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Technology-enabled remote monitoring

How can we build staff and patient trust and confidence in tech-enabled remote monitoring? Q Lab worked with the NHS to explore sustainable models to be scaled across the health and care system.

Q Lab worked with the NHS to bring people together between November 2021 and May 2022 to explore the evidence, issues and opportunities around trust in technology-enabledremote monitoring. Four test teams developed and tested prototype interventions for challenges in their settings. A report on the emerging insights from the Lab is available. 

Background to the Lab

Our topic for the Q Lab in 2021/22 was: how to build staff and patient trust and confidence in technology-enabled remote monitoring, so that it can be scaled across the health and care system.

Technology-enabled remote monitoring is the use of digital technology to support patients to monitor or manage their health or long-term conditions. It makes it possible to track and send health information – such as blood pressure, glucose levels, protein levels and symptom reporting – to a health or care professional, to assist diagnosis and management. 

Examples include wearable activity trackers, the smartphone-connected artificial pancreas’, and at-home diagnostics such as connected pulse oximeters.

Even before the onset of the COVID-19 pandemic, technology and digital transformation were priorities for the health and care system. While the pressures of the pandemic accelerated the pace of adoption of digital care in some settings, it also intensified some of the challenges. 

Digitally enabled care was a key part of the vision for improving value and access for patients during post-pandemic recovery of the health and care system. However, we need sustainable models for different settings and populations that prioritise staff wellbeing. 

What we did

Working in partnership with the NHS, Q Lab brought contributors with digital and/​or improvement expertise together with four test teams.

Over six workshops, the lab explored the topic, generated and tested ideas. The test teams then had the opportunity to bid for funding to implement successful ideas in practice. 

A timeline graphic depicting a six-step workshop process in a series of green rounded rectangles connected by arrows, indicating the flow from one step to the next. The steps are labeled: Workshop 1 Kick off, Workshop 2 Sharing insights, Workshop 3 Idea generation and prototyping, Workshop 4 Prototyping and testing, Workshop 5 Prototyping and testing, and Workshop 6 Closing. To the right of these steps is an orange rectangle with text that reads “12 months Grant funding phase,” explaining that teams are tested for grant eligibility to enable them to implement ideas in practice. Each workshop phase is associated with specific themes such as research and discovery, developing and testing.
The Q Lab ran across 6 workshops to explore the topic, develop and test prototype interventions and share learnings from those prototypes. Teams then applied for 12-month funding to implement successful ideas. 

Test teams

  • Chelsea and Westminster Hospital NHS Foundation Trust. Their challenge was explore digital health care exclusion in their diverse patient community. And specfically to make technology-enabled support for respiratory conditions accessible to all. 
  • Aneurin Bevan University Health Board with TEC Cymru. Wanted to understand how they might design and deliver remote monitoring services in secondary schools to help support, enable and manage physical health data in young people with eating disorders.
  • South Tees Hospitals NHS Foundation Trust and What Works Centre for Wellbeing. Sought to understand how remote kidney monitoring devices could be used to improve health and wellbeing outcomes in kidney patients. 
  • Healthcare Improvement Scotland. Explored how they can engage clinicians and people with rheumatoid arthritis to introduce remote monitoring technology to support and co-produce care.

The approach

The exploration phase of the Lab used several techniques to develop a deep understanding of the issues surrounding technology-enabled remote monitoring. 

Surveys, storytelling and sensemaking sessions all contributed to the co-development of a system map to identify the various factors that affect trust and confidence, and how they connect and influence each other. 

No matter how smart or easy to use the device is, that will not determine whether such technology is going to be of value and enhance wellbeing for patients […] We have to ensure that personalisation of care prevails. 

Q Lab UK participant

Participants then used a systems thinking tool called the iceberg model to more deeply consider the systemic issues leading to the problems that we see. 

A graphic of an iceberg floating in water against a light blue background. The top of the iceberg above the water is labeled “Events” with a question “What just happened?”. 
Below the waterline, there are three sections labeled from top to bottom: “Patterns,” “Underlying structures,” and “Mental models.” Each section has corresponding questions; for Patterns: “What trends have there been over time?” For Underlying structures: “What has influenced the patterns?” And for Mental models: “What are the relationships between parts?” 
On the right side, four arrows are pointing downwards with labels next to each arrow that read, from top to bottom, “React,” “Anticipate,” “Design,” and “Transform.” 
This image represents an iceberg model used for guiding systemic thinking by categorizing thought processes into visible events and underlying patterns, structures, and mental models.
The iceberg model helps us consider the systemic issues that may underlie the problems we see on the surface’. 

The iceberg supported very interesting and thoughtful discussions. 

Q Lab participant

Test teams connected the systems discovery with their own local learning to identify areas ripe for change. They were supported in a process of idea generation and prototyping, and testing their ideas in practice. 

Explore the outcomes

We published emerging insights from this Q Lab in June 2022. Explore the report for the identified challenges and broad learnings for teams looking to build trust in technology-enabled remote monitoring. 

Summary of the key emerging themes

The report details the key tensions and challenges identified during Q Lab for teams doing this work. 

  1. Data and technology vs human interactions that add value. It is important to consider what sits around the remote monitoring to address adherence, motivation and the wider determinants of health
  2. Evidence we value vs evidence that counts’. Qualitative and more holistic quality of life measures need to be valued.
  3. Embracing discomfort: co-design and community engagement. Health and care professionals are not always trusted or are not best-placed to engage different communities.
  4. Equity and choice. Some people will choose not to use remote monitoring but unless we give it attention it will only be a choice for those already well-served, who have the means and skills.

The report also discusses two broad questions identified as needing careful consideration. 

  1. Is trust and confidence the most important issue? This is an important barrier that is often not fully addressed during implementation of technology-enabled change, but other areas may carry more weight for some teams. 
  2. Is there a shared understanding of remote monitoring? It’s not a well understood term and can conjure positive and negative perceptions in different people. This makes the job harder. 

Test team progress

All four teams were awarded follow-on grant funding from the Health Foundation and NHS England to continue to implement their ideas, demonstrate feasibility and effectiveness, and consider applicability beyond their local context. 

This Q Lab UK project has been a journey of dedication, openness to learn new things, a willingness to sit with discomfort and a desire to connect with others.

Zarina Siganporia, Q Innovation and Collaboration Manager

Contact Q Lab

Contact us about Q Lab at Qlab@health.org.uk 

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The Health Foundation

Q is led by the Health Foundation and supported by partners across the UK and Ireland

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