Dr Ruth Chambers and Marc Schmid explore the opportunities for practices to improve efficiency using digital developments
New technology is often oversold, especially in healthcare, and you may be cynical about apps that promise to transform care and ease workload. But often, tools can minimise unwarranted variation, boost your productivity and improve patient experience. Here, we examine just a few of these and show how every practice can benefit from technology, regardless of their level of digital literacy.
First, it makes sense to establish what tech your practice has the capacity to offer.
Tech-enabled care doesn’t have to be daunting. In fact, you’re probably already familiar with many of its platforms.
At the most basic level, your team could promote healthy living via the practice website, Facebook page and mobile apps. Clinical management could be improved with text reminders, or by offering video consultations, for patients who struggle to access the practice.
Practices are already seeing the benefits of these fairly simple tools in terms of productivity, through:
• Carrying out care-home consultations remotely instead of face to face, which helps reduce the need for visits by GPs.
• Enabling patients to take more responsibility for follow-up care.
• Improving patients’ adherence to medication regimens and care plans.
To maximise uptake of tech across your team, you need to explore how digitally literate they are. They might be comfortable using their smartphone to video-call children who live away from home, or doing online banking and shopping, but still be nervous about using tech tools for delivering healthcare to patients. To find out, present your colleagues with the quick digital literacy test questions.
Example of a digital literacy survey for practice team members
How often do you use digital tech, eg apps and telehealth, at work?
Which statement most closely describes how you feel about using digital tech as part of your practice?
To what extent do you agree:
‘I can see the benefit of using tech-enabled healthcare for my patients and my fellow practice nurses/GPs?’
There are several areas where tech will help. For example, in respiratory medicine you can prompt patients to self-monitor and take medication accordingly. This could be facilitated via a closed Facebook group for patients with COPD, for example, which can nurture a beneficial atmosphere via peer support, with regular health messages posted by practice nurses.
For hypertension, messaging apps are also simple and effective. Flo Simple Telehealth is a text messaging system that sends patients reminders and health tips tailored to their individual needs. A patient with hypertension could be prompted to check their own blood pressure and text the results back to Flo, which in turn would alert the GP if necessary. The service can support patients with long-term conditions, encouraging those with COPD or asthma to self-monitor for early signs of deterioration and prompting them to start treatment according to an agreed shared-care plan. This makes attainment of QOF indicators more likely, and unnecessary admission less likely.
The Manage your Health app offers a variety of resources for professionals and patients to help manage long-term conditions. Its resources include, for example, avatars demonstrating how best to use a variety of inhalers.
You could consider using animation on your practice website to highlight the dangers of smoking and to remind patients about the cessation services you offer. An example of an animation promoting NHS Health Checks created by nurses can be viewed on the online video platform Vimeo.
If you are scoring substantially lower than other similar practices in any long-term condition or lifestyle area, you could agree a team plan to improve care for that condition, taking the opportunity to introduce technology as a central element of the plan.
Apps such as those mentioned above can empower patients to share responsibility for their own health, helping them address adverse lifestyle habits, such as smoking, or control long-term conditions, such as diabetes or hypertension. This will also be useful for demonstrating your focus on quality improvement at your next CQC review.
Used appropriately, remote consultations can be more efficient, saving both money and time. This is most obvious where video consultations, using software such as Skype, are an option between patients in care homes and GPs, advanced nurse practitioners and pharmacists.
In Staffordshire, video has been used to connect GP practice teams to care homes. In just a year, more than 2,000 video consultations with one GP were conducted, which reduced spend on locums.
Additionally, video is being used in Lancashire and South Cumbria to support retention in the profession by allowing GPs to work flexibly to support patients remotely. It can also be useful for patients who find it difficult to get to the practice. Skype can also be used to discuss cases with other clinicians.
If you need guidance, a protocol for introducing and conducting video consultations can be downloaded from CliniTECS.This is a resource designed to support healthcare professionals in the use of tech-enabled care services. It highlights how simple tech can make a difference to the way we communicate with patients. CliniTECS also has guidance on setting up Facebook groups and building staff’s tech skills. The box above offers advice that can be used to help address patients’ concerns about the use of video.
While doing so, ensure your practice has clinical indemnity cover for all the clinicians who will be likely to administer consultations of this type. In addition, make it clear to your medical defence organisation that you are offering these instead of face-to-face consultations between clinicians and patients – not in addition to.
Each practice will face unique challenges, but all can be met with the principle of the 7Cs: competence; confidence; capability; capacity; communication; continuity and creativity.
It’s easier for healthcare professionals to demonstrate modes of tech-enabled care to patients if the staff have their own tablet with trusted apps to showcase to patients or use on home visits.
Equipment must also be accessible. For example, atrial fibrillation screening devices are useful to have to hand. Although they are not cheap, with the Kardia AliveCor costing around £100 each, they are certainly worth the investment. They simply connect with a smartphone or tablet and typically average a 95% specificity and sensitivity for AF. If the screening indicates AF is likely, a 12-lead electrocardiogram will need to be organised by the practice.
Be prepared for times when WiFi isn’t available – such as on home visits. You might also have ‘dark spots’ where the signal is weak in certain areas of your practice. Ensure you have a back-up plan for these situations, such as a phone consultation if appropriate, or rebooking as a face-to-face appointment.
Regular evaluation of the use of tech is also a worthwhile exercise for practices. Being able to demonstrate that tech-enabled care provides a good return on investment can justify its continuing use.
Don’t be afraid to embrace digital platforms to get the message out and promote aspects like self-care. You can use your website and social media. CliniTECS’ free guide Making Digital Healthcare Happen in Practice can steer you through the process.
Invest the time to build the digital confidence of your colleagues. Encourage them to identify opportunities in this area, and prioritise tech-enabled care in your overall quality improvement plan.
Create a culture where all levels of staff are inspired to learn about healthcare tech, no matter what their starting point. As the practice benefits from implementing tech solutions, staff will begin to realise the positive difference simple technology can make to patient care.
Dr Ruth Chambers is a retired GP and Staffordshire STP clinical lead for the tech-enabled care and digital workstream services programme. Marc Schmid is director of Redmoor Health, which supports practices across the UK to use technology
Video consultations and patients’ rights
Before asking patients to participate in video consultations, practices should ensure they are aware of their rights and the policies in place to protect confidentiality. The following can act as a guideline for patients.
• I understand that the NHS privacy and confidentiality policies and procedures relating to my medical information also apply to video remote consultations.
• I understand that the Skype/video technology used by the clinician is encrypted to prevent the unauthorised and unlawful access to my personal confidential data.
• I have the right to opt out and to withdraw my consent to the use of Skype/video for consultations at any time.
• I understand that clinicians have the right to opt out and withdraw their consent to the use of Skype/video for consultations at any time.
• I understand that the remote consultation will not be recorded.
• I understand that the clinician will not allow any other individual who is not directly involved in my care to listen to, or watch, my Skype/video consultation.
Resources
CliniTECS
Designed to support health professionals to use tech-enabled care services
Clinitecs.uk.
Fingertips
Provides easy access to in-depth analysis of a wide range of health and health-related data Fingertips.phe.org.uk
Florence Simple Telehealth
Text messaging system
Tinyurl.com/flo-intro
Manage your Health Promotes sharing of new modes of
delivery of care and adoption of proven innovations.
Manageyourhealth.info
NHS Health Checks Animated video example
vimeo.com/349882598
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