HTN recently covered the announcement of NHSX’s new Adoption Fund winners. The 35 successful innovations, and the teams behind them, will each receive a share of the £6.5 million funding pot.

Spread out across five areas – gastroenterology, musculoskeletal, perioperative, cardiology and cardiac surgery pathways, and digital inclusion – the innovations are expected to support priorities around elective recovery and have the potential for a rapid roll-out across the NHS.

Expert panels comprised of charities, clinicians and researchers, chose the winners from 138 applicants. And then there were 35 – but what are the innovations that topped the shortlist, and which could be coming to a hospital or a clinic near you, soon?

From remote care, self-management models, and targeted pilots, through to ways to empower digital maternity services, a digital exclusion mapping tool, video rehab, and AI triaged health coaching, there’s a feast of imaginative ideas and insights for harnessing technology.

So, HTN decided to take a closer look at the winning entries…

Gastroenterology – winners

The successful gastroenterology pathway entries cover a broad range of initiatives, with a focus on bowel preparation for colonoscopies and endoscopies, as well as faecal calprotectin testing and ways to manage Inflammatory Bowel Disease.

• Automated SMS and patient videos to improve bowel preparation quality for colonoscopy

The North East London Health and Care Partnership will work with partners, including Kings College Hospital NHS Foundation Trust, Barking Havering and Redbridge University Hospitals NHS Hospitals Trust, and Healthcare Communications, on procuring and implementing  automated text messaging. The system will send patients reminders of dietary and medication changes, starting 14 days before an appointment, to help improve bowel prep and reduce repeat appointments and missed diagnosis.

• IBDoc: Gastro remote care & monitoring

From NHS Derby and Derbyshire Clinical Commissioning Group, in partnership with the University Hospitals of Derby and Burton, and Chesterfield Royal Hospital Foundation Trust, comes IBDoc, which offers remote monitoring and care for the gastro pathway. The diagnostic device detects faecal calprotectin levels in stool samples and is set for a home pilot that will allow patients and clinicians to access results through a web portal. The overall aim is to reduce outpatient appointments and colonoscopies, and promote self- management and medication compliance.

• Home faecal calprotectin testing pilot in an area of high social deprivation

The second of several innovations focused on faecal calprotectin testing, this pilot instead focuses on supporting patients in areas of social deprivation. Cheshire and Merseyside Health & Care Partnership and Liverpool University Hospitals NHS Foundation trust (LUFT) will also pilot the tests in home settings, using DrDoctor for different IBD patient groups, with the goal of increasing the return rate of results, reducing the amount of patient journeys and improving follow up times.

• Automated endoscopy bowel prep pre-assessment and patient education

The Remcare app, which provides ‘on-demand access to bowel prep instructions and education’, will be trialled for endoscopy patients who are usually required to attend a 30-minute appointment for a pre-assessment. It’s hoped use of the app by Staffordshire and Stoke on Trent STP, Stoke on Trent CCG and University Hospitals of North Midlands NHS Trust, would instead enable the release of clinical capacity and collect key patient information remotely.

• Integrating e-Health into the IBD patient pathway using virtual monitoring and faecal calprotectin home testing

Our Health South East London plans to work with a number of partners on a ‘three pronged project’ to help IBD patients in remission to use home monitoring, with the ultimate aims of reducing face to face appointments and the use of endoscopy resources, and enabling patients to monitor themselves safely and trigger follow ups. Users will be offered a virtual review via the My IBD Care app, three-monthly calprotectin testing through CalproSmart home kits, and some will also trial Thriva’s at home blood testing.

• Supported self-management and remote monitoring of IBD patients within Herefordshire and Worcestershire

Patients within Herefordshire and Worcestershire CCG will also be given the opportunity to self-manage and remotely monitor their IBD. The CCG intends to use the My IBD Care app for home monitoring, alongside the CalproSmart kits, for patients in the Wye Valley. It’s hoped the result will help determine clinical actions and prioritisation of patients, as well as increasing patient empowerment and experience.

• IBD Home: Patient initiated supported self-management care model

Similarly, Humber, Coast and Vale Health and Care Partnership will link up with Hull University Teaching Hospitals NHS Trust to pilot the My IBD Care app and at home faecal calprotectin (FC).

• Establishing an integrated PIFU assessment service for stable IBD patients in Manchester

Greater Manchester Health and Social Care Partnership, working with Manchester University Foundation Trust and Ampersand, will deliver a patient pathway for IBD patients, focused on a patient initiated follow up (PIFU) navigator. It will use of the My IBD Care app and home calprotectin tests for patient self management.

Digital Health Inequality Pioneers – winners

There were also a number of winners who looked at ways to tackle digital health inequalities, with the successful applicants in this area offering ideas and innovations to improve maternity systems and remote monitoring, as well as digital exclusion mapping, and a focus on improvements in access for asylum seekers and rural communities.

• EDAMS: Empowering Digital Access in Maternity Services

Cambridgeshire and Peterborough ICS will investigate the main barriers facing women in accessing digital services within the maternity pathway, specifically focusing on the impacts of ethnicity and level of deprivation. Results will inform ‘suitable localised action’.

• 100 Day Health Equity Challenge: BP at home

Suffolk and North East Essex ICS, along with partners, will focus on patients who are suitable for at-home monitoring programmes, such as the ‘BP at home’ project, where patients are monitored through a wearable device for a short period of time. Outcomes will be used to tailor at-home health care, with the aim of increasing participation in the most deprived communities.

• Digital exclusion mapping

North West London ICS/CCG is reviewing patients receiving, or recquiring, community or mental health treatment. Its aim is to understand the scale of digital exclusion across North West London and the process will include mapping exercises, literature reviews, focus groups with those who are currently digitally excluded, and research exercises. Ultimately, a strategy and and action plan will be produced to help ‘address the gaps, and ensure equitability’.

• Reducing Inequalities: A key deliverable of the adult community mental health transformation

Central North West London will commission an external supplier to complete a ‘comprehensive independent review of digital inequalities’ within its community, for patients with severe mental illness. A co-created research report will be published based on the outcome of the review and will focus on local understanding, a gap analysis, and recommendations on how to mitigate.

• Digital exclusion feasibility study: South West London MSK app

South West London Health and Care Partnership (SWL ICS) has introduced an app for MSK patients and wants to understand why one cohort of patients has not taken up its use. In response, SWL will undertake research into digital exclusion, aiming to understand the barriers facing patients and potential co-design solutions. The ICS will also develop a digital exclusion assessment to use as a guide for future patient facing solutions.

• Florence Nightingale Dermatology photographic hub

NHS Derby and Derbyshire Clinical Commissioning Group will work with Florence Nightingale Community Hospital to implement a  photography service, which will support its current Dermatology pathway. The initiative means that patients who are unable to provide images, or would benefit from a dermatoscope image, can access the service in a community setting. There is also the potential for the pilot to extend to a mobile service to assist those who find it hard to leave home.

• Reducing digital inequalities in maternity services for asylum seekers

Surrey Heartlands ICS will commission an external contractor to undertake an extensive digital inclusion gap analysis. The goal is to understand how prospective parents in deprived and digitally excluded areas, as well as asylum seekers and their families, could have better access to services and information.

• Piloting the route to make inclusion planning standard in digital mental health transformation projects

Surrey Heartlands ICS has plans to develop and implement a digital exclusion plan for patients, focusing on those who are accessing the Early Intervention in Psychosis (EIIP) service in East Surrey. It’s thought that the cohort may be ‘at risk of digital exclusion and not benefitting from digital tools’. Learnings and research from the project will be used to to support other work across the ICS around digital inclusion.

• Flexible digital inclusion model for pathways using a digital product or service

Bristol, North Somerset, South Gloucestershire (BNSSG) CCG aims to ‘research, review and address’ digital inclusion across its cancer and MSK pathways. The plan includes looking at the MSK pathway, which already has digital tools embedded, to understand the barriers facing people in using those tools, with an action plan created to address any issues. For the cancer pathway, which is due to have digital tools embedded, BNSSG will look at which cohorts could experience digital exclusion and also create an action plan to work on that area.

• Increasing confidence, knowledge, support and skills with rural communities in Devon to help tackle digital and health inequalities

Devon ICS will also look at user research and a gap analysis to understand the digital barriers facing patients in rural communities. The approach will include virtual consultations and research, with the aim of understanding how patients feel, what support there is for them and ‘what good looks like’. The research is then intended to be used to produce a digital exclusion strategy.

Musculoskeletal – winners

Next up are the winners of funding in the musculoskeletal section, which includes programmes of work around self-management, remote monitoring, video rehabilitation and supporting patients through digital means.

• Empowering self-management through online education for MSK conditions

Harrogate and District NHS Foundation Trust is developing its own advice and education website, called the Harrogate Health Hub, which helps with the treatment of MSK patients by encouraging self-management from ‘ high volume, low complexity’ patients. Funding will be used to further develop resources and educational content to help patients with topics such as post-operative orthopaedic education and rehabilitation.

• Supporting rheumatology patients in the community through remote monitoring

Guy’s and St Thomas’ NHS Foundation Trust is working in partnership with King’s College Hospital NHS Foundation Trust and Lewisham and Greenwich NHS Trust, on its Healthier South East London project. This focuses on ’embedding and scaling digital remote monitoring and patient reported outcome measures collection’ in rheumatology departments across the South East London ICS. By analysing data, they will work to improve shared decision making around appointment need.

• Web-based exercise prescription to support self-management

Northamptonshire CCG and Northamptonshire Healthcare NHS Foundation Trust are working to enhance remote monitoring through virtual physiotherapy rehabilitation. ‘Physitrack’, an interactive platform which records patient progress through the remote capture of patient reported outcome measures, and is supported by exercise videos and customised information, will be embedded into the CCG’s offering. The platform aims to facilitate active participation in rehabilitation and can also enable video assessments.

• Using decision support tools to self-manage low back pain

Midlands Partnership NHS Foundation Trust is collaborating with a number of universities, hospitals and trusts on a platform that supports the digital self-management of lower back pain, for low to medium risk patients. Called ‘SelfBack’ and ‘STarTBack’, the tools will together provide information about physical activity, strength and flexibility, as well as daily educational messages.

• Going paperless to support patients to self-manage MSK conditions

Shropshire, Telford and Wrekin CCG will partner with several organisations to utilise ‘MyRecovery’ to support patient MSK services. This will involve ‘going paperless’ and collating electronic patient reported outcome measures to support patients to self-manage their condition, as well as those who are on waiting lists, and to provide robust data to support patient initiated follow up.

• Tracking patient progress through the remote capture of patient reported outcome and experience Measures

Brighton and Hove CCG will lead on a project to implement ‘Cemplicity’, which will remotely track MSK patients’ health after what’s described as an ‘episode of care’. Alerts will warn clinicians if patients are showing signs of deterioration and facilitate ‘proactive recall’ for rapid reviews, which it’s hoped will support a reduction in patients presenting in places such as A&E.

• Video-based exercise rehabilitation and physiotherapy-led group exercise classes

North East Hampshire and Farnham CCG are partnering with the Surrey Physio Group to roll out the latter’s ‘Rehab Me’ app. The technology provides video-based rehabilitation and online physiotherapy-led group exercises, and also enables the sharing of rehabilitation programmes between multidisciplinary teams, through integration with clinical systems.

• Supporting people with MSK conditions to live well within the community

Dorset CCG and partners including local councils, trusts and primary care practices, are set to implement a population health management approach to support a number of MSK patients, whose conditions do not require hospital care, to live well within the community. A personalised care approach will be adopted through the MSK Matters website, providing programmes for lifestyle optimisation and early intervention, as well as further development and implementation of shared decision tools on the Dorset Medical Decisions platform.

• Integrating voluntary, community and social prescribing resources into digital self-management for common musculoskeletal conditions

The final winner in the MSK section is Gloucestershire CCG, which is to work with trusts in the area to implement the GetUBetter platform, which provides end-to-end support through the prevention and self management of common MSK conditions. It does this by mapping dedicated resources to local population needs. The CCG will work with the voluntary, community and social enterprise sector, to make sure that community offers – such as social prescribing – are included within local MSK pathways on the app.

Perioperative – winners

In the perioperative pathway, the six successful projects look at digital innovations to support care, AI triage, scaling existing platforms, redesigning pathways, and more…

• 4 site test, evaluate and scale approach for four digital innovations in high volume low complexity pathways

Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System is part of a project that seeks to implement and scale up digital innovations within the perioperative care pathway. Led by the ICS Director for System Performance, the consortium includes colleagues from three NHS trusts, four evidence-based technology providers, and the Oxford Academic Health Science Network.

• Waiting well, AI triaged health coaching

Cheshire and Merseyside Health and Care Partnership and Liverpool CCG’s AI triaged health coaching project will look to optimise clinical care pathways and participation in managed self-care for patients awaiting surgery. Focused on support before, during and after operations, the work will involve use of the C2-Ai risk stratification tool, which uses machine learning algorithms to identify of patients on waiting lists who are at risk of deterioration and or that need individualised prehabilitation, as well as enlisting Sapien Health to deliver remote health coaching.

• Developing and scaling digital perioperative capabilities in an existing technology platform

Humber Coast and Vale ICS and partners will utilise the existing Patient Knows Best platform for digital prehabilitation, preoperative assessment, shared decision making and consent. Some of the project’s goals include ensuring surgical capacity is used appropriately through  improved shared decision making and consent processes, using clinician time more effectively through remote services and monitoring, and transformation of the patient journey.

• Digital preoperative assessment, patient education and two way communication within an existing ICS shared system

Gloucestershire CCG, in partnership with Gloucestershire Hospitals NHS FT, plans to digitise its pre-assessment pathway, including through questionnaires, documentary information, universal prehabilitation guidance, and the potential for two-way communication. The technology will be developed in an existing patient record, with Allscripts EPR providing the clinician facing functionality and surface clinical and patient information, while InterSystems Healthshare will provide the link between Allscripts and Notify, so that clinicians can communicate directly with patients.

• Digital preoperative assessment and consent for High Volume Low Complexity pathways

South West London CCG and partners will, on behalf of the ICS, use technology to support the development of a pre-op pathway to help identify low risk patients who could be managed through alternative approaches. The Cerner patient portal will allow patients to  complete preoperative assessments remotely, with three digital consenting solutions also shortlisted for procurement. Work in this area will focus on the six High Volume, Low Complexity (HVLC) specialities.

• Digital redesign of preoperative pathways

Leicester, Leicestershire and Rutland STP aims to redesign its preoperative processes to ‘reduce administration time, improve process, traceability, data accuracy and increase patient engagement’. The partnership is currently in the process of selecting digital technology for consent and preoperative assessment, and wants the packages to co-exist and integrate with the trust’s existing digital architecture.

It’s hoped this will enable shared decision making, with patients able to access information leaflets and, once surgery is decided upon, patients who need further pre-operative investigations, treatment or consultations, will be identified, with information effectively shared across the pathway.

Cardiology and cardiac surgery elective care – successful applications

There were two successful applications in the cardiology and cardiac surgery (elective care) area, with remote monitoring technology, change management resources, and telehealth infrastructure, at the centre of proposed plans.

• London Cardiac Networks

London Cardiac Networks will work with five ICSs or HCPs across the capital, with representatives from east, north, north west, south east, and south west London.

The aim of the project is to win funding for the implementation of remote monitoring pathways in elective cardiac surgery and cardiac lists, through the use of remote monitoring and change management, across eight London sites. It is hoped that solutions will ‘enhance pre and postoperative pathways through digital investigation and virtual clinical tools’, before being rolled out to other national Cardiac Pathway Improvement Programme (CPIP) priority pathways.

• Cheshire and Merseyside Cardiac Network

This project will include collaboration between nine CCGs, the Population Health Board, the Cardiovascular Disease Board, Cardiology Network and supporting programmes and networks.

Cheshire and Merseyside will deliver enhanced clinical pathways through scaled up adoption of telehealth, based on existing infrastructure. The funding will go towards helping to address healthcare inequalities by supporting access to specialist care for all patients, through scaling active one-to-one patient-staff interactions and delivering care to homes. Prehabilitation and remote enhanced recovery will be supported using Docobo’s existing telehealth infrastructure for monitoring, support, education and alerting, with use of the platform expanded.

To find full information about all the winners, visit NHSX’s dedicated page.