Introducing IoT into health care for mental health patients

This case study will address:

• Low cost entry to IoT

• Sustainable care and social systems

• New business models

• Driving and supporting strong regional engagement & ecosystems

• Data sharing ecosystems

With funding from Pitch-In, a multi-disciplinary team from across healthcare and medical research aimed to answer the question of whether an IoT device for point-of-care blood testing can improve the uptake of physical health checks.

IoT in health and social care is a fast-developing field with many possible applications. Activity trackers, in-home monitoring systems, smart home controls and resource monitoring systems are just some of the IoT products already available and being used for healthcare. This Pitch-In project demonstrated how an IoT device introduced at the right point in the patient journey can have a significant impact on health care provision for mental health patients.

Pitch-In brought together partners including Akrivia Health, a spin-out from the University of Oxford, Oxford Health NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust and the National Institute Health Research MedTech Invitro Diagnostics Cooperative.

What were the problems or barriers?

People with severe mental-health illness are at greater risk of dying from illnesses such as lung cancer, a stroke or heart disease. On average they will die 15 years earlier than those who don’t have a mental health disorder. Increased death rates are mainly due to patients having other preventable physical health conditions, such as heart attacks and strokes. In addition, patients with a severe mental-health illness tend not to prioritise their own health and their mental health issues can distract medical staff from addressing other health issues.

Everybody diagnosed with a serious mental illness in England should receive a physical health check every year, as per NICE recommendations. Two important elements of the health check are blood tests: lipid panel (measuring cholesterol) and HbA1c (measuring blood sugar levels and detecting diabetes). Yet compliance rates vary significantly across the country. An audit of NHS South revealed only 38% of people in early intervention services had received a full physical health check (South Region annual report 2017). The findings from community mental-health teams are even lower (CQUIN audit data 2018).

Therefore the aim of the Pitch-In project was to introduce IoT devices for blood testing at the point of care in clinical services to see whether they would improve uptake of physical health checks.

What did you do?

• The team identified the most reliable IoT device for the trial. The portable device meant that blood tests could be carried out and the results received at the patient’s side.

• The device was introduced into an Early Intervention Team and an Adult Mental Health Team in Oxfordshire for six months. Training was provided for care coordinators with ongoing support to help them use the device.

• The team compared rates of blood tests and the completion of physical health checks in the intervention teams to a similar early intervention team and adult mental health team in Buckinghamshire.

• They created a team of informatics in Oxford Health NHS Foundation Trust (FT) and Oxford University Hospitals NHS FT who enabled test results to be automatically sent to the local hospital and added to the electronic patient record.

What was the result?

Service users and healthcare professionals found this approach to testing far easier. It reduced anxiety and increased engagement with a huge and positive impact on uptake of physical health checks in certain teams.

For example, rates of health check completions rose from 22.6% to 40.3%, per 6 months, for the Oxfordshire Early Intervention Team caseload. The use of point-of-care testing devices is now in routine in early psychosis services in Oxford Health, benefitting 100 people per year. However this was not universal, and the attitude of clinicians in the teams is a critical factor in whether this new technology is adopted.

Crucially, it enabled practitioners to engage with patients and make a plan together for potentially life-saving next steps. Clinicians reported that they appreciated the increased autonomy and ability to make a difference in their client’s care. Service users revealed that it made them feel less anxious and more engaged with a more efficient service and a better understanding of their own physical health.

Lessons learnt

• After eight years of discussion, the funding from Pitch-In provided the focus and timeframe to make ‘a good idea’ happen.

• Recruiting a clinician as the project manager was helpful as they were able to get buy-in from partners and ‘speak their language’.

• Interviews were invaluable in understanding why devices weren’t used in some mental health teams. They revealed that the issue was around the belief of some mental health teams and how they saw their role in physical healthcare, rather than the individuals struggling with the technology.

• Integration of the electronic patient records was achieved between the acute hospital and mental health trust, due to the inclusion of Mike Denis in the team. He was able to cross the boundaries of the different organisations and manage the integration.

What next?

• NHS England is funding a one-year project worth £218,608 for the implementation and evaluation of a point-of-care testing programme across the South East of England. This started in March 2021, and as of July 2021, over 90 early intervention in psychosis staff have been trained on 40 point-of-care devices, which have been delivered to 30 teams across 8 trusts in the South East of England.

• A related ECG project is ongoing to validate handheld devices before introducing them into clinical services.

• Further point-of-care testing devices are currently being evaluated in mental health services, including point-of-care full blood count measurement.

Professor Belinda Lennox, University of Oxford said:

“The support from Pitch-In has been critical to the success of this project. The integration of this technology into routine clinical practice benefits everyone. It has shifted the way that we work and there is now no looking back.”

Contact: belinda.lennox@psych.ox.ac.uk