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The King's Fund; “Florence is a low-cost, low-risk innovation with a strong track record.”

posted 18 Jan 2018, 09:19 by Hollie O'Connell   [ updated 19 Jan 2018, 05:31 ]

 Adoption and spread of innovation in the NHS 
 16 January 2018 

This latest independent publication by Ben Collins of The King's Fund discusses the challenges of innovation adoption in the NHS and draws on “eight examples of successful spread of innovation”. We’re delighted that our own Simple Telehealth Community of Practice including, ‘Florence’ and ‘Annie’ have been selected as one of the eight examples.

Some of our favourite quotes from the study; 
  • “Florence is a low-cost, low-risk innovation with a strong track record.”
    • The benefits Florence can deliver are wide ranging
    • Florence is an enabler rather than a solution for clinicians and their patients.
    • 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
    • “Florence can contribute to a dramatic improvement in quality of life for patients with long-term conditions”
    • “It fits within and can be adapted for existing work processes rather than requiring substantial redesign.  It doesn’t require staff to develop new skills or very different ways of working.”

    Click to read the full publication or the Florence case study.

    NHS England's "Challenging Health Inequality" report cites Flo as 'Soft Tool' for intervention

    posted 20 Dec 2017, 07:54 by Hollie O'Connell

      Flo identified as tool to reduce health inequality in England through self-management

    The "Challenging Health Inequalities" October 2017 report compares emergency admissions and unplanned hospitalisation inequality throughout England, and has identified Flo as a successful intervention tool in supporting the reduction of health inequality.  

    # TotallyUnique

    NHS Western Isles take top QuDoS Accolade

    posted 14 Nov 2017, 07:41 by Hollie O'Connell

    Congratulations to
    QuDoS in MS special award WINNER Rachel Morrison of the NHS Western Isles MS Service.  We're all thrilled that Rachel's good work has been recognised with such a prestigious national accolade and we're proud to support the NHS Western Isles MS service with Florence.

    #NHS Western Isles #TotallyUnique 

    Igniting Clinical Innovation

    posted 6 Nov 2017, 02:29 by Hollie O'Connell   [ updated 6 Nov 2017, 07:33 ]

    06 November 2017 

    Inaugural Shropshire & Wales Regional Network Event 

    The Shropshire and Wales Regional Network has recently become the latest collaborative event facilitating the sharing of best practice amongst the Simple Telehealth Community, hosted by Powys Teaching Health Board (PTHB) at The Victoria Memorial Hospital in Welshpool on 26th of September 2017.

    Lisa and Karen kick started the day by offering an insight into developments; an overview of all things Flo!  Attendees welcomed an update on various new and exciting developments.

    Vic Deakins, Head of Therapies and Health Sciences, and Kath Lloyd, Service Development Manager for Therapies and Health Sciences, from Powys Teaching Health Board (PTHB), shared their experiences and learning from the beginning of their journey with Flo in October 2016.  In just 12 months, a number of pathways have been developed, including diabetes, pulmonary rehab, and falls prevention.

    Patients with poor glycaemic control received motivational messages to support education sessions that they were attending.  Feedback collected showed positive health improvements for patients; 90% lost weight, 57% saw a reduction in diastolic BP, and 76% saw a reduction in HbA1c.  Additionally, patients also gave positive feedback about using Flo, with 88% of patients finding Flo easy to use, 64% commenting that Flo helped them to manage their health better, and 87% stating that they would recommend Flo to friends and family.

    Positive feedback was also received from those patients on the pulmonary rehab and falls prevention protocols.  Moving forward, due to the positive outcomes demonstrated in the first 12 months Vic and Kath are aiming to secure dedicated funds to support further expansion of Flo across Powys.

    Following a quick break for lunch, Niall Salisbury, Florence Telehealth Administrator from Shropshire Doctors Cooperative (Shropdoc), spoke to the room about a new innovative model of care recently launched.  Shropdoc is offering a managed service to their local GP practices to administer and monitor patients referred to them for Flo’s support with their COPD, hypertension, asthma, diabetes, as well as offering some support for lifestyle and medication reminders.  To expedite the referral process, Shropdoc have developed a secure EMIS form, designed to facilitate simple and quick referrals using a process familiar to the clinician.  Patient evaluation questions are integrated into all of the protocols in use, and so far Shropdoc has seen positive patient feedback which they hope to continue to build on.  Additionally, Niall is responsible for producing Shropdoc’s monthly “Florence Telehealth Newsletter”, with the Regional Network event being featured in October’s edition.

    Kath Fackrell, Voluntary Services Coordinator at Shropshire Community Health NHS Trust, also took some time to discuss some future plans around supported early discharge at the Princess Royal Hospital in Telford supported by Flo.  The idea was inspired by an existing supported discharge protocol in use in South Tyneside which previously saw the team awarded as winners of the ‘Regional Enterprise Collaboration’ award as part of the Charity Achievement Awards (read more about this here).  Patient feedback in South Tyneside was positive, with 97% of patients stating they would recommend Flo.

    Given this success, Kath is hoping to replicate a similar project with patients from her area, and is well on the way to achieving this.  We are looking forward to hearing more about this project once it is up and running, and hope that it will be as well received as its counterpart in South Tyneside.

    The last portion of the day was an inspiring and passionate discussion amongst members, sharing ideas on different topics and learning points.  One timely topic was how Flo could support organisations with imminent winter pressures during the colder winter months where the NHS faces increased pressures from more “seasonal” illnesses, such as flu and norovirus, compounded by accidents such as slips and falls if the weather turns icy with those patients already suffering from respiratory and cardiovascular conditions becoming more vulnerable as the temperature drops.  Members discussed how Flo could support the delivery of routine care to free capacity for those in greater need and could support patients to manage their own condition through these challenging months seeking support at the right time, and the right place.

    • Patients with respiratory or cardiovascular conditions can access Flo to help manage their health, facilitating time appropriate interventions – reducing the likelihood of admission or appointment capacity much needed at this busy time. 
    • Flo can support respiratory patients in particular (who are more prone to catching colds and flu which can easily become more severe in nature), avoiding having to visit the hospital or GP as often, thus keeping them away from environments which pose a risk to their health.

    Innovative Clinicians Drive 20x Growth in Maternity: Supporting Mums and Mums-to-be

    posted 20 Oct 2017, 08:02 by Hollie O'Connell   [ updated 23 Oct 2017, 05:04 ]

    23 October 2017

    Driven by the growing independent evidence base underpinning a Totally Unique approach, diverse clinical teams continue to innovate with Flo, adapting and adopting her as an integral tool, to help their patients to self manage better. 

    Maternity continues to be an area of creative innovation with clinicians inspired to integrate Flo into new pathways beyond their primary implementation; since 2012 patients supported by Flo within maternity pathways has increased steadily and in 2016 we saw almost a 20 times increase in use of Flo than in 2012!

    Click image to enlarge

    Pregnancy Induced Hypertension (PIH) and Gestational Diabetes Mellitus (GDM) 
    In 2012, Flo’s support was focused towards mums-to-be diagnosed with either pregnancy induced hypertension (PIH) or gestational diabetes mellitus (GDM) with organisations in the North East delivering compelling evidence that Flo’s integration has been beneficial for staff, and most importantly patients.

    Patients reported: 
    • Feeling more in control of their condition. 
    • Reduced anxiety due to knowledge of baby’s wellbeing. 
    • High levels of satisfaction and ease of use using Flo. 
    • Women who had previously developed PIH during previous pregnancies stated that their latest pregnancy experience, supported by Flo, was ‘better’ compared to previous before.

    Clinical Outcomes: 
    • Where Flo was used in GDM pathways, clinicians found that fewer babies were being born in extreme weight percentiles, and pregnancies were lasting longer where they may have previously been induced due to complications of GDM. 
    • For use with PIH, Flo’s notifications as a result of increased symptoms resulted in appropriate admission of patients, who subsequently had labour induced.  Both mothers and babies kept healthy and safe as a result.

    Cost Effectiveness: 
    Based on Sunderland City Hospital’s pilot project using Flo for PIH & GDM, some estimated cost savings were calculated by the team.  These were done by comparing the treatment and contact Flo patients received, compared to the normal non-Flo care pathway (for example number of appointments etc.). 
    • For PIH, based on a cohort of 79 patients, predicted savings of £7,745.82 could be made over the course of pregnancy (£40,002 non-Flo, £32,256.18 with Flo). 
    • For GDM, based on a cohort of 119 patients, predicted savings of £11,624.73 could be made over the course of pregnancy (£153,189.99 non-Flo, £141,565.26 with Flo). 
    • In addition to this, fewer appointments with patients will free up time for clinicians and improve capacity
    Positive patient and clinical outcomes were supported City Hospitals Sunderland’s 2014 CQC visit who cited the application of Flo to support the GDM pathway as an area of outstanding practice.

    These successful pathways spread further across the North East region to South Tees NHS Foundation Trust, the West Cumbria Antenatal Services, Newcastle-upon-Tyne Hospital and Gateshead.  The proven pathways then spread even further to the University Hospital of North Midlands, Poole and Bournemouth NHS Trust, who have recently begun supporting mums to be with PIH during pregnancy via Flo.  While Great Western Hospitals are also accessing similar best practice PIH protocols moving forward.

    The West Cumbria Antenatal Service have delivered some solid outcomes from their implementation of Flo within their outpatient pathway supporting mums to be with type 1 diabetes, or those who develop GDM: 
    • 15% reduction in preterm deliveries in type 1 diabetic pregnancies. 
    • 25% reduction of macrosomia in type 1 diabetic pregnancies. 
    • 8% reduction of macrosomia in pregnancies with GDM. 
    • 20% reduction in cesarean sections in type 1 diabetic pregnancies. 
    • 34% improvement in achieving HbA1c targets at 28 weeks.

    As well as great clinician outcomes, patient feedback was also positive: 
    • 90% of respondents found Flo to be beneficial for managing diabetes during pregnancy. 
    • 90% of respondents found Flo’s advice messages useful
    • 90% of respondents would recommend using Flo to others. 
    • 100% of respondents found Flo easy to use.

    More Clinical Innovation 
    Moving forwards into 2017, the number of maternity pathways supported via Flo continued to diversify: 

    Breastfeeding support 
    Similar to PIH and GDM, Flo’s development towards supporting mums with breastfeeding emerged from an innovative pathway developed in the North East, and recognising the impact has now been adopted in other maternity units across the country, increasing the number of patients supported; emerging as the 2nd most commonly accessed maternity pathway. 

    Outcomes reported by mums of improved reassurance and support but that those supported by Flo for breastfeeding support were more likely to continue breastfeeding at 6 weeks when compared to those mums without Flo’s intervention. 

    Lauren, a new Mum who hoped to breastfeed her baby featured in the award winning “The Power of People” 
    video, commissioned by The Health Foundation to highlight the impact of 5 successful innovations. 

    More information around breastfeeding support pathways here.

    Type 2 Diabetes in Pregnancy
    Sandwell and West Birmingham Hospitals are developing an innovative pathway for mums-to-be already diagnosed with type 2 diabetes pre-natally.  The pathway reinforces support to self manage whilst receiving a new treatment regimes due to pregnancy and offers opportunities of timely intervention and reassurance for mums to be outside of the traditional clinic environment aiming to deliver improved clinical outcomes and more efficient use of capacity. 

    Scottish Health Boards have embraced the opportunity to support women pre and postnatally and have developed a range of emerging new pathways, below. 

    • Foetal movement monitoring 
    Pathways helping mums become more aware of their baby's movements during pregnancy, improving awareness of their own daily movements and what normal level of movement is to be expected; and if necessary who to contact and when to support intervention. 

    • Perinatal, postnatal and antenatal care for mums and their babies 
    Pathways supporting new parents and their babies.  Flo offers relevant, timely advice and guidance to support parents and their babies in having the best start in life. 

    • Smoking cessation 
    Pathways adapted from best practice smoking cessation design, tailored towards key techniques helping expectant mums quit smoking

    Seven months of Flo in Powys; 'Florence and the [Telehealth] Machine'

    posted 11 Oct 2017, 06:58 by Hollie O'Connell   [ updated 16 Oct 2017, 04:19 ]

    NHS Wales   
    Powys Teaching Health Board   

    Seven months after receiving training on Flo, this is a fabulous video summary of how Flo has helped with weight management, diabetes and respiratory patients in Powys, Wales.   We hear from a number of patients and staff about their experience and how they plan to expand the use of Flo. 

    #Wales #Powys #Diabetes #Weight Management #Respiratory #TotallyUnique

    United4Health; Deployment of Telehealth at Scale: Lessons Learned

    posted 11 Oct 2017, 03:40 by Hollie O'Connell

    11 October 2017

    Deployment of Telehealth at Scale: Lessons Learned and Guides for Implementation

    Flo has recently been featured in a United4Health report: “Deployment of Telehealth at Scale: Lessons Learned and Guides for Implementation”.  United4Health is a large scale European deployment programme that ran for three years from January 2013.  The purpose of United4Health was to implement and assess the impact of remote monitoring of patients with chronic conditions.  The recently published report aimed to highlight the learning outcomes from the implementation of nine telehealth projects across three of Scotland's Health Boards.  The overall findings demonstrated that the introduction of these telehealth programmes had been successful across the board, creating “transformational change” and “an appetite for at scale solutions”.  You can read more about Flo’s involvement below, but first NHS Lanarkshire’s Morag Hearty has given us an insight into just what being part of the programme meant for herself and her team:

    “ Wow!  What a journey, Lanarkshire took Flo on when we agreed to be one of the Scottish partners in the European study known as United4 Health – we even went on
     amazing European and world wide expeditions!  We were excited to have the opportunity of exploring Telehealth options which would provide both a clinically and cost effectiv
    e delivery to a potential large cohort of patients.  One attraction to Flo was the minimal time it took to get set up – no complicated web platforms etc.  although in truth, we took th
    e opportunity to upgrade laptops, and provide very helpful Smartphones to our specialist nurses thus providing a welcome incentive!

    Our first admin training in August 2014 was momentous!  Thanks to the support from Phil and Simple Shared Healthcare team, plus our own enthusiastic specialist nurses, we started developing our protocols in line with the U4H requirements for COPD and Heart Failure monitoring.  Testing and refining always takes more time than you might expect but we all were thrilled when the staff training was completed and our first patient 'opted in'!  Even better was some of the initial feedback from patients – easy to use and lets me manage my condition.  Staff also quickly reported saving travel time and being able to pick up on small but vital changes in a patient’s condition much earlier.

    Evaluation and the many “lessons learnt” from U4H certainly gave us a firm basis for scaling up and using Flo across an ever expanding range of conditions, while happily sharing our experience extensively across the U4H European partners and of course with our Scottish TEC programme colleagues.

    NHS Lanarkshire’s successful use of Flo with patients with COPD, Congestive Heart Failure (CHF) and Diabetes was discussed in detail in United4Health’s report.  One of Flo’s unique attributes is that she is user friendly and uses simple text messaging, a technology which is easily accessible to the wider population.  Using familiar text messaging means that patients do not need to have a smartphone, nor do they need to have access to broadband - something which NHS Lanarkshire highlighted as a reason for choosing Flo.  Indeed, two key learning points from the report are that: 

     Technology must fit the ‘environment’ within which it is being deployed in terms of availability, infrastructure, accessibility and ability to customise
    …the newest technology is not always the best for the task

    Another benefit of using Flo is that patients are using their own mobile phone: they will be familiar with the device and it also means there is less cost incurred for the provider of Flo.  Simply put, from her early beginnings, Flo was designed to work in a way which this report suggests is the most effective!

    The efficiency of setting patients up was also an important reason for choosing Flo:

    Once the decision was made to go with a text messaging service, setting up the technology at the patient’s end was straightforward and quick.

    Additionally, Flo’s prompt replies were seen as another recommendation for her use, as they “ enabled the patient to assess his/her own condition, send answers into SMS Solution (Simple Telehealth) and get immediate advice. 

    Over the three years that the United4Health project ran, there was found to be a “...strong enthusiastic strategic support for at scale adoption and implementation of Home Health Monitoring and Technology enabled care” in Lanarkshire, which is further evidence to add to Flo’s already proven capabilities.

    There is a growing recognition of the potential for digital technology, particularly simple, low cost solutions like those adopted in U4H to support and improve many aspects of health and social care provision across the health board. ” 

    As part of the United4Health project, NHS Lanarkshire also interviewed some patients to get their perspective on having Flo’s help managing their health; of course, she received glowing reviews!

    The first patient interviewed found that Flo’s portability was a great convenience - especially seeing as he took the interview call from Paris en route to a business engagement in Asia!  As the gentleman frequently travelled for work, being able to text Flo his readings from wherever he happened to be was of great importance to him He felt that
    “ the fact that the text will go to a professional….[gave] him confidence, as he knows that a professional is reviewing his results 

    He also felt that Flo’s “ flexibility to work everywhere ” gave him  ...a feeling of safety that enables him to lead a normal life ".

    Two other patients were interviewed, both of whom had COPD and found Flo to be of great benefit to them, one going so far as to say 

     [Flo is] part of the family now- just a text away 

     Due to the nature of COPD, patients can often become worried about their symptoms and ended up panicking and rushing to hospital. However, using Flo gave the third patient interviewed the confidence to  differentiate between shortness of breath due to panic as opposed to a lack of oxygen .  The patient now feels that Flo’s help to review their symptoms has “ provided a high level of comfort ” to both them and their carers.  Another benefit of using Flo is that she offers a flexible solution to suit a patient’s needs, again something which those interviewed identified to be of value.

    Overall, those interviewed found Flo to be convenient, easy to use and helpful in the management of their condition.  Flo aims to give the patient the confidence to self manage their health by providing that extra link between the patient and their healthcare professional (HCP) to reassure them; this was certainly the case during Flo’s implementation in Lanarkshire: 

    “ [Flo] enables an “emergency visit from HCP”, the knowledge that there will be an immediate response when a problem is detected is very important. ” 

    Flo wins top "Digital" accolade at NHS Sustainability Awards 2017

    posted 30 Jun 2017, 07:43 by Hollie O'Connell   [ updated 16 Oct 2017, 04:58 ]

    ‘Flo’ in West Lancashire’s Heart Failure Service named No1 for NHS digital sustainability 

    West Lancashire Clinical Commissioning Group (WLCCG) implemented an effective Tele Health text messaging system – ‘Flo’ in West Lancashire’s Heart Failure Service.  Flo (which was named after Florence Nightingale) sends patients reminders and health advice tailored to the patient’s needs. 

    The technology allows Clinicians (Doctors or other health professionals such as Nurses or Community Matrons) to design specific protocols (define messages, set up parameters and alerts, etc.) on Flo for their patients.  Flo enables Clinicians to capture real time information about their patients at any time via a simple messaging interface.  The solution prompts the patients to submit readings such as their oxygen, pulse, blood pressure and weight readings.  Depending on the readings, prompt advise & guidance is given to the patients; Clinical alerts (if any) are sent to the Clinicians.

    Since the implementation of Flo within the Heart Failure Service, the selected cohort of patients, identified suitable for this technology, were able to self-manage their conditions more effectively.  It decreased unnecessary Clinician-patient contact and released capacity within the system for more appropriate appointments and referrals.  

    Recent feedback captured from patients using Flo, following it’s implementation, have shown:
    • Significant reduction in the number of face-to-face Clinician-Patient contact, thereby reducing hospital admissions/unnecessary visits
    • Empowered patients to manage their health conditions better
    • Freed up Clinician’s time to see other patients who need urgent care
    • Delivered positive patient experience due to a sense of personal support and flexibility offered by the unique Tele Health solution
    • Patients felt more confident co-managing their condition  

    Scotland; 'Mission Slimpossible', ‘Walk 500 Miles Step Count Challenge’ & fab new video from NHS Lothian

    posted 30 Jun 2017, 05:05 by Hollie O'Connell   [ updated 16 Oct 2017, 04:21 ]

    It's another busy month for Simple Telehealth Community members and whilst we're not able to share everything that members achieve each month, heres a couple of new items from Scotland worth checking out this month.

    A great new patient video animation showing how Flo works and the type of conditions being supported by good old Flo in Lothian !  

    And...   'Mission Slimpossible' and ‘Walk 500 Miles Step Count Challenge’ from NHS Western Isles, describing how clinicians are using Flo to help their patients to lose weight and keep fit with innovative programmes.

    #Scotland #NHS Lothian #NHS Western Isles #TotallyUnique

    RCGP Technology Enabled Care eLearning course stars Flo

    posted 14 Jun 2017, 08:15 by Philip O'Connell   [ updated 16 Oct 2017, 04:21 by Hollie O'Connell ]

    Hannah Mountford 
    Assistant to the Director of Services and Community SSHC 

    15 June 2017 

    RCGP "Telehealth, Telemedicine and Telecare: an Introduction to 'TECS'"

    Technology continues to develop at a rapid pace, often improving our lives and becoming integral to how we conduct our day to day and professional lives.  A prime example of this is the development of the smartphone; given that we have embraced technology so fully in today’s world, it is vital that our healthcare services do so to maximise opportunities that it offers and bring healthcare into the world of how many patients operate their lives.

    This is where Technology Enabled Care Services (TECS), such as Flo come in using accessible and convenient methods in motivating patients to increase their engagement in their own self-care by providing that extra support that really gives patients the confidence to engage in the self-management of their health.  Indeed, Flo’s efficacy hinges on the fact that she utilises one of the most accessible and familiar forms of modern technology: text messaging.

    To get the most from TECS such as Flo, it is vital that healthcare staff are well informed, and have the knowledge that allows them to use TECS to bring true benefit to the lives of their patients.  The Royal College of General Practitioners now offers a free online course to introduce the core concepts, applications and advantages of TECS to healthcare workers.

    How to access the RCGP eLearning Course
    To access the eLearning course, you can either use your existing RCGP login details, or if you are not registered you can sign up for a free account. Sign up open to all, so non-clinical members of staff are also able to improve their knowledge and understanding of TECS.

    How is the course structured?
    The course begins by taking you through a pre-course assessment with 8 multiple choice questions, providing a baseline for what you may, or may not already know about TECS.  Having completed this, you will then work your way through 3 learning sessions:
    • Telehealth, telemedicine and telecare: an introduction to "TECS" 
    • Technology enabled care in practice: ideas and examples 
    • Technology enabled care in practice: developing and evaluating
    Each of these sections is made up of interactive slides that along the way will ask you to consider your existing knowledge of TECS as well as what you have learned during the session.  For example, the first session, Telehealth, telemedicine and telecare: an introduction to "TECS" asks you to write about any example telehealth you may have already come across already, a prime example being Flo. Having done so you are able to submit your answer, and additional information specific to the question is provided.  These tasks are present in all three learning sessions, and are useful to both consolidate knowledge and prompt more consideration of the application of TECS.  Additionally, at the end of the learning session, there is the option to download any answers you may have submitted so that you can review them at a later date.

    Having completed the learning sessions, there is a post-course assessment and once complete you will be able to download a certificate stating that you have completed the online course. 

    What is the course like?
    The course itself is very informative; it provides a great overview for any who are new to the idea of TECS, or can act as a useful refresher for those who already have some knowledge of the subject.  The learning sessions also feature a number of short videos about the application of TECS; how they are implemented, how they work and the experiences that patients have of using them, the focus of many of the videos being Flo’s application.

    The questions asked during the learning sessions are particularly useful, as the suggestions given afterwards are likely to prompt more in depth thought on the subject.  The post-course assessment is also helpful in this way, as once submitted the answers are expanded on, which further consolidates your knowledge. 

    The length of this course is suggested to be around 90 minutes; while this may be accurate for those with prior knowledge of TECS, perhaps slightly more time may be needed by those unfamiliar with them to really get the most from the course.

    This RCGP eLearning course showcases the implementation of the NHS's Flo as the subject example, something that we here at Simple Shared Healthcare are proud of.  The eLearning course also features an excerpt from the Health Foundation’s award winning short film about the impact that Flo has on patient’s lives, “The Power of People”.  You can watch the full film here.

    This recognition by the RCGP by using Flo as the exemplar example of TECS delivery in their pioneering eLearning package is another milestone for Flo distinguishing the scale at which Flo is used and the impacts delivered across the United Kingdom.


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