simple.uk.net
for patients, not profit
We couldn't have wished for a better start to 2018. In addition to the absolute privilege and joy of working with front-line clinicians and hearing first hand, how our work has helped to transform patients' lives, independent research projects by The Kings Fund and The Health Foundation have been published showcasing our work alongside the best of the best innovations in the NHS.
Below I have set out a few insights into the attributes that make up Simple Telehealth and our sustainable methodology.
Unprecedented recognitionWe were delighted in January to read that Simple Telehealth and Florence had received unprecedented recognition as an exemplar case study in two publications; The Kings Fund - "Adoption and spread of innovation in the NHS" and The Health Foundation - "AGAINST THE ODDS : Successfully scaling innovation in the NHS". Using independent methodologies, both organisations researched innovations in the NHS to determine how and why some innovations had become successful, whilst others had not. Out of the thousands of innovations in the NHS, The Kings Fund narrowed the field down to 8 and The Health Foundation narrowed their field to 10 exemplars, both of which included Simple Telehealth and Flo. This adds to the recognition received in the prior year in the Nuffield Trust publication "The digital patient: transforming primary care"? where Flo was selected to feature in the top four! “Florence is a low-cost, low-risk innovation with a strong track record.” The Kings Fund “The benefits Florence can deliver are wide ranging” The Health Foundation "Flo has been formally evaluated, with positive results" Nuffield Trust This remarkable treble achievement is attributable to the fantastic work of members of the Simple Telehealth Community of Practice who ethically and genuinely focus on the interests of patients, which in turn ultimately benefits the whole Community. Adding to the recognition, last year too saw Florence cited in NHS Scotland COPD best practice and NHS England Challenging Health Inequalities. Our model is one of an enabler. We don't "sell" solutions, rather we work with and help clinical teams to solve real world problems and share their learning freely amongst peers. Our approach, developed with the help and patience of many enthusiastic clinicians is, like our name, "Simple". 1) Commissioners buy clinical services based on the assumption that an investment of A will yield outcomes of B for patient cohort of C. 2) Commissioners accept the assumption that to achieve outcomes of B, clinicians will practice "best practice" care and patient cohort C will have a certain level of engagement and adherence, both with and to the care provided. 3) The Simple approach, is to help patients improve their level of engagement and adherence to the best practice care already being provided. 4) Consistent with literature, for cohort C the inevitable result of improved engagement and adherence with best clinical practice is better and faster clinical outcomes. Attainment of better and/or faster outcomes than are achievable under normal care alone helps teams to solve real world problems, freeing up clinical time, reducing cost and reducing the risk of complications developing further down the line. In regions where thinking goes beyond short term savings, such as Scotland, significant benefits can accrue, although some of the benefits are realised in other organisations, as the first academic study of Simple Telehealth showed; Cottrell E, Chambers R, O’Connell P (2012) BMJ Open 2:e001391 Using simple telehealth in primary care to reduce blood pressure: a service evaluation. It is the sum of the techniques and methods used to help patients to better adhere to, and engage with shared care plans and clinicians that enables such results. The underlying technology plays it's part, but it is just one aspect in a unique combination. The Health Foundation The Simple Telehealth Community of Practice led by Lisa Taylor, is without doubt the heart of our model, bringing members together to share knowhow, stories and material and to help each other to achieve successful outcomes. Lisa's team's primary objective is to invest in organisations for the long term to continually increase their capabilities to ensure patients and the organisation benefit from evidence based implementations for the lowest possible cost. Our commitment to do the right thing for the right reasons for the benefit of patients, appeared somewhat counter intuitive, as we would be investing in organisations to be able to do things themselves that a protectionist industry would normally charge for. However this very approach gives organisations the tools, skills and knowhow to adopt, adapt and to innovate, leading to a diverse array of uses in clinical areas and with patient cohorts we would never have been able to envisage. "The flexibility of the platform and capability support model enables adoption in a wide variety of contexts, as well as co-production of the way in which Florence is adopted in each site with clinicians and patients." The Health Foundation Of particular importance are the regional and national learning and network events inspired by Lisa. At these events clinicians gather with their peers and showcase case studies and published literature on their local adaptions and uses. With the methodology being condition independent, these events attract clinicians with diverse clinical interest but uses and techniques presented are totally transferrable. A huge amount of energy is generated by these events and some of the patient stories evoke an emotional response leaving not one dry eye in the house. In short these events are inspirational and a joy to attend. The Simple Telehealth methodology goes way beyond the system itself. One aspect covers the development and adoption of best practice shared clinical management plans, which sounds obvious doesn't it? What we find, however is that not all clinical teams have a systematic way of implementing best practice across the team and there can be variations of "best practice" in use. Simple Telehealth is a catalyst, it provides a framework for adoption of a common understanding of best practice and with a wealth of materials already shared in the Community of Practice there may already be something to draw on. These materials are not specifically for use with the system, the objective of the development of the materials is that they are simply the embodiment of best practice and can be used stand alone in normal practice. Members report that this alone delivers positive results for the team, but considerably more significant improvements are made when Florence is used to augment them. "The Florence team highlight the importance of gathering evidence on how Florence is used in a particular context, or with a focus on a particular cohort and their clinical outcomes." The Health Foundation Critically, being part of the Community of Practice means uses need to be evidence based so the design of uses, evidence and sharing studies and evaluation is key to the whole community. It is as important to share what doesn't work as what does work and how that has been achieved. Whats not worked
| Clinician innovatorsThe Simple Telehealth methodology (incl Florence) is designed to fit with clinical practice and offers clinicians the tools to easily augment best practice care. It is condition independent and once familiar with the framework, clinicians are able to adapt it to new cohorts or even individual patients. From a base of COPD and mental health in 2010, the 2017 graph below shows how innovative clinicians have adopted and adapted it into their own diverse clinical areas of interest. However there are exciting developments ahead where clinicians are using the framework to help new cohorts of patients, some of which are new to digital health interventions. The graph below summarises some of the 'other' areas of interest in 2017. “Its greatest strength is offering a simple, adaptable framework for clinicians to work more effectively with patients and for patients to take a greater role in managing their conditions, without the need for costly investments” The Kings Fund We started with Florence in the UK, then worked with the VHA to bring Flo's cousin 'Annie' to life in the USA, and having almost run out of superlatives, we are extremely excited to be talking about the next generation of Flo's family, Nellie in Australia and Clara in the USA too! This next-gen version of the persona based software uses clever technology allowing us to leverage learning from 8 years with Flo and Annie. I'm delighted to say that Nellie successfully passed her field trials in Melbourne at the first attempt and has now graduated to use in clinical practice across a range of clinical applications. The team in Melbourne are firmly members of our Community of Practice and are already involved. For a little insight, take a look at these two videos from the Nellie conference, filmed at the Royal Yacht Club, Melbourne in November 17. Dr Elizabeth Deveny - 'Nellie' in primary care Nellie and Clara will continue evaluation in Australia and USA throughout 2018. Some of Nellie's talents include workflow specific views, dynamic dashboards and patient records that update live as patients interact, simple to use sliders to adjust values, interactive graphs and charts, and access to local and community wide libraries to browse and share clinical protocols and resources. One of the key considerations in the design of Nellie is it structure, which is tightly designed around the needs and capability of clinical teams and the Community of Practice. The Flexibility of Florence is one of it's strengths and it's structure encourages innovation within organisations but there are still constraints around the ability of individual teams to be able to innovate and share their work. The flexibility designed into Florence was considered a departure from industry norms at the time, but I'm pleased to say that Nellie goes further, allowing clinical teams to innovate in an exciting and "radically different way". We can only wait and see where innovative clinicians take us with Nellie! Modelling LanguageWith the growth of the Community of Practice over three continents and three platforms, to help members more easily share ideas and protocols we've created the Simple Protocol Modelling Language which uses a schematic approach to design and visually communicate the structure, make-up and content of Simple Telehealth protocols. Florence data integration
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