Q Exchange

‘Virtual sandbox’ opening Cornish General Practice for telehealth pilots

Telehealth interventions hold the promise of better quality care and reduced workload, both of which could make primary care more sustainable. The Kernow CIC group could be offered as a small scale 'test bed' for companies to pilot telehealth ideas, something we have already discussed with the 'Launchpad' unit at Falmouth University. Successful interventions could then be extended nationally and fed back to Q as a potential stakeholder in the process.

Read comments 11

Idea
2018

Meet the team: Kernow CIC (community interest company of 61 GP practices)

Christopher George Tiley

I am a Q member and a GP in Cornwall – our group of 61 practices has united under an umbrella group (community interest company) which enables us to speak -pretty much -with one voice.

With companies trying to bring telehealth products to the market, a ‘sandbox’ in which to introduce / trial / tinker with products being road tested by GPs could be a valuable way of assessing ideas and which are more likely to succeed.

The hope is that by renting the sandbox for these exercises and then benefiting from products that improve quality (and / or reduce workload) the CIC group will act as a useful link in the product development chain and also help bring good QI initiatives into practice – surely a core aim of Q!

How you can contribute

Advice on what else is out there, risks / opportunities of the proposed plan, caveats and any prior experience of anything similar. Hpw to maximise GP engagement at a time of stress has always been a concern when trialling new ideas so how to make things as simple and user friendly as possible.

Comments

Helen Smith 17 Jun 2018

Hi Chris

I particularly like the potential about supporting self-care. As well as the areas Hein suggested I wonder about measures around patient satisfaction. We know people get anxious coming to see us and often forget what we say, I wonder if consulting from home would have any positive benefit on this.
Dougal Hargreaves 16 Jun 2018

This is a good idea and highlights the need to trial technology in-context before implementing at scale. You mention the importance of formative and summative evaluation – recently published work on the NASSS framework may be a good way to structure this so you can identify various domain of complexity at an early stage and tailor the technology accordingly. See here for more details: https://www.jmir.org/2017/11/e367
Hein leRoux 10 Jun 2018

Interesting and as a fellow GP, I can see the potential of this idea. One outcome measure you might consider is 'patient time' in that this sort of technology can save on journey times getting to and from hospital, also parking fees. In a geographically dispersed area such as Cornwall (and Gloucestershire where I work) I am sure people would welcome this technology.
chris tiley 6 Jun 2018

Whilst we can tailor the offer, primary attention will consider how health tech products address existing system pressures, as opposed to a traditional pharma ‘clinical efficacy’ trial, which we see being delivered elsewhere. Our product focuses on how the eHealth product:

- Reduces cancellations or unnecessary appointments in primary care.
- Supports the empowerment of patients in self-care.
- Improves communication between patients and care-givers.
- Reduces GP workloads.
- Provides care in unmet areas of need.
- Delivers system cost savings.

We are working with academics and our GP network in Cornwall to develop and refine our methodology.

Whilst we are seeking some initial pump prime funding our vision is to create a model where eHealth businesses purchase services within the Sandbox - these services include an assessment of adoption readiness, co-design, usability, gap analysis, benefits analysis, published research papers.

We have a number of prospects, these range from infrastructure approaches (connectivity), apps, online tools and medical devices. These are from both U.K. and International businesses.

Developing a consistent evaluation framework against things that matter is really important, both to weed out products that won’t make an impact and to help excellent products get adopted.
Tim Benson 29 May 2018

Telehealth innovation is a good example of a complex innovation, where success or failure depends on many factors. Doing things at scale makes it easier to identify key success ingredients. This needs methods of tracking both impact , such as patient outcomes and experience, and process, such as GPs' innovation readiness, user digital literacy, application ease of use etc.
Olly Watson 18 May 2018

Hello,

You may be interested in an evaluation that NIHR CLAHRC West did of an e-consultation system piloted in 36 GP practices in Bristol, N Somerset and South Gloucestershire. You can read more here:

https://clahrc-west.nihr.ac.uk/news-item/improve-online-gp-consultations/

There are three open access publications that may be of interest from this work:

http://bmjopen.bmj.com/content/8/3/e019966

http://bmjopen.bmj.com/content/7/11/e016901

http://bjgp.org/content/68/666/e1
Elizabeth Angier 12 May 2018

HI Christopher,

Like your idea. As you proably know Helen Atherton is doing work on alternatives on face to face consultations in general practice might be worth linking in ?
Thomas John Rose 3 May 2018

A sandbox is used to test changes to or development of software code and its interface with other applications. Can you give some examples of existing applications and potential applications where sandbox testing would be necessary? Regards Tom
1. Thomas John Rose 17 Jun 2018
  
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Rebecca Fisher 1 May 2018

Hi Christopher, sounds really interesting, and clearly topical. Absolutely agree that having a sandpit to test ideas would be useful, and it's not something I've come across so far (though can't claim exhaustive knowledge). I may well be missing something, but I'm not clear on the funding model you're suggesting. What would the money from Q Exchange be used to support, and would companies be paying the CIC group to test their ideas?
Dimple Keen 28 Apr 2018

Hi Christopher, thanks for sharing your idea! Using technology to help relieve workload pressures (and better support patients) is an important goal.

I wondered if you could expand on what might be in the 'sandbox'; have you and others been approached with some products which you're particularly excited about testing? How would you go about evaluating the impact of any of the products, would this be through a formal route such as rct or using other measures?

I was a bit unclear on what the proposed funding would be and what it might cover, could you clarify?

Thanks

Dimple