Transforming patient care with remote monitoring

The challenge

Chronic conditions, such as rheumatoid arthritis, can often be effectively managed with medication. Patients still need to visit the hospital for check-ins. Some patients whose symptoms are stable find these appointments unnecessary and inconvenient. Others, whose symptoms have got worse, find it hard to get an appointment when they need it most.

We saw an opportunity to help patients self-report symptoms from home, making it easier for consultants to see when patients’ symptoms were changing. This could build on the existing, paper based system of patient reported outcome measures (PROMs).

Background

Consultant Toby Garrood, an advocate for design thinking at Guy’s and St Thomas’ Hospital, commissioned Unboxed to explore opportunities for user-centred service transformation.

Through a series of workshops and user research we identified a need for a better way to monitor longer term patients in between appointments, to give them the right treatment at the right time

Our approach

We used an agile, iterative and collaborative approach, working with patients, care coordinators and clinicians. We appointed a ‘clinical product owner’ to build trust and confidence in our approach and help us access busy clinicians.

We engaged users of the service by bringing sketches and simple prototypes to the waiting room, and delivering regular show and tells at existing clinical meet ups.

Through repeated testing and feedback loops, we built a simple online form that patients could complete at home. Patients are prompted to complete their form by text, managed through GOV.UK Notify.

A care coordinator can check their responses and send out advice to help patients self-manage their symptoms. Clinicians can view a dashboard to see patients PROM scores and monitor changes in symptoms over time.

By supporting the clinical team to join research and design sessions, we could demonstrate the tangible effects of their input and give them a sense of shared ownership.

What we learnt

Clinicians work in busy, pressured environments and can be fed up with software that doesn’t work for them. It’s important to demonstrate value quickly and show clinicians how the service fits in with other tasks. We need to understand the other systems they use every day, and the wider process of how the department interacts with patients.

Language is important when encouraging patients to self report. We used a content design approach to iterate website landing pages and SMS content to increase uptake.

Designing user-centred services to scale to other groups requires careful consideration of use cases for every feature, for example, how can we build this in a way that it could be flexed for future users?

Beyond the project

We continue to evolve the service through workshops with the rheumatology team, for example, redesigning the dashboard to make it easier for the care coordinator to respond to patients that need support.

Dr Garrood champions the service amongst across South East London. We are working with the South East London long Covid team to reiterate the service for their patients and to work with GPs. This has led us to reiterate features to enable multiple PROMs to be sent to a single patient.