East London Evaluation, March 2020

TMA was commissioned by Healthy London Partnership to deliver a platform and app that would allow: deployment of digital care plans; remote condition monitoring; access to educational resources for young people with long term conditions; and have access to pollution, pollen and weather data.

The initial focus was on asthma, and involved working with leading clinicians and young people across the capital to develop our ‘Minimum Lovable Product’. The DHP was initially launched in October 2019 at two sites in East London: Chrisp Street Surgery and the Royal London Hospitals with Barts Hospital following on in January 2020.

NICE Evidence Standards Framework

An evaluation has been undertaken demonstrating evidence to Tier 2 on the NICE Evidence Standards Framework for Digital Health Tools and presented to clinicians and commissioners from across London. We evaluated the following components:

Tier 1
Credibility with UK health and social care professionals
Relevance to current care pathways in the UK health and social care
system
Acceptability with users
Equalities considerations

Tier 2
Reliable information content
Ongoing data collection to show usage of the DHT
Quality and safeguarding

Challenges

The main challenge during the pilot was recruitment of teenage users – this included a lack of appointments for care plan reviews and high level of ‘Do not attends’. The need for an additional ‘Clinician Portal’ for healthcare professionals to enter care plans into was also a significant barrier to adoption at scale. Ideally care plans would be entered into native GP or hospital software and a Personal Health Record app (PHR) would ‘pull’ the plan via a Local Health & Care Record. Using another portal requires changes to workflow, potential double entry and additional technology to be incorporated within already constrained consultation time.

Positive Feedback

Within the patient group those onboarded were positive about the app with a high number being  active users of the care plan and remote condition monitoring features. One user summed this up: “The name as a Digital Health Passport is exactly it – you can travel around with it and use it as and when you enter into a service.” We received concrete user feedback for future features, which will lead to us registering the DHP as a medical device.

Clinicians were highly supportive of the key features – allowing patients access to their care plans at all times on their smartphone was highly prized with one commenting: “This app is just brilliant and could save a life”.

The pilot, with the support of the clinical teams, allowed us  to have a presence within clinics, enabling us to gather evidence and feedback whilst providing support and encouragement for the clinicians and patients – critical for adoption at this stage. The evidence and learnings generated from the pilot are centered around how it is possible to concentrate on patient adoption through the PHR app and for the clinician involvement to form part of existing and developing clinical systems. In addition the pilot has highlighted issues around interoperability between PHR’s and Electronic Health Records (EHR).

The ‘live co-design’ continues supporting Respiratory Nurses at the Royal London to provide a Digital Asthma Action Plan to patients preparing for discharge.