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.
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.
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.
The iceberg supported very interesting and thoughtful discussions.
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.
- 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
- Evidence we value vs evidence that ‘counts’. Qualitative and more holistic quality of life measures need to be valued.
- Embracing discomfort: co-design and community engagement. Health and care professionals are not always trusted or are not best-placed to engage different communities.
- 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.
- 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.
- 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.
The team’s project is called Digital Inclusion for Social and Health Impact (DISH project). It focuses on creating a collaborative approach to technology-enabled care and community health that meets the needs of local populations. The team will continue to engage seldom-heard communities and individuals and aim to empower them by:
- Providing tools for people to engage in their health and well-being, in the context of how technology impacts other aspects of people’s lives.
- Produce adult learning training manuals for respiratory conditions and NHS tools. The production of training manuals is in partnership with the adult learning division in the council, patient representatives, health workers, and digital leads.
- Empower digitally excluded groups/patients with technology enablers, for example linking with the local authority to improve access to broadband internet, smart devices such as smartphones, tablets, laptops, and remote monitoring devices.
- Diversify remote care projects in Hounslow to improve patient discharged respiratory projects and introduce other chronic health support projects across the borough in line with the council’s long-term plan.
Contact: Sadia Khan
Working closely with young people, the team successfully designed, tested and refined a remote monitoring service for young people with eating disorders.
They will continue testing and developing this Technology Enabled Remote Monitoring Service (TERMS) in schools and clinical settings, and for a wider range of clinical conditions.
Find out more about the early phases of this project in this short film from the TERMS team.
Contact: Alka Ahuja and Gemma Johns
The team aim to improve health and wellbeing outcomes for kidney care by introducing a wearable device that monitors kidney function and alerts when reading fall outside defined parameters.
During Q Lab the team identified three ways they can build staff and patient trust and confidence in this system.
- Personalise tech to meet the individual needs of each partnership of patient and health professionals.
- Consider how the devices are introduced and managed across the different pathways of care, for example, chronic kidney care, kidney transplantation and heart failure.
- Deliver digital equity. Ensure that all patients, including those undertaking home dialysis, or in rural locations, have the opportunity to access the technology effectively.
Contact: Joanne Smithson and Jonathan Murray
The project aims to develop a smartphone app to enable patients under outpatient rheumatology care to self-report data in real time before consultation. They’re also able to access additional information and support resources.
Building on their learning from the first phase of Q Lab, the team will look at the triage process to make sure data flows, sharing and monitoring, and workforce planning are built into the clinical pathway.
They will work with others to establish an evidence base for the solution and define the factors needed for success elsewhere.
Contact: Liz Murphy
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.
Contact Q Lab
Contact us about Q Lab at Qlab@health.org.uk
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