Digital Healthcare: the essential guide

by Dr Ruth Chambers, Marc Schmid, Jayne Birch-Jones

Foreword by: Julia Manning

Introduction

Different modes of digital healthcare have enormous potential to dramatically revolutionise the delivery of healthcare as we know it in health and social care settings. Technology enabled care greatly improves health outcomes, enhances end users’ experiences and saves money. We have to do it. But what exactly is it? And how, when and where do we implement it? 

 

Digital Healthcare: the essential guide

Details

266 pages

Published  2016

Price print/ebook £24.99 Kindle £28.49

ISBN print  978 1 910303 06 1

ISBN ebook  978 1 910303 07 8

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Kindle edition

Authors' Introduction

Different modes of digital healthcare have enormous potential to dramatically revolutionise the delivery of healthcare as we know it in health and social care settings. Technology enabled care greatly improves health outcomes, enhances end users’ experiences and saves money. We have to do it. But what exactly is it? And how, when and where do we implement it?

What does it mean for you as a health or care professional or manager? We all need to understand the implications of digital healthcare and embrace it to make it happen. This book tells you how.

It does it with a very practical approach incorporating case studies, checklists, FAQs and other tools, simply providing the insights and answers that you need. The authors and contributors all work on the frontline and between them have vast experience of making digital healthcare work.

“(This book) deserves to be found in the hands of everyone who works in the health and care services, because patients need to reap the benefits of digital healthcare.” From the foreword by Julia Manning, CEO, 2020 Health.

 

Foreword

Julia Manning

Three years ago, I travelled with one of the authors and some of the contributors to Digital Healthcare: the essential guide to the United States on a National Health Service Leadership Exchange with the Department of Veteran Affairs. Day after day we saw evidence of the power of making digital connections between service providers and service users: our lives would never be the same again!

In this guide Ruth, Marc and Jayne present an accumulated wealth of knowledge from authors who are embedded at the front line of health and care. The book offers a powerful case for accelerating the potential of digital health, which enables a transformational health and care information exchange that was previously impossible. It captures the aim of value- based care, the goal of which is to lower healthcare costs and improve quality and outcomes.

As a proponent of personally held healthcare records during my 19 years of working with patients, and having run a digitally enabled home- visiting optician service, it is fantastic to see the progress that has been made. Digital technology is making it much easier for professionals to share knowledge and build understanding and confidence in the lives of the people they are serving. Convenience is a major benefit as well, and with trends showing that the public expect to be able to have the expediency of remote monitoring and consultations through apps, there is every reason to harness digital health.

This is an immensely practical book cum workbook which has been missing on the market. The authors don’t just extol but explain exactly how to harness digital technology with great attention to detail and specifics. Throughout, you are signposted to research, evidence and existing implementation with some checklists for application and frequently asked questions (FAQs) answered too.

All the necessary insights required to move from pilot to permanent programme, along with team development and management considerations, are covered. Some of the case studies that narrate the improved confidence and independence of both carers and those they care for are genuinely moving, and if you are a finance director, be prepared to be stirred by the associated cost savings too.

The unwritten hypothesis of this guide is that the culture of learned dependency has to end. We all have to become more intentional about our health and, for professionals, this means accepting and promoting the inherent dignity and right to information of those that we serve. Equipped with knowledge and understanding, people can become active ‘participatients’, depending less on professionals and thus using precious NHS resources more appropriately. It does require a changed dynamic and transitions are rarely smooth, but this journey is worth it.

It is an honour to be able to recommend this book, knowing both the passion and commitment that have driven the authors, and something of the improvement in people’s lived experience that they have enabled. It deserves to be found in the hands of everyone who works in the health and care services, because patients need to reap the benefits of digital healthcare.

Julia Manning
BSc(Hons MCOptom FRSA
Chief Executive 2020health
1st Floor Devon House,
171–177 Great Portland Street,
London W1W 5PQ, UK

07973 312358 | www.2020health.org

2020health is an independent, social enterprise think tank working to improve health through research, campaigning, networking and relationships. We do not lobby on behalf of companies, organisations or individuals and retain editorial control of all our publications.

Contents List

Contents

Part One: What is digital healthcare?

1 Where we are now with technology enabled care and services
Dr Ruth Chambers

2 Telehealth
Dr Ruth Chambers

3 Why assistive technology should be a key part of health and social care services
Richard Haynes

4 Applying telecare and assistive technology in practice
Jim Ellam

5 Telemedicine and video or Skype consultations: gaining benefits, minimising risks and barriers, and overcoming challenges
Marc Schmid

6 Apps: the future is mobile
Marc Schmid

7 Use social media? Get the benefits but minimise risks
Marc Schmid

Part Two: Making digital healthcare happen

8 Patient and public perspectives: listen and communicate well
Jayne Birch- Jones, Dr Ruth Chambers

9 Making digital delivery happen in health and social care: at an organisational level
Dr Ruth Chambers

10 Making digital delivery happen as an individual manager or practitioner: adopting established technology and innovation
Dr Ruth Chambers

11 Commissioning, implementing and mainstreaming technology enabled care services
Jayne Birch-Jones

12 Managing risks of technology enabled care services
Jayne Birch-Jones, Dr Ruth Chambers

13 Overcoming resistance and maximising opportunities for the adoption of technology enabled care services
Lisa Taylor

14 Including technology in the delivery of person-centred, integrated care 
Dr Ruth Chambers

Part Three: Moving digital healthcare on

15 Learning about technology enabled care services: so improving uptake
Dr Ruth Chambers

16 Evaluation of technology enabled care services
Dr Lizzie Cottrell, Dr Ruth Chambers

17 The future: what will remote delivery of healthcare look like in five years’ time?
John Uttley, Ciaron Hoye, Jayne Birch- Jones

In The Press

How to set up a Skype consultation service (Medeconomics article)

How GP practices are using video consultations (Medeconomics article)

Practice protocol for video consultations (Medeconomics article)

How video consultations

How video consultations can benefit patients and the NHS (GP Online article - see http://www.gponlin

About the authors

Dr Ruth Chambers, Marc Schmid, Jayne Birch-Jones

Professor Ruth Chambers OBE 

Ruth is an experienced GP, having worked for more than 30 years in different practices along with many lead roles in academia, the Royal College of General Practitioners, Department of Health, learning and development, and various clinical interests - all focused on disseminating best practice in healthcare.

Ruth’s main driver is her passion to improve the quality of patient care across the NHS; she has co-led an effective quality improvement scheme with underpinning learning and development in Stoke-on-Trent.

Ruth is always thinking of new ideas – and actually puts some into practice, testing out innovations in creative ways, then disseminating learning as widely as energy levels and opportunities allow. Currently that is as clinical Chair of Stoke-on-Trent Clinical Commissioning Group (CCG) and clinical lead for the West Midlands Academic Health Science Network (WMAHSN)-funded
programme to promote person-centred care exemplars of technology enabled care services (TECS).

Specific lifetime achievements: Ruth has written 69 books as main or coauthor; three for the general public, the rest for healthcare staff. Some have been translated into Japanese, Italian and Korean. Many of these books have been used in university/NHS courses across the UK and abroad. Those for the general public (on heart disease, back pain and stress) have had good reviews and sales.
ruth.Chambers@stoke.nhs.uk

Jayne Birch-Jones

Having a master’s in health service research, Jayne has spent much of her 32-year NHS career working as a nurse, health informatics professional and most recently as an independent programme manager.

Jayne was instrumental in identifying the potential of simple telehealth (STH) as being able to realise significant ‘invest to save’ benefits, establishing it as a programme of work and implementing it across the whole of Nottinghamshire’s health and social care community, where it is now a mainstreamed operationalised service.

Jayne also provided operational support to the national AIM (Advice and Interactive Messaging) for Health programme, advising other organisations on how to implement Florence (Flo) simple telehealth. Jayne has authored and co- authored several published articles describing her experiences of implementation and evaluation of telehealth.

Currently Jayne is working as a TECS programme consultant with the East Midlands Academic Health Science Network (EMAHSN), developing a TECS programme.
j.birch-jones@nhs.net


Marc Schmid 

Marc has had a career spanning over 20 years in media and communications. Having worked as a PR advisor to a member of the European Parliament and member of Parliament, he has developed a career at a senior level working across communications in local government and the NHS. He is the communications and digital lead for the Pennine Lancashire Health Transformation Board and a member of the Lancashire Digital Board. He is also seconded to the Lancashire Care Foundation Trust to support the digital health Lancashire programme with particular responsibility for connecting communities through digital means.

In these roles, and as a director of a social enterprise, Redmoor Communications, he has delivered digital projects across education, the NHS and local government for the last eight years as well as part of an apprentice training programme he delivered for the Department for Work and Pensions (DWP). With most of his attention focused on the health portfolio, Marc has worked across the West Midlands and North West England developing the use of social media in primary and secondary care as well as training and developing health and social care staff to use digital modes of delivery as part of the transformation agenda. As part of these projects he is developing peer to peer support networks among patients linked to GP practices or hospitals. He has also been developing the use of Skype technology for use in primary care and with hospitals where interpreters are required for patient care.

Marc also delivers innovative health journalism projects in schools for public health where pupils are given research and writing tasks on a host of public health subjects such as smoking, road safety, diet and alcohol.

In his spare time Marc is a qualified rugby league and rugby union coach and coaches children aged between 8 and 11 years for Leyland Warriors RLFC and Wigan RUFC.
Twitter @marcschmid

Julia Manning (foreword writer)

Julia is Chief Executive of 2020health, an independent, social enterprise think tank working to improve health through research, campaigning, networking and relationships.

About the contributors

Jim Ellam

Jim originally trained as a social worker and has worked within a wide variety of residential, hospital and community social care teams in London, Worcestershire and, since 2000, in Staffordshire.
Since 2008 Jim has worked in commissioning, leading on assistive technology, supporting service transformation and personalised care. Jim works closely with partner agencies to encourage the utilisation of the full range of technology solutions from simple to complex types and he is committed to supporting people to live independently, exercising choice and control over their lives, and supporting those who provide care.

Dr Lizzie Cottrell

Lizzie is a clinical lecturer at Keele University, spending half her working life as a salaried GP and the other half specialising in evaluation and research relating to health service provision. Lizzie has recently completed her PhD which has been focused on investigating attitudes, beliefs and behaviours of GPs regarding the management of chronic knee pain. This has led to an interest in trying to better understand the behaviours of GPs. Lizzie has written books for medical students and medical educators. Throughout her GP training and since qualification, Lizzie has evaluated a local health service quality improvement scheme and local and national STH initiatives; the findings have been disseminated at national conferences and in peer-reviewed journals.

Lizzie likes to combine her academic and clinical experience to promote better practice in her local clinical environment and more widely. For example, she has published two good-quality audits in peer-reviewed journals about gout and inflammatory arthritis and has most recently published a clinical intelligence article about Addison’s disease in the British Journal of General Practice. Lizzie is a peer-reviewer for many health journals and has recently commenced a post as an editorial board member for the ‘Knowledge, attitudes, behaviours, education and communication’ section of BMC Family Practice.

Richard Haynes

Richard has a vast amount of knowledge and experience across the care spectrum, working for local and central government. For example, he has previously delivered modernised day care services, specialist dementia services, home care reablement, electronic home care call monitoring, provided residential care, personalised budgets and implemented the retail model for community equipment. His knowledge of telecare, telehealth and assistive technology (AT) services is second to none. Richard has won two national awards for work in the public sector, from the Local Government Association and Municipal Journal, related to social work, and one for innovative service delivery of AT.
Richard has worked with the Department of Health and Department of Work and Pensions. He is a certified PRINCE2 practitioner and has trained in other related tools including Managing Successful Programmes and Management of Risk.
Richard is the founding director of The Community Gateway CIC, a social enterprise with a genuine and passionate interest in communities and people: see ww.communitygateway.co.uk/

Lisa Taylor

Lisa is a specialist and thought leader in the development of the STH Florence methodology. She enjoys supporting positive change to deliver improvements in quality outcomes for patients and their families. Lisa has worked within the NHS for over 15 years, across primary care, acute and community services in operational and multi-agency redesign roles at local, regional and national levels. Lisa has a BA(Hons) in economics and an MBA and also plays a leading inspirational role in the ongoing international NHS England/US Department of Veterans Affairs (NHSE/VA) exchange programme.
Lisa specialises in the use of innovative personalised models of care delivery to achieve better and faster outcomes where patient and clinician feel involved, equipped and enabled. Lisa has a keen focus on evaluation and dissemination of best practice, with recent research focusing on the barriers and enablers to STH’s adoption and diffusion. Having been closely involved with Florence’s early implementation and infrastructure, Lisa now uses this experience to enable organisations across the UK to develop and improve their capability and maturity with the STH methodology and to share best practice.


John Uttley

After graduating with a master’s degree in European and international law, John joined the NHS in an IT role. He has 18 years’ experience in the NHS (acute and primary care), mostly in senior management and director roles (including as chief information officer). He is currently involved in the evolution of one of the most successful Commissioning Support Units (CSUs) in England, from its inception as the e-Innovations director. Midlands and Lancashire CSU’s e-Innovations department has a dedicated team of experts who represent the CSU’s commitment to fund innovation, which will drive benefits for patients and Clinical Commissioning Groups (CCGs) and other NHS trust customers.

John has pioneered the creation of the UK’s first real-time urgent care tracker, which enables operational and medical teams to better manage the flow of patients within the urgent care system. The team led by John has also created a case management tool based on evidence from research, which has resulted in a BMJ open publication on the benefits of joining datasets to identify cohorts of patients, resulting in improved patient outcomes.
John is also leading on England’s largest primary care Virtual Desktop Infrastructure (VDI) project for Birmingham Cross City CCG. This technology will revolutionise the way in which the CCG provides IT services to GPs, and will, more importantly, improve patient care, increase clinicians’ productivity and the CCG provides IT services to GPs, and will, more importantly, improve patient care, increase clinicians’ productivity and reduce costs.

John has significant experience in telehealth, including working on an international project with the US Department of Veterans Affairs to create a telehealth application. At present John is working with a small number of truly innovative telehealth solutions providers, with pilots planned with a number of CCG and trust customers.
John has close ties with Keele University’s Health Service Research Unit, and is an honorary research fellow with the Institute of Science Technology and Medicine (iSTM). He is working with both the West Midlands and Greater Manchester Academic Health Science Networks on various projects, which aim to drive innovation and create a digital economy in our health system.

Ciaron Hoye 

Ciaron Hoye is the senior information officer at NHS Birmingham Cross City CCG, the fourth largest CCG in the country, and is the digital lead for the wider Birmingham digital economy, including primary and secondary care organisations covering a population of 1.8 million patients. He has a strong track record of bringing digital innovation into the NHS, with a particular focus on leveraging technology and machine learning to help service clinician and patient needs.

 

Extracts from the book

Digital Healthcare
THE ESSENTIAL GUIDE

Part One: What is digital healthcare?


Chapter 1: Where we are now with technology enabled care and services
Dr Ruth Chambers


Digital technology offers great opportunities for transforming health and social care services and associated outcomes, and for improving the experiences of patients or service users and their carers.

If we focus technology enabled care services (TECS) on all the common organisational priorities in health and social care settings we will be able to show that successful remote delivery of care:

  • saves money (e.g. fewer unplanned hospital admissions, less medication wastage)
  • is more convenient (for patients, carers and practitioners)
  • enhances productivity of NHS or social care teams (e.g. fewer home visits or face-to-face consultations)
  • enhances clinical outcomes (so people live longer in a healthier state).


The vision for TECS for all NHS organisations and local authorities in the UK is to optimise the ‘potential of technology to transform traditional models of care and support and to enable greater self-management of care and support people and their carers to be as independent as possible’.10 This will empower people of all ages to take greater responsibility for their own health and well-being and make their own choices, with more control over their own health and lives. It will also reduce admissions and readmissions to hospital and enhance long-term care of older people. The goal is also to find particular technology and TECS that work in trusted ways for the clinical team or individual practitioner using them.

Read more on:


Collaborative working via TEC

Virtual access to patient records

Patient online access

How can virtual access to care help the general public?

Choice of technology

Range of technology commonly used in health and social care settings:

Telemedicine, Skype, Telecare, Telehealth, Apps, Social media, Telephone consultations, email healthcare services

Selecting the right type of TEC

Overcoming the challenges to integration of TECS

Information sources to help you to select or provide the right TECS for your purpose

FAQs, for example:

Would you draw a line in supplying technology to certain age groups – maybe only focus on under-80 year olds?

 

Chapter 2: Telehealth
Dr Ruth Chambers

Using telehealth for care of long-term conditions


Most clinicians would recognise that despite their best efforts, patients are for one reason or another unable to absorb all the information that the nurse or doctor would like to give them in a clinic visit. They may read it if it is handed to them on a leaflet, but often will not even do that, and instead rely on further advice from a health professional – or friend or unreliable media source. With a condition like chronic obstructive pulmonary disease (COPD), patients worry about their oxygen level (if they have a pulse oximeter to measure it), or the colour of their sputum or extent of breathlessness, and yet lack the confidence to manage on their own.

Telehealth readings can signal an impending crisis and enable the patient to seek help in advance of the deterioration of their condition; as well as their overseeing clinician(s) responding to relayed alerts. Patients may learn to rec- ognise triggers that tend to derange the measures of their health that they are recording – such as stress triggering a raised blood pressure, or a rushed activity lowering their oxygen saturation level (SATS); then they can learn to avoid creat- ing these triggers. Dual management plans agreed between the patient and their clinician(s) can allow the patient to initiate an intervention as previously agreed with their GP or practice nurse. For example, those with COPD can start taking standby prednisolone and/or antibiotic medication when there is a recognised deterioration in their condition.

Read more on:

Types of telehealth equipment

Widespread rollout of telehealth: Flo simple telehealth as an example for lots of Long Term Conditions

FAQs, for example:

Does using a telehealth system make a patient with a long-term condition feel that they are being treated by a ‘robot’ rather than a healthcare practitioner who cares for them?

 

Chapter 3
Why assistive technology should be a key part of health and social care services
Richard Haynes

 

Assistive technology (AT) can be used successfully by commissioners, care and support organisations, and the public in order to significantly improve outcomes in care of the elderly, frail, long-term or chronically sick, and disabled or impaired people. There is likely to be a type of AT that could be utilised to enable better care and support for all people, from those who have a low level of impairment, through to substantial and critical levels of need.
Organisations that support people are facing extraordinary challenges in meeting continuously rising needs in health and social care, in terms of absolute numbers, rising complexity and expectations. Economic pressures are driving changes so that resources are used to achieve improved outcomes in health and well-being within budgetary constraints.


Social pressures create a further burden on an already financially challenged system. People have increasing expectations of the quality and extent of care they think they should receive. As technology evolves and becomes more mainstreamed, some people will expect such technology to be made available from statutory organisations such as local authorities. These pressures are prompting organisations to consider ways that people can increasingly help themselves and be more self-reliant and independent. Embedded within the Care Act is a new emphasis on prevention and well-being: acting to prevent crises that might otherwise trigger admissions to hospitals or care homes. Technology enabled care services (TECS) play an important role in addressing these challenges.

Read more on:

Legislation and policy

Defining assistive technology (AT)

Maximising the benefits for as many stakeholders as possible

Innovation

Beyond telecare and telehealth

How can e-assistive living technology (eALT) help people?

Lack of uptake

Technology needs to be personalised and tailored to the individual

Return on investment and value for money for citizens

Service user take-up

Greater user involvement leads to better take-up, more useful application of technology, increased satisfaction and more efficient services

People are not ‘hard to reach’, rather services are hard to access

So how can we apply learning from the evidence to improve provision of AT?

Taking AT forward as an organisation or local health and social care economy

FAQs, for example:

How will AT for my patients or service users be paid for?

 

Chapter 4
Applying telecare and assistive technology in practice
Jim Ellam

 

Telecare is support and assistance provided at a distance using technology. It involves the continuous, automatic and remote monitoring of users through the use of sensors which allows people to continue living in their own home, at the same time minimising risks such as preventing a fall. This chapter focuses on how community alarms and telecare work, and where and how they can be used. It also looks at commonly used standalone technologies with examples of how telecare can support independence and assessment processes. These solutions can underpin assessment processes and offer ongoing support and reassurance for informal carers, friends and family.
Assistive technology (AT) is ‘any device or system that allows an individual to perform a task that they would otherwise be unable to do, or increases the ease and safety with which the task can be performed’.

Watch: this short video that demonstrates some of the technologies available and outcomes that they can support: www.youtube.com/watch?v=mq_AKfjFkDo

Read more on:

Assistive technology as an enabler

Telecare technology

Activity monitoring systems

Cost savings from telecare?

The ARCHIE framework that defines quality in assistive living technology

FAQs, for example: 

Is there a list of community alarm and telecare providers?

 

Chapter 5
Telemedicine and video or Skype consultations: gaining benefits, minimising risks and barriers, and overcoming challenges
Marc Schmid

 

Telemedicine and teleconsultation include ‘the use of video conferencing facilities (or high-quality webcams) to enable remote consultations between patients and healthcare professionals, as well as peer to peer consultations between professionals’.
There is no specific accepted definition of ‘telemedicine’ and how this differs from the term ‘telehealth’. It is often assumed that telemedicine includes a diagnostic element – such as teledermatology where a diagnosis is suggested or confirmed remotely (maybe requiring subsequent biopsy etc.). This renders the application a ‘medical device’ which requires accreditation.

Read an Example of Clinical delivery


The video communication service was deployed in 40 patients’ homes. Clinical out- comes during the first six months included:

  • replacement of 13 clinics with remote teleclinics
  • more than 50 video consultations with patients at home
  • introduction of ad hoc video calls into the renal department during clinic hours
  • strong clinical engagement with five consultants using the video (two transplant and three nephrologist) and
  • positive renal nurse engagement.

Read more on:

Benefits

Challenges to using Skype as a mode of delivery of care

Risks and barriers

FAQs, for example:

What are the barriers to implementing telemedicine?

And the Appendices:

1.Example practice protocol for Skype or video consultations with patients in their own home or a nursing or care home/ patient consent form and information

2. Records and Information Group Best Practice Guide for Nottinghamshire, Nottingham City Health and care services providers

 

Chapter 6
Apps: the future is mobile
Marc Schmid

 

‘mHealth’ can be defined as ‘health-related mobile applications (apps) and health-related wearable devices’. There are more than 165 000 health apps available in Europe, including those designed to support general health and well-being, those that help to monitor health conditions, apps for clinicians or carers and apps that function as medical devices. Uses for personal wellness and activity tend to be initiated by individual consumers so there is less need for confidentiality of the data generated. When used for reporting to clinicians or patient/hospital systems, data confidentiality must be preserved.
All apps in the UK are regulated ….. If an app is considered to be a medical device (i.e. it is used for diagnosis, prevention, monitoring, treatment; or alleviation of disease, injury or handicap; or investigating, replacing or modifying the anatomy or physiological process or controlling conception), it is regulated by …… So clinicians are advised that they should not use or recommend medical apps, including website apps, that do not have a CE mark; and clinicians should always exercise their professional judgement before relying on information from an app.

Read more on:

Data protection

How will increased use of apps transform health and social care?

Better access, Improved communication, Encouraging self-care

Enhancing provision of care

Risks of apps

Improving access to services with an app

Look at lots of great examples, for example:

Manage Your Health app

The School of Pharmacy at Keele University has developed an ‘app framework’ to support the delivery of healthcare messages for people with long-term conditions. Additional programming can be deployed to create a separate app for users to download. Clinicians evolve, check and sign off content. As well as useful health information and a personal log and diary, the app uses an innovative avatar to visually demonstrate health information and advice.
The app can relay updates to users and deliver a rich range of interactive materials on Apple or Android smartphones or tablets. Materials include text, images, interactive quizzes and activities with a 3D avatar giving information relevant to long-term conditions that users of the app may download. The app also uses augmented reality (AR) for patients with an Android or Apple smartphone or tablet with a built-in camera. The AR content will overlay information on top of the medication (e.g. an inhaler) to illustrate how best to use the medication; for example, demonstrating good inhaler technique and answering common questions to help the patient’s own asthma management, via an avatar.
Generic content helps guide users towards a healthier lifestyle, covering topics such as managing stress, goal setting, exercise, healthy eating, managing alcohol consumption, quitting smoking, coping with financial concerns etc.
Visit Google Play Store at https://goo.gl/n1WswP or the Apple App Store at https:// appsto.re/gb/nNL-9.i

FAQs, for example:

Can apps be used for diagnostic or assessment purposes?

 

 

Chapter 7
Use social media? Get the benefits but minimise risks
Marc Schmid

 

Will social media not open the floodgates for people to criticise our organisation? How will we moderate negative posts? How will I find the time? These types of questions commonly arise during discussions as to whether an NHS organisation or local authority should embrace social media and regard it as a key channel with which to engage with service users. Sadly, in many instances, this discussion is all that needs to happen to bring a halt to its use before it has even started. Senior managers may offer a multitude of excuses as to why social media shouldn’t be used – security risk, reputational risk, too time consuming, the domain of the young etc. But while there is a need to understand the risks, and agree that social media should never replace all other modes of communication, it will be detrimental to any organisation if it simply ignores the advantages of using social media to engage with its population.
An example of this can be seen with YouTube. Many health and social care organisations ban staff from accessing YouTube. However, YouTube can be a powerful tool that disgruntled patients use to get their voice heard as in Example 7.1.


The point illustrated here is that whether an organisation wishes to use social media or not, there is always a chance that it will appear there anyway. The risk is that it may be on a site over which the organisation has no real control or ability to engage patients or service users. A patient can now ‘check in’ to a social media site when they are waiting for a doctor’s appointment and create a profile on the practice’s behalf. Having your own well-planned, helpful social media profile can counter this by offering both happy or disgruntled patients and service users not only a helpful medium to speak about their experiences but one which affords the NHS or local authority a right of reply. So listen to patient feedback, monitor online forums and references to your practice or organisation or your name; respond appropriately online, respecting patient confidentiality; and seek to have inappropriate comments removed.

Read more on:

More UK adults, especially older adults, are now going online, using a range of devices

Social media usage

So who uses social media to obtain health information?

Getting started: develop your social media strategy using the five ‘Ws’

Be creative

Creating advocates

Dealing with difficult posts

Conflict between professional and personal

Maintaining a healthy personal online profile

Treat people with respect

Don’t spread gossip

Keep private information private

Google yourself

Think about the future

FAQs, for example:

How can I learn what is good practice so that I can start using Twitter?

 

Part Two  Making digital healthcare happen

Chapter 8
Patient and public perspectives: listen and communicate well
Jayne Birch-Jones, Dr Ruth Chambers

 
Do people want technology enabled care services (TECS)?

Well, it’s usual now for people to interact with digital services for banking, shopping or booking holidays – so why is it not the norm for them to interact with NHS and social care services in similar online ways? Many health and social care professionals and staff are frustrated by the lack of technology infrastructure and support for interoperability between teams in different care settings, and between health and care professionals with patients or service users.
Patient representatives do support the potential benefits for digital care – but warn them that it may be difficult for some vulnerable people with, for example, dementia or learning disabilities, to learn to adapt to using the Internet and other digital modes of delivery of care. There are lots of examples, though, where TECS have helped these population groups, so one of the current challenges is to give NHS and social care leaders confidence that online services have a major part to play in health and social care service provision. More than 80% of households in England are thought to have Internet access, so there are lots of opportunities to develop online access to care.


Listening to patients’ experience

So what difference does patient and public involvement in the implementation of TECS make? How can you organise it and what are the benefits? A patient champion shares his experience in the case study in Example 8.1. His story is
inspirational. It demonstrates the power of patient stories as an effective communication conduit; you could mirror this when you’re implementing TECS in your own health or social care setting.

Read more on:

Promoting patient empowerment and self-care

Self-management

Engaging individual patients in use of TECS

Sharing decision making

User involvement

Communicating with the general public

FAQs, for example:


Have you any concerns about the suitability of TECS for some patients or service users?

 

 

Chapter 9
Making digital delivery happen in health and social care: at an organisational level
Dr Ruth Chambers

 

Technology enabled care has become more embedded in all health and social care settings over the last 10 years via self-monitoring or interactive exchange between person and clinician, or using diagnostic or reporting equipment based at the person’s home with oversight from their health or social care professional. The widespread rollout of such technology focused on individuals’ self-care, prevention of deterioration of long-term conditions and healthy lifestyle habits offers many potential benefits. These include reduction in avoidable hospital (re)admissions, improved quality of life, enhanced patient understanding and self-management of their long-term conditions underpinned by shared care management plans agreed with their clinician, lower mortality rates and reduced costs of acute care. Technology enabled care services (TECS) offer service commissioners and NHS or social care providers the opportunity to transform services and improve the quality and convenience of patient care while at the same time minimising costs of providing care. So we all need to ‘create the right commissioning environment that supports and encourages the innovative use of technology to improve health outcomes, enhances productivity of the NHS/ social care workforce and delivers more cost effective services’.

Read more on:

Current challenges

How do we change organisational culture so that staff think digital first?

Create an agreed strategy

Developing a vision

Understanding the environment

Management of the strategy

When a strategy goes wrong …

Basic planning processes

Try doing a political, environmental, sociological and technological (PEST) analysis

A strengths weaknesses opportunities threats (SWOT) analysis might be useful too

Implementing your strategy

Create a communication plan

Evaluation


FAQs, for example:

Is there a good example of a region-wide strategic approach to digital delivery?

 

Chapter 10
Making digital delivery happen as an individual manager or practitioner: adopting established technology and innovation
Dr Ruth Chambers


Innovation should be everyone’s business – whether that is inventing a better way of doing things and making a difference to people’s lives, or adopting a great new way of delivering care that has been established elsewhere as being worthwhile, or contributing to local dissemination. Remember that technology is an enabler of effective delivery of health or social care and not the solution or prescribed treatment or intervention. It might help the person take more responsibility for their health, or aid a health or social care professional to track a person’s progress for the likes of wound care or clinical control of their long-term condition.

Taking forward innovation

The development, implementation and spread of innovation are central to the commissioning of service redesign and service improvement. All innovative initiatives or interventions should be evaluated to determine whether they are successful before rolling out or proportionately decommissioning or disinvesting in products or services that the innovative idea, service or product replaces or improves.

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Areas of focus for innovation

You as an innovator?

Don’t be afraid of barriers

Celebrate the successes of innovations that work

Be self-disciplined and persistent

Try to be an inspirational leader

Work with people with the right skill mix to develop and roll out this innovation

Find those resources that you need to make the innovation happen.

Build or renew your personal development plan

You need good project planning 

Invest in communication

Invest in training

Tolerate risk and challenges

Work with practitioners who’ll benefit from digital modes of delivery

Work with patients and carers who’ll benefit from the digital mode of delivery

Demonstrate improved health outcomes

Understanding how to make change happen

and laugh at our 30 or so cartoons!

FAQs, for example: 


There are many innovators about but not all are successful. What areas should I focus on in the NHS where I would be most likely to succeed?

 

Chapter 11
Commissioning, implementing and mainstreaming technology enabled care services
Jayne Birch-Jones

 
Commission for outcomes, not for technology

Technology enabled care services (TECS) should be built into the commissioning culture in the NHS to become a standard stream within any long-term condition care pathway to deliver better outcomes and support integration and collaboration between health and social care services and other providers. But any such pathway should allow for local flexibility and adaptation.
But commissioners don’t know everything. So they need independent support for service redesign and the associated decommissioning of services already in place.
Technology should be seen as an enabler for improvement of health and social care services. However, too often there is a focus on commissioning technology rather than delivery. The health and social care workforce should be supported to make TECS a normal part of the assessment and care planning. We need to deliver paper-light services in the NHS and social care to support their long-term sustainability. This is a real challenge, but one which should generate substantial cost savings – NHS England projects potential cost savings of up to £10 billion by 2020 over a five-year dissemination and adoption period for evolving TECS. There are restrictions that can be easily overcome to turn projections into reality, such as making Wi-Fi freely available in all NHS settings so enabling clinicians and care staff to use hand-held devices in their everyday work and creating a ‘paperless’ service.

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Evolution of TECS

Learn from our example: A whole systems approach to establishing TECS across health and social care sectors in Nottinghamshire

  1. Clinical event: identified need to use assistive technology (AT) to support clinical care delivery
  2. Team appointed
  3. Literature review, patient views and baseline captured
  4. Stakeholder accelerated design event
  5. Business case development. Clinical workshop held and expressions of interest requested
  6. Business case accepted
  7. Programme progressed
  8. Justifying subsequent business case based on initial outcomes
  9. Usage of telehealth written into provider contracts, clinical strategies and business plans
  10. Spreading local experience at regional and national levels
  11. Evaluation of initial pilots
  12. 2014/15 business case developed: increased numbers engaged and Flo operationalised
  13. Ongoing learning and sharing good practice
  14. International partnerships
  15. Government interest
  16. Mainstreamed service

Building your own business case

 

Chapter 12
Managing risks of technology enabled care services
Jayne Birch-Jones, Dr Ruth Chambers

You do need to anticipate and manage risks associated with implementing technology enabled care services (TECS) to be effective. This includes data sharing, informed patient consent, device management and other information governance and clinical safety issues. Risk management is an essential component of clinical governance too.

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Risk assessment

Risk management

Risk management when implementing TECS

Completing information governance requirements

Data sharing

Privacy Impact Assessment (PIA)

Informed patient consent

Devices

FAQs, for example:

How can you interact or involve the public or individuals in decision making about risks and benefits of TECS?

 

Chapter 13
Overcoming resistance and maximising opportunities for the adoption of technology enabled care services
Lisa Taylor

 

Digital healthcare is developing at an exponential rate and has quickly harvested the interest of global technology and pharmaceutical companies; yet there is a wide variability across Europe and beyond in its maturity. Despite the many drivers to adopt new models of care and innovation in the NHS, adoption and diffusion of technology enabled care services (TECS) is still very variable in relation to its existence and impact. Those working in health and social care need to overcome the characteristic challenges for their organisation, clinicians and patients or service users to enable the necessary diffusion, if TECS is to be an integral part of how today’s healthcare is delivered.
We must recognise the differing contexts for influencing new clinical practice that organisations provide as well as focusing on the importance of organisational strategy and implementation planning for delivery of TECS and associated service developments in generating cost savings alongside improved patient satisfaction and clinical outcomes. Building on existing cultural and structural features will significantly influence the likelihood that TECS will be successfully embedded as routine care.

 

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Cultural impact

Equipping the workforce

Maximising effective clinical champions

The role of clinical leader for TECS

Navigating the options

Enhancing patient or service user acceptance

FAQs, for example:

What are your top tips on overcoming barriers to the adoption of TECS?

 


Chapter 14
Including technology in the delivery of person-centred, integrated care
Dr Ruth Chambers

 

Integrated working is central to all plans to transform health and social care services. All related strategies aim to deliver more efficient, enhanced quality and more patient-focused care. Such strategies will only succeed with collaborative working across sectors and care settings to deliver integrated services. So this needs a change of culture – not just structure and processes alone – to achieve the outcomes everyone wants. To help make that change of culture happen in your local health economy you need to:

  • communicate plans to everyone involved in delivery and receipt of care – by every communication means you can think of, to every group of people affected, in a planning cycle where feedback influences ongoing service transformation
  • relay the sense of purpose of the change in ways that match with workforce priorities
  • take steady steps forward, with much consultation and increasing commitment, rather than leap too fast to goals that are regarded as irrelevant by most of the workforce who’ll be delivering the changed services
    enable everyone to work together – during the service reconfiguration, by learning together, supporting new ways of teamworking etc.

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What is person-centred care?

How can we make integrated care happen effectively with technology enabled care services (TECS)?

Encouraging self-care

FAQs, for example:

What is needed to make integrated health and social care really happen?

 

Part Three   Moving digital healthcare on

 

Chapter 15
Learning about technology enabled care services: so improving uptake
Dr Ruth Chambers

 

Learning about technology enabled care services (TECS) and being capable of deploying the various modes of delivery are not about education and training alone. They are about developing and utilising the skills, knowledge and abili- ties of all the staff in your organisation or team to ensure optimum, safe usage. You’ll need to ensure that services continue to meet the needs of patients, new service developments and policy changes. Your organisational or team learning should be a process of continual improvement and innovation – an ongoing cycle of action and reflection followed by revision of your approach.

Read more & complete the exercises that appeal to you - to reflect, action plan:
Sorry, but learning how to use technology is not an option

 

Read more about:

Learning styles

Being more effective at work with TECS

Getting clinicians or social workers using TECS

Showcasing evidence

Being flexible

Wide-ranging local learning programme requirements

Leading service redesign – maybe by positive dissonance

Push for a continuous improvement culture

Significant event audit or analysis

Gauge the driving and restraining factors that will influence whether your digital delivery plan is likely to happen and be embedded in local services

Understanding key barriers to adoption of TECS

Building your team

FAQs, for example:

How do I make this learning fit what’s required for my professional continuing professional development (CPD)?

 

  

Chapter 16
Evaluation of technology enabled care services
Dr Lizzie Cottrell, Dr Ruth Chambers


Use of technology enabled care services (TECS) is well justified and appropriate if the benefits outweigh the costs (including time, financial and burden) to patients, professionals or services. Depending upon the aim of the TECS the benefits may not be explicit, although some of the costs may be. Evaluation is a tool that can be used to demonstrate the benefits, costs and value of the service from the perspectives of patients or service users, care professionals and managers. Unfortunately, many modes of technology have not been evaluated when they have been produced or adopted in service provision, even though the providers may have collected some outcome data through tracking and self-reporting.
This chapter describes what types of evaluation and audit there are, adds a little more about why evaluation is important, and how you can get started in evaluating a TECS service. To contextualise the information contained within the chapter, an approach to a hypothetical technology enabled care service, sleep-E-head, is described throughout the chapter.

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What is evaluation?

What is clinical audit?

Why evaluate?

What will you evaluate?

Where do you start?

What next?

Patient or service user confidentiality

FAQs, for example:

How can we disseminate our learning and successes after our evaluation report is finalised?

 


Chapter 17
The future: what will remote delivery of healthcare look like in five years’ time?
John Uttley, Ciaron Hoye, Jayne Birch-Jones

 

The next five years will bring new healthcare innovations that are even now yet to be considered. With constraints on resources, rising expectations and an escalating demand on services, the NHS and social care system are under increasing strains and unprecedented challenges. Better use of technology enabled care services (TECS) is central to addressing these issues.
So what are we on the cusp of? What is around the corner in relation to TECS? A recent review of how access to innovative medical technologies might be accelerated proposed the case for change.

Patients should be given a stronger voice at every stage of the innovation pathway; for example, to direct innovation towards outcomes that patients themselves value; speeding up commissioning of wanted new technologies and models of care and decommissioning those that are out of date.
Being much more proactive with making service transformation happen.
Supporting innovators in more productive ways to optimise their chances of succeeding with more flexible systems while evaluating risks and benefits of new products and approaches.
The NHS should be a more active partner in promoting innovation and be incentivised to adopt new products and systems quickly and effectively.


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National strategy

The future is already here

The possibilities that adoption and dissemination of TECS could bring

Impact on patient engagement

Impact on communications

Impact on public health and public behaviour

Impact on long-term conditions

Impact of understanding

Impact on finance

Benefits realisation

The future development of healthcare: with genomics

The future: with wearable technologies

 

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