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COVID-19; Digital Health response for the UK and Australia

posted 25 Mar 2020, 09:56 by Hollie O'Connell   [ updated 25 Mar 2020, 10:05 ]

25 March 2020 

During the current outbreak of COVID-19, adherence to official national guidance1 is a primary determinant of the effectiveness of any precautionary steps that members of the public take.  There is currently a wealth of advice shared from various sources, including the NHS and Government around self-isolation, social distancing and other preventative measures. 

However, people may be overwhelmed with the deluge of official information and updates, and confused by misinformation spread via word of mouth and social media.  This is a particular problem for vulnerable groups and serves to exacerbate anxiety.

While concerns about COVID-19 are raised globally, for at risk groups (e.g. the elderly and those with pre-existing conditions such as respiratory or heart diseases), the outbreak is even more concerning as the consequences of contracting the virus are more severe. 

At the time of writing, Simple Shared Healthcare are collaborating with NHS organisations on pathways to help patients self-isolating and social-distancing at home.  The collaboration has created a bank of advice messages and structured protocols based on official NHS and Government guidance that can be integrated into pathways with Flo, covering all manner of topics from symptom tracking, hygiene, loneliness and isolation, to advice for parents.

Flo’s gentle prompts are also designed to encourage subtle behaviour-change over time.  This is particularly crucial for those self-isolating or social-distancing to ensure guidelines are followed to reduce the likelihood of contracting or further spreading COVID-19.

Building on Flo’s considerable capability, her ‘Next- Gen’ cousins Clara and Nellie, who’ve been working for over 2 years in Australia, USA and UK, offer a service specifically designed for a rapid public health response.  The foresight of NHS Stoke-on-Trent inspired us to add a layer of functionality to Clara we called self- subscribe.

This enables healthcare workers to ‘prescribe’ Clara for a patient.  The healthcare worker simply advises the patient to text a keyword to a specific mobile number and that’s it!

In the case of COVID-19, this may be as simple as a general self/household isolation protocol which provides a trusted source of information and advice; thus reducing anxiety, increasing adherence and directing patients on the appropriate use of NHS resources at any particular time during self-isolation or just helping vulnerable patients to manage pre-existing conditions.  Clara engages patients with a rich dialogue and updates to guidance provided to patients can be done on the fly, hot off the press.

Most importantly for patients using either Flo or Clara, they feel that they have a ‘human’ connection to their healthcare provider, making them feel that they are not facing this alone, helping to mitigate the mental health issues that self-isolation may cause in many patients.

If you would like to discuss how Flo could potentially support patients during this testing time or are interested in self-subscribe with Clara, please contact us via our website and a member of the team will get back to you.

TEC Lanarkshire Celebrate over 10,000 Patients Supported by Flo

posted 10 Mar 2020, 04:51 by Hollie O'Connell

10 March 2020 

Kerry Fletcher, Lesley Aitken & Morag Hearty

TEC Lanarkshire Team attending the Digital Health & Care Scotland Awards in February

We are delighted to share that in February 2020, over 300 new patients in Lanarkshire started to self-manage their health with Flo’s unique support, taking the total number of patients that Flo has helped in Lanarkshire alone to over 10,000 patients across a broad range of conditions.

The award-winning team in NHS Lanarkshire worked passionately to support the introduction of Scotland’s National Florence hypertension pathways, including the integration of Flo into hypertension diagnosis and hypertension monitoring pathways, alongside medication titration for those patients whose hypertension is newly diagnosed or uncontrolled.  This has proven to avoid the need for some non-value added appointments, thereby allowing remote blood pressure monitoring to increase practice capacity and reduce patient travel costs.

The pathways have standardised and streamlined Lanarkshire primary care hypertension pathways, ensuring that patients receive best-practice care & freeing up time for busy clinicians with Flo acting as a catalyst to move responsibility away from healthcare professionals to patients, thus increasing the effectiveness of interventions. Read more here.

To date, over 5,000 patients have received Flo’s friendly messages to motivate, engage and educate them specifically with their hypertension, which is a fantastic achievement.  Well done to all of the team at TEC Lanarkshire for their forward-thinking and innovative approach with Flo to engage & motivate patients & achieve better and faster outcomes!

Simple Shared Healthcare join the AHSN Network at Arab Health 2020

posted 27 Jan 2020, 06:45 by Hollie O'Connell

28 January 2020 

This week thousands of delegates will be congregating in Dubai for four days of Arab Health 2020.  The AHSN Network, following the success of their visit last year, are returning again to support a small group of innovative UK Healthtech companies including Simple Shared Healthcare, at the Association of British HealthTech Industries UK Pavilion.

With delegates travelling from all over the world, Phil and Lisa are representing Simple Shared Healthcare at the event and are excited to have the opportunity to share how Flo and her international cousins Nellie and Annie have utilised the NHS owned “Simple Telehealth” methodology to deliver better and faster clinical outcomes by improving patients’ motivation, engagement and adherence to their best practice healthcare regime.  

You can find out more about the event here.

Journal of Psycho-Oncology; Supporting cancer patients with mindfulness-based CBT

posted 18 Dec 2019, 01:37 by Hollie O'Connell

18 December 2019 

We are excited to share with you that members of the Community of Practice from the Clinical Psychology Cancer Service Team at Sherwood Forest Hospital Foundation Trust, have recently published their proof of concept evaluation of using Flo to support cancer patients undertaking mindfulness-based CBT in the open-access Psycho-Oncology journal.   In addition to the work being published, the cancer support pathway was also shortlisted as a finalist for this years’ HSJ Awards, and has received a commendation in the category for mental health innovation at the Health Business Awards 2019.

A relatively new service, the Clinical Psychology Cancer Service was set up in 2014 to provide support to adults affected by cancer and were recently awarded a Macmillan Professionals Excellence Award for Integration Excellence.  Despite the team having high levels of clinical effectiveness, the drop out rates for psychological therapies were found to be quite high, especially amongst cancer patients, who have three times the risk of developing depression and anxiety.

Dr Sam Malins and the Clinical Psychology Cancer Service Team were looking for a low-cost digital solution to develop a blended approach of face to face and remote therapy sessions, with supportive messaging between clinical contacts.  In collaboration with Nottinghamshire University, their local Florence administration team and some additional support from Simple Shared Healthcare, the team developed pathways with Flo to reduce drop-out rates, encourage ongoing engagement throughout the course of treatment to achieve better mental health outcomes and improve relapse prevention.

The resulting protocols are unique & innovative with some of the responses Flo sends being fully personalised, written collaboratively by the patient and their healthcare professional.  During treatment, patients receive additional support and advice between their scheduled appointments, alongside messages to reinforce learning from their most recent sessions.  Whilst under the care of the team and also beyond discharge, patients are also regularly prompted to return a wellbeing score, to which they receive their personalised messages based on the work completed with their clinician.
Integration of Flo into the pathway has had some fantastic results, including:
  • Patients supported by Flo were eight times more likely to complete their treatment programme when compared to those not supported by Flo.
  • Patients supported by Flo also reported a greater improvement in depression over the course of the programme.
  • Interviews with patients suggested that they found Flo’s messages to be motivating reminders to practice techniques, and also acted as a personal connection.
Patient comments included:
I thought they were good, [Flo] sort of motivated you and was a gentle reminder really.... I thought that that was a good idea
If you found yourself getting lost they were good reminders to put you back on track
When you got it you felt “oh somebody is thinking about me.” Even though it was just a text message
You felt like - I mean, I know they [Flo’s messages] were automated, but in a silly way it felt like somebody was motivating you. I enjoyed them actually.” 
Florence seems to text me exactly when I need it the most. Always helps me. Overall amazing ” 

From the clinician’s perspective, implementing Flo has a number of benefits such as:
  • Prevention of re-referral.
  • Increased therapeutic capacity, with more patients successfully treated in each group.
  • Simple & easy for clinicians to implement with a low input and time cost.
The full journal article is open-access and available here, or if you would like to learn more about the pathway and the team’s journey, you can contact Sam at Sam.Malins@nottshc.nhs.uk

Scotland’s Scale-Up team scoop three top awards with Florence

posted 6 Dec 2019, 01:19 by Hollie O'Connell

06 December 2019 

Scotland’s largest health and social care conference ‘Digital Health and Care Fest’ was held on 20th and 21st November 2019 at the University of Strathclyde Technology and Innovation Centre in Glasgow in partnership with Scottish Government, NHS and the Coalition of Care and Support Providers in Scotland (CCPS).  The two day event showcased the very best of digital innovation in health and social care encouraging strong debate amongst key national digital strategy colleagues from Scottish Government, the NHS, academia, industry and the care and support sector. 

We were delighted to see the trend continue from the last few years, with a significant number of Flo enabled showcases at the event, ranging from innovative evaluation studies through to deployment of digital health (Flo) at scale across multiple Healthboards and diverse teams. 

We were delighted to see that amongst the shortlisted evaluation case studies to be judged by the event panel, 25% were based on Flo’s unique abilities to enable the attainment of better and faster outcomes.  The abundance of robust, independent evidence of clinical acceptance, improved patient outcomes, improved access to care and improved patient engagement and adherence with self management speaks for itself.

Special congratulations to winner, Mary Paterson, who on behalf of the Scale-Up BP Team accepted the winning accolade with their presentation of the impact across 3200 patients from ‘Introducing Telemonitoring for Blood Pressure into Routine General Practice at Scale: An Implementation Study in collaboration with the University of Edinburgh. The results described how, compared with the previous year, the participating practices:
  • made 18.9% fewer face-to-face appointments for any reason
  • patients mean systolic BP fell by 6.55mmHg
  • patients mean diastolic BP fell by 4.23mmHg
  • patients whose baseline systolic was >135mmHg had a mean fall in BP of 15.1mmHg

The evidence from this study contributed to the Scottish Government’s recent £1.2million commitment to support Scottish Health Boards to move to large scale deployment and mainstream the delivery of remote patient monitoring within primary care services with Florence, read more here.

Scale-Up BP is part of the wider Technology Enabled Care (TEC) Programme established in Scotland in 2015/16 and to date, more than 150 practices recruited Flo to support their patients requiring blood pressure monitoring either to diagnose hypertension, monitor BP or titrate medication, with over 10,000 patients benefiting.

A notable point on the use of Flo’s unique psychological techniques, is the very low dropout rate, which was less than 9% over the length of the study, something we’ve found simply isn’t achievable when using other methods or apps.
  • Other shortlisted Florence based studies included;
  • Cost avoidance achieved with Hypertension monitoring
  • Using lifestyle interventions to lower blood pressure
  • Highest success rate in Scotland for Beating the Blues CBT completion

The prestigious UK General Practice Awards were held on 29th November 2019 at the Park Plaza Westminster Bridge, London.  The awards are held to recognise the very best of general practice and we are again delighted to share that the ‘Clinical Improvement Award: Public Health and Prevention’ was won on the night by the Scale-Up BP Team led by Prof Brian McKinstry.  This fabulous at scale achievement in digital healthcare with Florence was a well deserved recognition for all involved.

The sixth annual Scottish Public Service Awards took place on 4th December 2019 celebrating excellence within Scotland’s public services, and showcasing some of the most innovative and outstanding work being achieved.  We are excited to share that the winners of the ‘Digital Public Services Award’ were the NSS Integration Team, with their work on ‘Remote Blood Pressure Monitoring’.  We worked with the NSS Integration Team to implement Flo’s GDPR compliant APIs to allow routine blood pressure data from individual GP Practices to be extracted and analysed in the NSS safe Haven.

Florence and the strangest secret of self care

posted 19 Sep 2019, 06:58 by Hollie O'Connell

19 September 2019 

The use of digital technologies in healthcare is a fast growing industry with a whole host of technology start-ups offering solutions using online video conferencing, apps and AI.  Within this crowded market, many come with a promise from the vendor of a clinically effective and sustainable service but all too often we see these solutions struggle to live up to the salesman's promise.  Healthcare by its nature of course is a tricky area for digital technology, with the need to provide independent evidence of a direct causal clinical effect and improved efficiency for healthcare providers.  This is particularly tricky within the requirements of rapid change driven by new advances in care but anchored in long established methods of care delivery.

Flo is now in her 9th year of supporting patients towards better and faster clinical outcomes and helping them to manage their own health conditions better.  Along the way the evidence from Flo’s use has enabled the introduction of her US and Australian cousins (Annie and Nellie) and although these locations are very different, Flo, Annie and Nellie have all continued to demonstrate the same positive and sustainable outcomes. 

So what makes Flo, Annie and Nellie different to other digital technologies and what’s the evidence?

In this short webinar Phil O’Connell, our founder, talks through our unique methodology and how the secret to self-care has little to do with digital technologies, and everything to do with human behaviour. 

Home and Mobile Health Monitoring Evaluation - Economic case studies

posted 13 Sep 2019, 03:15 by Hollie O'Connell   [ updated 3 Oct 2019, 05:12 ]

13 September 2019 

We are delighted to announce another exciting publication, Home and Mobile Health Monitoring Evaluation - Economic Case studies” by Digital Health & Care Scotland, who have previously published their National 3-year evaluation "Towards Scaling Up Home and Mobile Health Monitoring 2015-2018".   This report provides us with a detailed analysis of the considerable cost savings across three varying locations in Scotland; Ayrshire and Arran, Lanarkshire and the Western Isles, where the substantial outcomes were fundamental in the decision to Scale Up with Flo. 

The aim of this report was to look at the return on investment when using HMHM (Flo) to support patients with Hypertension and COPD, and explore the “monetary equivalent of capacity released, the monetary equivalent of reduction in resource demands, the cost of HMHM compared to baseline costs, and the number of cases that would need to be implemented to break-even.”

When looking at COPD patients supported by HMHM (Flo) key findings were:
  • HMHM is cost effective - Using Net Present Value, savings over a 10 year period per 100 patients:
    • Ayrshire & Arran £26 - £28 million
    • West Dunbartonshire £496k - £1.4 million
    • Highland approximately £23 million
  • Fewer NHS24, ambulance call outs and emergency admission bed days
  • The number of items prescribed increased (due to more appropriate prescribing)

Key findings when using HMHM (Flo) to support patients with Hypertension:
  • HMHM is cost effective - Using Net Present Value, savings over a 10 year period per 100 patients:
    • Ayrshire & Arran £52 - £73k
    • Lanarkshire £15 - £67k
    • Western Isles £62 - £85k
  • Capacity is released. Comparing costs and benefits shows that to break even:
    • Ayrshire & Arran need 56-76 patients to use HMHM (Flo)
    • Lanarkshire need 42-68 patients to use HMHM (Flo)
    • Western Isles need 13-18 patients to use HMHM (Flo)
  • Patient travelling time is avoided, 33 - 50 hours were saved per 100 patients
  • Productivity is increased - estimated that £1,800 in loss of earning is avoided per 100 patients by having their BP monitored remotely
  • Savings can be increased by recycling of BP monitors
“ Despite considerable local variation between the partners providing data for these case studies, all of the scenarios modelled were shown to be cost effective over a 10 year period.  Although most of the benefits are non-cash releasing, aspects such as avoided appointments do create additional capacity for staff working across primary and secondary care, many of whom work under considerable pressure. “

You can read the full report and evidence towards these savings by clicking here.

Thousands of patients in Lanarkshire evaluation

posted 3 Sep 2019, 08:29 by Hollie O'Connell

03 September 2019 

Towards Scaling Up Home and Mobile Health Monitoring in Lanarkshire - An evaluation towards 
scale-up, spread and sustainability June 2019 

We are pleased to announce the publication ofTowards Scaling Up Home and Mobile Health Monitoring in Lanarkshire - An evaluation towards 
scale-up, spread and sustainability” where the substantial high quality evidence base helped support the further £1.2 million investment into Scotland’s National BP Scale-Up with Florence. 

NHS Lanarkshire received an exciting opportunity to be part of the National Home and Mobile Health Monitoring (HMHM) Programme which looked at how HMHM could improve clinical outcomes and explore the potential for sustainable scale-up with Florence.  This document provides an in-depth and detailed independent evaluation of evidence gathered over a number of years, where the passion and commitment of clinicians combined with Flo’s unique persona and methodology were able to over deliver on targets and demonstrate that HMHM can be successfully integrated into multiple conditions including hypertension, mental health, health lifestyle/health improvement, diabetes and pain management.

Examples of the highlighted outcomes for patients are “people have positive experiences of services, supported by HMHM”: 
  • More people self-manage their health and care - one piece of evidence gave a total of 7,455 patients supported with Flo by 28.4.2019
  • Condition control improves - “One person who refused to believe they had hypertension accepted their diagnosis after using Flo.   Their blood pressure was 183/87 before remote monitoring and 135/80 after accepting the diagnosis and medication”
  • Face to face contact are optimised - “3,545 people have texted BP readings to their GP surgery to support diagnosis and medication titration, ensuring that accurate readings are available to support diagnosis and hypertension management”
  • Access to services increase - “HMHM is particularly useful for people whose working hours clash with surgery opening, who are stressed by the time they get to their appointment, and then have high readings.  Now after an initial visit to start Flo we follow up the readings sent in remotely by phone”
  • Resources used effectively and efficiently - “An average of 4.3 blood pressure monitoring appointments were avoided per patient. For 3,545 patients each avoiding 4.3x10 minute Practice Nurse appointments = £82,467 (greater savings where GPs did the BP monitoring)”
While key learning of HMHM on effectiveness and efficiency:
  • “HMHM appears to be a catalyst for shifting responsibility away from healthcare professionals to people/patients, thus increasing the effectiveness of interventions.
  • HMHM can increase engagement with services e.g. more people start an on-line programme, it is easier to text readings from the workplace than get to a GP surgery.
  • Fewer HMHM efficiencies are observed when the service doesn’t have someone to lead or it is not highly valued by staff, even when people/patients appreciate the support.
  • Where HMHM enables more accurate diagnosis e.g. hypertension, it can also save ‘White Coat’ prescription costs.
  • HMHM has been most effective in Lanarkshire when those using it appreciate its value, the set-up is relatively straightforward, and there is expert support to resolve any issues.
  • HMHM avoids the need for some appointments e.g. remote blood pressure monitoring increases staff capacity and reduces patient travel costs. “

Sharing the Learning: Efficiencies Delivered Across Acute, Primary and Community Healthcare

posted 31 Jul 2019, 03:25 by Hollie O'Connell   [ updated 2 Aug 2019, 04:18 ]

31 July 2019 

We are pleased to publish a series of resources that encapsulate the unique outcomes and benefits realised by our members.  The collection of Efficiency Savings summaries have been developed to offer a concise overview across Primary, Acute and Community Care.

Each resource provides highlights of how Flo has delivered efficiencies in healthcare delivery based on evidence shared with us from members of the Simple Telehealth Community of Practice. 

Areas covered in the documents include;
Primary Care:
  • COPD
  • Asthma
  • Hypertension
  • Medication concordance

Acute Care:
  • Maternity
  • COPD
  • Asthma
  • Hypertension
  • Oncology

  • Medication concordance
  • Diabetes
  • Orthopaedics
  • Ascites management
  • Renal transplant
Community Care:
  • COPD
  • Children’s community nursing (enteral feeding weaning & BP monitoring)
  • Diabetes
  • Mental health
  • Wound care

Paediatric and Young Adult Member’s Network Launched

posted 30 Jul 2019, 06:01 by Hollie O'Connell

30 July 2019 

Paediatric and Young Adult Member’s Network Launched 

Over the years, Flo has supported many children and parents with their healthcare needs, with the benefits being enjoyed by both patients and clinicians.  Consequently, the Community of Practice is now seeing a sustained increase in clinical interest in this area.  Therefore, in support, we are extending the reach of our Condition Based Member’s Networks and launching a new area of interest for clinicians delivering paediatric and young adult services.  The network’s aim is to share and discover how other like-minded clinicians have been innovating with Flo, and the learning that has been created by this.  For an example of one of our other networks, please see here

To launch the Paediatric and Young Adult Member’s Network, we would like to take this opportunity to share with you an overview of some of the inspirational innovation that is being delivered across the Simple Telehealth Community of Practice.

Supporting Children and Young Adults with Type 1 Diabetes

One of the most sustained applications of Flo’s support is for patients with Type 1 diabetes.  Children and young people diagnosed with Type 1 diabetes can find adapting to and managing their condition particularly challenging, as it often happens at a time in their life of already increased physical, psychological and social change.  Much like with adult diabetes pathways, Flo is on hand to provide additional support to help children and young adults: engage with their health, feel more in control of their condition and improve their education early on via an accessible and effective tool; their mobile phone.  Flo has proven to be particularly effective within younger cohorts due to their familiarity with technology and the fact that they find that receiving simple SMS text messages is discreet, uncomplicated, and does not interfere with their wider use of their handset e.g. using data.

Two patients who have benefitted from Flo’s helpful messages are Naomi and Erin.  Naomi had struggled to manage her diabetes throughout her teens resulting in raised HbA1c and the development of diabetic bulimia due to concerns over weight gain.  But with Flo’s support she was able to significantly reduce her HbA1c, which improved her long-term health outcomes.  Similarly, Erin was struggling to manage her diabetes, and had been unfortunately previously admitted to hospital with ketoacidosis.  Following her admission, Erin was introduced to Flo and was also able to reduce both her HbA1c from 112mmol to 83mmol, and also the risk of long-term complications due to poorly controlled diabetes.

Supporting Early Years Practitioners to embed changes in their clinical practice

NHS Highland have integrated Flo as part of their “Words Up” initiative.  Words Up provides training to Early Years Practitioners, Teachers and Pupil Support Assistants to ensure that adult-children interaction is of a high quality to help to improve language and communication skills.  The team have harnessed Flo via a unique and interesting approach by providing support to practitioners in reinforcing key elements of their training.  Practitioners interact with Flo around the topics covered, which in turn refreshes and compounds the key messages shared during their training.   Practitioners are also asked how easy or difficult they are finding making changes, which allows them to reflect and seek additional support if needed.  To find out more about Words Up, take a look at this blog.

Improving Compliance with Inhaler Regime for Children and Young Adults with Asthma

For patients with asthma, ensuring compliance with inhaler regimes is key in controlling the condition and symptoms.  For younger children with asthma, parents or carers usually take on the responsibility for ensuring that inhalers are taken as prescribed which can sometimes be difficult due to the competing priorities of family life.  As a helpful prompt for parents, Flo has been recruited as a timely nudge to administer their child’s inhaler.  You can find out more by watching this short video of Dr John Alexander from the University Hospital of North Midlands talking about how Flo has been helping his patients and the benefits she brings to patients, parents and his team.

Children’s Community Nursing - Enabling Remote Enteral Feeding and Blood Pressure Monitoring

The Children’s Community Nursing Team within Shropshire Community Health Care NHS Foundation Trust developed two innovative pathways around supporting parents whose children undergo enteral feeding, and also those whose children require scheduled blood pressure monitoring.   Around enteral feeding, parents are prompted to send Flo their child’s weight, instead of having to arrange their schedule around a visit from a member of the Children’s Nursing team.  For children requiring BP readings to be taken at regular intervals, Flo prompts parents to take them and reply with the reading.  For both pathways, augmenting the patient’s normal shared management plan, if any child’s readings are outside of the desirable range, the Children's Community Nursing Team would be notified, and be able to take appropriate action.

The implementation of Flo into these pathways has benefitted both staff, children and their families.  For families, sending readings into Flo gives them the freedom to not have to plan around visits from the Children’s Nursing Team.  Flo also reassures them that if there is cause for concern, a member of the team can pick this up when reviewing the readings, and initiate any required action.  For clinicians, Flo is helping to reduce the number of home visits required by some patients, enabling them to better manage their caseload and allocate resources to other patients who may require additional support.

A summary report by Children’s Community Nursing Team found that across only 7 patients, a total of 795 clinical hours were saved, which released the same capacity as an extra 1.0wte nurse working for over 21 weeks.   To find out more about these pathways, take a look at the following blog.

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