Empower Your Practice

Journal for Practice Managers

From an illness service into a wellness service

As Medesk is a practice management system and indeed ecosystem, we invited Liz Ashall-Payne, CEO and founder of ORCHA, the Organisation for the Review of Care and Health Applications, to tell us about her career path and future of medicine with digital health solutions.

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How did you start your career in healthcare? What drove you to support digital health in the way that you do?

I started my career just about 20 years ago as a speech and language therapist, developing clinical expertise in complex paediatric care. Very early on I became frustrated that I could support only the one patient sat in front of me at that moment in time while knowing that there were patients on the waiting list and in the community who needed an assessment or treatment.

I got interested in the improvement of information for patients and was always thinking to find more time for care and to assess whether there was an improvement. When digital health and then m-health became available, I was interested in all those elements because of the opportunities they brought to the provision of healthcare.

Liz Ashall-Payne

I have worked in a number of roles in my career. Both at a systems level regionally with the Advancing Quality Alliance (AQUA), NWC Innovation Agency (AHSN), and as a health adviser nationally with an organisation called TSA. I also worked across Europe supporting leaders to achieve better outcomes with the European Connected Health Alliance.

During my career I started to see a massive growth in apps and m-health. In the main, these products were free for the end consumer and the NHS. People were already downloading apps and using them, and people were commissioning apps to support their patients or population health. I got really frustrated with the fact that we had this amazing body of resources, people were using it and professionals thought it was a great idea, but there was no way to systematise the use of health apps to promote the best ones. That’s where ORCHA comes from.

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You provide a vast wealth of information about digital health platforms like practice management system options for patients and doctors. What sort of problems do doctors most frequently come across when they are trying to implement digital solution in their practice?

It’s a classic change in management process, whereby if you’ve always done something in a certain way, to change that practice is the biggest challenge. The first stage in that process is to think about the change that you’re going to be implementing. How do we trigger a doctor to think about using a product?

The best way of doing that is putting it into one part of a process where they can use the product. This is the most successful approach to trigger the thought of when to use an app. Now, that has happened most often with the nurses in primary care or with care assistants. They may be doing an annual review with a patient who has a long-term condition, and they’ve got a little bit more time to spend with the person. They could also be doing a health check, and one point on that process asks whether you’ve recommended an app.

For the GP, we see what you always see with innovation. Because it’s still at the innovation level, you can’t expect people to sign up and use a new tool. We see about 20% activation at the deployment stage. As it becomes more normalised, you start to see an increase in the number of people who use a product. We have to be realistic while also being supportive by enabling people to use new products and processes.

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The other thing to bear in mind is that all physicians like to see an evidence base, so you need to have that feedback loop. One of the key things that we have in our professional license is a request for data which is available in real-time so that clinicians who prescribe an app can see who they’ve recommended an app and whether the patient has downloaded it. They can also see what clinicians like them are prescribing. You can see how many apps Dr. X has prescribed, so there’s a little bit of competition in there.

Particularly in the private sector, many doctors only see new patients when they are required to resolve an acute condition. How can digital health help these physicians and practice managers to retain patients beyond the initial appointment?

Digital health has a solution for everything. It’s just a case of finding the right solution for the right condition.

It won’t always be the same solution for a given health need at different points in your life. Even if a GP sees a patient and is able to resolve an acute condition, that patient may be left with an ongoing challenge or actually have an underlying long-term condition.

Digital health can support an ongoing challenge or provide an intervention to help an individual stay healthy and well. I think that when you look at digital health, the majority of people in our community are using wearables and apps now. You see a lot of Fitbits out there. If the GP is able to talk about digital health solutions like wearables and apps, then the patient doesn’t feel like a patient. Instead, they feel like a person who is being healthy and well rather than somebody who turns up at a practice at a point of crisis or need.

I think digital health can really help to support the patient conversation and turn things from an illness service into a wellness service. Through digital health, the person is then able to monitor and manage themselves to stay healthy and well.

If they have to come back to the doctor, they’re able to share the information. At the moment, it’s not necessarily in an intra-operable way, but in a way that means they can talk about the information from their app or wearable.

It’s a richer conversation that’s more functional and real from the perspective of their life and how they manage it on an ongoing basis. I think it opens a new conversation. As our young people become middle-aged, and our middle-aged become our older communities, the conversation has got to move in that direction. After all, people expect it.

Absolutely. Looking at the demographic curve and who is using digital health or at least willing to do so, you can see that more and more consumers are going to be ready for it over the next 10 years.

What’s interesting is that

the most downloaded app category globally is period tracking, and the people who are most likely to download an app are women aged 30-40.

This is the demographic that has smartphones and is thinking about having a family. It’s also the demographic that has family members who might need some support and care. Engaging that community is absolutely critical when it comes to supporting our young and our old patients.

Coming soon - the next part of our interview with Liz Ashall-Payne where we discuss exactly what is required of a practice management system and other digital solutions to help patients and doctors alike.

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