Case Studies

Dr Alice Byram

Contact me if you want to have a free no obligation 15 minute consult about what I can do for your digital health product.

Digital health solutions are everywhere in the lives of patients and clinicians.

Case A – EHR.

“Not another EHR” can the reaction when you suggest bringing your electronic health care record to market. Knowing what works and doesn’t work means you can tailor your product to the reality of your clinician customers. But it doesn’t need to be better than the current EHR, it also has to offer a clinically and evidence based advantage which improves patient care.

Choosing between EHRs as an investor or a physician has similar elements. It needs to add to patient care and not detract from it. It needs to be safe and compliant, now and in the future. The factors which contribute to this aren’t always easily identifiable even to the physician. Or administration staff who input in the initial information. Or the nurses who document how, when and what they have administered. Or the porter who is in charge of making sure the patient gets to the right place, be it specialist, imaging room or bed. Because the patient will not always be in front of you in the consulting room. They may end up in hospital where you can lose time looking for them. Make medication prescribing errors if you don’t know when the last medication was actual given as opposed to prescribed. Medicine is a team effort. Communication and feedback between every person involved in the care is what happens “on the shop floor”. Nurses, healthcare assistants and porters often contribute valuable information vital for a diagnosis or a plan but they need the place to do that. Not recognising the multidirectional communication and a flat hierarchy leads to rigid systems that will be rejected. All the while respecting different levels of patient confidentiality.

Decreasing physician frustration is a secondary end point when they see that you offer them a product which means that they can get back to old school medicine of actually looking at their patients and not a screen. Respecting their way of working will mean that your EHR will be used by everyone.

Speak to doctors and they will be able to tell you what their biggest frustrations with EHR are, or sometimes not if the system limitations have been internalised.

This international EHR project had many options but being able to offer a function doesn’t mean that it needs to be visible. Too many options and clinicians will have alert and option overload. Offering an easy personalisation of the options to each physician independently of their speciality was a game changer. Initially, the plan was to offer a different format for each speciality. Having made sure that a wide range of physicians in different contexts was consulted, we made sure that all the clinical options were included. This was tweaked to then enable each physician to only see the options that they wanted. Technically not complicated to set up but almost counterintuitive to not display all the options your product has.

No two clinicians work in the same way and empowering individuals by making the ER work for their own practice will ensure maximal engagement. A clinician involved in research may have different priorities to one involved more in outreach.

Knowledge of audit or billing needs in some countries was communicated to the technical team, enabling a discussion as to where this product was heading now and in five and ten years. From a technical point of view too, the long-term vision has to be there. Privacy by design is a fundamental concept whether for HIPAA or GDPR compliance. Understanding the direction that the legal regulations are taking is fundamental to ensure longevity. As is an understanding of the GMC (General Medical Council) or other national and international recommendations.

You need to find and follow through on the clinically valid function which your competitors don’t have. Then the format has to be one that is accepted by the end users to make sure that there is uptake across more than the initial hospital or physician practises. Word travels fasts in medical circles as to which systems actually improve patient care and practice. When they don’t they will be circumvented and more than one EHR has been rejected by the actual users despite signed contracts by managers.

Finally, but certainly not last. In fact probably first. Your EHR has to work for patients. Whether indirectly by contributing to ethical research or directly by making your EHR the go-to one they want to use with all the clinicians interact with. For that to happen you need to understand the health reality or real patients and the health ecosystem in the context you wish to place your product. This may be providing across the board interoperability -you can’t expect patients to change their fitness trackers, phone OS or social media channels. Don’t underestimate the power of a patient recommending the EHR they want to the physician, especially if they see that it works. Contact me for details about this case history.

Case B – Silver economy app.

Gone are the days when it was only bright young things who use mobile phones. Age is certainly no barrier to using apps on a daily basis, and if older people are struggling there is plenty of help around in the form of family members and carers.

There are a plethora of silver economy health projects to invest in. However, too many haven’t taken into account the concept of frailty which is how clinicians work. Complex patient groups present a new challenge to physicians coming from one speciality or from outside clinical settings. I know how it all comes together in acute and chronic settings. Having that overarching view means that I can see if and how you offer a product that will really be used and not deleted within a week.

This brings up a whole new discussion about who can see what about a person’s details. Not every older person wants their family to follow their every movement or dietary transgression. Privacy issues come into play when a person has several carers or several physicians.

Interoperability with existing systems is fundamental, but have you thought about how currently little used technologies such as augmented reality will integrate into your rehabilitation option, or even home appliances help section.

A silver app with buy in from major institutions was struggling to place itself in a crowded market. Knowing that no two patients have the same needs, that age is just a number and a reminder that patients are people with lives outside their conditions brought a new longevity to this product.

Frailty is a concept that brings together conditions and needs. Incorporating a frailty calculator into any app, with a longitudinal record of changes, leads to people getting the care they need according to their baseline situation. Internationally used scoring systems such as the clinical frailty scale give back patients a holistic view of their global needs and are used to decide treatment and social plans. Speaking the same language as all the care providers and integrating their care gives people the future they want to define. Keeping the longitudinal view means this app does not have an end date but rather accompanies the patient from marathon running to broken hip to rehabilitation and back to training again.

Giving the older person the ability to integrate different information at different stages of their life empowers them and means this app is their advocate for their needs and choices. This may be a fitness tracker or it may be a falls alarm, or both. Too often the silver economy is equated with a projection of what we think older life is for others rather than what we all aspire to. Joining up all the different parts of a person’s life leads to better care and an enthusiastic take-up of this technology.

Contact me for more inspiration about digital health options for your product in the silver economy. Based on real long lasting changes I have created in both primary and secondary care settings, I can ensure that you tap into the real silver economy opportunities.

Case C – Point of care testing.

Great advances in technology can truly transform patient care. However, knowing which trials to include your product in and who to pitch it to needs an intimate knowledge of the healthcare ecosystem including the areas physicians inhabit. This client had the engineering knowledge to produce a cutting edge technology but not the use. I was able to point to various uses which would save time and money and also the ongoing trials where it could be incorporated. Sometimes all that is needed is a practising clinician to point out how to make your cutting edge technology truly relevant both in a research setting and “on the shop floor”.

If you are looking to invest and see something that you feel is outstanding but are not quite sure about the end-use, with my extensive primary, secondary and tertiary care across all specialities I can find you the direction the project should follow. It may be that you have already extensively invested in a project but it’s lost its way or not quite lived up to expectations (or investment). You don’t have to assign it to the 8 out of 10 failed projects bin as part of the course. Instead, take a step back and rethink the application setting and outcomes it can offer.

When you offer a truly practical and validated life-saving option to a physician, there will be no pushback. In fact, they will be the ones pushing for implementation and giving you valuable feedback.

Case D – Telemedicine.

Although everyones is talking about telemedicine and recent viral events has made its implementation a non-negotiable, the reality is that the ongoing uptake has been less than we would have liked. Identifying the barriers both from the physicians and the patients’ side needs on the ground knowledge of what their reality is. Too often a preconceived version of what is needed leads to digital health options which are created to answer a non-existent question. Identify real needs and offer real solutions by offering telemedicine to the section of society who will embrace it. Chronic patients, who may or may not be housebound, are not the trendy images used to sell telemedicine but these patients are often early and enthusiastic users of relevant technology. Use patient advocate groups and get organic growth because you know and respond to a real telemedicine need.

A telehealth project that was compliant was struggling to find the patient and physicians that would choose it above others. Here the game changer was thinking outside the box and focusing on a specific patient group but with an international reach. In private practice the world really is your oyster and language is not a barrier. Expats across the world look for continuity of care no matter where they are. Tests can be done locally and results uploaded. Coordination with local hospitals in the case of surgery or emergency treatment is much easier by telehealth than by traditional methods. When you are abroad you appreciate having the security of knowing that one person knows all your health history and takes over the coordination when you are unwell. Tapping into this market led to exponential growth through word of mouth.

Contact me for more information about this and further case studies in a variety of settings.

Case E- Big data

Any AI project in health now has the potential to harvest big data. Knowing what and how to use that big data needs industry-specific knowledge.

Research and pharmacological applications are ever-changing and having current clinical knowledge is a must in order to be first in line for new opportunities.

Make sure your product is exploited in every possible way to get maximum yield. You will be pleasantly surprised by the applications and uses which you have not yet discovered but which an experienced international clinician can identify. Data protection is of course paramount but don’t let that limit your potential market or applications.

For investors who have recognised the fact that health data is the currency that can give the most returns, knowing which of the multiple projects to choose can be a challenge. Especially if you are presented with quantity of data in appealing formats.

However, algorithms are only as good as the programmers who create them, no matter how much raw material. Identifying potentially costly and/or project ending biases is hard unless you know where and who the data comes from. You don’t know what you don’t know. Cross clinical and research experience that have led to clinically relevant publications put me in a unique position to identify what constitutes valuable data, now and in the future.