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Developing a digitally-enabled remote oximetry service across the South East

What was the aim?

During the first peak of COVID-19 it was common for patients to present extremely late with silent hypoxia. In response, new national guidelines were established for early identification of the deterioration of COVID-19 patients using remote monitoring (pulse oximetry and symptom diaries in community care settings).

Hampshire Hospitals NHS Foundation Trust, with a population of around 600,000 people, wanted to embed a remote monitoring service that would empower patients to recognise COVID-19 symptoms and when to call for help. This enabled more patients to be cared for where they live, reducing both admissions and readmissions and the pressure on the emergency department and inpatient services.

Project aims

The project aims to enhance the digital capabilities of the COVID oximetry at home (CO@H) service, including enabling patients to enter their own data, improving the visibility and use of data across different settings and creating better alert systems to identify and prioritise patients who need urgent treatment.The technology will:

  • improve the quality of service for patients by giving them more choice and control over how they enter their data
  • enhance the safety and speed of the service by ensuring healthcare professionals can access relevant information quickly and effectively
  • support better decision-making in respect of workflow and capacity management across primary and urgent care as well as CO@H teams
  • allow digital interoperability, enabling patient level data to be seen across all settings, including ambulance services, hospitals as well as CO@H teams

What was the solution?

The Inhealthcare CO@H remote monitoring digital platform allows patients with confirmed or suspected COVID-19 to be looked after safely at home by allowing health professionals to track their vital signs and act on any changes to their condition.

Procured and built as a partnership between Wessex AHSN and Hampshire and the Isle of Wight ICS, the digital platform supports the existing process whereby patients with confirmed or suspected COVID-19 use a pulse oximeter to monitor their oxygen saturation levels and report these readings alongside other vital signs on a regular basis to their healthcare team.

The platform asks patients a series of questions and requests vital signs readings, which can be submitted via text, app, online or an automated call service, generating real-time information for each patient.

This data enables healthcare professionals to track patients over time so that changes in their health can be quickly identified – while the system integrates with EMIS and TPP SystmOne GP systems so that the patient’s records are automatically updated with their progress.

What was the impact?

Over 1,300 patients have been successfully onboarded with all localities now signed up to deliver fully digitally-enabled CO@H services. Early evaluation from one area found:

  • services prevented over 670 emergency department attendances
  • saved over 350 bed days, as well as saving clinicians’ time.
  • 86% of those eligible patients are now setup digitally, which is delivering an additional reduction in daily telephone calls to each patient

The impact on people: The patients’ and carers’ perspectives

While the project is still being formally evaluated, it has already received a wealth of positive feedback from those who have benefited. Below is a small selection of comments from patients and carers using the CO@H service.

“The automated phone call to monitor my readings was excellent and if any of my readings were out of range, I had a phone call not long after to check up on me.”

“The contact was very good – the phone calls were on time and the service was easy to use.”

“I was prompted with texts to send my readings, and I was always called if my readings were not good to check I was okay.”

“This service was excellent. It felt very reassuring to know she was being monitored. Thank you so much.”

“This service was very helpful and it was reassuring that someone was checking on me three times a day because living alone with COVID-19 is very scary and lonely.”

How is the technology working in practice?

We asked a selection of health professionals to describe the real- world impact of the technology on their patients and their own working practices. Here are their personal experiences.

“It’s changing the way we’re thinking about healthcare”

Alison Hullah, a lead nurse, describes how the project is changing practice across primary care, exploring its potential to be used more widely to reduce hospital admissions, support early discharge and improve the way people manage their own health in the future.

“Patients have told us this technology has saved their lives”

GP Dr Caroline O’Keefe describes how at the height of the pandemic the technology enabled the team to care for growing numbers of patients, helping them to spot early signs of deterioration and ensure these patients received the life-saving care they needed.

“The advent of digital care has been a gamechanger”

Dr Matt Inada-Kim, a consultant at the Royal Hampshire County Hospital and the National Clinical Director for Infection, Antimicrobial Resistance and Deterioration, reflects on how this technology could be utilised in many different ways and is an opportunity to better support a range of chronic and acute health conditions in the future.

Key actions and insights

Looking ahead, how might this project help to shape the future direction of health services in the region? We asked members of the project team to outline the key lessons that are shaping their priorities for the future.

1. What went well

  • A common shared purpose with a focus on system working and collaboration
  • Localities being given the space to innovate within an agreed framework
  • Pooling skills and expertise across three Academic Health Science Networks
  • Building in evaluation and feedback across services
  • Shared resources, including use of Future
  • NHS and national learning webinars

2. What we want to improve

  • Improve capacity modelling to plan future CO@H delivery needs
  • Ensure greater continuity of personnel, which has been disrupted due to other COVID pressures
  • Develop IT systems that can support the integration of CO@H across other sectors
  • Enhance public messaging and communications to support onboarding
  • Deliver even quicker access to data for local and regional teams

3. What we’re prioritising next

  • Manage CO@H capacity effectively as demand fluctuates, including retaining staff and knowledge base
  • Build on the success of this programme by considering the digital and technology solutions available for remote monitoring of other conditions
  • Deliver further integration of digital services across patient pathways, including greater join up of patient records and staffing teams
  • Continue to share learning and best practice locally, regionally and nationally as new models embed and expand

Find out more

You can read the full case study on the work across the region on our Innovation Collaborative workspace at FutureNHS.

Join the National Innovation Collaborative

The Innovation Collaborative is open to all NHS, social care and local authority staff with an interest in remote monitoring, providing access to peer-to-peer support, guidance and tools designed to help you implement a remote monitoring service.

Existing members can access the Innovation Collaborative Digital Health workspace on the FutureNHS platform. Alternatively, to join or ask any questions email innovation.collaborative-manager@future.nhs.uk.