Early data from the NHSX tech-enabled remote monitoring pilot
NHSX Chief Digital Officer Tara Donnelly and Dr Matthew Knight MBE from West Hertfordshire Hospitals NHS Trust reflect on early experiences and insights on the use of remote monitoring in COVID-19 patients, further to the recent blog post by Tara and Matt Inada-Kim, National Clinical Lead for Deterioration, NHS England and NHS Improvement.
As the first wave of the coronavirus pandemic hit the UK in March, NHSX began to receive a wave of generous offers from digital health innovators to assist. One of these was from HUMA offering its Medopad platform on a pro bono basis to a number of sites. At the same moment, NHSX was approached by Dr Matthew Knight who was running a large virtual ward at Watford General Hospital and was interested in technology that could help. NHSX was able to bring these needs and offers together and support implementation of a care at home model enabling people to leave hospital earlier and continue to be monitored at home.
The platform enables remote monitoring of patients’ symptoms and physiological parameters such as heart rate, level of oxygen saturation and temperature. It includes an app that patients download onto their smartphone and dashboard that flags results to the clinician in real time. It means medical teams can focus on those showing signs of deterioration, while keeping an eye on those who look to be recovering well.
The solution was rapidly implemented in three sites: Watford and two primary care hubs in west London, going live to patients in under four weeks. NHSX appointed Kent Surrey Sussex Academic Health Science Network (KSS AHSN) to complete a rapid evaluation of the experience of staff and patients at these first pilot sites. The purpose was to look at the early suggested impact of tech-enabled remote monitoring and how patients and clinicians found it.
Of the 30 patients surveyed, 95% (20 out of 21 who answered the question) said they found the application easy to use and 93% (28/30) said they were pleased with the remote care service. Clinicians were able to review patients’ data in a more efficient manner, saving approximately 32 minutes per patient per day in the acute hospital setting (reduction in calls) and three minutes per patient per day in the primary care setting for the total Central London CCG patient population during the study period (this was a self-reported metric).
You can view a visual summary of the report (PDF, 2.5MB) and a text version of the summary is also available.
While this was only a small, rapid study, with a very small sample size, it does show positive indications of the utility and usability of Medopad and similar platforms for patients and clinicians. Further evaluation will need to be undertaken with a much larger sample size.
At Watford General Hospital, the introduction of this model during wave one of the COVID pandemic allowed clinicians to manage more patients in the safety and comfort of their own homes, whilst identifying with minimal delay any patients deteriorating and in need of face-to-face review in the hospital. Both patients and clinicians found this reassuring, and as wave one abated this allowed a more rapid resumption of non-COVID clinics. The platform allowed patients to upload symptoms and oxygen saturations, and clinicians to review these promptly, letting patients know that their results had been assessed.
We were delighted to see Dr Matthew Knight recognised with a MBE in the Queen’s Birthday Honours for his contribution to the pandemic response in this work.
Scaling remote monitoring solutions
On our website, we have shared several case studies of NHS organisations who are using a number of solutions, and have shared their initial findings. Additionally, a recent case study by South Tyneside and Sunderland NHS Foundation Trust found that in addition to keeping care home residents and staff safer by reducing visits, tech-enabled care is helping to avoid non-elective admissions, lower A&E attendance and improve patient outcomes and satisfaction. Going forward colleagues in the trust want to examine how the technology might be utilised as a referral platform.
Similar findings resulted from a pilot study at Torbay and South Devon NHS Foundation Trust where internet connected equipment was provided for patients with long-term conditions to self monitor. The information that was collected was sent to nursing teams via a smart home assistance device, and smart devices with a screen enabled nurses and patients to see each other during remote consultations. As well as keeping vulnerable patients safe during COVID-19 by reducing face-to-face contact, this approach also helped community nurses to identify and prioritise which patients required further assessment or treatment.
Next steps on tech supported COVID oximetry@home
The tech supported model described above was extended to 10 sites in London and the Home Counties including Imperial College Healthcare, Whittington Health and Hillingdon Hospitals, using Medopad.
In September Crown Commercial Services (CCS) concluded a procurement exercise on remote monitoring platforms and portals on behalf of NHSX. There are a range of platforms on this Spark Dynamic Purchasing System (DPS). This means local NHS organisations can select from these suppliers through a very simple process. Teams have been establishing remote monitoring services for COVID patients and others with long term conditions and in care homes, using a range of digital tools. There is more information about the Spark DPS here on the NHSX website and on the CCS website to help you make the most of this locally.
There are now 19 sites live with a similar tech-enabled model across the country, using a range of digital platforms, with 37 further sites in progress so we anticipate at least 50 live sites in the weeks ahead, forming an important component of the second wave response.
NHSX is working in partnership with the COVID Oximetry@Home schemes. If you’d like to know more about the work described here, you can view a recording of a virtual workshop, “The tech enabled virtual ward - the West Herts experience”, hosted by Dr Matthew Knight and Alex Newland-Smith.
The extension of the tech supported model is being accompanied by a full evaluation.
For further details of support and guidance available to support clinicians, social care staff and Innovation Collaboratives with the implementation of tech-supported remote monitoring, do join our site at FutureNHS where there is much more information. This workspace is open to all NHS, social care and local authority staff with an interest in remote monitoring. Join the workspace using the link above or email: innovation.collaborative@nhsx.nhs.uk