Interview with Nick Barlow, Chief Officer for Digital Transformation at University Hospitals Birmingham (UHB) NHS Foundation Trust
University Hospitals Birmingham NHS Foundation Trust (UHB) have an established track record in using technology to improve the care they provide to patients. Our Shelford Group Managing Director, Will Warburton, sat down with Nick Barlow, Chief Officer for Digital Transformation at UHB, to learn more.
What are you trying to achieve through UHB’s digital transformation programme?
We want to design and deliver healthcare that is more integrated, preventative, and designed around people, not institutions. We’re excited about ways technology can help solve problems that are pressing today, and do so in a way that enables new and better ways of delivering care for the future. For example, we can be smarter about how we diagnose illness, how we help people manage their conditions at home and in the community, and how we get people access to the right expertise, earlier than we do now. The technology available today is allowing us to do just that.
Can you give me an example? How are patients benefiting?
One great example of how we can be smarter about how we diagnose illness is the work we have done on identifying skin cancer. When a patient has a skin lesion that needs investigation, they can attend a clinic where we take a high-quality digital image. We can then apply artificial intelligence technology – with a human second read to begin with to assure safety – to assess the image and identify which lesions are benign, and which warrant further investigation.
As of February 2022, we had tested 9,500 patients in this way, 2,400 of whom avoided the need for a hospital appointment. This has enabled us to continue to see more than 90% of patients within two weeks of referral from their General Practitioner. It also means our dermatology specialists can spend their time with the patients who most need their expertise.
That means reduced anxiety for people who don’t need further clinical intervention, and quicker access to treatment and better survival chances for those who do. We’re now working with colleagues across the city to test whether this technology could also support decision-making in primary care.
We all know there are long waiting times for care across the NHS right now, particularly in hospitals like UHB that had to pause some routine work to treat large numbers of patients for Covid-19 in the pandemic. What are you working on that could help patients access the diagnostics and care they need quicker?
Our longest waiting list at UHB is for patients seeking care for Ear, Nose and Throat (ENT) conditions. Currently, getting a diagnosis means coming into hospital for a face-to-face consultation with a specialist doctor in an outpatient clinic. There are more patients seeking care than there is specialist time, which leads to patients waiting longer than they want for an appointment and a diagnosis.
The model we are testing takes place in a clinic led by a physician assistant, supported by audiologists and nurses, who take a patient’s history and use an otoscope to capture a digital video of the ear or nose. An ENT specialist can then review the information remotely, during dedicated time for review, and decide whether further treatment is required. Our testing suggests this will allow specialist clinicians to assess and diagnose patients between 1.6 and 2.5 times more quickly than currently.
As a result, patients will get much quicker decisions on their care, and specialist clinicians can use their time more efficiently. While we’re initially deploying these clinics on our hospital site, this model could over time also increase convenience and improve patient’s experience of care, as they could take place in high streets and community facilities, rather than requiring a visit to hospital.
Can digital transformation also improve staff’s working lives?
As the example above shows, technologically enabled change can have a significant impact on the roles and daily experience of healthcare professionals. Our digital transformation team work hand in glove with our clinical colleagues in designing and testing these new models of care, including assessing how that affects professionals’ experience of work and their ability to deliver the quality of care they want to. For example, we’ve learned that it’s important to specialist clinical staff that time freed up by technology isn’t used in a way that simply further intensifies the pressure on a clinic – which could easily happen if technology takes care of straightforward cases, and those are replaced with complex patients. Clinicians want the time freed to enable higher quality of care, more time with patients, and a more manageable workload.
What is the role of your team? Where do you fit in terms of getting from an initial idea to a scaled solution?
We can have the best technology in the world, but we can’t do anything alone as a digital transformation team. We work in partnership with our research and development team, who help validate potential solutions, our clinical teams, who work with us on redesigning the pathway of care and testing ideas, with patient groups, an evaluation team and with our operational and management colleagues to help take ideas to implementation. We frequently cross traditional boundaries of primary, community, and secondary care, so work closely with colleagues beyond the walls of the hospital too. Our work is also highly integrated with that of estates colleagues, as the ability to move information rather than people has major implications for the nature of the physical estate we need in future.
UHB has a long history of investment in digital capabilities. What do organisations need to have in place to deliver this kind of change effectively?
UHB has built and developed an in-house electronic health record over the past 20 years, which provides an essential platform for the work we are now doing. The leadership experience, technical capabilities, clinical engagement, and effective governance developed over that time have helped develop a culture where digital is part of the way we do change. Clinicians trust that digital change will happen and be effective. The executive leadership of the agenda and willingness to set direction are also there to forge consensus when needed.