Partners for good: how tech and the NHS work together
The COVID-19 pandemic revealed how the United Kingdom’s National Health Service (NHS), one of the largest public health systems globally, could benefit from the influence of an increasingly disruptive tech sector. For many, this has been a long time coming, as projects to bring technology into the NHS have been and gone over the last 20 years.
Joop Tanis is the Director of MedTech Consulting at Health Enterprise East (HEE), a company providing a bridge between the NHS and the industry. Tanis suggests the need for the NHS to collaborate with the tech sector has always existed. "A lot of research happens within the NHS, but many technological solutions are developed by industry. Arguably, technology has always played a part in the development of healthcare. But in the past 20 or so years, there has been a greater recognition that this partnership is mutually beneficial."
Solutions developed during the pandemic made this increasingly apparent. "Some of the testing and vaccination technologies have required industry to step up and really work very fast to develop these new ideas", Tanis says. "But for me, it's almost more interesting how we, as a healthcare delivery system, recognised that you [could] actually make quite rapid changes if you need to, that dramatically change the way we deliver care."
HEE delivers programmes such as the Clinical Innovators Network and the MedTech NAVIGATOR Innovation Grants. These help to identify unmet clinical or organisational needs in healthcare and provide a platform for SMEs to respond to those needs by developing innovative new products and services. The Innovation Grants are designed to help SMEs gain access to medical or other necessary expertise during the product development phase.
"Having access to clinicians, researchers and other key stakeholders in the public sector is an essential part of successfully developing and commercialising new products and services for the health and care market", explains Dr Anne Blackwood, CEO of HEE.
Blackwood says that the NHS has a much more open relationship with technology providers now compared to when HEE was founded in 2004. "This has accelerated during the pandemic, where the NHS and industry came together to solve problems, whether it was accessing teleconference technology for remote consultations or responding to the shortage of ventilator technology. The rapid adaptability of the NHS to the coronavirus pandemic shows what can be achieved in a time of national crisis."
"The interesting challenge now, as we emerge from this latest wave, is how do we make the changes ‘stick’ in terms of adoption of new technologies once the crisis is over?" she adds.
The pandemic has created additional challenges that will likely endure once the worst of the crisis is over. There are currently an estimated 5 million patients waiting for treatment that has been delayed due to COVID-19. Is there an opportunity for the tech sector to tackle these issues? Joop thinks there is. And that a lot of these solutions are already available. "A lot of funding goes towards research and development of new ideas and products, but on the adoption side, we've not had that seen the same effort towards implementation."
"Innovations and technologies that can support greater efficiencies in care, reduce the backlog on waiting lists, continue to support and monitor patients at home, and free up clinical time are all needed, and industry can help the NHS recover here", Blackwood says.
Examples include the grant recently awarded to Tekihealth Solutions Ltd to help fund the development of a telemedicine device to combat the effects of COVID-19 among care home residents. A hand-held device, which connects to a lightweight wireless router, has been designed to help care home residents who may have been struggling to access their doctor’s appointments due to poor IT infrastructure. Another grant has been given to a rehabilitation device called SoftPower, aimed at the elderly and partially able individuals whose ability to exercise has been affected by the pandemic.
Start-ups such as these are "engines of creativity and innovation", Blackwood says. "Like much of the public sector, I think the NHS has previously overlooked start-ups. Concern over lack of evidence when it comes to new technologies, and lack of a track record of delivering created a more risk-averse culture."
"I am hopeful that procurement channels will remain open to start-ups after this phase and that hospital trusts will recognise that within the communities that they sit, there is a wealth of creativity and innovation that they can tap into right on their doorstep."
What makes a successful collaboration?
Tanis says that for the NHS and tech sector to work effectively together, they need to understand each other's worlds. "HEE works for that reason", he explains. "We offer insight into the other side's world. For the NHS, that means we understand intellectual property, how to identify whether something is unique, whether it's practical in terms of development and production, and whether it would be value for money. From a clinical innovators' point of view, we can shine a light on what commercialisation, product development, and a successful rollout would look like."
It's also important that creators understand that in isolation, their product has no impact. "When I talk to technology innovators, they are quite rightly very enthusiastic about what their product or new technology can do, that's what they're passionate about, and I completely understand that. But often, the person using the product is not that interested in the technology. All they're interested in is whether it helps them deliver better care, more efficiently."
"As well as genuinely solving a problem, [the] tech must be something that can be adopted into clinical practice", Tanis adds.
This is where health economics comes in, which has proven to be crucial to ensuring the maximum benefits are gained from a new product. "If you're developing a product that would make a real difference but is simply unaffordable, you need to adjust the specification or the production so that when you get to the point of sale, it will actually have commercial viability", Tanis explains.
Another key area is how the technology will be rolled out. "You need to understand the environment in which it needs to be adopted", Tanis says. "We do a number of product evaluations where we look at a product being adopted by an organisation and what the learning points are, how it changes clinical practice and also how it changes operational practice."
In 2019 the NHS Long Term Plan was published, setting out the priorities for the health services over the following ten years ─ a crucial part of which is the digitisation of services. "Supporting integration of health and care services is critical", Blackwood says. "We saw the benefits of trusts collaborating across larger geographies during COVID-19, but vertical integration is desperately needed too, and digital technologies can be the enabler here. Also, AI technologies to stratify and case find in the community will enable the prevention and early diagnosis of diseases, saving lives as well as NHS time and resources." Tanis says that there has never been a better time for healthcare innovation. "History tells us that we very quickly go back to our old ways, simply because the need to do something differently has gone away."
"We were definitely running out of runway to match what was expected of us to what we could afford and what we could deliver within the capacity of the current workforce and infrastructure. This last year has really focused us on that and moved us along in terms of the willingness to make changes. We should use the time we have right now to transform the way we deliver healthcare permanently."
Introducing Dosis - the AI powered dosing platform
Cloud-based platform Dosis uses AI to help patients and clinicians tailor their medication plans. Shivrat Chhabra, CEO and co-founder, tells us how it works.
When and why was Dosis founded?
Divya, my co-founder and I founded Dosis in 2017 with the purpose of creating a personalised dosing platform. We see personalisation in so many aspects of our lives, but not in the amount of medication we receive. We came across some research at the University of Louisville that personalised the dosing of a class of drugs called ESAs that are used to treat chronic anaemia. We thought, if commercialised, this could greatly benefit the healthcare industry by introducing precision medicine to drug dosing.
The research also showed that by taking this personalised approach, less drugs were needed to achieve the same or better outcomes. That meant that patients were exposed to less medication, so there was a lower likelihood of side effects. It also meant that the cost of care was reduced.
What is the Strategic Anemia Advisor?
Dosis’s flagship product, Strategic Anemia Advisor (SAA), personalises the dosing of Erythropoiesis Stimulating Agents (ESAs). ESAs are a class of drugs used to treat chronic anaemia, a common complication of chronic kidney disease.
SAA takes into account a patient’s previous ESA doses and lab levels, determines the patient’s unique response to the drug and outputs an ESA dose recommendation to keep the patient within a specified therapeutic target range. Healthcare providers use SAA as a clinical decision support tool.
What else is Dosis working on?
In the near term, we are working on releasing a personalised dosing module for IV iron, another drug that’s used in tandem with ESAs to treat chronic anaemia. We’re also working on personalising the dosing for the three drugs used to treat Mineral Bone Disorder. We’re very excited to expand our platform to these new drugs.
What are Dosis' strategic goals for the next 2-3 years?
We strongly believe that personalised dosing will be the standard of care within the next decade, and we’re honored to be a part of making that future a reality. In the next few years, we see Dosis entering partnerships with other companies that operate within value-based care environments, where tools like ours that help reduce cost while maintaining or improving outcomes are extremely useful.
What do you think AI's greatest benefits to healthcare are?
If designed well, AI in healthcare allows for a practical and usable way to deploy solutions that would not be feasible otherwise. For example, it’s possible for someone to manually solve the mathematical equations necessary to personalise drug dosing, but it is just not practical. AI in healthcare offers an exciting path forward for implementing solutions that for so long have appeared impractical or impossible.