Monitoring vulnerable patients and remote diagnostics

This was the third webinar in the The Institution of Engineering and Technology’s (IET) series on Healthy Living and Housing.  The focus for this session was on monitoring vulnerable patients and remote diagnostics.

You can access the session by clicking the link here and registering to watch on demand.

Speakers for this session included

• Jessie Cunnett, Head of Health and Social Care at Traverse
• Tara Marshall, Clinical Improvement Lead at the Eastern Academic Health Science Network
• Daniel Casson, Digital Social Care, Digital Transformation Adviser, Care England and Managing Director of Casson Consulting London.

The experience of digital care

COVID-19 has radically transformed the delivery of health and care with a rapid shift towards virtual consultations. However, little research had been done on understanding the virtual health and care experience, and how this might differ across populations and care requirements. To understand this, Traverse, alongside Healthwatch and National Voices, conducted research on understanding the virtual health and care experience.

Jessie discussed the recent report, The Doctor will Zoom you now. The research began with the understanding that to get the most out of the virtual health and care experience, it is necessary to understand the patient experience. The research involved interviews with 69 people via digital platforms and telephone. The focus was on remote care experiences as they relate to mental health, general practice, and outpatient appointments. Unsurprisingly, there was a mix of views with some responding positively, with others left feeling apprehensive and frustrated with their consultations.

The research highlights that no one approach suits everyone. Instead, it’s necessary to take into account differing circumstances and needs. In addition, a number of key themes emerged –

• The importance of boundaries – while for some remote consultations were viewed positively, for others they were seen as an ‘invasion’ of everyday life;
• The quality of personal communication matters – the need to adjust remote consultations and types of communication to messaging and pace that works;
• The importance of information and preparation – giving people the opportunity to prepare for remote consultations.
• Choice – that people wanted the opportunities for choice in terms of consultations – this could be remote or face to face, or though other channels such as a phone call or text rather than a video chat.

It is worth noting that only three of the respondents had been asked for feedback on their experience of remote consultation. Jessie flagged the importance of asking for feedback – to test, to learn, and to improve.

Jessie went onto flag issue of digital inclusion and exclusion. Digital exclusion has impacted some people’s ability to remain and become well. For others, remote consultations offered greater access particularly for people with physical disabilities where leaving home may be difficult and to others shielding. It also gave the opportunity to share records and screen share information, and some felt it redressed the balance of power between clinician and patient.

The research resulted in the publication of top tips for patients and clinicians. There is also an easy read version to ensure these tips are accessible to as wide a range of people as possible.

Jessie stressed the importance of both functionality and usability in design in terms of thinking through the impact on people’s ability to receive appropriate care. This is essential to ensure people aren’t left behind and that we don’t further entrench health inequalities. There remain important questions around understanding opportunities that these forms of communication provide to both patients and clinicians, as well as how we can use technology to redress the balance of power.

Digital transformation in social care

Daniel focused on how care professionals can ensure they get the best tools to create real value in delivering services – for those being supported and for organisations. A key challenge in doing this is working across the system, for example by ensuring that various records are joined up.

And there are various tools that can be utilised for just this purpose.

• Carezapp – a support tool for care homes and other support settings. It supports person centred care through real-time information. It can also support the self-management of health and care. Systems such as this also enable the collection of data over time.
• Cornerstone – remote monitoring devices used in people’s homes and other settings to monitor people more closely, less invasively, and more efficiently. The real advantage of this approach is that it has freed up 40% to 60% of staff time.
• Just Roaming from Just Checking – supports independence in supported living by providing support when needed via technology that uses sensors in the home. The dashboard is linked to sensors and other technologies in the home. Personalised alerts are sent to a mobile phone via an App.
• Remote monitoring tools from Feebris which link GPs and other health professionals to residents in care homes. This makes it possible to take real time vital signs and use them in video consultations.

It’s worth noting that NHS Digital are currently undertaking a project on remote monitoring tools. These are being tested in care home environments.

At the system level, there are two areas where engineers and technologists could make a significant difference. First is the development of overarching systems that can support a holistic approach to care needs. The second is to address the challenge of interoperability. At the core is designing systems and tech for the everyday with a clear focus on improving health and wellbeing.

Monitoring vulnerable patients and deterioration

Tara is part of the patient safety collaborative and works on managing national improvement programmes throughout the UK. Her focus on is managing patient deterioration. Early recognition of patient deterioration can lead to earlier interventions and better outcomes. This is done via a National Early Warning Score – a standardised tool used across the NHS. It’s also been adopted by health care trusts, ambulance trusts and work is being undertaken in primary care. And it’s begun to be taken up by residential and care homes.

Tara stressed the importance of ensuring tech works for its intended purpose and is designed to be user friendly. She noted that there had been a significant cultural shift in patient safety over the last 15 years, from looking at individuals to examining systems. This is made possible through the collection and utilisation of data in ways that weren’t previously possible.

And considerable work has been undertaken in response to COVID-19. Essential to deployment of technologies and systems that can be used to manage deterioration are digital solutions that are easy to use. And there are many solutions coming onto the market.

Tara is involved in an Innovate UK project with Whzan to support residential homes to use telehealth care equipment. The equipment can be used to take observations with a blood pressure cuff saturation probe and a temperature probe. It’s been testing in a number of care homes. And because it’s Bluetooth to a tablet, it reduces the risk of errors. It can also be used to take photos such as profile shots, and also for other purposes such as monitoring wound healing. The data can be used for multiple purposes – for GPs to get a view of the health of residents in care homes they visit, or for hospital visits. It uses a secure portal and is compatible with other systems.

A key question is how do we sustain these types of solutions as we move forward? Tara noted the importance of the tech working for multidisciplinary teams, that these teams are engaged and it is built in as part of their day to day workload. The tech also needs to be flexible enough to keep up with changing regulatory guidance and requirements.

Key discussion points

Will remote consultation methods reduce the accuracy of clinical decision making?

• If done well, there’s an opportunity to enhance clinical decision making through better engagement and better data.
• To get this right, a blended and flexible approach to consultations is needed to ensure people’s needs are met.

How has COVID-19 changed the digital health landscape?

• Over the last six months and in response to COVID-19, we’ve seen a rapidly growing acceptance of digital health approaches. This is a significant cultural change.
• If done well, it can support better health and wellbeing. But, we also need to better understand how people interact with technologies.
• The role of engineers and technologists is critical for bringing the necessary systems together to make best use of data and these technologies.
• More needs to be done in supporting people to get access to technology, whether it’s by enabling people to get access to data, whether it’s about increasing confidence or about accessibility.

What would you recommend for how the UK Government can enhance the support for monitoring vulnerable patients with technology?

• Clarity on funding systems
• Free WiFi to support greater access

How do the solutions presented apply to independent living?

• Independent living has many different forms. Many of these technologies are being brought into retirement village settings as part of their offer. Many of them are also available for the home and can be easily fitted.
• It’s about getting the balance right between what the organisation does and what individuals are responsible for. Individuals should be encouraged to self-manage their care as far as possible, and there’s a suite of products available for doing this.
• Given the recent rapid uptake of remote monitoring and diagnostics, it’s likely we’ll see greater adoption of products that can support people to live independently.

How do we get better at listening and sharing people’s lived experiences across health and social care?

• While there have been improvements, there’s an ongoing need to find ways to work meaningfully and effectively with patients, families, carers and people who use services.
• Those using and accessing services need to be a key player in identifying and developing the solutions.

How can remote monitoring provide the same support for people living with dementia?

• We’re seeing the development of technologies such as monitoring sensors that support people to remain in their homes.
• Monitoring technologies can also be a useful aid for supporting people’s independence and get on with their day to day living.
• An important consideration is to provide people with choices that suit them.

If we could do one thing over the next couple of months, what would it be?

• Get to the heart of how people are experiencing the shift and apply their experience to the design of innovations.
• Agreeing tech standards to support the development of integrated systems.
• Ensure tech solutions work as intended and are easy to use – for individuals, families, and health and care staff.

As part of The IET’s series on Responding to COVID-19: Healthy Living and the home

1. Healthy living and housing
2. Community care and care homes
3. Monitoring vulnerable patients and remote diagnostics
4. Reducing social isolation and loneliness
5. Smart home tech to support people’s needs
6. The future of Intelligent homes to support health