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HSJ Awards 2020: Winner

posted 18 Mar 2021, 06:17 by Hollie Stirman

18 March 2021 

We are delighted that Florence, along with our partners at the University Hospital of North Midlands, Health2Works and Signum Health took top spot in this year's HSJ awards for the Florence inspired NHS Testbed project; Smart With Your Heart 

"This was a great example of a truly patient-centric project, looking at holistic needs and delivered by a passionate team. The judges said it was refreshing to see a project that is deliberately seeking to combine the use of simple technologies with non-clinical coaching to enable widespread uptake and ease of access. The winners provided clear evidence of efficiencies that had been delivered and had a very clear focus on system-wide working and engaged actively across its ICS. "

Judges Comments

#HSJ_Awards #TotallyUnique #UHNM #HF #Heart_Failure #Cardiology

Florence: Delivering Mid Nottinghamshire’s Oxygen@Home Service

posted 15 Jan 2021, 07:16 by Hollie Stirman

Jayne Birch-Jones 
Change Management lead – Assistive Technologies, Connect Nottinghamshire 

Emma Moore 
Team Lead – Community Urgent Response Team, Nottinghamshire Healthcare Trust 

15 January 2021 

Flo "most effective and safest tool to use to ensure good quality of care" 
for Oxi@Home Service in Nottinghamshire 

“Florence” has been in use across Nottinghamshire since 2012 supporting the delivery of a wide range of pathways across health and social care.  Our ICS currently averages between 600 – 800 patients using Flo at any one time which for us is low whilst we develop a role for dedicated staff to support and develop further pathways.  However even so, this is a great indicator that our staff and patients value Florence as part of their health and care and that she is a recognised, mainstreamed tool across Nottinghamshire.

In November, like all other ICS’s across the Country, we were tasked with setting up an Oxygen@Home service.  In Mid Nottinghamshire ICP, the Community Urgent Response team were asked to deliver the service.  The team leader had previously utilised Flo within other patient cohorts and recognised that Flo was the most effective and safest tool to use to ensure good quality of care to this patient group, while having the least impact on staff workload.

The benefits identified included:
  • Safe patient care - patients are immediately given advice according to our locally agreed pathway if clinically indicated via their response to Flo; there is no need to wait for instructions or to contact the team on the telephone.
  • Immediate clinical notification to facilitate early intervention reducing risk of further admission - clinical staff receive an email and text message notification if a patient breeches their set parameters - no need to log into the dashboard.
  • Management of deteriorating patients - clinicians can view deteriorating patient’s readings via dashboard
  • Clinical record data - patient’s readings submitted via Flo can be quickly uploaded into a spreadsheet and attached to the clinical record.
  • Cost effective – reduction in administration time and cost for telephoning patients; subsequent cost avoidance associated with timely and appropriate clinical intervention.
  • Real-time patient evaluation data - patient experience is collected as part of our local protocol on day 15.

As members of the Simple Telehealth Community of Practice, we based our protocol on good practice from another area and learned from their experience (thank you Northern Care Alliance!).  Locally we had a Microsoft Teams call to agree the protocol with our clinicians, tested it with staff, trained the trainer and within a week went live in one of our Primary Care Networks.  Our referrals are slowly increasing which will ramp up as access is opened up to other refers and we roll the pathway out to the rest of the ICP.  We have also applied for some additional funding via the East Midlands Academic Health Science Network to fund expansion to more patients. 

A big thanks to the national Flo team for all their support and amazing response times!

COVID Virtual Ward with Florence: Enabling Safe Recovery at Home

posted 16 Dec 2020, 05:17 by Hollie Stirman   [ updated 17 Dec 2020, 08:18 ]

16 December 2020 

Across the country, members of the Simple Telehealth Community of Practice are using Flo’s rapid pathway design capability and unparalleled operational simplicity to give Flo a significant role in their local COVID-19 response plans.  Members have developed new targeted pathways to enable the earlier safe discharge of patients post COVID admission at scale and pace.

Utilising Flo to extend the reach of the hospital team after discharge, emerging pathways are targeted at safely releasing valuable bed capacity as we enter a new phase of the pandemic and a difficult winter.  A number of pathways are already supporting patients across the country with many new pathways in development.

Florence & Oxi@Home: Northern Care Alliance NHS Group and University Hospitals of North Midlands NHS Trust /Midlands Partnership Foundation Trust launch virtual ward for Covid-19 patients

The Northern Care Alliance (NCA) virtual ward model supports patients post COVID admission for up to two weeks post discharge, and NCA have designed three specific pathways tailored to areas within the organisation’s geographical reach and ensuring local clinical relevance.

The pathway is now enabling clinical teams at NCA to be able to safely discharge patients home earlier whilst maintaining a sense of connectedness between the patient and clinician that provides both reassurance and confidence for patients to be able to understand when, and if further clinical intervention is required and clinicians to provide a supported discharge.

University Hospitals of North Midlands and Midlands Partnership Foundation Trust are partnering to deliver an Oxi@Home programme enabled by Florence.  The aim of the project is to increase acute bed capacity at the Trust by provisioning a safe opportunity for patients to measure and report their oxygen saturations and pulse at home post discharge and receive clinically approved guidance on what action to take, or helpful reassurance that symptoms are being managed appropriately at home.

Ashfield PCN implements Florence Covid-19 Virtual Ward in only 5 Days!

The Community of Practice underpinning Florence has enabled Ashfield North PCN to be able to access and build upon the learning shared from other areas who have recruited Flo to their COVID virtual ward team.  With similar ambitions, Ashfield [North] PCN have been able to provide access to Florence to support safe and early discharge of Covid-19 patients within five working days.  Clinicians are now able to support patients to safely manage any symptoms for two weeks post discharge, and clear pathways are defined to enable timely escalation of care should this be required.

Jayne Birch Jones, Change Management Lead - Assistive Technology, Connected Nottinghamshire says: 

We have just gone live in Ashfield, Nottinghamshire today [Tuesday 15th December] using Flo for community pulse oximetry service for patients with Covid.  This is aimed at supporting patients with Covid who may need extra support in the community and preventing hospital admissions.

Our staff are really excited about using Flo for this cohort of patients.  Emma, the Team Leader has been astonished that we have set this up in a week; from agreeing and testing the protocol, identifying the new processes and training the trainer.  Many thanks to Hannah and Kylie [the Florence team!] for their brilliant support.  We look forward to sharing our outcomes.

Flo Showcased in NHS England’s Cardiology Digital Playbook

posted 8 Dec 2020, 07:03 by Hollie Stirman

8 December 2020 

We are delighted that cardiology pathways enabled by Flo have been recognised and featured in NHS England’s recently published Cardiology Digital Playbook.

The series of digital playbooks have been launched to support clinical teams and organisations that are looking for digital tools that support the delivery of patient pathways.

The first example showcases how Sherwood Forest Hospital recruited Florence to reduce the number of avoidable cancelled operations and shorten the pathway to surgery for patients with white-coat hypertension, along with the recent “Smart with Your Heart” NHS England Test Bed project reducing readmission rates for Heart Failure Patients by over 50% at the Royal Stoke University Hospital

#NHSx #NHS #Blood Pressure #Florence #Best Practice #TotallyUnique

New partnership set to power Florence into exciting digital future

posted 23 Nov 2020, 03:44 by Hollie Stirman

23 November 2020 

Mediaburst Ltd. including Florence was acquired by psHEALTH on 19th November 2020 

This next phase with Simple Shared Healthcare partnering with psHEALTH brings investment to be able to further develop Florence in the UK.

We are really excited that early next year we will also be able to bring back to the NHS the capabilities of “Nellie”, Flo's Australian cousin with enhancements based on over 10 years of learning with Flo such as a patient app, patient downloadable reports, patient self subscribe features and care home tablet interfaces, plus its unparalleled flexibility and workflow which will only accelerate the benefits that Florence brings to patients and clinicians alike.

There will be more information over the coming weeks.  To read more please see the psHEALTH blog, or contact lisa.taylor@simple.uk.net

PLOS Medicine Journal: Integrating Florence into Clinical Workflow at Scale

posted 1 Jul 2020, 06:55 by Hollie Stirman

02 July 2020 

Telemonitoring at scale for hypertension in primary care: An implementation study 

Uncontrolled hypertension is the largest manageable cause of stroke and myocardial infarction.  Despite the effectiveness of anti-hypertensive medication, many patients still have uncontrolled blood pressure (BP).

Having previously demonstrated that Florence encourages medication use and is effective at lowering BP in this cohort, NHS Lothian’s award winning Scale-Up BP Team led by Professor Brian McKinstry expanded their scope to understand if integrating Florence directly into the clinical workflow would increase adoption even further, what impact this would have on clinician workload, and if study participant changes in BP would match those of randomised controlled trials (RCTs).

NHS Lothian subsequently developed an integrated system providing regular summaries of patient home-monitored BP readings via Florence to routine GP data management systems accessed by their general practitioner.  Patient home-readings were delivered alongside routine laboratory results for clinical review.

The number of participating practices grew steadily following the launch, and by July 2019 75 practices had participated and recruitment reached 3,200 patients with established hypertension.  Expected challenges to the adoption of new technology were mitigated well by the project team by engaging frontline clinicians in development of Florence’s use, activating local champions, and strong continuous support from a facilitator team.  The success of practices who recruited large numbers of patients acted as a stimulus for other practices to follow; patients liked Florence and there was a low rate of discontinuation.  Previous studies have been in the context of RCTs with practices contributing relatively small numbers of patients that are relatively easy to manage however within this study some practices were recruiting hundreds of patients.

The evaluation subgroup of 8 practices (905 patients) demonstrated clinical value in that BP fell in the intervention group:
  • a mean systolic BP reduction of 6.55 mm Hg
  • a mean diastolic BP by 4.23 mm Hg
Click image to enlarge

Along with Florence’s uptake, change in BP and participants’ views, a key objective of the study was to understand the impact on changes in clinician appointment use.  Compared with the previous year, the study demonstrated that there was no increase in practice workload, specifically:
  • participating patients made 19% fewer face-to-face appointments, compared with 11% fewer in patients with hypertension who were not supported by Florence.
  • total consultation time for participants fell by 15.4 minutes, compared with 5.5 minutes in patients not supported by Florence.
The paper states;

 " There have been no direct trials to our knowledge exploring the impact of telemonitoring on cardiovascular outcomes, but based on previous studies of anti-hypertensive agents, BP reductions of the magnitude achieved in this study, probably through intensification of anti-hypertensive therapy, if sustained, would be expected to lead to a greater than 15% reduction in risk of stroke and a greater than 10% reduction in risk of coronary heart disease 

Learning from Flo: STP TEC programme supporting the adoption of technology-enabled care for patients with respiratory conditions in primary care

posted 26 Jun 2020, 03:24 by Hollie Stirman   [ updated 26 Jun 2020, 03:36 ]

26 June 2020 

Empowering patients to feel confident and supported in managing their health can be a key role for technology-enabled care (TEC) such as Flo, with robust evidence citing the benefits to both patients and clinicians.

To encourage more wide-spread adoption of TEC, Staffordshire Sustainability and Transformation Partnership’s (STP) Digital Workstream have introduced a TEC programme aligned with the national ambitions for STPs using Flo as an exemplar.  Focuses of the programme include:
  • Strengthening prevention and early intervention
  • Improving productivity
  • Tackling variations in care
  • Developing enablers
  • Upskilling the workforce
  • Redesigning and improving healthcare services in all settings
The programme has now rolled out nationally supporting general practices to become more digitally-enabled whilst supporting respiratory conditions at scale.  Promoting TEC and digital care not only gives patients the reassurance and confidence to manage their health at home, but it can also upskill clinicians, improve patient safety and improve clinical capacity.
Around 300 attendees have taken part in workshops so far across the country, giving them the opportunity to discuss the learning developed during their local TEC implementation.  A number of attendees provided feedback that they would like to improve their digital capabilities, such as:

I would like to persuade the practice nurse team to use Flo Simple Telehealth to engage younger asthmatic patients

Flo telehealth is a good way to monitor patients’ blood pressure and chronic obstructive pulmonary disease (COPD)

To find out more about the programme, take a look at the full article available via RCNi’s Primary Health Care journal, to read examples of how Flo is supporting respiratory patients please see here

Lifestyle Industry Magazine features our partner Bitjam, and Nellie!

posted 17 Jun 2020, 07:58 by Hollie Stirman

17 June 2020 

Based on 10 years of healthcare quality and safety learning through clinical innovation with Florence, ethical development company, Bitjam Ltd are featured in the new issue of Lifestyle Industry Magazine sharing how they are working with us at Simple Shared Healthcare to deliver telehealth with a human touch worldwide.

Cutting edge telehealth technology is extremely powerful, as it allows the NHS to care for more people in their own homes, thereby reducing GP visits and hospital admissions and saving money.  Many people are finding the system useful because it is ‘telehealth with a human touch’. "

East London Foundation Trust: Maintaining Connectedness post COVID-19 Discharge with Flo

posted 12 Jun 2020, 00:59 by Hollie Stirman

12 June 2020 

Community of practice members from East London NHS Foundation Trust (ELFT) were some of the first to recognise Flo’s role in their local COVID-19 response and begin developing pathways to support patients during the COVID-19 pandemic.

The ELFT Telehealth Team is aware that people may be overwhelmed with the amount of official information and updates, and confused by misinformation spread via word of mouth and social media.  However, it was of the utmost importance that members of the public adhere to and follow up-to-date official advice in order to reduce the likelihood of further transmission of the COVID-19 virus.  As a result a pathway was developed to provide reassurance to patients with a confirmed diagnosis of COVID-19 who were well enough to be discharged home, and patients that were at the extremely high risk group in the community.

On a daily basis, patients are self-monitoring their symptoms including patients post-Covid discharge through integrated discharge hubs from the acute setting, with Flo providing approved guidance or support around how to continue to monitor their recovery at home.  If a patient meets a designated clinical threshold, Flo directs the patient to contact 111 as per official guidance.

In addition, the Telehealth Team at ELFT have integrated daily symptom checker questions into pathways for patients already being supported by Flo.  These patients are likely to already have pre-existing health conditions; the consequences of contracting the virus could therefore be more severe, thus increasing the importance of following current guidance.
Recognising the increased levels of anxiety around both their physical and psychological wellbeing during COVID-19 within these patient cohorts, Flo’s regular friendly prompts are reassuring patients, keeping them safe and helping them to feel cared for, connected during this difficult time and getting a holistic intervention in the community at the right time and thereby avoiding hospital admissions where appropriate.

One patient was particularly grateful for Flo’s help and provided some feedback explaining how Flo has helped them during this difficult time:

 The team are looking after me very well. But at this time when I feel more anxious with COVID-19, they have added some new questions to my Florence app. I can answer the questions and send my answers over very quickly, and they respond to me if I’m having any problems. This has made me feel a bit more at ease and not call my GP at this busy time.
Thank you to the Telehealth Team 

Raguraman Padmanabhan, Telehealth Clinical and Service Lead, commented on his experience implementing Flo during the COVID-19 outbreak:

Flo for COVID-19 has been a significant addition to the existing protocols and has helped reshape care pathways to facilitate care from hospital to home. Our service users informed us that it has been very reassuring and felt well connected with the team if they had any queries. We are looking into extending it to other specialist services in the community.

British Journal of Psychology; Preventing relapse with personalized smart‐messaging after cognitive behavioural therapy: A proof‐of‐concept evaluation

posted 11 Jun 2020, 04:42 by Hollie Stirman

11 June 2020 

We are delighted to share a recent British Journal of Psychology publication “Preventing relapse with personalized smart‐messaging after cognitive behavioural therapy: A proof‐of‐concept evaluation”.  The study independently evaluates the application of Florence’s smart-messaging techniques to reduce relapse from Cognitive behavioural therapy (CBT) and compliments the recent publication from the Clinical Psychology Cancer Service Team at Sherwood Forest Hospital Foundation Trust, around their proof of concept evaluation of using Flo to support cancer patients undertaking mindfulness-based CBT in the open-access Psycho-Oncology journal.

The publication reports outcomes from two focussed studies
  • STUDY 1: Clinical Outcomes of Smart-Messaging Users Versus Non-Users Following Remotely Delivered CBT for Health Anxiety
  • STUDY 2: Feasibility of Smart-Messaging Users in Routine Care (see here)

CBT can improve symptoms of anxiety and depression, but importantly also reduces the risk of future relapse after therapy completion.  However, current CBT relapse prevention methods are resource‐intensive and can be limited in clinical practice.  Studies suggest that acquiring CBT‐related coping skills is an important component of any relapse prevention.  However, 30–50% of patients attending CBT for anxiety and depressive disorders still relapse within the first year after treatment, with greater relapse rates found in clinical practice than controlled research conditions (Delgadillo et al., 2018; Hollon et al., 2005).  Existing CBT interventions to specifically prevent relapse are time and resource intensive with mitigation typically involving additional therapy sessions focused on developing relapse prevention plans, identifying potential triggers for relapse, and learning coping strategies to manage such eventualities (Bockting et al., 2005).
Digital health interventions have previously been harnessed to increase the reach and accessibility of relapse prevention interventions in several recent trials, however meta‐analyses of digital relapse prevention interventions suggest that the benefits are moderated by the degree of personalisation included (Hennemann et al., 2018).  In addition, minimal, but personalised, relapse prevention methods that include an individual plan are preferred if regular contact with a mental health professional is not an option (Muntingh et al., 2019). 
From this evidence, the team identified that Florence's unique persona-based, pragmatic and innovative mix of messaging technology and psychology was an opportunity to extend the impact of therapy sessions across both cohorts.  The team also recognised that it was critical for Florence’s interactions to be personalised, and subsequently worked with participants within their final two therapy sessions to co-design Florence’s interactions around the advice that they would want to receive once face-to-face therapy had ended if in future they were either doing well, experiencing early warning signs of relapse, or experiencing full relapse including patterns of thought, behaviour, and characteristic emotional responses. 
For 25 weeks post-therapy, participants were supported by weekly interactions with Florence, being able to rate their well‐being and dependent upon their response, receiving the tailored advice they had written, appropriate to the well‐being level reported after recovery from health anxiety. 

Outcomes collected by independent researchers demonstrated that:
  • Across a 12‐month follow‐up, participants receiving smart‐messaging showed greater health improvements than those who did not.  Well‐being scores showed stability between CBT completion and 6‐month follow‐up among routine care patients.
  • The findings suggest that a low‐intensity, personalised relapse prevention method can have a clinical benefit following CBT for common mental health problems.
  • In clinical practice, post‐treatment smart‐messaging can be well used by patients and may help maintain stable well‐being in the 6 months after CBT ends.
  • The evidence supports the clinical utility of a brief tailored digital intervention, which can be integrated within routine clinical practice with minimal therapist input.
  • Overall, longer‐term post‐CBT outcomes may be improved by integrating a smart‐messaging intervention at the end of therapy.
  • The study offers initial evidence that post‐treatment smart‐messaging may support greater outcome improvement over a 12‐month follow‐up period and is worthy of formal evaluation in a randomised controlled trial, due to its potential as a cost-effective and accessible means of enhancing CBT outcomes.
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, please don't hesitate to get in touch via our contact us form.

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