The role of remote monitoring in the future of the NHS

Melanie Martin, a physiotherapist, Clinical Advisor at NHSX and Topol Fellow shares her experience of scaling a remote monitoring service during the COVID-19 pandemic and why she believes that this is key to recovery and transformation of outpatient care.

I have frequently been told by patients with a long-term condition they do not wish to be reminded they are ill when they are well. Yet the traditional outpatient model of timed follow-up appointments and lack of interoperable data captured only at fixed intervals can often mean patients in disease remission are seen more frequently than necessary, and with missed opportunity to capture disease flares.

In 2017 I embarked on discovery work to explore better ways to help identify patients who could benefit from greater flexibility through remote care and continue to live well by avoiding the reminder of disease through attending unnecessary hospital appointments. I began by framing the significance of regular remote capture of patient-reported outcome measures (PROMs) between appointments to support shared decision-making about when patients needed care the most. Enter remote monitoring, the process of using technology to monitor patients outside of a traditional care setting, such as in their own home, or care home. Using symptom trackers, monitoring devices, portals or patient dashboards, together with remote consultations, enables patients to maintain a holistic view of their well being through the tracking of disease progress whilst alerting  clinicians to any deterioration in their condition.

By 2018 as the Clinical Product Owner, I led an agile, multi functional team through the user centred design and delivery of a minimally viable rheumatology remote monitoring service in South East London. The solution has been to implement a two way SMS channel for patients with rheumatoid arthritis which captures monthly PROMs whilst allowing for SMS contact from patients between clinic visits.  Whilst opening multi channels of remote dialogue with patients was seen as risky it is essential to sustainable transformation of care.  Learning and sharing insights from patients’ experience of the digital service has been invaluable in understanding the building blocks needed to form meaningful remote clinician patient relationships and optimising user engagement at scale.

Design features such as automated reminders, graphical feedback on scores, a red flag system to alert to changes and an SMS template library have supported personalised care for disease flare, emotional well being and appointment deferment, accelerated in uptake by COVID-19.

Scaling a minimally viable remote monitoring service in a pandemic

Prior to COVID-19, rheumatology services across the South East London Integrated Care System (ICS),  recognised the common problems facing services.  The key to unlocking a cross boundary solution has been to come together to design and implement a unified remote monitoring digital pathway, supported by a Digital Pathway Co-coordinator and building upon the minimally viable service model. The Health Innovation Network, the academic health science network for south London, are supporting this work and the on boarding of approximately six hundred patients across six NHS hospital sites across the region over the next year, anticipated to be rapidly accelerated by the COVID-19 pandemic and the need for outpatient recovery.

Remote monitoring is the future for the NHS

Delivering care to patients within the comfort and safety of their own homes (including care homes) is being enabled by NHSX through the launch of the remote monitoring procurement dynamic purchasing system or DPS.  This exciting DPS will make it easier for NHS and social care organisations to select and use the right remote monitoring platform for patients through a needs based approach, which takes into consideration the preferences and capabilities of the patients to manage their digitally enabled care in the home.

NHSX is working in partnership with the seven NHS Regions to support scale of remote monitoring.  This new DPS will help streamline the process for NHS and social care organisations by making it quicker and easier for them to select a product.

You can view a short video about the rheumatoid arthritis remote monitoring service

Health and social care professionals are also invited to join the free Innovation Collaborative - Digital Health platform on NHS futures. Use this link Future.nhs.uk/InnovationCollaborative or email innovation.collaborative@nhsx.nhs.uk to join.

Remote monitoring really is the future of the NHS.