Comment: Integrating care – the ‘smart’ way

Mark Vizard from Hicom on how mobile technology is being used to empower clinicians and patients

In this article, Mark Vizard, business development manager at Hicom, looks at how mobile technology can be used to transform community services, empower clinicians and patients, and support the national objective to establish efficient and effective models of integrated care

The aspiration to move care out of hospitals and nearer to patients’ homes has been a long-standing strategic objective, but progress has remained both slow and limited

The aspiration to move care out of hospitals and nearer to patients’ homes has been a long-standing strategic objective of UK governments for decades. But, despite the rhetoric, and countless policies at transforming community services, progress has remained both slow and limited.

The most-recent attempts, under the 2008 policy umbrella of Transforming Community Services, have delivered incremental benefits such as a reduction in lengths of stay in NHS hospitals. Likewise, the 2013 redrawing of the commissioning landscape, along with subsequent localised QIPP initiatives aimed at redesigning care pathways, has led to a redoubling of efforts to reduce the pressure on hospital resources with the introduction of more-innovative services. But demand on secondary care, as typified by the enduring A&E and winter bed crises, continues to grow – and the need for more efficient, effective and joined-up community services intensifies.

The contextual symptoms are well-known; an ageing population, the continued growth in patients with long-term conditions and the inexorable rise in people with multiple morbidities are placing a strain on NHS resources that cannot easily withstand the frugal demands of the current economic climate. As real-terms healthcare expenditure apparently slows, a reliance on old, ponderous and expensive models of care will no longer work. But while diagnosing the problem is straightforward, finding the cure – and indeed managing the change required to deliver it – is entirely more challenging.

Community centre

In the age of the smartphone, technology is providing a powerful stimulus to make communication – and indeed activity – across the health and social care system, fittingly, much more smart

Community services have long been hailed as the knight in shining armour that can transform NHS care. And why not? Appropriate care in the community, nearer to patients’ homes, offers a significant improvement in the patient experience – and can only help reduce avoidable hospital admissions and unnecessary queues at A&E. Likewise, in line with widespread Public Health initiatives aimed at shifting emphasis away from emergency care and towards disease prevention, community services can play a significant part in transforming patient/NHS engagement to alleviate the burden on critical NHS resources.

Moreover, as the age-old problem of ‘bed-blockers’ persists, whereby patients with no need for medical care clog up hospital wards as they await transfer into social care, community services can play a valuable role in providing liaison, support and indeed care outside of the hospital environment. The argument is therefore uncontested: strong community services are the key to an effective model of integrated health and social care. The question is: how do we move beyond the rhetoric and optimise the opportunity?

Mark Vizard is healthcare business development executive at Hicom

Optimising technology

There will undoubtedly continue to be much debate around the structure, funding and resourcing of community services. One thing, however, is certain: to succeed, technology must play a prominent part in any future model.

The UK currently invests more than £11billion each year in community services – around 10% of the total NHS budget. This, according to a recent King’s Fund report into community care, manifests itself in approximately 100 million community contacts each year – ranging from ‘public health functions such as health visiting and school nursing, to targeted specialist interventions in musculo-skeletal, services, chronic disease management and intensive rehabilitation’.

The King’s Fund argues that the scale of these interventions is poorly understood, and not well-served by health debate that often defaults to GPs and hospitals or primary and secondary care. The worst examples of sub-optimal care are commonly found in the gaps between these headline settings; the transfer of care from hospital to primary care – or vice versa – can often lead to gaps in communication that slow down care, delay treatment and, at times, result in patient deterioration and an avoidable hospital admission. Technology can help to fill these gaps, empowering clinicians, nurses and other healthcare stakeholders with information to enable a rapid, safe and accurate response to critical clinical issues – and better still, to help them manage more routine clinical issues, before they escalate to being critical.

The Smart approach

The technology to bolster community services that straddle both health and secondary care is now well established. A proliferation of digital and mobile media has enabled multi-channel communications across multiple devices and platforms – allowing mobile workers instant and reliable access to vital information to support clinical decisions.

In the age of the smartphone, technology is providing a powerful stimulus to make communication – and indeed activity – across the health and social care system, fittingly, much more smart. Increasingly, the NHS’ mobile workforce is being empowered by innovative mobile technologies that are enabling HCPs to become more responsive, informed and agile in community settings.

The most-effective mobile tools are those that are integrated and interoperable with existing systems in hospitals and primary care settings

A growing number of clinical/patient portals, online tools and mobile apps are being used to inform community services and improve outcomes in areas such as diabetes, paediatric care and mental health. Evidence shows that the effective use of mobile tools is helping trusts to unlock Best Practice Tariff funding, reduce administrative overheads, improve productivity, and increase time spent with patients.

The most-effective mobile tools are those that are integrated and interoperable with existing systems in hospitals and primary care settings, meaning that community-based HCPs can view, share and interact with the same data sets as colleagues in fixed locations, irrespective of whether they themselves are in a patient’s home, a school or a mobile clinic. Such an approach helps them make real-time decisions underpinned by real-time access to key clinical information. Furthermore, as the mobile telecoms infrastructure around the country continues to strengthen, the best systems are being developed and optimised to work offline, allowing HCPs that are operating in poor signal areas to capture and collate information and then synchronise it efficiently at a later stage.

Upwardly mobile

The barriers to introducing mobile technology into the NHS are disappearing. Senior decision-makers are recognising the efficiency and productivity gains that mobile can provide, as well as how smarter communications can expedite treatment pathways and the delivery of care. Mobile technology is increasingly being used across hospitals to record patient observations, escalate interventions and improve patient flow. It is also being used to transform secretarial operations and accelerate clinical correspondence. These same benefits are equally applicable in community settings and will indeed complement the long-term transition to integrated care.

In a demand-rich, cash-poor environment, the NHS must be clever with its resources. It’s time, quite literally, to get ‘smart’

As the introduction of the Community Information Data Set (CIDS) draws closer, robust mobile tools can help remote HCPs capture data at the point of clinical delivery. This supports the CIDS objective to use local and national comparative data to improve community services by informing commissioning decisions. The HSCIC mandates suppliers of IT systems for community services to become fully compliant with CIDS new data standards during 2014/15. These new standards provide further evidence of the important role technology is anticipated playing in helping the NHS harness information to transform care.

Get smart

Debate into how new models of community services can be developed to optimise health and social care resources will no doubt continue. Whatever the outcome, mobile technology can, and indeed must, play a role in the revolution. In a demand-rich, cash-poor environment, the NHS must be clever with its resources. It’s time, quite literally, to get ‘smart’.

Companies