Toby has been a consultant rheumatologist at Guy’s and St Thomas’ NHS Foundation Trust since completing his PhD in 2009 and is currently Clinical Director for Specialist Ambulatory services. He has a particular interest in digital innovation having recently run a transformation programme across a number of services.
Toby is leading projects focusing on developing novel platforms for the management of newly-referred patients and those with long-term conditions. He has experience in the application of user-centered design in healthcare and is a passionate believer in the importance of solving the problems which matter most to patients.
Rheumatoid arthritis is an inflammatory condition which can cause progressive joint damage and disability. It affects around 1% of the population. Patients are managed using a ‘treat to target’ approach with the aim of achieving remission. The current model relies on seeing patients at arbitrary intervals meaning that patients may be seen when they are well and not when they most need it. The use of remote monitoring technology would enable more continuous monitoring of disease activity and a more flexible approach to patient care.
We undertook extensive discovery work to learn what patients and others involved in the care pathway needed from a new system. Key learning was around what makes patients feel safe and what a responsive system should look like. We prototyped a remote monitoring platform based on SMS delivery of validated PROMS which correlate with clinic disease activity. This would enable monitoring of patients more continuously while they are away from the hospital.
The project currently has £180,000 of funding and is based in the Rheumatology Department at Guy’s Hospital. There are around 20,000 outpatient appointments per year in the department and we have around 3,000 patients with rheumatoid arthritis. The project will develop a platform which will monitor multiple types of inflammatory arthritis and can easily be adopted by other departments. We are exploring how this might be expanded into and other long-term inflammatory conditions.
The aim is to develop a platform with high user uptake and retention. The intended outcomes are reducing hospital visits for patients in remission and more flexible appointment structures for patients with active disease and better long-term control of disease activity.
The first ‘Minible Viable Product‘ (MVP) went live in January 2019. Our current funding will support development until it is introduced into routine practice later this year.