Over the last 25 years, David Patterson has played key roles in forging clinical and academic links between the UCL Centre for Health Informatics and Multiprofessional Education (CHIME) and the Whittington. Here, DigitalHealth.London talk to him about how he and his team have developed, evaluated and clinically tested a series of educational, clinical, and technical components culminating in the creation of Helicon Health, a UCL spin-out company partnering with the Whittington, and one of DigitalHealth.London’s 2016/17 Accelerator companies.
“The NHS and many healthcare systems, are facing fundamental challenges,” David says, “Long term health conditions are increasing and responsible for over 70% of the health budget. They threaten the sustainability of health services globally. They are associated with growing rates of preventable complications and premature deaths, with soaring costs. People with a long term condition spend 99% of the time managing their condition themselves, with only 2 to 3 hours per year with a health care professional. Many people wish to be more informed and involved with their own care. This offers opportunities for better health through increased prevention and supported self-care.
“Technology is transforming our ability to predict, diagnose and treat disease, leading to the opportunity to break out of the artificial boundaries between hospitals and primary care, between health and social care, between generalists and specialists. There is now an imperative to make better use of technologies to involve the person and their family in their own health. The increased confidence and competence, derived from education and activation, enables them to take more responsibility for their own care resulting in better health care at a lower cost.
Helicon Heart is a standards and cloud-based clinical information system, based on a powerful, scalable electronic health record, which comprises modules for diagnostic workup, risk assessment and selection of therapy, in atrial fibrillation, heart failure and anticoagulants, and a CE Marked module for warfarin dosimetry.
HeliconStrokePrevent is an app and digital platform currently in development, which will help people at high risk of stroke to manage their own blood pressure, their anticoagulant control, and activity and lifestyle, as well as improving their health understanding, and encouraging them to collaborate as partners with their GPs and other healthcare professionals.
HeliconeLearning has two versions. The healthcare professionals’ version, which is designed at CPD level and is accredited by UCL, covers stroke prevention, atrial fibrillation and anticoagulation. The development of the second version, for patients, was guided by them, using understandable language, and ensuring it supports their needs, enhancing confidence and competence. Patients’ HeliconeLearning is linked to MyHelicon, an app allowing patients to track key health parameters, support self- care and to share information with their clinicians.
“Innovation is by its nature disruptive, the benefits are not always apparent to others, and therefore challenging,” David points out, “The process-orientated NHS and social care and the pervading financial difficulties, stifle new ways of delivering a better service, while clinicians are wary of any innovation involving technology. I believe that the overemphasis on big-data challenges true clinical and personalised medicine, and threatens to jeopardise the full benefits of the rich longitudinal clinical data which can enable us to explore and integrate the rapidly developing genomic and proteomic data.
“Acceptability is also challenged when the functionality of an innovation crosses health care system boundaries, for instance where it’s designed for both primary and secondary care, or where it works with medical and pharmacy.”
David and his team met these challenges by using education and research to help persuade multi-disciplinary groups, including managers, about the advantages of their solutions. They implemented prototypes to illustrate what is possible, as well as to demonstrate the early benefits for the practitioners and managers who embrace new approaches and technology.
Over 20 years, over 7,000 patients were moved from hospital into a service delivered in General Practice and Community Pharmacies in 5 CCGs. A unique Clinical Governance across 35 delivery sites was developed to oversee the service quality and received patient feedback. The team also developed a Community of Practice to enhance the confidence, competence and learning of the HCPs. This model is now being extended into Europe in the context of heart failure.
The development of these services has been the subject of 3 PhD theses and several peer reviewed papers, and the project has been quoted and displayed by the National Institute for Health and Care Excellence (NICE).
The services were referred to the Cabinet Office as an example of Transformational Practice in 2010, and were awarded a UCLB Enterprise Award in 2014. In 2016, David was selected as Clinician of the month by DigitalHealth.London, and HeliconHealth won a Design Council/MedCity award. HeliconHealth was also selected for the DigitalHealth.London Acclerator programme in September 2016.
The team’s heart failure contract with the European Society of Cardiology in 7 countries, will also be testing the viability of Information Governance across the country boundaries with data being hosted within N3 in the UK. They plan to scale this innovation by pursuing two routes to market: B2B and B2C.
“The solutions are largely digital, and scalable,” David explains, “Purchasers or providers of healthcare can access them through Social Prescription alongside a package of wellbeing, such as health coaching, diet and exercise, or smoking cessation. The NHS can channel CCGs-STP’s focussing on prevention (via national-tariff or STP funding in line with Accelerated Access Review). Private health insurance companies can sell MyHelicon in conjunction with insurance, and there is also a market via healthcare device companies and wearables manufacturers who will seek to cross-sell between wellbeing and medical grade solutions.”
David believes there is also room to sell digital solutions to the professional market, including large healthcare IT vendors, and he suggests that the slow adoption of innovations by the NHS points to the development of a version for those at risk of stroke. “We will also market directly to the worried well and their loved ones,” he adds.
Helicon has secured a contract to pilot its professional product for heart failure in several European countries starting in early 2017, and has also been approached about possible business in China and India.
“These innovations which enhance patient engagement will change the relationship between the patient and the HCP to more of a partnership model,” explains David, “ Although this is disruptive, a healthier more sustainable relationship will ensue. It will also change the character of the clinical care pathways into a more patient-focused pathway where the requirements and needs of the patient are much more clearly defined.”