Implementing new and innovative technologies is vital to transform healthcare for both patients and healthcare staff, and having the right evidence to do so is also essential. In this webinar hear from an expert on their evidence journeys, focussing on the problems they faced and how they overcame them.
Dr Jean Ledger – Senior Research Fellow, UCL
Dr Paul Wallace – Clinical Director Digital, Health Innovation Network; Academic Lead, DigitalHealth.London Generator; Professor Emeritus Primary Care, University College London
Peter Thomas – CCIO and Director of Digital Medicine, Moorfields Eye Hospital. Clinical Lead (Digital), National Eyecare Recovery and Transformation Programme (NHSE).
We’ve summarised the key themes from the discussion:
Organisational change to hardwire evidence generation
Trusts and providers have implemented a huge number of technology solutions over the last few years but have often struggled to describe what the benefits were. Without evidence generation we cannot build business cases, so it must be hardwired in.
Hardwiring evidence is achievable but not without organisational change. It is an incredibly varied picture across NHS trusts – some are very advanced in professionalising their clinicians to support good digitisation. Moorfields identified a different approach and created a department of digital medicine – a central nexus where clinicians could go for support and a way to formalise connections with other roles in the hospital such as in information governance, IT and research and development. This has led to a much better project management approach to innovation projects and through this, they are able to ensure that all projects have got an evidence generation arm and where possible are linked up to one of their digital innovation fellows. This creates an environment for evidence generation.
Having this approach also helps to ensure they are not just doing the evidence that people find interesting but producing structured, useful evidence for sustaining services e.g. the environmental footprint, time saving for patients.
Peter shared that Moorfields had a lot of the raw materials to set up this new department and was already very focused on research. He suggested that organisations should try to think about what useful publications can come out their projects and this naturally leads them to think of the evidence they need.
Setting up the department for digital medicine required three main things:
- Support from the senior team – set out a vision justifying why clinical information is key and how structuring it would help the system run better
- A clear understanding of what was already being done
- A realistic money ask – not asking for huge amounts
Example: Generating evidence for video consultations
It was said that there was no role for video consultations in ophthalmology as it was believed that OCT (Optical Coherence Tomography) machines were always needed for diagnosis. The cultural switch to remove that belief was difficult. They had to see where it would be useful, and this was on the emergency side. They were worried about blinding disease and Covid patients not coming in to be checked. They therefore set up a video service and within a month it was the largest video consultation service platform. They coupled this with evidence generation straight away to avoid scrutiny and justify what they were doing. They gathered evidence for 900 patients in the first month and they were published in lancet, in an article supporting the platform’s safety. 78% of patients presented as an emergency and they could be sent to right place. They also collected evidence that the patients preferred the service, it saved them time and carbon emissions were reduced.
Digital inclusion and exclusion considerations were another element that had to be considered in the implementation of the video services. They found that for many the video consultation increased their ability to access the service as they did not need to travel or take time off work. But alternatives had to be considered for those digitally excluded. There needs to be a big support offering for these new services such as a phoneline for patients to call when there is a problem or sitting with patients to explain first. Moorfields are currently doing a lot of work in this area to work out the best way to provide alternatives. They have a travelling video pod patients can use on site, coupled with a training opportunity which shows them how to access from home. Peter highlighted that an organisation shouldn’t not try a new innovation because of digital exclusion but should start and see if efforts to remove exclusion work, or try something else.
What is the biggest challenge in embedding evidence generation?
Having the resources to do it. Resource for evidence generation is wildly varied and often underfunded across NHS Trusts. Clinical informaticians are often the ones leading the effort but if they don’t have a team they will struggle. CCIO’s often aren’t on Trust boards and that means that the understanding of digital transformation and evidence generation is not represented at a high enough level. It requires a lot of engagement with senior leaders in a Trust to develop the case for more resource and get more professional about clinical informatics.
Nationally most funding does not fit easily for evidence generation as it requires a more iterative approach than traditional grants allow for. National training is also a huge issue, but this is improving with Fellowship initiatives and opportunities for clinicians in training to get involved in digital. Things are currently disconnected and there should be more of a national process in place.