interviews

Going with the 'Flo'

Phil O’Connell, telehealth project manager at NHS Stoke-on-Trent, describes the power of a system which hands
responsibility to the patient.

Designed and developed in the NHS, ‘Simple Telehealth’ is a communication tool that increases patient adherence and compliance with treatment, and aims to take telehealth to the next level, where it truly “helps patients to help themselves”.

Telehealth project manager at NHS Stokeon- Trent and global project lead for Simple Telehealth, Phil O’Connell, talked to NHE about influencing patient behaviour, and saving money, time and effort for both those using the technology and the NHS.

O’Connell said: “If every patient was 100% concordant with their own healthcare, understood their condition, what they’re doing and they could phone a clinician as and when necessary, then there would be no need for telehealth systems at all.

“That’s not how the real world is – but this goes some way to help patients increase that adherence to pathways and education that’s already in place. It can be used with alerts and alarms if clinicians want them, but the primary function is to drive patient independence and re-ablement.”

Remember, remember

In this sense, the system serves more as a reminder to patients than a mode for nurses and clinicians to impart new instructions, where patients are aware of their overall symptoms and the appropriate course of action to take in the case of a flare-up in their condition.

Operating through a text message system, Simple Telehealth relies on people’s impulse to check their phone for people to pay attention to the messages. This has been overlaid with an emotional response, O’Connell said.

The persona of Florence, or Flo, is the web-based author of the messages requesting readings. She behaves like a person and responds to patients in a friendly manner, to provide reassurance and encourage compliance.

He explained why this makes a difference: “We’ve changed the way it feels, it doesn’t feel as if it’s mechanical, it feels as if you’re interacting with a person.”

The same content or request is sent in a variety of different formats to optimise reception, demonstrating a certain subtlety of messaging. An instant response is also available, ensuring patient engagement.

“It can be quite specific or it can say something more general like ‘Don’t forget the advice your matron gave you’,” O’Connell said. “If the situation continues, the response will be different; it will send a message asking the patient to call their nurses. Because it’s instant, it feels as if someone’s there and somebody cares – which of course they do.”

The message to remember previously offered advice aims to activate knowledge the patient is already in possession of, and prompts a proactive approach to their own treatment.

Fun with Flo

Part of the system uses natural language competencies, which allows Flo to ‘understand’ colloquial language, or messages in nonstandard English. This makes the interface seem more like communication with a real human, psychologically influencing the patient to maintain contact and follow advice.

Patients interacting with Flo have fun and feel cared for, rather than being constantly bothered by an impersonal system, O’Connell said. Patients who do not like the system can opt out at any point, without reference to the clinician.

Customer satisfaction is reportedly high, with 90-95% ratings reflecting how much people enjoy using the service and find it easy to use.

“It saves time and keeps that contact with the patient,” he said. “You get people engaged with their healthcare who it found it difficult and inconvenient to do so previously.”

Patient ownership

O’Connell stated: “The idea behind this is that it’s the patient’s responsibility for doing things themselves. It’s about an appropriate NHS response to the particular cohort and risk of that particular group of patients.”

Benefits of the system include active patients being able to adjust their medication more quickly, reduced face-to-face GP interventions and the project also creates productivity gains for health professionals who previously held responsibility for taking these readings. Patients enjoy the independence the system offers, as they do not have to miss work or wait around for a nurse visit.

“This allows them to do it at a time and a place which is convenient for the patient,” he added.

The system has been implemented at 26 locations around the UK already, by trusts, CCGs, hospitals and community providers. The technology is web-based and therefore extremely affordable, allowing many more patients to benefit.

“It’s a new innovation,” O’Connell said. “Every group we go to, we show them how this tool works and then they adapt it to help to increase the adherence within the pathway that they’re working in.”

Simple Telehealth and Flo are used with acute patients suffering from cancer, with kidney disease, lung disease, learning disabilities and by pregnant women, although O’Connell pointed out, “the list is pretty much endless.”

Another advantage of the Simple Telehealth project is that Flo is available 24/7, providing a point of contact with patients who may fall ill at the weekends or out of hours.

WSD & dependency

Despite the mixed results currently being published from the Whole System Demonstrator (WSD) programme, O’Connell was adamant that there was a bright future for telehealth.

He said: “I wouldn’t agree that [the WSD] is not entirely positive. That trial was done three years ago with the equipment and knowledge that was around then.

“The data is absolutely essential and it’s the reason we went ahead and developed this Florence programme; a system which can be used to do what that does and a lot more.

“But also at a much lower cost point and a more clinically valid perspective.”

He described some previous telehealth studies where COPD patients were asked to take their blood pressure daily, where there was “no clinical point” in doing so.

“What clinicians do with Florence is use it for the clinical appropriateness,” he added. “Because it doesn’t create dependence.”

O’Connell explained that some of the systems studied in the WSD could create dependence, as the patient was ‘rewarded’ for improper use of the technology through the resultant contact. This was also more expensive than making use of an electronic monitor.

While direct phone calls or visits can still occur with Flo, the responsibility lies with the patient, as Flo sending a message directing them to ring in, rather than passively await contact.

“For certain teams we do have alerts and alarms and it can work the same way those others do, but we’ve tried to make sure it’s in an appropriate team that would be able to respond to it. “It puts responsibility on the shoulders of the patient,” O’Connell concluded.

Productivity gains

South Staffordshire trust has conducted Simple Telehealth trials with diabetes patients.

Over the period of the 12 week project, the trust found an 80% increase in compliance with the patient group, as well as a 60% productivity gain for staff due to less time spent managing the same patients.

O’Connell commented: “You’ve got the double whammy there, saving time but increasing compliance, which increases the quality of the outcomes! And with diabetes, that’s crucial for all the knock-on things you get if you don’t take the medication properly.”

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