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HSJ Awards 2020: Winner
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
Change Management lead – Assistive Technologies, Connect Nottinghamshire
Emma Moore
Emma Moore
Team Lead – Community Urgent Response Team, Nottinghamshire Healthcare Trust
15 January 2021
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:
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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
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.
Flo Showcased in NHS England’s Cardiology Digital Playbook
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
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
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
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:
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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
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:
| 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!
17 June 2020
“ 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
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
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
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:
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