In light of the launch of My Arthritis, Ampersand Health hosted an industry roundtable to discuss the future of clinician-patient communication.
This event is part of a series of expert roundtables discussing the benefits and barriers to using digital health for patients living with long-term conditions. Experts from healthcare organisations, academic institutions and industry bodies shared their insights and we’ve summarised the learning points below.
For context, My Arthritis, our latest digital therapeutic, has been designed to help patients self-manage their condition. The app supports people with inflammatory arthropathies such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Through the app, patients can independently access educational resources and courses that focus on lifestyle factors that can significantly impact the lives of people with inflammatory conditions. In addition, if their NHS Trust uses the platform, the app can be used in conjunction with a clinical team to facilitate two-way, asynchronous communication with clinicians. This provides reassurance and ongoing communication between both clinicians and patients outside of regular appointments.
The app and digital therapies have been developed by Ampersand Health’s in-house team of behavioural scientists and clinicians, in collaboration with specialists from King’s College Hospital, University Hospitals Dorset and the National Rheumatoid Arthritis Society. Clinical trials are currently underway.
Host: Dr James Somauroo – anaesthetic doctor by background with extensive experience in health innovation and technology. He runs a healthtech communications agency, somX and is a regular contributor to Forbes.
Dr Jonathan Marks: Consultant Rheumatologist at University Hospitals Dorset
Jeremy Andrews: Associate Director for healthcare partnerships at Ampersand Health
Zoe Peden: Investor at Amanda Impact Ventures
Paul Hudson: Senior Digital Innovation Manager at NHSX
What are the current models of care and communication?
Dr Marks opens by explaining that “the current model of outpatient care is very linear, rigid and inflexible.” This model of care hasn’t changed in decades, with very few touch points existing between clinicians and patients and relatively brief appointments. Following a consultation, letters are digitally dictated, transcribed, printed and posted to the patient with follow-up appointments scheduled for 3-6 months time. As our users know, inflammatory conditions, such as rheumatoid arthritis and inflammatory bowel disease, are unpredictable and associated with periods of relapse and remission. This older, rigid model of outpatient care does not provide enough support for these patients. The linear model of care assumes that no or very little disease process is happening in the duration between appointments.
Dr Marks comments that working within the current model, as demand for services continue to increase, the only options are to:
- Increase the time between appointments
- Employ more staff for services
- Dilute services
COVID-19 has shed light on the inadequacy of current communication methods between clinicians and patients. Dr Marks recalls how the rheumatology service faced a huge logistical challenge at the beginning of the pandemic when they tried to communicate with approximately 10,000 patients, delivering information about shielding, medication advice and additional measures.
Unfortunately, hospital records of patient contact details are very fragmented. The process was not as simple as sending an email to all patients as there were no email addresses for a large proportion of patients. “We’re not being as dynamic as we can be in our day-to-day work” commented Dr Marks, “outpatients is often overlooked within the system.”
What role can technology play in improving communication?
Jeremy from Ampersand Health describes how, with current models of care, follow-up appointments are scheduled for an arbitrary date in the future, “just in case.” The use of technologies such as remote monitoring and self-management apps allow for data to be delivered to clinicians. With the right level of monitoring and support, Jeremy notes that appointments can now be scheduled based on patients’ needs. With the My Arthritis app, clinicians can track patients’ progress day-to-day on various metrics (e.g. sleep, pain, diet, exercise etc). Patients are reassured that they do not need to be seen by their doctor for Just-in-case appointments and doctors can focus their time on patients who are unwell. By shifting from a Just-in-case to a Just-in-Time approach, capacity can be unlocked within systems and ultimately ensures those with the greatest needs can have priority access to services.
During the discussion, links were drawn to other industries that have innovated using technology. Examples included highly-regulated industries such as banking. Banking apps enable customers to remotely view their balance and transactions, send and receive money and provide users with a better understanding and control over their finances. Based on how users use and engage with these apps, banks can work to provide a more tailored service for their customers.
Paul Hudson from NHSX described how this feedback loop is missing in healthcare. Technology can fill in the gaps between appointments helping clinicians to make more direct, data-driven and timely decisions. Patients have a better understanding of what is going on with their health, consequently feeling empowered and more in control. Their experience of the system as a whole is much better. With these more frequent digital touch points, clinicians can begin to better understand the expectations of patients and patients can begin to better support themselves.
In addition, investors like Zoe Peden from Amanda Impact Ventures are looking for solutions that can improve patient experience in healthcare. Amanda says Impact Ventures is focusing on the challenges of waiting lists, especially given that the pandemic has significantly increased waiting times.
Zoe describes how she is seeing healthcare organisations slowly transition from a time-based system (e.g. follow-up in 3 months time) to more of a needs-based system. The ability to monitor patients between appointments, using technologies such as follow-up questionnaires and wearables, allow clinicians to schedule appointments based on the needs of patients. A needs-based approach can help reduce waiting lists. Simple technologies such as text-message appointment reminders and the ability for patients to cancel and rearrange appointments can help to significantly reduce did-not attend (DNA) rates. The speaker’s note that the challenges facing clinician-patient communication are not confined to the NHS and the UK either. Dr Marks described how in countries such as India, there may only be one rheumatologist serving a very large population whilst countries like Canada face challenges around geography.
Examples of challenges to adopting new models of care
- Lack of structure: Dr Marks describes how the lack of structure in outpatients and best practices make it very difficult to adopt new models of care
- Risk: if mistakes are made in healthcare, there is potential for enormous risks. With healthcare solutions that are patient-facing, it is not possible to move fast and break things
- Media scrutiny: the NHS is beloved by the public and as a result unlike other industries, healthcare faces significant media scrutiny about whether it is being mismanaged
- Interoperability: it is very challenging to integrate private and public solutions into the NHS. NHSX is leading conversations around how data flows between these systems. Technology needs to be secure. Data integrity is very important, especially when involving patient data. “We have to be very clear what data is being used for” states Paul
- Industry engagement: engagement is a massive challenge for developers. People engage with technology in different ways and Jeremy recalls the necessity of co-creation in thinking about challenges and designing products. From the offset, the team at Ampersand have been working closely with clinicians. Dialogue with clinicians, along with early patient feedback through hospital patient groups and engagement with leading national charities such as Crohn’s and Colitis UK, helped to better define the problem statement. Partnerships help to improve engagement levels with patients. Jeremy mentions how patients can use Ampersand Health products, My Arthritis and My IBD Care, on a stand-alone basis as self-management tools but higher engagement rates are seen when clinical teams also engage with the platform
- Patient engagement: from a patient engagement perspective, providing tailored content and support is fundamental. With a disease-specific approach, Ampersand is able to build therapies that can add significant value in a very personalised and specific way to patients with those conditions
What’s next for patient – clinician communication?
The pandemic has expedited innovations that address the manner by which clinicians and patients communicate with each other. However, there is still a great deal of low hanging fruit that can significantly free up capacity. With resources stretched in the NHS, Dr Marks speaks about the use of well-established technologies such as chatbots to automate repetitive administrative tasks that do not require staff involvement such as signposting patients to other resources and FAQs.
Solutions such as My Arthritis are supporting the move of healthcare from a solely biomedical approach to care towards a more holistic, personalised approach which allows for patients to be in the driver seat and initiate their own care. Dr Marks speaks optimistically about the future, “We’re ready for it. We cannot wait until the whole population is ready for the new models of working or asking for it. The more we integrate it, the more we see it works, the more we can push it to patients.”
As noted by our panel, there are clear, specific and measurable problems that can be solved with regards to clinician-patient communication in outpatients. The challenge exists around adopting and implementing technologies into the multiple areas where innovation can deliver results. As pointed out by Dr Somaruoo, “how do you get aligned so everybody is pulling in the same direction?” It is encouraging to hear individuals from various industries speak about the prospects of a data-driven future.
How is Ampersand developing for the future?
At Ampersand Health, with our two core products – My IBD Care and My Arthritis – and future products, we will continue to work closely with patients and clinicians as we look to scale across secondary care. A long-term goal is to begin thinking about integrating with electronic patient records. Patients with inflammatory conditions often have many blood tests and by connecting diagnostic data with self-monitoring data, we can build a fuller picture of their overall health.
To find out more about Ampersand Health for your healthcare organisation, get in touch with the team at firstname.lastname@example.org