Five digital health transformation considerations from a clinical fellow

James Cleland, Superintendent of Nuclear Medicine at the Chelsea and Westminster Hospital, dives into what Nuclear Medicine is and the idea behind his Horizon Fellowship project.

What is nuclear medicine exactly? Well, it’s the flamboyant and ever exciting sub-specialty of radiology.

We are able acquire the function and or structure of a selected biological system in real time via a targeting agent that our cameras will detect. that allows us to observe, record and report with aid of our cameras.  The processing computers connected to our imaging cameras, observe, record and report the actions occurring within the body, and often we use bright dynamic colours against a black or white background to showcase the events.

Nuclear medicine is often ridiculed, which is all in good humour, as ‘unclear medicine’ due to our abstract, ambiguous and convoluted answering to clinical question put forward to us. Often what happens during imaging is obvious to us but not to everyone else, mainly due to our heavy use of technical jargon, physiological thinking and the large dose of essential physics.

We enjoy being the ‘friends of friends’ in radiology.

The idea behind my Horizon Fellowship Project

This leads to my Horizon Fellowship project. Having worked across the different imaging specialities of radiology, there has never been a fluid way to circumnavigate and schedule nuclear medicine appointments. Often, we will come in between or towards the end of multiple diagnostic appointments. For example, a newly diagnosed breast or prostate patient may have initial imaging with mammography, ultrasound, computed tomography, magnetic resonance imaging and then nuclear medicine. Such appointments are time-critical as they ensure appropriate treatments(s) and intervention(s) are delivered for an effective outcome – especially in the recovery and the quality of life for the patient.

There should be a seamless approach to scheduling of appointments, let alone nuclear medicine. However, this is not always the case, as a newly diagnosed patient who is referred to different radiology departments, usually has to make trips across multiple campuses.

The technology I wish to develop is a simplified scheduling ‘whitebox’ application, to be used as multifunctional patient centred aid throughout their diagnostic journey.

While introducing my horizon fellowship project to a key stakeholder I was hit with a simple question, ‘Why is this necessary when there are already technologies within the trust that do what it is you are suggesting?’

Joining the Horizon Fellowship has allowed me to enter the arena of digital health innovation with the opportunity to use the resources provided to build an iterative solution and answer the ‘why’. I feel this infamous Rumsfeld quote is relevant to my digital health fellowship project so far.

 ‘We know, there are known knowns, there are things we know we know; we also know there are known unknowns, that is to say we know there are some things we do not know’.

I can order food from my smart device, then track its progress with real time delivery analytics in a matter of minutes. Each of the processes within this goods and service transaction of thinking and then tasting that food, is broken down into measurable but auditable components that up to a point can be instantaneously altered without major disruption to the end point.

Smart devices and patient-centred scheduling or patient portal technologies have been a focus in digital health transformation and for radiology, are sorely needed, especially as the majority of current radiology patient portal systems lack real life human elements.

The process of booking a multi-modality radiology appointment is very archaic. The additional patient preparation information provided is often not read nor followed and if it is, it can be perceived as ‘convoluted’ despite the best intentions of being clear.

Protective measures ensure that the correct imaging study is justifiably requested in the first instance, but to meet today’s NHS patients demands, it is about time we innovate our radiology patient portal systems and mirror the digital technologies that other industries have been using for almost a decade.

Starting with the why

Digital health transformation, value-based healthcare delivery, personalised patient centred medicine, and disruptive innovation in healthcare strategies to reduce digital divide in our population, all play a significant part in my project. Yet the question of ‘why’ and ‘what we know or don’t know’ is really the primary starting point to any major project, especially where patient engagement with a technology is involved. 

From gathering anecdotal evidence by simply talking with my patients over the past 20 years, it has become clear that there are gaps in their pathways – particularly with engagement and communication. Patients to the effect, feel overwhelmed especially with taking in new information when newly diagnosed.

On top of this, all NHS radiology departments perform at a prolific rate to meet time critical imaging demands, this pace can increase this feeling for both the patient and their immediate friends and family.

Therefore, I believe that intuitive patient portal and interconnection applications such as the scheduling ‘whitebox’ application I am developing, are essential.

5 key insights for implementing patient portals and applications

Ultimately, as a seasoned postgraduate and hopeful future PhD candidate, I am comfortable with researching deeply on the digital health technology fundamentals as part of my Fellowship journey. Through my research, I’ve identified five considerations related to patient portals and applications that were reoccurring and have provided value to me and they may also be to you as the reader:

1. The unified theory of acceptance and use of technology (UTAUT) – this is logical model and idea based on the individual’s engagement of a technology, particularly its usefulness, performance and how its social value is perceived by others (Venkatesh et al, 2003).
2. An individual may enrol, engage and use a personalised technology regularly if it impacts on their health outcomes (Grossman et al, 2019) however technical assistance throughout the individual’s interaction is just as important, particularly with users in the aging demographic (Sakaguchi-Tang et al, 2017).
3. Having secure messaging between either the primary clinician (Hoogenbosch et al, 2018), the clinicians department (Sakaguchi-Tang et al, 2017) or having verbal communication (Goel et al, 2011) were seen as key success factors.
4. Data security, trust and the transparency of how a patient’s data would be used (Portz, et al 2019), and who by including the sharing between parties (Sun et al, 2018), factors heavily into whether or not there will be uptake by the targeted users (Goel et al, 2011).
5. Use literature that has meta-analysed social media platforms – ‘Dr Google’ and ‘Professor Wikipedia’ both are starting points for patients which provides a wealth of information of where there are gaps in patient understandings. Alariff et al (2021) reported on patients seeking assistance from social media interactions on their radiology reports, however in their research it was identified to this author that the information patients sought was centred on what their needed to prepare for based on other user experiences.

Returning to the initial question of the key stakeholder, the answer is not ‘yes’ or ‘no’ rather, what I can learn and how can it help in providing a solution to the problems with the patient portal or patient centred scheduling technologies available now.

References:

Alarifi, M., Patrick, T., Jabour, A., Wu, M., & Luo, J. (2021). Understanding patient needs and gaps in radiology reports through online discussion forum analysis. Insights into imaging, 12(1), 1-9.

Goel, M. S., Brown, T. L., Williams, A., Cooper, A. J., Hasnain-Wynia, R., & Baker, D. W. (2011). Patient reported barriers to enrolling in a patient portal. Journal of the American Medical Informatics Association, 18(Supplement_1), i8-i12.

Grossman, L. V., Masterson Creber, R. M., Benda, N. C., Wright, D., Vawdrey, D. K., & Ancker, J. S. (2019). Interventions to increase patient portal use in vulnerable populations: a systematic review. Journal of the American Medical Informatics Association, 26(8-9), 855-870.

Hoogenbosch, B., Postma, J., Janneke, M., Tiemessen, N. A., van Delden, J. J., & van Os-Medendorp, H. (2018). Use and the users of a patient portal: cross-sectional study. Journal of medical Internet research, 20(9), e9418.

Portz, J. D., Bayliss, E. A., Bull, S., Boxer, R. S., Bekelman, D. B., Gleason, K., & Czaja, S. (2019). Using the technology acceptance model to explore user experience, intent to use, and use behavior of a patient portal among older adults with multiple chronic conditions: descriptive qualitative study. Journal of medical Internet research, 21(4), e11604

Sakaguchi-Tang, D. K., Bosold, A. L., Choi, Y. K., & Turner, A. M. (2017). Patient portal use and experience among older adults: systematic review. JMIR medical informatics, 5(4), e8092.

Sun, R., Korytkowski, M. T., Sereika, S. M., Saul, M. I., Li, D., & Burke, L. E. (2018). Patient portal use in diabetes management: literature review. JMIR diabetes, 3(4), e11199.

Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D. (2003). User acceptance of information technology: Toward a unified view. MIS quarterly, 425-478.

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