They might be simple and not really new, but notifying patients and clinicians can help save money and lives.
Push notifications are mostly associated with smartphones – the ability for an application to alert the smartphone user about some sort of engagement, whether it be a text, a WhatsApp message, a credit card charge, or an e-mail.
But while these notifications are useful for everyday communication between friends and family, there are use cases which are far more significant in healthcare that could bring huge benefits to patients.
For example, there are mundane reminders that patients get from their GP surgeries about their appointments and reminders for patients to take medicines at the prescribed times.
These ideas are being enhanced as we speak; customer engagement vendor Acqueon has worked on an ‘IoT connected pillbox’, which enables a healthcare organisation to know when medication has been opened.
“If the box has not been opened, automated push notifications can be sent via phone or text – if there is still no response this can be escalated, so that patients are only called by a clinician or visited at home when an issue arises,” says Acqueon president Ashish Koul.
Push notifications have been used in NHS trusts for a number of years – the Careflow clinical communications product from healthcare software company Graphnet enables clinicals to manage referrals and handovers between teams.
“It’s all about teams – healthcare really revolves around teams and if someone is a hospital bed deteriorating and they need support then being able to notify a clinician or refer the patient for a second opinion, or use a WhatsApp group type format to decide what to do with a patient in a multidisciplinary team – these are popular use cases,” explains Beverley Bryant, Chief Operating Officer at System C & Graphnet Care Alliance.
So if someone had broken their leg, it would require a team of clinicians, nurses and anaesthetists to all make decisions quickly about how to help this person – and knowing that the patient has allergies or other conditions can help them to decide which approach is the right one to take.
The ability to automatically notify clinicians about a patient’s condition is of far more significance than text reminders, and this concept has recently been taken into other healthcare settings.
For example, the myCareCentric initiative is a project using the wearable device Microsoft Band and machine learning in a bid to help people with epilepsy monitor their condition better. It has been developed by a private-public consortium called the Epilepsy Care Alliance (ECA) whose members include Graphnet, the University of Kent, Poole Hospital NHS Foundation Trust and Shearwater Systems.
The centre has looked at using the Band to distinguish seizures, and then using machine learning to monitor the data. The idea is to help individual identify when they are at increased risk of seizures, as well as the ability for the centre to contact people when they’ve had a seizure.
For Bryant, who was the former director of digital at the NHS, this use case, which is currently live but also being developed further, is an example of the way technology needs to be used in the healthcare industry.
“We have to build technology that makes the life of the clinician easier, and that adds value to the patient and clinician because historically we haven’t done that; we’ve built it to meet functional, bureaucratic needs,” she says.
But she adds that it’s impossible to make a generic technology to cover all bases, instead there has to be a focus on each condition separately.
“The technology that works for epilepsy will not be the same for a different condition, you have to adapt the condition for the specific use case and that’s important,” she states.
Other use cases Bryant envisages include helping those with mental illnesses or the elderly by pushing out notifications to their specific healthcare support worker.
“So if someone has a mental health illness and they are on a crisis plan and they have a psychiatrist, and they turn up to A&E on Saturday night having a crisis – it would be great if someone could let the psychologist know that they’ve just turned up at A&E.
“Some elderly people get health visitors every day to help them; if they’ve gone to A&E and they’re not home, it saves the health visitor the journey if they can be notified in some way,” says Bryant.
Push notifications could essentially save money and more importantly, lives.
Ecosystem and barriers
Bryant believes that the healthcare industry is open for small businesses and small wearables companies to get involved, as well as the bigger tech companies.
“We quite like the idea of working with an ecosystem of small companies to get integrated into the system and into our products around wearables,” she says, adding that Microsoft isn’t the only big tech company Graphnet is working with.
But the technology itself isn’t where the issues lie. Dr. Lucinda Scharff, information lead at Forward Health, another company aiming to make communication easier between healthcare professionals, states that one of the biggest regulatory problems the NHS and anyone producing software for the NHS faces is that while push notifications and similar technologies are not new, they’re new to the NHS.
“This means there has been no precedent for how to manage and regulate them. Working in a high stakes environment, those in decision making positions and often clinical staff are naturally risk averse and unwilling to be the first to take a risk with something new,” she says.
However, there are organisations that she has met that are open to using new technology as long as the appropriate steps have been taken to safeguard patients and their security.
But even then, other areas can let healthcare organisations down – even things as simple as connectivity.
“Hospitals are often mobile data black holes and in some cases front line staff do not have access to free or secure Wi-Fi,” she says.
On top of this, organisations have to take into account the cultural impact – and potential resistance from some staff – of using the technology, as well as the obstacle of making it acceptable to staff and patients to use a mobile device in a clinical environment.
But there’s no doubt that these hurdles will all be overcome by the NHS and the wider healthcare industry as the benefits to patients and clinicians are too big to miss out on.