Physiotherapists are loath to move too far away from pen and paper because it is what we have always used, says Euan McComiskie, CSP professional adviser for health informatics. But he believes it is essential for the profession to shift: ‘The main reason is to provide a good service for our patients. They expect digital because of the advantages in other areas, such as banking or travel. Another reason is money. It costs a lot to run an inefficient service.’
Although these are significant drivers, around the world healthcare is at least a decade behind other sectors, according to the Nuffield Trust. Its findings show that this gap is highly visible in the NHS. While 88 per cent of adults in the UK use the internet, only two per cent report a digitally-enabled transaction with the health service.
Although the use of IT in primary care is well established, acute and community sectors lag behind. Even here the scene looks set to change. Most acute trusts have the technology to support mobile working, e-rostering, patient flow software and e-health records, the Nuffield Trust has found.
NHS Choices stands out as a major health service success. The website, with comprehensive advice on conditions and services, gets more than 1.5 million visits each day, or more than 550 million through the year.
There are examples of physiotherapy-specific digital systems capable of successfully supporting patients and services, too. One of these is Physitrack, an online system of video-based exercise programmes which tracks patient outcomes in real time.
Making the change
St George’s University Hospital NHS Trust in London, where Ben Wanless is a consultant physiotherapist and the digital and innovation lead for allied health professions (AHPs), uses Physitrack. ‘We used to give people exercises by drawing them on paper,’ he says. ‘The next evolution was a programme called PhysioTools, a database of exercises and we printed out the exercises we wanted. Now we go online, choose exercises from the videos and email them to the patient.
‘For the patient, it is much better. They can go home, watch the videos and engage with the website, and the app, if they want to. We can update that any time without the patient having to come in.’
While Physitrack is used widely in private practice, the company has struggled to break into the NHS. The reason is cost, Mr Wanless explains. ‘Drawing pictures and printing out stuff costs little, whereas a licence for this type of product is expensive,’ he says. ‘The advertised price is £10 a month per clinician. If we have 50 clinicians and 20 don’t use it, you are throwing away £200 a month.
‘One of our biggest challenges has been getting people out of their normal behaviours and using technology to assist them. If people have been drawing stick figures for years, it’s quite difficult to tell them there’s a better way.’
St George’s is also looking at the getUbetter app to help people self-manage back pain. This app has the potential to provide people with appropriate, evidence-based information early. And as Mr Wanless says, if an individual can manage their own back pain, they don’t need a physiotherapist.
‘We started looking at this about 18 months ago as a solution to a problem, which was that we had 26,000 referrals and not enough capacity,’ he says. ‘Wandsworth clinical commissioning group has committed to buying 3,500 licences as part of the pilot phase and we are ready to start implementing it in a GP practice.’
When it comes to wholescale digital transformation, is it always driven from the top? After all, directors hold the purse strings. The Nuffield Trust has found that strategic decisions about technology, and associated investment, are often a footnote to NHS board discussions.
Even at trusts where digital is centre stage, AHPs face a particular problem.
‘We are almost fourth division when it comes to engagement,’ says Mike Folan, NHS England’s informatics lead for AHPs.
‘At local and national level, we struggle to get data out of systems because there are no AHP data requirements or obligations in any of the national strategy data sets.
‘Physiotherapists and other AHPs still have to write out discharge summaries, or type out information, whereas we know that in other parts of the system tools have been developed that will automate that.’
Mr Folan says there are core objectives in NHS England’s Five Year Forward View that digital systems improve patient safety, clinical outcomes, patient or staff experience and the sustainability of the health service. The good news is that he is on a mission to make sure physiotherapists achieve ‘digital maturity’.
His first objective is to make sure that digitisation does not occur for its own sake, but is directed to support care and other purposes, such as research. The second is to ensure that all AHP requirements are captured in one or more national data sets. Good data means the value of physiotherapy can be demonstrated.
This is already happening in the first contact practitioner pilots, launched in England in June. ‘We and the CSP have done the work to identify how the physiotherapists can capture data at the point of care. This data will support agendas about reducing demand on general practice, about the socio-economic factors around work and sickness, and how patients can be managed appropriately.’
With the NHS under growing pressure, most efficiency gains will continue to be delivered locally through specific opportunities. The Nuffield Trust predicts that the most significant improvements in productivity over the next few years are likely to come from the combined impact of a large number of small changes and extracting the full benefit from technologies.
‘If you can identify processes within your service or day-to-day job that can be made more efficient with technology, then think about the practicalities of actually embedding them,’ Mr Wanless says. He recognises, however, that this may not be easy.
Mr Folan thinks individual physiotherapists could influence digital improvements, by knowing the right people – a chief technology officer or chief information officer – and familiarising themselves with some of the terminology they use. Understanding the broader health and care system is also important.
‘Having that knowledge will allow you to work collaboratively with colleagues and use language that allows you to articulate clearly to the people designing the system how to take your requirements on board,’ he says. There are other opportunities too. Physiotherapists can get involved at local level in the Global Digital Exemplar programme, which promotes the best digital technologies and the sharing of learning with the aim of spreading innovation across trusts.
Use the CSP’s network
Some physiotherapists are already part of the NHS Digital Academy, a virtual organisation to develop a new generation of digital leaders who can drive information and technology transformation in the NHS. ‘There is a programme of work to develop a faculty of clinical informatics,’ says Mr Folan. It will provide a professional home for clinicians and develop competencies that are expected of all clinicians in a digital age.’
Mr McComiskie believes it is important for physiotherapists to share good practice, as well as challenges. He says the iCSP information management network is a good way to do this. ‘We need to be cooperative because I bet the problems and challenges faced in south London are almost identical to those in Glasgow or Belfast.’
He wants digital education to spread beyond physiotherapy undergraduates to those in practice. He thinks the profession should be exploiting social media to sell the physiotherapy message. And he argues that the profession should stop thinking of system suppliers as ‘the big bad IT men’ and understand how it can structure what it asks of vendors.
‘Rather than seeing digital transformation as an instruction from the government, I think we should be seeing it as an opportunity and a call to arms to deliver more efficient services. We should be saying, here are some of the ways we can do it,’ he says.