WITH Andy Cachaldora General Manager, Digital Service North Europe, GE Healthcare

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Clear guidance and support will help clinicians choose the best digital technology to meet the needs of their patients.

©IMAGE PROVIDED BY GE HEALTHCARE

igital technology and artificial intelligence (AI) are already everywhere in our lives, often without us even realising: satnavs telling us where to go; fashion apps showing us what to wear; and, in healthcare, tools such as the choose and book system of arranging appointments. Overcoming reservations around digital health However, the uptake of digital solutions in healthcare for more complex workflow and clinical applications has been slow and cautious. This is largely due to a lack of understanding of the technology itself and of its potential to improve efficiency and productivity, plus an underlying misconception that digital solutions might ‘replace’ healthcare professionals. There is also no clear guidance for choosing the right tools, regulating the technologies on offer, and getting the best out of the AI opportunities out there. While the NHS is starting to work on quality standards and process models, clinicians are bombarded daily with promises of the latest hi-tech wizardry, but with no independent evidence to prove its worth. The huge increase in workload created by the COVID-19 pandemic has brought digital healthcare and AI to the fore, catapulting technology ahead several years or more. Hospital staff are staring down the barrel of 12-hour days and seven-day weeks for the foreseeable future, and the search is on for tools that can really help.

Working together to develop the best solutions There is a growing recognition that digital solutions can help to make workloads manageable, preventing clinician burnout, reinforcing standards that may have – out of necessity – slipped and, crucially, improving clinical outcomes. However, the market is striding ahead so quickly that, while today’s AI solutions look fantastic, tomorrow there will probably be something even better. And the problem with speed can be lack of quality. It will be extremely important to identify where this technology can be most effective and useful, and sift through all the options available. GE Healthcare’s EMEA Edison Accelerator programme aims to do just that. This unique initiative serves as a hub, bringing together SMEs with AI capabilities and validation partners within the NHS to develop digital solutions that can meet clinicians’ and patients’ ongoing needs, and providing a framework to help monitor quality. The power of digital solutions in healthcare has already been shown to improve efficiencies in workflow. There are undoubtedly numerous ways that this technology can be exploited further to not only transform today’s healthcare pressures, but also to develop healthcare provision for the future, in synergy with clinical medicine.

Bringing technology to the point-of-care Customisable, mobile workstations provide the foundation for implementing efficient, patient-centred care in adaptable, integrated and agile care environments.

INTERVIEW WITH Paul Zuidema Managing Director, Ergotron EMEA

Paid for by Ergotron EMEA

Utilisation at the point of need Mobile medical carts have long made it possible to deliver the resources health teams require to document and treat patient conditions at the point of need. Utilised in medical dispensing and numerous other workflow scenarios, these workstations on wheels enable doctors and nurses to access key patient information directly at the point of care, via a computer or laptop. This allows data capture and recall in real time, which helps save time, keep accurate patient records and support medical teams with working more comfortably with technology. Requiring no extension cords or generators to power them, today’s

customisable medical carts support the installation of vendor-agnostic barcode scanners, printers, monitors, and keyboards needed to facilitate efficient patient interactions and optimal working. Importantly, this also makes it easy to set up remote triage locations and guarantee uninterrupted runtime for laptops or computers. Supporting safe, efficient vaccination processes Mobile carts and charging solutions are currently being used to power the UK’s speedy COVID-19 vaccination rollout. Supporting temperature detection and facilitating access to digital records and equipment that maximises workflow activity, the carts are making it possible to support the efficient vaccination of people outside clinic walls in non-traditional locations like car parks and drive-through facilities. These lightweight mobile solutions ensure medical teams can undertake data access and data capture in real-time while providing access to vaccination materials. All of which makes it possible for front line personnel to deliver joined-up, safe care to patients in the most efficient way possible.

©IMAGE PROVIDED BY ERGOTRON

orkflow optimisation with the use of technology to serve patient and clinician needs is not new; it has always been essential in healthcare environments. The fundamental challenges currently posed by COVID-19 brought forward, among others, the importance of the ‘Triangle of Care,’ which brings together the patient, clinician and technological means, to promote increased interaction, safety and efficiency.

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Patient experience of digital health: We still have a way to go

Digital transformation legacy will require good evidence If the legacy of the pandemic is to include the digital transformation of health and social care services, generating and using good evidence will be vital.

he digital health sector has been developing standards and frameworks for evidence generation for years. However, defining what good evidence looks like is still complex and challenging. Good evidence enables digital health to be implemented at scale and make the biggest and most effective impact possible. It should ensure industry can demonstrate products are clinically effective, safe, empower patients and offer potential cost savings. It should also be conducted in a way that has a measurable impact on decisionmaking in the sector.

WRITTEN BY Jenny Thomas Programme Director, DigitalHealth.London

access their GP in this way. It will be interesting to see more detailed evaluation on the sociodemographic factors relating to preferences and usage in coming months and how that could inform the way care could be provided in the long term. Evaluating this not only helps inform what comes next but how to optimise providing care and cater for all.

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The future of evidence generation There are many digital health products and services that can offer solutions to challenges as we recover from the pandemic such as COVID-19: Evidence the backlog of care in action and services, the Thousands of challenges of social GP practices care and supporting a Good evidence enables implemented continually stretched virtual consultation workforce. digital health to be platforms to enable As a sector, it implemented at scale and millions of people is vital that we make the biggest and most approach these to access their local GP from home. challenges with the effective impact possible. Although evidence same open attitude, supporting the use of doing all we can to online consultation has been emerging support digital health companies and for years, we should now begin to see healthcare organisations to implement evaluation of the technology in widenew solutions where improvements scale use. This should allow heath and can be achieved. By building the care organisations to make informed evidence base the health and social decisions about their future use of care sector can provide the very best these technologies. care with confidence. Having spent some time using virtual At DigitalHealth.London working with industry consultations, many clinicians may now through our Accelerator and NHS staff through be far more supportive of using beyond our Digital Pioneer Fellowship, we identified this the pandemic. The insights evaluation ever-growing demand for good evidence and set of patient experience could show many up the Generator. are very supportive of continuing to

Over the past year, the NHS has been forced to rapidly adapt to an incredibly challenging environment. Digital health technologies have been a key aspect of this urgent pandemic response.

D WRITTEN BY Rachel Power Chief Executive, The Patients Association, Chair, Patient Coalition for AI, Data and Digital Tech in Health

The Patient Coalition for AI, Data and Digital Tech in Health published the report on ‘Digital Health during the Covid-19 Pandemic: Learning Lessons to Maintain Momentum’

espite the fact that digital health technologies hold great potential to improve the efficiency and effectiveness of health services to the benefit of patients and the NHS, this has not been the experience of all patients. Alongside fantastic examples where digital innovations have provided vital services that would otherwise not have been available, there are also cases where patients have struggled with access or found that digital technology did not improve their care. Beyond telephone consultations, we still have a long way to go before we can say that patients across the UK are truly benefitting from the full potential of digital health technology. Learning from patient experience of digital health The Patient Coalition for AI, Data and Digital Tech in Health recently published a report to help improve our understanding of the role of digital health during the pandemic. As the Coalition is focused on championing the patient perspective, this report draws on in-depth research, a new patient survey and a collection of case studies of good practice in digital health technology to shed light on the patient experience of digital health. It offers a range of principles for the most effective approach to digital health, including ensuring technologies respond directly to patient needs and maintain the human aspect of care. The report also offers recommendations to the Government and the NHS to help ensure we learn from the unique experience of the past year – both the good and the bad. We must continue to improve the implementation and uptake of digital health technology to the benefit of all patients. Patient priorities must lie at the heart of digital health If we are serious about capitalising on the incredible potential value of digital innovations to the benefit of all patients, they must be developed and introduced in partnership with patients. Patients’ needs and preferences must be the starting point for the use of digital technology. A partnership approach will not only achieve this but also ensure that patients come to feel increasingly comfortable with related, complex issues such as data sharing. Ultimately, there is still much to be done to improve access to digital health so that we can continue to move from pockets of progress and cases of good practice to widespread implementation and use.

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Bridging the digital divide through community and patient collaboration Webinar, 18th March 2021

The lessons learned from the move to digital health services during COVID-19 need to be carried forward into the post-pandemic recovery period and beyond.

P INTERVIEW WITH Uday Bose Managing Director, Boehringer Ingelheim UK & Ireland

Written by: Ailsa Colquhoun & Kirsty Elliott

Paid for by Boehringer Ingelheim UK & Ireland

ost lockdown, health services face a pinch-point. Not only are services themselves grappling with their own recovery, but they also face unprecedented pent-up demand from service users. For Uday Bose, Managing Director of Boehringer Ingelheim UK & Ireland, health technology is part, but not the total solution to this quandary. A key learning from the pandemic is that people can find themselves on the wrong side of the digital divide. Some 11.7 million people in the UK are estimated to be without basic digital skills and poor access to digital services is often associated with poorer health outcomes. COVID-19 has forced a shift in accessing healthcare services digitally, so we must look to solutions that ensure patients are well equipped to access the care they need and release resources to prioritise more complex patients. Bose says: “Digital won’t be for all, and it is important that health tech remains an option not an imposition.” But, he says, there is no doubt that it has found a place. “Similar to online shopping; once people have tried it, and have become comfortable with the way it works, in most cases they rarely want to go back to the old way of doing things, however we need to take people on the journey and ensure no one is left behind.” Putting patients at the heart of digital transformation Vital to tackling the digital divide is to co-design with communities, making sure that we reach all patients, especially those most vulnerable. Bose has suggestions on ways we can drive patient centric digital transformation. He says; “De-siloing care delivery is critical and if the pandemic has taught us anything, it’s that we can achieve great things for patients when we work together.” He goes on to say: “Patients value the role of digital technology and the potential to enhance access to care, but they also have concerns around the use of their data. The NHS recognise this and the importance of connecting data with patients and maintaining transparency with them about how and why their data will be used. It’s a central issue in creating a more accountable and sustainable healthcare system and this is an area we can and should support them on.”

Some 11.7 million people in the UK are estimated to be without basic digital skills and poor access to digital services is often associated with poorer health outcomes. Building on this, Bose says we can learn a lot from what we already do well in some sectors of healthcare. The life sciences industry has always involved patients in research all the way through the innovation process. This is a translatable skill and points to the need for us to have a wider perspective and take cross sector learnings to support the integration of different approaches for better outcomes. Overcoming barriers to uptake Supporting digital innovation is a government priority and policy makers can improve receptiveness and inclusivity by involving clinician and patient input in decision-making. However, central to change is to address the barriers in uptake to digital heath technology within the NHS. Our new Innovators Guide provides a comprehensive assessment of the English health system, pooling key stakeholder insights and signposting to further information for entrepreneurs to overcome barriers to the adoption of new technologies. It also makes suggestions that help to address the issue of digital equality and literacy, through building digital skills into core medical education programmes. Having a national patient digital education strategy, supporting specialist medical teams to become early adopters of new technologies in the NHS and targeted education programmes to those most in need, will create a more receptive mind-set for patients and clinicians alike. Bose says: “It’s great to see the huge impetus behind digital innovation in the NHS and as a family-owned, purpose-led, innovation-driven company we are committed to helping improve the health of people now and for future generations – our focus on patient centric digital transformation very much supports this ambition.”

An Innovator’s Guide to the NHS: Navigating the barriers to digital health, created by Boehringer Ingelheim, is helping to address these challenges by providing a holistic view of the digital landscape and providing advice for digital innovators to work more closely in partnership with the NHS.

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Helping patients manage multiple conditions in one place

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How healthcare has turned to technology to manage mounting pressure

Current pressure on the NHS and growing waiting lists are well publicised, but what is often not spoken about is that currently one in four people have two or more long term health conditions, a number predicted to double by 2035.

n Torbay alone, the number of people with two or more conditions equates to 50,000 people. The only way our integrated care organisation can manage this is to shift from reactive to proactive care, by putting the knowledge in the hands of patients to better manage their own health at home. The rise in digital technology, accelerated over the past year,has meant that there are many tools available to patients. However, there is one key challenge. There are a growing number of individual apps for each condition, which at present, do not link up with one another. A need has arisen to create better unified care to help connect these conditions and reduce the burden on patients. Effective industry collaboration In 2018 we started working with our partner organisation Health and Care Innovations LLP (HCI) on an app for patients with MS and Rheumatology conditions. Early evaluation has shown a reduction in rheumatology related appointments of up to 50% and seven hours of weekly nursing time has been released from our education programme for patients being prescribed new medications. Plus, within six months, the waiting times for our MS clinics have diminished. Looking forward, the aim this year will be to make more conditions available through the app, including Cardiology, Hip and Knee pathways, Ophthalmology, Gastroenterology, Respiratory and Diabetes. This will not only bring more benefits to patients with multiple conditions, but will reduce even more unnecessary appointments. In the Hip pathway alone we aim to reduce post-procedure appointments by 80% and achieve savings of £216,000 each year. This puts us right on track for meeting the challenge of reducing our face-to-face appointments by 30%.

Adel Jones, Director of Transformation & Partnerships at Torbay and South Devon NHS Foundation Trust together with Health and Care Innovations LLP (HCI) have created the CONNECTPlus app. Find out more and how you can commission CONNECTPlus by visiting hci.digital

WRITTEN BY Adel Jones Director of Transformation & Partnerships at Torbay and South Devon NHS Foundation Trust

Technology has been instrumental in healthcare’s COVID-19 response by helping support patients and the NHS workforce.

B WRITTEN BY

Guy Boersma Managing Director, Kent Surrey Sussex Academic Health Science Network

efore COVID-19, pressures in healthcare services meant technology innovations contributed to managing increasing demand and workforce shortages. The pandemic emphasised this need as services have changed at pace to respond to growing demand with greater workforce shortages. The ASHN Network - the innovation arm of the NHS and collective voice of the 15 Academic Health Science Networks (AHSNs) across England responded to these challenges by collaborating with industry and healthcare partners to quickly facilitate spread and adoption of tech innovation. Discharging patients quickly and effectively A number of the AHSN Network’s pre-existing innovation adoption programmes supported the healthcare COVID-19 response. For example, our national programme ‘Transfer of Care Around Medicines’ (T-CAM), supports safe discharge from hospital. The initiative uses a safe and secure digital platform to establish electronic interfaces between hospital IT and community pharmacy systems, enabling community pharmacists to provide support to patients who need extra help taking their prescribed medicines. AHSN’s expertise in supporting technology adoption meant they were well placed to support local healthcare services to accelerate roll-out and uptake of online patient triage by GP Practices and remote consultations during the first wave of the pandemic. Assisting frontline support As the second wave of the virus emerged, we built on this knowledge, and NHS connections to further

Remote monitoring supports social distancing in healthcare by reducing face-to-face appointments. support frontline services with spread and adoption of technology. AHSNs across England are currently supporting the roll-out of remote patient monitoring using in-home oximetry devices. Patients with COVID-19 can experience dangerously low blood-oxygen levels without the patient noticing, known as “silent hypoxia”. The ‘COVID Oximetry at Home’ initiative supports citizens with confirmed and suspected cases of COVID-19 and can spot critical signs of deterioration early. It enables them to report deterioration from their homes and care homes. Remote monitoring supports social distancing in healthcare by reducing face-to-face appointments, reserving them for when they’re needed most and can provide stepdown services for patients discharged from hospital. Technology in a post-pandemic world COVID-19 has encouraged us all to embrace new technologies. Remote monitoring is likely to become a healthcare mainstay in a post-pandemic world, as the healthcare sector adapts in order to deliver high-quality care to a growing and ageing population.

The AHSN Network works in collaboration with industry and healthcare partners such as NHS England, NHS Improvement, NHSX and NHS Digital. AHSNs were able to respond to COVID-19 by collaborating with partners to quickly facilitate spread and adoption of tech innovation.

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Necessity is the mother of adoption The present and future of digital health is entwined with the global response to COVID-19.

P WRITTEN BY Professor Peter Bannister Healthcare Sector Executive Chair, IET and Academy of Medical Sciences FLIER

rior to 2020, adoption of digital health was slow. Despite the promise of datadriven healthcare including personalised medicine, public and professional concerns focused on the challenges of data privacy and interoperability. Real-world applications of artificial intelligence (AI) targeted small populations and were relatively unproven, relying on validation by already-busy healthcare professionals. Meanwhile telemedicine had never been more than a nice-to-have, despite the growing complexity, cost and inefficiency of healthcare delivery. Embracing a new digital way of working The last year has forced the global community to adapt to a new digital way of interacting and working. Many examples of digital health have been applied at scale to tackle the pandemic head on while also looking to sustain pre-existing health and care delivery. Contact tracing, enabled by mobile and web, has been implemented by multiple governments while AI has contributed to the breakneck pace

of vaccine development. Care homes have been upgraded to both combat isolation and deliver point-of-care diagnostics. Common to these diverse and agile solutions is unprecedented cross-sector collaboration between clinicians, patients, regulators and manufacturers including industries outside life sciences.

The openness of regulators, key to the rapid approval of new treatments, must be reciprocated by technology firms so that clinical safety can be appropriately assessed by experts. As we dare to look forwards, what is still left to do to realise the promise of digital health? The openness of regulators, key to the rapid approval of new treatments, must be reciprocated by technology firms so that clinical safety can be appropriately assessed by experts. Much of what has been achieved over the last few months should be viewed as prototyping with further development and testing required.

Tackling digital inequalities While necessary and convenient, remote consultations still lack the accuracy of face-to-face consultations. More can be done to automate steps in cancer diagnosis and radiotherapy to deal with the present treatment backlog. When healthcare now matters less about where you are, more about the quality of your internet connection, we must use our new-found experience to drive improvements in care across all economic settings. At the same time we have to be vigilant about the risk of health data inequalities and bias which mean the populations who need it most fail to benefit. Empowered by these recent collaborations, the challenge is to apply the lessons learned consistently and globally to create our new normal and put us in a healthier, more robust position whatever the future holds. Please read the full report on artificial intelligence and engineering for healthcare crises at theiet.org/ai-for-healthcare-crises

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Advancements in digital mental health and leaving no one behind Advances in digital technology have greatly benefited healthcare over the years, and never more so than in the last year. It has allowed patients to continue accessing treatment for both physical and mental health conditions.

T WRITTEN BY

Sean Duggan Chief Executive for the Mental Health Network, NHS Confederation

he NHS Long Term Plan contains ambitions for all secondary care providers – including mental health – to digitise and integrate with other parts of the health and care system by 2024. In the wake of the COVID-19 crisis, and with social distancing measures in place, the use of remote or digital mental health services was rapidly accelerated. As the pandemic continues, with more innovations and even wider use of digital solutions expected, it’s absolutely vital that we make sure digital services are as inclusive as possible. It is especially important for those needing mental health support, who may experience heightened feelings of isolation and disconnection. Addressing the barriers to accessing support It’s likely that face-to-face care will continue to be affected in the coming months, which means it’s more important than ever that alternative forms of care remain available. The barriers to accessing digital mental health services must be dismantled, so that as many people as

possible can access services if and when they need to. In December, the Mental Health Network published a dedicated guide for mental health providers on digital inclusion. Digital inclusion means ensuring everyone is able to access the internet and associated technology, and importantly, that they know how to do so.

It is also important to tailor and personalise digital services and care as much as possible. Alongside internet access, the importance of the skills to be able to navigate and engage easily in an increasingly digital world must not be underestimated, and we must remember that not everyone has these skills.

A personalised approach As one of our members recently told us, the digital approach needs to be informed by what people find useful and driven by both the ability and willingness of people to take it up. It is also important to tailor and personalise digital services and care as much as possible. While the rapid adoption of digital solutions across the UK has largely been positive, it has also revealed areas of operational and clinical processes that can contribute to exclusion from accessing these services. This could risk increasing existing health inequalities – avoidable, unfair and systematic differences between different groups of people – that could be exacerbated through a growing digital divide. Digital mental health has many advantages, including better access to services such as online self-help. It has also helped to reduce the stigma surrounding mental illness. But more needs to be done to bridge the digital divide.

The Digital Inclusion Guide was developed by the Mental Health Network’s Digital Mental Health Forum and the Association of Mental Health Providers. The guide was also informed by people who access or provide services from across the statutory, voluntary, and independent mental health sector. The guide can be downloaded on the Mental Health Network website.

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“It is completely invaluable to my role as an AMHP and my mental wellbeing within my role.” S12 Solutions is an app and website, which helps mental health professionals efficiently complete Mental Health Act 1983 (MHA) processes, leaving them more time to focus on what they do best: supporting the person. • • • •

MHA Assessment Team organisation Electronic Statutory MHA Forms Claim Form creation, submission and payment Video Calling

• • • •

Founded in 2018 by an Approved Mental Health Professional (AMHP) 4,000+ AMHP, section 12 doctor and claim processor users 70% of England’s Mental Health Trusts are represented on the platform Shortlisted for ‘Best Mental Health Partnership with the NHS,’ HSJ Partnership Awards 2021

Get in touch with our team to find out more: info@s12solutions.com

01761 235 277

s12solutions.com

@S12Solutions Quotation taken from Wessex Academic Health Science Network’s ‘Independent Evaluation of the S12 Solutions Platform in Hampshire and Southampton.’

Why digital technologies are the key to value-based healthcare As we emerge from global COVID-19 crisis, we must rethink our health systems to withstand future shocks and focus on the principles of value-based healthcare for building a resilient and sustainable health system.

G WRITTEN BY

Sofiat Akinola Project Lead, Shaping the Future of Health and Healthcare, World Economic Forum

lobal health challenges, including complex co-morbidities, increasing chronic diseases, a shortage of healthcare personnel, decreased healthcare funding and increasing health costs must take centre stage if we are to achieve the United Nations’ Sustainable Development Goal 3, good health and well-being. Valuebased healthcare is necessary to address these issues. Focusing on the individual Value-based healthcare is about focusing on delivering health outcomes that truly matter to the individual and the society at large in cost-effective ways. The key here is the individual, putting the individual at the centre of health services – from prevention to rehabilitation – to ensure appropriate access to quality, affordable care. There is also a benefit in cost to health systems. By eliminating inefficiencies in healthcare delivery, we could save an estimated one-fifth of health spending in the OCED and about $1 trillion in the United States every year. Such saving

allows for investments in prevention services and the implementation of value-based healthcare principles and tools, as well health education and health literacy to enable individuals to make informed decisions about their healthcare services and outcomes. Power of digital technologies The pandemic saw a surge in digital technology and telehealth tools to enable access to care. Since value-based healthcare is founded on systematic measurement of health outcomes, technology can be particularly helpful in monitoring health outcomes. The goal is to improve value by using the technology to deliver customised interventions, create more precise and personalised care, and allocate resources efficiently. For example, wearable technology allows for both behavioural and social interventions that encourage prevention as well as long-term monitoring and management of health conditions. Such advancement in health technology can be particularly useful for patients with chronic diseases. For

The pandemic saw a surge in digital technology and telehealth tools to enable access to care.

example, the development of insulin pump therapy, a computerised device to manage blood sugar level, provides flexibility for individuals living with Type 1 diabetes. An opportunity for transformation As healthcare institutions and health systems globally embrace the shift to digitally enabled care, there is an opportunity to transform and accelerate the transition to a value-based healthcare system in all economies. This shift will lead to better health outcomes, improve quality of care, staff experiences and lower the cost of healthcare. To help scale the benefits of valuebased healthcare, the World Economic Forum’s Global Innovation Hub for Value in Healthcare is working to identify evidence-based, matured pilots to serve as a proof of concept for valuebased healthcare initiatives. We need more of such platforms to accelerate the pace, influence policymakers, and transform health systems globally.

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COVID-19 will change primary care forever

They freed up GP time to care for people who are vulnerable, need extra care, or do not like using electronic devices. The pandemic has ushered in a whole new way in which GPs in local practices can manage and treat patients remotely – and it’s come much quicker than we were expecting.

A WRITTEN BY

Charles Lowe CEO, Digital Health & Care Alliance

t the start of the coronavirus pandemic, GP practices with fixed in-person appointment schedules really struggled. Those that used what the NHS refers to as “total triage”, where the patient explains their health problem by phone or online and the doctor decides how best to treat it, coped far better. Some virtual systems such as askmyGP have reduced waiting time from three weeks in some practices to less than 30 minutes. At the same time, they freed up GP time to care for people who are vulnerable, need extra care, or do not like using electronic devices. Most of the total triage “appointments” end up as brief phone calls or text messages. Easier access to medicines and apps After the consultation, how do we then treat patients staying at home? For prescription fulfilment, online pharmacies can receive them electronically and send out the medicines by first class post. In addition to medicines, in surgeries using Egton Medical Information Systems (EMIS) technology, GPs can also prescribe apps, simply by sending a text message to the patient with a download invitation. Many apps are now free to patients, depending on local NHS agreements. In

lockdown, there was increased usage of mental health apps for advice and support as well as apps to ensure you are taking your medicines correctly such as Be Mindful. Home testing GPs can also now order equipment to be sent to patients, such as blood pressure meters to record regularly or single use cardiac monitors that patients attach themselves and then post back after being worn. An increasing range of blood and urine tests can also be done in the home. For example, with Testcard the necessary materials arrive in the post to the patient, then they can use a smartphone to analyse the dipstick and communicate the result directly back to the GP. Keeping safe Safety first is critically important for all these innovations. Changed medical device regulation of apps in particular was in danger of stifling innovation in the EU. This was because of the much-increased need for the use of specialist investigators called Notified Bodies, however the UK has now opted to retain the existing regulatory environment for a while.

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Why better tech is the smart way to manage diabetes New smart and connected technology is helping people with diabetes live better. It means they don’t have to constantly think about their condition and monitor themselves.

INTERVIEW WITH

Professor Pratik Choudhary Professor of Diabetes, Diabetes Research Centre, University of Leicester, and Chair, Diabetes Technology Network UK

Written by: Tony Greenway

Benefits of closed-loop systems Professor Choudhary believes we’re approaching a technological tipping point in diabetes care. “The burden we place on people with diabetes has been growing incrementally,” he says. This is partly down to how technology has advanced over the years. Take glucose monitors. These have done away with the need for finger prick tests, but they’re also constantly reminding people for the need to manage their condition. “Monitors might beep 10 times a day to tell you that your glucose is too high or too low,” he says. “That’s good to know — but then you actually have to do something about it.” However, closed-loop systems take this pressure away. Data from continuous glucose monitoring (or CGM) is sent to a person’s insulin pump which automatically adjusts the insulin it needs to deliver. Access to this technology is limited admits Professor Choudhary, but it’s a game-changer. “Closed-loop systems allow people to go about their lives without having to constantly monitor themselves or think about their diabetes because the machine does it all for them. It’s the future of diabetes care.”

reviously, whenever Professor Pratik Choudhary altered someone’s diabetes treatment, he would arrange a face-to-face follow-up appointment to assess the impact it was having. Now, however, advances in connected tech and remote monitoring mean that he may not even need to follow-up with a video consultation. “That’s because some glucose meters or sensors can send data to the cloud, that I can read in my office. The way we interact with those in our care has changed - which COVID-19 has accelerated dramatically,” he says.

The way we interact with those in our care has changed — which COVID-19 has accelerated dramatically. The future of diabetes care technology The next few years promise to be an exciting time in diabetes tech. At present, 40% of those with type 1 diabetes are using flash monitoring systems (a sensor that sits on the skin, and a reader that scans the sensor to read sugar levels). “Evidence shows that flash monitors significantly improve glucose control and quality of life, and reduce hospitalisation,” says Professor Choudhary. “It would also be good to roll them out to those with type 2 diabetes who need them.” “We used to tell people living with diabetes: “If you work hard to manage your condition, you’ll get better results,’” says Professor Choudhary. “Now that’s changing to: ‘Thanks to new tech we can take some of that work away from you — and you’ll get better results.’”

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ons for seamless diabetes management.

reeStyleLibre.co.uk

Share glucose data from your phone to your healthcare team.Δ

AGP Report

December 7, 2019 - December 20, 2019 (14 days) GLUCOSE STATISTICS AND TARGETS

TIME IN RANGES

14 days 97%

December 7, 2019 – December 20, 2019 % Time CGM is Active Ranges And Targets For

Very High

Type 1 or Type 2 Diabetes Targets % of Readings (Time/Day) Greater than 70% (16h 48min)

Glucose Ranges Target Range 3.9–10.0 mmol/L Below 3.9 mmol/L

1% (14min)

>13.9 mmol/L

13.9

10.0

High 10.1 - 13.9 mmol/L

18% (4h 19min)

Target Range 3.9 - 10.0 mmol/L

78% (18h 43min)

Less than 4% (58min)

Below 3.0 mmol/L

Less than 1% (14min)

Above 13.9 mmol/L

Less than 5% (1h 12min)

Above 10.0 mmol/L

Less than 25% (6h)

Each 5% increase in time in range (3.9-10.0 mmol/L) is clinically beneficial.

Average Glucose Glucose Management Indicator (GMI) Glucose Variability

Defined as percent coefficient of variation (%CV); target <36%

7.8 mmol/L 6.7% 31.6%

Low

3.9 3.0

3% (43min)

3.0 - 3.8 mmol/L

Very Low

0% (0min)

<3.0 mmol/L

AMBULATORY GLUCOSE PROFILE (AGP) AGP is a summary of glucose values from the report period, with median (50%) and other percentiles shown as if occurring in a single day.

mmol/L

13.9

Healthcare teams can manage their patient population remotely.₼

95%

10.0

75%

Target Range

50% 25% 5%

3.9 3.0 0 12am

3am

6am

9am

12pm

3pm

6pm

12am

9pm

Review glucose reports with your healthcare team during virtual consultations.₼

DAILY GLUCOSE PROFILES Each daily profile represents a midnight to midnight period with the date displayed in the upper left corner. Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

10.0 3.9 12am

12pm

12am

12pm

12am

12pm

12am

12pm

12am

12pm

12am

12pm

12am

12pm

12am

10.0 3.9 Source: Battelino, Tadej, et al. ‘Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range’ Diabetes Care, American Association, 7 June 2019, https://doi.org/10.2337/dci19-0028

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Healthcare technology is ushering the NHS towards a more compassionate, inclusive culture As our health professionals are still on the frontline fighting to protect us from the COVID-19 pandemic, we must look at how healthcare technology can support the NHS and its workforce.

W WRITTEN BY

Allen Swann Chairman, Locum’s Nest and Founder Member, Oracle UK

Paid for by Locum’s Nest

e all know how our National Health Service has been under tremendous pressures in the last 12 months and we’ve heard about the negative behaviours some healthcare professionals are still facing, from bullying to flexible work arrangements being systematically refused. The most recent NHS data shows 93% of Trusts leaders report concerns about staff burnout. The NHS has recognised the need for a culture shift, with the NHS People Plan detailing its commitment to foster an inclusive and compassionate culture. Time is of the essence Healthcare professionals across the country are leading us out of the pandemic with compassion and humility, despite the immense pressure they’re under. Now more than ever, it is paramount that we do

everything to support them in their crucial work. Finally, after so many years, I’m delighted to see the shift towards workforce empowerment solutions such as Locum’s Nest Rota, the e-rostering service creating inclusive, compassionate and flexible rotas with its focus on staff wellbeing. Efforts such as these will help cultivate a more supportive culture for our NHS people and retain more staff. Offering flexible and fair rosters to our front-line clinicians is a step in the right direction in making the NHS the modern exemplar employer as set out in the NHS People Plan. Understanding the needs of staff The fact that new technology that is being implemented was developed by frontline workers, with first-hand experience of the day-to-day struggles on the wards and in the clinics, is of

Healthcare professionals across the country are leading us out of the pandemic with compassion and humility, despite the immense pressure they’re under. paramount importance. Doctors, nurses, pharmacists and all allied healthcare professionals are being rostered in a newly founded person-centric manner, with a deep understanding of their needs. Trust leaders up and down the country are listening to their staff. Today money, budgets and other financial metrics are no longer the only drivers in how decisions are being made regarding their workforce - trust, empathy and empowerment are prevailing.

Solutions 4 Health are a CQC regulated major provider of a range of healthcare & technology services. Our services include – Public Health Nursing, Sexual Health, Integrated Lifestyle services, COVID 19 Testing (LFT), Occupational Health, Falls Risk Assessment, ADHD/Autism support, Domestic Violence support, and Mental Health services. We also offer a Wellbeing Suite – a suite of innovative and evidence-based artiﬁcial intelligence & digital health apps to provide wellbeing at scale. Solutions 4 Health now employ over 600 people comprising of: doctors, nurses, consultants, subject matter experts, behavior change advisors, designers, and engineers. Trusted by NHS Integrated Care Systems, Local Authorities, and Workplaces to deliver positive behaviour change and improved health outcomes at scale.

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Wellbeing Suite

Locum’s Nest, the workforce technology company listed in The Telegraph’s “Top 5 ideas to save the NHS”, is on a mission to solve the NHS staffing puzzle. Its flagship product, Locum’s Nest Match, connects 30,000+ healthcare professionals to vacant work in nearly 40 NHS Trust and hundreds of GP practices. locumsnest.co.uk