Gemma Self, Senior Manager at Attain talks about opportunities to support the delivery of integration through digital innovation
Five opportunities to use digital solutions to integrate in health
It is undeniable that the predominant agenda for health over the last ten years has been integration; with a macro-focus on organisational form, foundation trust assurance and operational efficiency. Over the same decade, the digital world has moved us from flip-phones to apps; 2G for voice communications to 4G for rapid data transmission; pulling us en masse towards communication via social media and a new dawn of digitisation that has enhanced commerce and entertainment alike. The Five Year Forward View kick-started the migration to a future health system that is bigger than just the treatment of ill health; digitisation of health is essential to deliver us to this future.
Attain has a wealth of experience in developing integrated health services and increasingly, on how emerging developments in digital solutions for health fit into the integration agenda. This has led us to consider how we can use developments within the digital arena to support and accelerate progress in the integration of health organisations, in order to meet the current and future health needs of the populations they serve.
Five opportunities to deliver integration through digital innovation
Increasingly, digital innovations have been a catalyst for industry change, with Uber disrupting the taxi industry and AirBnB the hotel industry. Within health, given the complexities of the interactions, it is more likely that digital solutions will sit alongside leadership and system change to support integration. However, digital innovations still have the opportunity to enable organisational integration, increase efficiency and encourage self-care.
We believe there are five key opportunities where technology can play a significant role in planning, and delivering integrated healthcare, as well as preventing illness, at a systematic level.
1. Transparently publishing health outcomes
Over the last few years, NHS England has been publishing the outcomes of surgical interventions by consultant and by hospital. Nationally and internationally this transparency has driven an improvement in outcomes, as when data is transparent and reported publicly, “providers face tremendous pressure—and strong incentives—to improve and to adopt best practices, with resulting improvements in outcomes.” (Porter and Lee, 2013)
With care systems coming together under capitated budgets and payments associated with improvements in outcomes, it is more important than ever to have intelligent data systems at an STP-level that enable:
- Capture of outcome measures that are accurate, timely, systematic and integrated into current processes
- Output of data that provides the necessary insight and intelligence, demonstrates progress, incentivises innovation and triggers payments associated with outcomes
To date, any capture of outcomes has been done at a small scale, for example, with the capture of surgical PROMS, and through local Business Intelligence systems. With a future focused on alignment of funding flows to outcomes, and system-level working, there will soon be demand for a more systematic use of data to inform decision making.
Having a set of shared system measures defining success, and automatically and publicly sharing this data, is an essential element of developing a mature and integrated system. The best way to rapidly improve data quality is to start measuring and sharing information, and doing this at the earliest opportunity supports the desired culture change.
Current systems could be up-scaled, however there are a number of associated challenges, particularly: the number of organisations; data governance rules; cultural barriers to sharing data; and the sheer multitude of data points that require measurement.
Our work with care systems, whether they be STPs, success regimes or organisations aspiring to become ACOs, has highlighted that it is essential to establish a single set of shared health and social care outcomes as a foundation of system working. In order to move to this new approach, all current mechanisms that allow money to flow around systems and monitoring of performance will have to change. As a result, new digital solutions for business intelligence that span multiple organisations will be required.
2. Communication within virtual teams
Health and care systems can learn a great deal from the communication approaches used by small start-ups, particularly as these systems move towards increased matrix working and virtual teams. Start-up organisations are typically tech-savvy, blur the boundaries between personal and professional communication, and have a reduced reliance on email.
As multiple organisations align to deliver care collaboratively, the number of potential communication channels will increase, and the requirement for simple and effective ways of bringing teams together virtually will be necessary.
Small businesses have been using digital solutions such as Slack, WhatsApp and Jive to provide focused communication across teams. Inevitably, within healthcare, it is necessary to consider how personal identifiable information is used through these systems. However, these digital solutions are already being used within teams and there is the opportunity to harness this momentum.
Our view is that proactively developing, and making digital communication solutions and policies available, will support the necessary Organisational Development during a period of change, whilst ensuring appropriate safeguards are put in place. With movement towards population health, services will need to work across multiple care settings and in collaboration with teams from other organisations. Formalising this capability can enhance partnership working and change cultures, therefore we recommend such solutions are considered to be an essential element of integrated care.
3. Digital ownership of health
People are now living longer with more complex combinations of medical conditions, comorbidities, lifestyle choices and treatment modes. Consequently, the information and data trail relating to an individual’s health is far more varied and detailed than ever before. Furthermore, the creation of personal devices (such as Fitbit, Jawbone, etc.), that passively capture data, activity and sleep patterns, are also starting to enhance our digital record of health and lifestyle choices.
In combination, all this information offers a huge potential to empower individuals to improve and maintain their own health for longer, to self-care when they become unwell and to begin shifting the culture towards one of personal responsibility. There have been developments in this area, with apps such as uMotif and Babylon Health combining information collected through wearable technology, with supporting clinical advice and guidance.
In our view, the wider care system must positively engage with the large proportion of the population who are generally healthy and want to manage their own health on their own terms (i.e., use the data collected by individuals to support self-care). This is an important population segment, where the primary aim is to support people to maintain good health and to be empowered to seek support when required. Wearables and passively collected data, when considered with the primary care record, can start to provide rich data on health patterns and support the movement towards a wellness service.
4. Preventing ill health
Integrated health organisations of the future and STPs are increasing focus on prevention, as well as treatment, to slow the trend in lifestyle-related conditions and to enable the NHS to become sustainable.
Where there are segments of the population who are broadly well, or those who are already living with long term conditions, a digital solution may demonstrate good value to manage risk factors related to ill health.
Apps and online programmes, such as Big White Wall, are already being commissioned by CCGs; the One You set of apps has been developed by the Department of Health as a useful resource for the public. At the moment, there is little evidence as to the impact of these and other apps upon health outcomes, and upon return on investment to the health system.
There are still as many questions as there are answers regarding readily accessible apps that encourage healthy behaviours, but it is hard to ignore the fact that they are being seen as a commercial opportunity and, as such, are being developed alongside considerable public interest. There is the opportunity for local health economies to develop commercial partnerships and to bring in health technology companies to support the prevention agenda for specific population segments.
In our view, the challenge for the system is to nurture this impetus and to ensure that the momentum to test apps within communities and to evaluate impacts, continues.
5. Targeted treatment
Technology and data can be used to target treatment for different segments of the population, as well as to prevent ill health.
Many of these developments are starting off as research projects, using big data that is readily available and matching it with clinical data to improve how patient outcomes can be improved (such as a diabetes partnership that is using big data analytics to allow greater precision in care).
Deep Mind’s partnership with the Royal Free Hospital NHS Foundation Trust is starting to demonstrate the power of artificial intelligence in monitoring clinical indicators, highlighting outliers and subsequently directing clinicians’ time to be used more effectively.
However, some clinicians are choosing to proceed straight to implementation, such as the GP Keith Grimes, who is bringing Virtual Reality (VR) technology into the primary care arena, supporting pain management and the management of mental health conditions.
Our view is that there is significant opportunity for local health economies to work with industry partners to develop solutions that improve people’s health. Many solutions require local testing and early adoption, and the examples above demonstrate the art of the possible when radical thinking is allowed to occur.
Where to start?
We have only begun to explore the myriad opportunities regarding utilisation of technology that is readily available today. With technological advancement proceeding at a rapid pace, the NHS and Care Sector must keep its eyes and ears open, be brave and test locally.
There is a lot of scope for making use of simple tools which can enable even the most complex of NHS agendas to progress. There are barriers, of course; however, we believe that none of these barriers are insurmountable. Identifying local advocates, giving them the opportunity and scope to be creative, and implementing the necessary safeguards for data governance, can initiate a culture shift that the NHS simply cannot afford to miss out on.
Attain is at the forefront of the integration agenda, embedded within organisations to deliver new models of care, STPs and ACOs. They are advising several critical regions of the UK on how they can integrate to improve health outcomes and the digital solutions to support this.