Getting the most from technology requires pathway redesign

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The topic of technology led at September’s NHS Innovation Expo conference. More organisations were confirmed for the global digital exemplar (GDE) and fast follower programmes, focused on digitising providers. Meanwhile, Simon Stevens’ keynote speech majored on technology and he announced funding for a further two years of the existing test bed programme. This programme supports real-world testing of combinations of different innovations in the hope that they improve care, at the same or lower cost as existing services.


NHS England used Expo as an opportunity to showcase the test bed areas, publishing a ‘Story so far’ update. These seven areas test different technologies with the aim of demonstrating how to choose, implement and iterate technology to transform care pathways and the experience of care. The most interesting aspect of test beds is how they aim to change the way that care is provided to patients, with the technology acting as a rallying point that brings together clinicians, managers, innovators and patients to redesign the pathway. This means change is as much about how health care professionals work as it is about the technology.

Take the Care City Test Bed in North East London. It started by convening clinicians and innovators in workshops and conversations to identify the kinds of innovation that would be most valuable and how these might work in clinical practice. Bad ideas can die quickly; good ideas develop to become better.

In North East London, community pharmacists are piloting the use of a device, Kardia Mobile, in conjunction with a smartphone to screen for atrial fibrillation. Pharmacy staff were trained to use the device (even if they had no clinical training) and during the pilot 1,400 people were referred to their GP for further screening. Through a process of constant feedback from evaluation partners in UCL, it became clear that while the technology was working, the pathway was not. Patients were being referred to their GP who would then do the same test again. This needlessly extended the time between initial screening and treatment.

As a result, the pathway is changing. A new rapid referral route is being developed for pilot pharmacies to refer patients directly to Whipps Cross University Hospital One Stop Shop. It is hoped that this will reduce screening to treatment time from 12 weeks to just two. What started as a simple low-cost technological innovation means that patients could now be treated more quickly – and without having the added step of seeing their GP – at a lower overall cost to the system. The improvements here are delivered directly to the patients who get seen more quickly.

Sheffield’s Perfect Patient Pathway Test Bed explicitly focuses on transforming the patient pathway. Digital care homes, one part of the test bed that is being developed, has started to facilitate conversations between innovators, the local hospital, community nursing and care home staff. The goal? To track the vital signs of residents and intervene before they need to be admitted to hospital. 

Staff in participating care homes will regularly measure the vital signs of patients and feed this into an electronic patient record that is shared with community nurses and a specialist triage centre at the local hospital. The shared record is the technology here, but the real change comes with this data being regularly collected and reviewed. If a resident is flagged as at risk, the care home is called and if staff agree with the triage centre’s assessment a community nurse is sent out within four hours to administer a more detailed check-up. When implemented, this new pathway could reduce unnecessary admissions by intervening early. In Sheffield, early intervention is a priority because of the high numbers of care home residents attending A&E, 40 per cent of whom are then admitted to a specialist frailty unit. Bringing social care into the mix is important, building ways of working that integrate health and care.

There is much to learn from the test beds, but it’s easy to focus, magpie-like, on the technology. As exciting as the technology is, the more enduring lessons are much wider: focus on how to optimise the patient pathway and then allow the technology to follow. Focusing too much on wanting to implement digital technology can lead to clinicians simply doing the same thing they have always done, but with technology. But if you really want to change patients’ care, getting technology right needs to be backed up by co-design, continuous evaluation and a willingness to change clinical practice.

The lesson for NHS organisations to take from test beds is this: how that technology is used as a focal point for collaboration to foster patient-centred care is more important than the technology itself. At The King’s Fund, we’re focusing on how technology can be adopted at scale in NHS organisations, but the system should not forget that it’s not adoption but pathway transformation that will lead to the real change.

This article was originally published in the British Journal of Healthcare Management on 11 October 2017.


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