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In this blog our Public and Patients Involvement and Engagement Lead, Graham Prestwich, explains his work with the public and patients to look at HN’s novel, predictive and preventive artificial intelligence guided Clinical Coaching service aimed to support people with long-term conditions.

Recently I have been involved in a very interesting project pioneered by HN, a healthcare company that delivers artificial intelligence-guided case-finding, clinical coaching, remote monitoring, and virtual ward solutions to the NHS.

The project involved engaging with 25 patients to gather their opinions and feedback about HN’s clinical coaching service and concluded with the publication of a report: ‘Patient feedback on the benefits of artificial intelligence guided clinical coaching’.

This report describes what people think about implementing a practical approach that shifts the thinking and practice of routine good care from responding to a problem once it has happened to identifying the higher risk of an issue and helping people with confidence, knowledge and skills to stay healthy and well in their own homes.

HN has developed a solution for patients with complex multiple needs, using a combination of artificial intelligence (AI) and personalised care. The company has developed an AI algorithm which looks at patient level data and identifies those at the highest risk of becoming high users of clinical services.

Patients who agree to take part in the service are comprehensively assessed and personal goals agreed with support from their clinical coach. Clinical Coaching is a (usually) telephone-based clinician-led service, and through regular discussions, empower patients and assist in improving care coordination with other services.

The patient stories reveal how the desire to become and stay healthy is generated through sharing knowledge and experiences between patients and clinicians whilst building confidence, the will, and the rewards of being and staying well. Importantly, the approach recognises and builds on the beliefs, strengths, and capabilities of every individual, creating a unique personalised and successful solution.

It was a privilege and a pleasure to hear patients share their individual stories and experiences of their treatment and care of common long-term conditions. Patients’ experience of healthcare services is vital to better understand the impact of those services and what works well, what could be improved and what is important to the people who should always be central to all the activity and processes that go towards achieving good care. When these stories are brought together, and common themes are identified, it provides a compelling case for expanding the deployment of an approach that helps more people stay well by being more effective in the way they manage their own health and care needs. In other words, it helps more people, and particularly those with the greater needs, become better managers of their own health and wellbeing.

These ideas are not new, Derek Wanless in his review published in April 2002 emphasised the importance of meeting patient expectation with high quality care and the adoption of new technologies and innovation to meet increasing demand and changing expectation.

The effective diagnosis and treatment of ill health has been fundamentally challenged by the events of the last two years. The way patients access primary and secondary care services has been transformed, particularly in the rate of change from face-to-face to online consultations. Over a period of one month, in March 2020 remote consultation in primary care rose from 15% to 50%. At the same time the rate of new prescriptions fell by 30%. The potential consequences of such changes are highlighted by Dale et al indicating 491,203 fewer individuals initiated antihypertensive treatment in England, Scotland, and Wales, increasing the likelihood of associated cardiovascular events such as stroke. The authors concluded that methods to identify and treat individuals who have missed treatment are urgently required to avoid large numbers of additional future cardiovascular disease (CVD) cases.

The views shared by patients emphasise several common themes which shine a spotlight on what needs to be done more effectively to satisfy the growing and expanding demand for NHS and social care services and support. The first is the close association and interplay of physical and mental wellbeing. Physical ill health has a detrimental effect on mental wellbeing. Recovery and prevention require a motivated and positive patient, not least because of the amount of work involved in planning, organising, and doing the things that keep people well, including but not limited to organising and taking medicines every day. The second important theme was overcoming barriers to doing the right thing. These barriers are not often shared by patients in a routine clinical consultation and maybe it is because they did not fully realise the full extent of the impact or indeed believe that it is a barrier that could be removed or significantly diminished.

The feedback also revealed that the process of using routinely collected health data was not necessarily the barrier to the approach that some might expect, with the caveat that the associated process must be transparent, clear, secure, properly governed, and in the best interest of patient care.

There is much more to be done to build on this initial work to refine the design and approach. HN has recently received funding through the Small Business Research Initiative (SBRI) which encourages organisations to conduct challenge-based research and development of products or services that address a specific unmet public sector need.

If you would like to learn more or get involved, the Yorkshire and Humber AHSN would be delighted to hear from you, email us at info@yhahsn.com

Read the full report ‘Patient feedback on the benefits of artificial intelligence guided clinical coaching’