Monday is T1SWAS clinicEveryday is T1SWAS Day

Dr Pete Davies

Janet Kinson Diabetes Centre,Sandwell Hospital,SWBH NHS Trust

What is this Tiswas you speak of… Bwian?

2014: It’s time for Type 1 diabetesOutcome: Birth of T1SWAS, T1 SWBHT Advice & Support

• 10+ years of transformation – “Right Care, Right Here”– Type 2 diabetes care closer to

home

• Helped to create time/space to develop type 1 diabetes care – BUT ask people with diabetes– ‘Voice of the customer’

• Planned continuous improvement methodology Survey autumn 2014

Cycle 1: Autumn 2014:Voice of the customer

We asked PWD type 1:• What are their specific

needs?

• Which new elements could add value?

• Which features must we retain?

• Imagine… “no holds barred!”

PWD type 1 told us:• Access needs improving

– Greater flexibility in the timing and frequency of support

– Faster access to support & advice

• “Mind the gap”– Peer support– Emotional support– Psychological support

• Tools that allow closer communication – Open to Skype, sms-support,

secure messaging, etc.

36 online & 17 paper form responses analysed

Patients get to spend an average of three hours

per year with a professional…

…if they are lucky!

The average person with diabetes:

spends three hours each year with a professional

The remaining 8,757 hours, they care for themselves.

3

8,760= 0.03 %

Spring 2015, T1SWAS launch:supported by PHR "Patients Know Best™"

PlanPlan

DoDoStudyStudy

ActAct

““Voice of customer” Voice of customer” surveysurvey

Improve accessImprove access Greater breadthGreater breadth Technology enabledTechnology enabled

PKB “the vehicle”PKB “the vehicle”

Carry out the planCarry out the plan

Determine what Determine what changes need to be changes need to be mademade

What was learnedWhat was learned

👍

PHR/PKB at my Trust

• Pricing model a barrier to extended use*• Behçet service Specialist Commissioning fund surplus

used to add diabetes/endocrinology**

2013 2014 2015 2016 2017+…...

Immunology* choose PKB

Behçet service* join in, ££

Desire to scale-up PKB**

Evidence of meaningful use

Cerner Patient Portal:

HealtheLife

Why use PKB?

• Expediency! It was available

• Someone else was paying!

• Tried & tested• Rich variety of functions

• Functions include– Secure messaging– Laboratory test result

Integration– Care planning– Library for links &

documents– Skype consultations

integrated– Tracking of biomedical

measurements… etc.

Implementing Patients Know Best• Each person invited face-face in consultation

– 1 minute sign-up– PKB leaflets to take away, for the curious– Clinic letter sent by secure message within 3 business days

• Team members trained & added, patient-by-patient

PlanPlan

DoDoStudyStudy

ActAct

““Voice of customer” Voice of customer” surveysurvey

Improve accessImprove access Greater breadthGreater breadth Technology Technology

enabledenabled

Implement PKBImplement PKB Offer to PWDOffer to PWD Engage the Engage the

teamteam trainingtraining

Determine Determine what changes what changes need to be need to be mademade

What was What was learnedlearned

People with diabetes

Diabetes nurses

Dietitian

Doctors

Emotional support team

Peer support team

Evaluation Sept 2015•In use 5 months•~200 patients using PKB• 50:50 type 1

diabetes & endocrine

•N = 30 (15% response rate)N

umbe

rs o

f pat

ient

s / H

L7 m

essa

ges e

xcha

nged

Cycle 2 of continuous Improvement

Evaluating PKB

Evaluation of PKB: September 2015Use of PKB by people with type 1 diabetes:

I do not own the record

I feel I own the record

The potential that people with type 1 diabetes see for PKB

Evaluation of PKB: September 2015Time & cost saving Impact of PKB as perceived by people with type 1 diabetes:

Can help support a business case justification to adopt PHR

Impact of PKB on doctor/nurse-patient relationship perceived by people with type 1 diabetes

Can help support a values-based justification to adopt PHR

People with diabetes said…“Using the messaging service put my mind at rest”

“I received a reply much faster than I would have expected through more traditional means.”

“It’s useful that correspondence is saved for me to look back over, so I can process the information at a pace that suits me” “PKB helped me to construct

a more considered and detailed question than I would have managed verbally whilst feeling unwell and confused”

“I feel safe in the knowledge that I have expert advice at the click of a button. Excellent.”

“I like to use this PKB because I don't have to keep going to appointments and it saves me a lot of time”

“PKB has enabled me to have discussions with my consultant and the team - for which I am incredibly grateful.”

“I find it very reassuring that you are able to contact your consultant very quickly and resolve any concerns or fears you might have”

“I think this is really useful when you are worried or concerned”

“I have found PKB invaluable, I needed guidance with an issue & the doctor was able to help, advise and guide me through my treatment via the messaging service.”

Diabetes UK annual professional conference March 2016

Runner-up

DUK Education and Self-care award

Further evaluation: February 2016•In use 10 months•346 patients using PKB•New focus is• Value-added• PKBs capacity

to eliminate ‘wastes’

Num

bers

of p

atie

nts /

HL7

mes

sage

s exc

hang

ed

Spring 2016:Cycle 3 of continuous Improvement

PKB use adds value & can eliminate ‘wastes’

Commonest wastes are ‘waiting for things’ & ‘duplication’

Greatly Improved

Not changed

Add value such as•Great to have advice from my nurse, dietitian and consultant on hand in one place•Online processes are faster and more convenient •When I ask a question, I get a speedy response that puts my mind at rest •It shows me that the whole team is working together to solve my problem•Greater understanding of test results

Eliminate waste such as•No more appointment reminder letters•Specialists and GPs no longer request same tests •I used to have to leave telephone messages and not know when my call will be returned any more•No more unnecessary clinic visits•My query used to be handled by several people before it got to my nurse, now it's immediate

People with diabetes said…

Latest Use Statistics:>400 patients, >1100 HL7, >3000 secure messages

PKB Overall• Functions ++• Ease of use & liked by

patients• No need for training• Flexible modes of

connection, e.g. sec. message/Skype

• Achieved meaningful use• Potential to promote team

working• Potential to work across

whole system pathways

• Not all find it easy• Disadvantages the ‘digital

poor’?• LTC care+, but no good in

episodic (acute) care• Use by professionals patchy• Lack of work credit & JP time• Sign-up task rests with senior

nurses & docs • Poor analytics• Not integrated into workflow

Tools for diabetes #ConnectedHealth

HbA1c Results to Patients+ https://vimeo.com/91089977 ‘Florence’ Simple Telehealth* http://bit.ly/1OtehBC

Skype Consultations** https://youtu.be/e6JSVVtBkto Cerner Patient Portal*** http://bit.ly/24TpVKb

2013 2014 2015 2016 2017+…...

‘Florence’ Simple

Telehealth*

Skype Consultations**

PHR with secure messaging, PKB

Evidence of meaningful use

Cerner Patient Portal***

HealtheLife

2011-12

HbA1c Results to Patients+

“Make like an electron”

So… everyday can be a T1SWAS Day

Tools for diabetes #ConnectedHealth

• Can help sustain supported LTC self-care

• Can be deployed effectively

• Offer great opportunities to add value to diabetes care

• Break down traditional boundaries in care

• Help build closer relationships between people with diabetes and their healthcare team

“Healthcare is a relationship based on trust”

Using #ConnectedHealth

“at first it improves your relationship. Later on it improves

the person’s health”

Thank you!