Achieving the right balance in medical innovation
Steve Rogerson reports from October’s Digi Health UK conference in Manchester.
The medical industry wants to introduce the latest innovations while not putting at risk their often vulnerable patients. And thus many feel that the concentration should be on the problems they need to solve rather than going for technology for technology’s sake.
This often involves not just new equipment to deal with and learn how to operate, but a change to the mindset and culture of front-line medical staff.
This was the very clear message from October’s Digi Health UK conference in Manchester where the focus was understandably on the British National Health Service (NHS) and how it is coping with the transition.
“The technology is only a small part of the solution,” said Guy Lucchi, Digital Innovation Director at Health Innovation Manchester. “The rest is the people and culture. You need to start with a clear view of the problem that needs to be solved.”
He added that traditionally in the health sector it takes around 17 years from something being discovered to it being deployed. However, with the fast pace of technological development, that kind of sluggish speed is no longer acceptable. As other industries have discovered, notably automotive, the slow moving world of the past is now firmly in the past.
“We need to reduce the time,” said Lucchi. “We need to increase the speed of innovation and deployment. We need to do things differently and do different things. Digital is the enabler. Digital is disrupting everything we do. Healthcare is special but not different.”
Some of this is being driven by the patients themselves who, in a world of apps and smartphones, expect a different view of services they are offered. Many technologies already exist that can benefit healthcare but the trick, said Lucchi, is blending them together to enhance the patient experience.
“We shouldn’t focus on the technology but on the business problem,” he said. “For example, we need to improve outpatient efficiency so doctors only see the patients that they need to see. This means we have to collect the correct information for those decisions to be made.”
As an example, Health Innovation Manchester is running a trial with 500 patients who have pacemakers fitted that can detect problems early before they become critical and relay this information back to care givers who can thus take earlier action. However, he was very clear that medical staff will always need to be in the loop. “Digital will not replace doctors,” he said. “Absolutely not.” The theme was picked up by Radhika Rangaraju, Head of Integration at NHS X, the body responsible for the NHS’s digital transformation.
“We have to make sure digital services benefit our patients,” she said. “The technology has evolved into artificial intelligence and machine learning and this will continue to evolve going forward. We thus have to build a digital ecosystem that is future-proof, and that is a challenge.”
But with a shortage of skilled staff and an ageing population, the transformation had to happen, she said. “We have to set standards for deploying services,” she said. “There is an element of transformation we have to consider when deploying digital services.”
Putting this into practice, the conference heard case studies from around the country on how digital services had been deployed. One was at Berkshire Healthcare NHS, where they decided to tackle the problem of patients falling over, often when they went to the toilet.
First, they gathered some statistics and found that in 2018 they had 458 falls of which 71% were not witnessed. Most of these happened in bedrooms on the ward shortly after the patient left their bed. It decided to deploy technology from Approach Medical that can detect when a patient gets out of bed.
“As soon as someone gets out of bed, this sends an alert to someone to go to their assistance,” said Nathalie Zacharias, Deputy Director at Berkshire Healthcare NHS.
The system has been deployed across 17 wards and 425 beds and so far this year has seen fall reductions between 34 and 65% per month. Another nine wards, accounting for 250 beds, will soon be added. “We were previously using technology that was designed for home users and wasn’t fit for purpose for use on wards,” said Zacharias.
The technology they have now deployed uses capacitive-based proximity detectors in strips that are laid across the bed. “The patient can move across the sensors without setting it off, so it reduces false alarms,” said Christian Symonds,
Chief Executive Officer for Approach Medical. “A machine learning device learns how the patient moves over time so it recognises if the patient does something different.”
The device sends an 866MHz radio signal to another device worn by a health carer. Even though falls have been reduced, Zacharias admitted there had been some teething problems.
“It will take longer than 12 months to get this technology really embedded,” she said. “It is a lot of change for staff and we are continuing to work on it and show the benefits of the system.”
She said while it had been good, there were problems with consistency with two of the ten months so far being poor for different reasons. “We have to address that,” she said.
The Disabilities Trust found an additional benefit when it installed the Planday scheduling system. This brings together work scheduling, payroll, vacation planning and so on. Managers can see an overall view of where staff are deployed and when, whereas individual nurses and doctors can see their own schedule on the app. However, the app also allowed messaging between staff and, at first, the personnel department was a little wary of letting staff use this as they felt it could be used for confidential information or planning things behind the backs of managers.
As it turned out, the latter was exactly what did happen with staff organising cover for themselves when they were off sick or on vacation saving much organisational time.
“This was an accidental feature we got from giving data to staff,” said Geraint Thomas, Technology Transformation Partner for The Disabilities Trust. “We got staff engaging with the working environment by using an app. It is better than them using WhatsApp. WhatsApp is evil. It is not a work tool.”
Also going down the app route is North West Borough’s NHS. It is using My Pathway from ADI Health. This is a digital communications tool for linking patients and clinicians. In St Helens, it is being tested on patients with musculoskeletal problems.
“Lower back pain causes more disability than any other condition,” said Ruth Sephton, Consultant Musculoskeletal Physiotherapist. “In St Helens we are managing 14,000 new patients a year and we don’t have the resources to do that, so we needed to improve the way we worked.”
The My Pathway app sends patients details of their appointments as well as bespoke advice on their conditions. “It gives them everything they need to know about their appointments including Google Maps to get them there,” she said. “It will also give them exercise plans.”
While the health sector is grappling with the latest technologies, and with some success, it is doing so with a hand tied behind its back as it does not have enough people with the appropriate skills to implement these technologies.
“We are in a global battle for skills in this area,” said Andrew Davies, Market Access Director for the Association if British Healthtech Industries (ABHI). “The big tech giants are hovering up people, but we have to attract some of these people to the NHS.”
He said the long-term plan for the NHS was to move towards digitally enabled care. “We are still very much on a journey with technology in the NHS,” he said. “There are more than 300,000 health apps of which just 75 are in the NHS apps library.”
Bringing new technology into any industry can be tricky but the medical world has its own problems, not least that a wrong decision can literally cost someone their life. As such, it needs to tread cautiously but at the same time meet the needs of patients who are now used to a more digital way of living. And it has to do this in a way that is still accessible to those who have not embraced the latest technologies. It is a tricky balancing act for an overstretched service. The benefits are there but it needs the skills and the resources to achieve them.