Plymouth is demonstrating the potential of joined-up digital healthcare

‘Joined-up digital thinking’ has been the dominant buzz phrase in healthcare for at least the past decade. In recent years, it has become a more urgent call to action.

This has been driven in part by a growing realisation of how digital immaturity across the health sector has impacted what we know about what’s happening across our health system, and where funding goes as a result.

But if joined-up digital thinking is going to graduate from buzzword to reality, then we will need to shift our whole approach to care — not just technology.

Part of what’s holding us back is how we think about virtual hospitals and pilot programmes for new (and even not-so-new) technology. Above all, we need to be using technology to prevent hospital admissions.

Key to this will involve orchestrating the growing number of available data inputs available, so that practitioners can have the clearest picture of any given patient’s individual needs at their fingertips.

This will involve technical challenges (including how to structure databases and organise them so they can talk to each other) on top of equally tricky concerns around governance and patient privacy.

We should be realistic about the fact that all of this is still a few steps down the line. First, we need to prove the benefits of this approach beyond theory. In Plymouth, we are working to do just that.

Plymouth Community Homes, Plymouth's largest social housing landlord, owns more than 16,000 properties and provides homes to more than 35,000 people. Working closely alongside the integrated health and social care specialists at Livewell Southwest, and our team at the Centre for Health Technology, we are developing the UK’s largest community living lab.

Operating at this scale provides us with a whole range of cohorts of different age groups, comorbidities, and living conditions more generally that provide a rich, complex intermingle of possible data points to act on.

In Plymouth, we will be widening the scope beyond social isolation to draw in data from more disparate, and perhaps less obvious sources.

Sensors can tell us, for instance, if a dementia patient has been trying to leave the house in the middle of the night; wearables can detect if a person has fallen; and electricity usage data could show whether an older resident hasn’t been using their fridge or oven as often as they might usually, which could be a sign of reduced appetite, itself a sign of something else worth checking on.

Ours is a co-design approach, and we follow ethical, legal and social implications (ELSI) terms, considering these for each new piece of tech being tested or introduced.

It starts with assessing needs, then we directly involve the people or patients set to benefit, to find out what types of technology they would be interested in using. Simply thrusting a heap of new gadgets onto a person risks missing the point: they’ll only receive the benefits if they’re motivated to make these solutions part of their daily life. For those who are less enthused about new tech, passive options might work better.

Prototypes are produced with developers, and amended as needed after testing. Local piloting then begins, and we evaluate and iterate continuously with user feedback.

When gathering data, we’re looking to collect and collate information that the NHS doesn’t otherwise have direct access to — so we’re plugging knowledge gaps, rather than introducing new complications.

Crucially, this data needs to be arranged from an early stage in such a way that it can easily flow into the orchestration platform that will be designed and implemented — for that joined up effect — further down the line. If we get this organisation right, then adding new data inputs in future will become more straightforward.

Currently, however, we face considerable, and understandable, restrictions around sharing health data. Patient privacy is paramount, so protecting their data is too. This does make multi-partner projects like ours even more challenging. While homes can be fitted out with an array of sensors and other simple tech that can boost preventive care or alert healthcare staff to a resident in need, the dots between these services are currently not being joined. So the benefits can currently only stretch so far.

How do we get to the next stage? We need to prove this stuff works.

We have the means to gather the data — from wearables to other inexpensive sensors — but we don’t yet have the capabilities to paint a clear picture of all this information operating at the scale of the NHS.

Ultimately, we will need AI in order to operate at such a scale. This of course brings its own concerns and challenges. Even the mention of AI in a sensitive setting like healthcare can raise hackles. This is where our ELSI guardrails will become even more important.

At the very least, we will need: transparency over black box algorithms, so that decision-making is open and accessible to healthcare staff, patients, and families; to strike the correct balance between care and surveillance; and to develop a rock solid means of validating readings if we are to be able to rely on them. These are not insurmountable tasks, but failure to take them seriously carries a high price.

The living lab setup brings together industry, academia, health and social care, and citizens and local authorities, funded by Cisco CDA. In doing so, it lets us explore not just tech propositions and how they might work in theory, but how these ideas actually fare when rolled out in the real world, with all of its endlessly complex inhabitants, needs and unforeseen epiphanies and consequences. It means we are all of us on this learning curve together, offering a hand up and down to one another as we climb.

Perhaps most of all, we’re discovering that, if you bring your spirit of innovation to people, and make it fun and accessible — and show how all of this is supporting health management, and preventing people from ending up where they don’t want to be (in hospital) — then you can win people over to the possibilities. This generosity of spirit is a vital ingredient for success, and will ensure that serious, significant discussions about how to use all of this valuable data in a safe and beneficial way can be held in good faith — and to good ends. That, ultimately, is what strong joined-up digital healthcare will look like as buzz becomes reality