Dr Saif Ahmed, Clinical Digital lead for transformation at Health Innovation Manchester, joined an HTN panel earlier this month to discuss digital apps, wearables, self-care and personalised care.

Experience of digital as a GP

Saif talked about his background as a GP, and his current work with Health Innovation Manchester, leading on “clinical developments within the GM Care Record, including launching the My GM Care app for patients”. Recently, his work has also involved “working with industry and academia to develop proof-of-values around certain apps and wearables that patients can use across Greater Manchester (GM), such as an app to detect falls and deterioration in care homes”. At Tameside and Glossop, Saif has also been part of work on the trust’s own patient portal, alongside responsibilities for virtual wards and remote monitoring services, being “heavily involved in the digital aspects of patients being cared for in their own home”.

How the My GM Care app is helping to personalise care

Saif shared his perspective from Greater Manchester (GM), where the My GM Care app is allowing patients to enter information about themselves, what matters to them, and how they’d like to be treated in an emergency. “All of that information feeds into our shared care record,” helping to really personalise care, he said, “and we launched this in a PCN, where patients record their mood daily on the app, to monitor their reaction to medications and any behavioural changes; so we’ve been able to start to use the app for more self-reported measurements”. A heart failure care plan and a dementia care plan are also viewable on the app, so onboarded patients can view their own care plan and offer input.

Getting the information balance right for clinicians

Acknowledging the acceleration of tech in healthcare, Saif also highlighted issues he encounters as a GP, relating to “an overload of information”, adding that “there needs to be a happy medium going forward, where we start to understand what patients want, what we can do as clinicians, and how we bring that together, because as a GP I sometimes can’t see the wood for the trees”.

It’s also about using these apps and resources to ensure patients are keeping themselves well, Saif suggested, “and that’s the shift change we need, because we’re overrun at the moment and that’s getting worse by the month, so we have to look at that change, and technology has a massive part in that”.

The challenge around actionable data

On data in Greater Manchester, Saif noted the difficulty when it comes to apps, since “you can collect hard data points, but they’re not massively actionable – we can go on the My GM Care app and see how many people have accessed certain tiles, how many people have put in their blood pressure readings, how many people have logged in, and that gives us an indication as to its use, but for outcomes it’s very difficult”. In terms of “actionable” hard data, he gave the example of blood pressure and sats, which mean “we’re able to actually look for signs of deterioration and therefore predict and use machine learning to look at who is going to become unwell”.

Keeping up momentum

Saif continues, “patients are more likely to continue to do something when they can see the results – it needs to change their lives or the way they do something, otherwise they will just drop off”. Safety is also a major factor, he said, “because patients want that safety mechanism that the clinician will contact them if something is wrong”.

Prioritising clinical safety and governance from the outset

Saif feels “lucky” to have a digital office team at Health Innovation Manchester who are able to “look at new products and vet them against the NHS framework to make sure they pass those standards before we deploy anything”. Compared with this “rigorous process”, however, Saif also highlighted the difficulties as a GP, “because people come knocking on your door asking you to try things, and we don’t have formal roles in clinical safety or in technology, so we must rely on other people to guide us. That’s one of the reasons we’ve formed the digital office in Greater Manchester, so we can vet the tech before it goes in, which is what we did for our virtual wards.”

Saif suggests people start by using the resources they have within their ICBs, whether it’s their digital leads for chief tech officers, “because for me it’s not a clinician’s job to do that.”

Putting interoperability front and centre

Saif believes there is “a disjoint in terms of what people expect us to be able to do and what we can do within the NHS,” adding that some good progress is being made in moving toward open standards, which “will help in driving those conversations with providers”. It’s still “very difficult”, however, Saif conceded, “and that’s one of our biggest issues, and that’s why even conversations with people like Apple with Fitbit in terms of how that integrates into our GDPR or hospital EPR system haven’t got to a point where I can see that happening in the next 6-12 months.

“So, we’re very behind on the interoperability front, but it should be at the start of every conversation, because if we don’t make sure that that data is shared and interoperable, then we’re not going to be doing anyone any justice.”

Start small and learn, then scale

“I would start small,” Saif said of projects in this space, “and it’s very key to start with a pilot site that looks at outcomes for patients before scaling, because a Big Bang approach is when things can start to go wrong, potentially with quite large clinical safety issues”.

Likening this to large scale EPR go-lives, Saif also talked about the “huge amounts of resources” that accompany those kinds of projects, suggesting that “a small pilot that tests the safety issues and then allows you to overcome those barriers” is a better approach.

The transformation journey doesn’t end with implementation

“Education and training is key,” he continued, “and I can’t stress enough the amount of education and training that is needed for digital transformation – for our deterioration and falls prevention project in Bury care homes, we went out there maybe four or five times doing training sessions because of turnover of staff, held webinars on how to use the app, and we have a great communication team who were able to develop patient leaflets, clinician leaflets, webpage resources, and so on”.

The results speak for themselves. Bury saw reductions of “over 50 percent in ambulance callouts”, Saif cited the importance of performing a benefits analysis, then building a business case to go back to the ICB and demonstrate savings or efficiencies. “We’re doing that now,” he shared, “showing that the ROI has been quite significant, and saying we now need investment”.

Read the full article: HTN Now panel discusses digital apps, wearables, self-care and personalised care – htn

Watch the discussion: Panel Discussion Digital apps, wearables, self-care, personalised care on Vimeo