System levels up Digital to Empower 5.6 million Citizens and Save 30% in Costs

After learning about the benefits of the Digital Health programme commissioned by Our Dorset, Seven Integrated Care Systems Across the South West have also introduced the ORCHA system to empower citizens, increase their digital maturity, achieve consistency in Digital Health across the system and achieve cost savings. 

Background

A partnership of health and social care organisations working together, Our Dorset holds the ambition for its 750,000 residents to lead healthier, fulfilling lives supported by sustainable health and care services. But the ICS faces real challenges. Similar to many regions, Dorset is facing significant workforce gaps in nearly every area of care and its population is ageing, bringing more long-term conditions, and placing a growing demand on its services.

To address this challenge, the ICS understood the importance of breaking down barriers to the health and social care system in empowering citizens with digital health tools. It first aimed to lay solid foundations for public facing digital health and apps were agreed to be a key building block. 

Recognising the barriers in culture to embed the offering of digital health tools being firstly awareness and secondly accessibility, Dorset looked for a partner that would provide a single point of navigation both for the workforce and population in surfacing digital health tools in a simple way.  Rather than select point products , it identified ORCHA as its partner in enabling a comprehensive closed loop system for all of the ICS digital health needs. The partnership with ORCHA enables continuous horizon scans, identifying the best technologies and developers to work with. The clinically designed evaluation process assesses these digital tools against relevant measures and if appropriate, surfaces them in a library that has a good user experience in searching and filtering to download and use such tools by choice. It continues to re-evaluate each tool when a developer does an update which helps assure the ICS and recommender on the safety of such tools. Its closed loop system also safeguards product and regulatory changes.

So in early 2020, Our Dorset commissioned ORCHA to assess digital health, develop a formulary of digital health products for priority areas, build a bespoke health app library demonstrating its use to the workforce and empowering them in how to signpost, and where commissioned prescribe digital health tools. With ORCHA, Our Dorset delivered a programme that mitigated risk and assured clinical teams they are recommending safe apps during the pandemic to enable accelerated access to services from home.

When the AHSNs, CIOs and CCIOs from across the South West learned about the programme, the benefits of rolling out the system across the South West were clear. As although digital health had been adopted across the South West, it had only been part of other initiatives. For example, digital health was used in programmes to address remote monitoring and COPD. 

Because of this, and other Digital priorities, no single role had taken a step back and taken a holistic system wide oversight to digital health and the culture change for such services in its entirety. What Our Dorset demonstrated is that when a system wide perspective is adopted for digital health, benefit is seen across the whole health and care system, not just condition or issue-specific pockets. 

Transformation Boards universally agreed that the solution would particularly add real value in the prevention space, easing pressure on the system. They also reported that it should not be viewed separately to COVID, but part of the COVID recovery plans. 

Faced with an already stretched workforce, concern was expressed around resource requirements. However, as Our Dorset managed the programme led by one person, bringing in wider teams such as clinicians and marketing when needed, for a period of months; this concern was allayed. 

Solution

The seven ICSs commissioned ORCHA to manage digital health assessment and distribution across the South West. All seven ICSs would collectively benefit ORCHA’s governance and assessments, including Digital Technology Assessment Criteria (DTAC) a baseline for digital health technologies to adhere to, enabling patients and the system to adopt relevant, safe and innovative technologies more quickly. This meant that staff and patients would have access to a consistent digital health toolkit, whilst each ICS would have its own digital health library, giving it the flexibility to choose its own health priorities and maintain its own brand. With Our Dorset being the host organisation, all organisations have signed up to the programme individually. 

It was agreed that in every organisation, the roll-out would be led by Primary care. Each then looked for governance in which to anchor its deployment; this could be long term condition management, personalised care, healthy ageing, or anticipatory care, as they all share common ground with digital health benefits. 

Each ICS worked with ORCHA to build its own personalised app library, giving professionals and the public to assess apps, and highlighting what good looks like for digital health tools. To assist, Our Dorset gave examples of areas they have seen good traction, including wellbeing, weight management, smoking and Musculoskeletal (MSK). 

To aid workforce adoption and empower the skills and knowledge to use the app library and trust the digital tools featured, training was rolled out across a range of cohorts. Feedback was positive and teams valued that the system can act as their horizon scanning tool for new technologies.  

To help assess the impact on workforce digital readiness, pre and post deployments were conducted across every ICS. 

Results

The seven organisations in this programme now have a system-wide approach. They have a single point of navigation to a wide range of digital health tools across long term condition management, wellbeing, screening and diagnostics, assured they have undergone due diligence. 

It is essential today that digital literacy is made a priority for any workforce. The training programme delivered as part of the roll out helped to educate staff on digital health, giving them the professional development and confidence to recommend digital first. With staff shortages, having consistent training and tools also gives the system flexibility in movement. 

Commissioning and managing the system across seven ICS areas is not only delivering consistency for staff and patients, but it is also delivering cost savings. Comparing the roll-out to a single organisation the group has reduced costs by thirty per cent. This doesn’t even take into account the cost savings delivered by each digital health technology tool within the app library that helps individuals better manage their health.  

Since launching its programme, Our Dorset has seen significant impact. As they prepare to launch their libraries, the other six ICSs across the South West will be looking to achieve similar results. As in Dorset there have been almost 37,205 pages viewed on the site (up to the end of July 2021), and in one month alone, the app library achieved nearly 5,500 page views.  Social prescribers are actively recommending apps to service users and vitally, this advice is being acted upon, with almost 2283 apps recommended to date and 56% of recommended apps downloaded, which is a very good engagement rate, especially compared with other services. The most popular search terms include Mental Health,  MSK, Dementia, Diabetes and Cancer. Some of the most popular apps to be viewed are Wysa: Stress, Depression & Anxiety Therapy, Sleepio, NHS Weight Loss Plan and Musculoskeletal (MSK) Self Care, providing a range of health interventions and show that apps are being selected to improve the physical and mental health of the population.

The roll out has put in place the coordination needed to assure that the digital health technologies recommended by a team of 2,800 professionals across almost 50 organisations within the 7 ICSs, consistently not only meets standards, but pinpoints the best solution for every patient, in the 5.6 million population it serves.

Commenting on the programme, Crystal Dennis, Interim Lead for Digital Access to Service @Home, Our Dorset Digital, said: 

“After Transformation Boards learned of what had been achieved in Dorset, everyone was unanimous in the view that it was a no-brainer to roll out an app library powered by ORCHA across the seven ICS organisations.  For safety, practical and effectiveness reasons, it’s a foundation platform that every part of the health and social care teams should have access to. 

“It is possible for an organisation to get to where we are now. But it will be harder, take longer and cost an awful lot more.”

Challenge

A partnership of health and social care organisations working together, Our Dorset holds the ambition for its 750,000 residents to lead healthier, fulfilling lives supported by sustainable health and care services. But the organisation faces real challenges. Dorset’s population is ageing, bringing more long-term conditions, which places a growing demand on services. Its funding cannot keep pace with this growth in demand and without changing its services, in five years it would face an annual shortage of £229 million a year(1).

To address its ambitions and challenges, the Integrated Care System has identified a clear plan, in which digital plays an enabling role.  It established a ‘digitally-enabled Dorset programme’ to increase the use of technology in the health and care system, to support new approaches to service delivery.

Solution

The programme first researched and established the building blocks needed to establish public facing digital health.  Alongside videos and the NHS choices website, apps were identified as a key building block to enable patients to better manage their own health.

To understand more about if and how health professionals could recommend the use health apps and what would be needed to support them, a pilot was run with 20 nurses.  This revealed the team didn’t know where to find good health apps, how to know if they could trust them, if they met policy or who to ask for advice.

Without the expertise to establish a closed-loop quality assured programme, or capacity to be able to test health apps, let alone test them again when they are updated, the team recommended partnering with ORCHA.  They selected ORCHA as they had seen how it had delivered testing at a national level and for other regional providers.  With ORCHA, Our Dorset could build a programme to mitigate risk and assure clinical teams they are recommending safe apps.

ORCHA tested apps against 350 standards and measures and worked with Our Dorset to identify the best health apps across each priority health area. A dedicated app library was built to house the apps and enable patients and staff to search.  It was also agreed that if an app doesn’t appear in the library it will not be recommended by any member of staff.  If an app is ever nominated that isn’t in the library it will first be reviewed by ORCHA before being used by Our Dorset.

Our Dorset also opted to include a feature to enable staff to recommend apps via email or text message from the app library directly to residents and patients. This eliminated human error and enabled recommendations to be monitored.

Once ready, the team ran a series of 30 onboarding sessions across all ICS providers and governance leads, including all non-clinical teams, including link workers, health coaching and social prescribers.  Over one or two sessions, teams were briefed on the value proposition of health apps, walked through the system and key apps were demonstrated.  The health app programme also saw the emergence of a local Community of Practice which became a regular fixture on team meetings, prompting people to share learnings, tips and good practice including hearing about cohorts that are responding well to health apps.

Alongside training staff, the app library was launched to the public, forming part of its #HereForYou campaign which reassures Dorset residents that their health services are still available should they need them and that they should seek help and advice despite the Covid-19 pandemic.  This included PR, social and paid digital activities.

Results

Since introduction, the teams have actively embedded the app library and the practice of recommending health apps into their service offer. The teams drive home the concept of self-management and pick out effective tools that are available.

There have been almost 25,000 pages viewed on the site (up to the end of November 2020), and in one month alone, the app library achieved nearly 5,500 page views.  Social prescribers are actively recommending apps to service users and vitally, this advice is being acted upon, with almost 1,500 apps recommended to date and 56% of recommended apps downloaded, which is a very good engagement rate, especially compared with other services.

The most popular search terms include Mental Health MSK, Dementia, Diabetes and Cancer. Some of the most popular apps to be viewed are Wysa: Stress, Depression & Anxiety Therapy, Sleepio, NHS Weight Loss Plan and Musculoskeletal (MSK) Self Care, providing a range of health interventions and show that apps are being selected to improve the physical and mental health of the population.

One of the most active recommenders of health apps is George Mitchell, Social Prescriber, Live Well Dorset. One app from the library he finds useful is Quit Now, as he shares that “it gives people support 24×7.” He regularly shares app tips with other prescribers, as he says “Don’t assume that just because you know about an app, everyone else does.”

Commenting on the programme Crystal Dennis, Interim Lead for Public Facing Digital Health Services, Our Dorset Digital said:

“ORCHA power our health app library. They help us to break down the barriers and mitigate issues around digital health. Previously our clinical leads didn’t recommend digital health technologies as they had no idea where to look, were concerned about implied liability and couldn’t tell if a technology was of a good standard.  Thanks to ORCHA we are building the trust with clinical teams and have put in place the tools and governance they need.”

Source: (1) https://ourdorset.nhs.uk/wp-content/uploads/2018/07/Our_Dorset_STP.pdf

To minimise risks of exposing patients to COVID-19, around 70,000 physiotherapists in the UK alone¹ are being asked to adopt remote consultations. Already growing in popularity, physiotherapy apps are now a vital tool for physiotherapists to improve patient outcomes.

Apps can be used effectively to help in assessment, treatment compliance, monitoring of symptoms, or self-management of conditions, improving a patient’s physical and mental health.

On behalf of NHS organisations, ORCHA assesses more apps than anyone else, looking at clinical assurance, safety, data privacy and user experience. Below are two top scoring apps that are designed to help with remote physiotherapy.

Click below to watch our videos about each app:

GPEP Physiotherapy Exercises has been designed with the help of NHS GPs and physiotherapists with the aim of bringing users access to self-help advice from professionals, enabling users with back, muscle and joint conditions to start their recovery early.