IoT for social prescribing

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

In partnership with the Royal College of GPs, this Pitch-In funded project aimed to understand the barriers to and facilitators for the use of IoT to support and help promote the use of social prescribing.

It’s not only diseases that can make us feel unwell. Worries, lack of exercise and an unhealthy environment can all be detrimental to health. In such cases, poor health is caused by social issues. Recognising this, social prescribing looks beyond conventional healthcare to seek treatment in our communities and social support services. This could mean recommending someone join a gym or walking group to improve their physical and mental health, or referring them to a Citizens Advice bureau to help them with their money worries. In addition to benefiting individuals, social prescribing can lighten the burden on our health services by reducing the workload of GPs and the money spent on prescription medicines.

Technology, including IoT, has an important role to play in supporting the development and delivery of social prescribing because technologies like wearables and sensors can provide essential insights about individual preferences, behaviours and outcomes that previously were difficult to collect, while online databases and social media can help people find activities and stay connected.

In particular, this Pitch-In project looked at how IoT can help to increase the use of social prescriptions because:

• it makes it easier and cheaper to obtain relevant information on individual patients, providers and the system;

• it offers more flexibility than traditional, place-based care, through, for example, remote monitoring;

• it provides round-the-clock and potentially automated interactions, such as the ability to provide behavioural ‘nudges’ to patients and to allow them to provide feedback.

What were the problems or barriers?

There is a major challenge around changing the thinking of health professionals so that they don’t automatically turn to prescription drugs. There are several barriers, which need to be overcome to realise the potential of IoT-enabled social prescriptions:

• Care providers lack familiarity with the technology, while technology providers lack familiarity with social prescribing.

• No assumptions can be made about healthcare workers’ and patients’ technical proficiency, which in turn means that it can’t be assumed that IoT can seamlessly integrate into existing social prescribing processes.

• Stakeholders lack an understanding of how IoT can add value.

What did you do?

Pitch-In project partners worked with the Royal College of GPs to undertake a focus group at its headquarters in London. With participants including GPs, link workers, patients and social prescription providers, the aim was to understand the challenges and opportunities these stakeholders saw with social prescriptions.

It also provided insights into the role technology could play in overcoming such challenges, such as adherence to social prescribing and information on the outcomes from social prescribing.

This informed the approach for two workshops with social prescription providers and prescribers respectively, focusing on capturing the data that practitioners would need to deliver their services. These workshops used personas to reflect prevalent health conditions and capture insights from participants on the role they felt IoT could play in supporting social prescribing.

What was the result?

• As a result of the focus group and workshops a number of insights were gained about the use of IoT in healthcare:

• The best approach for engaging healthcare professionals with IoT for social prescriptions is to highlight how it can be used to collect useful data for them such as attendance and outcomes. For example, for walking-based social prescribing, this could be the number of steps attendees log through the use of an IoT-based fitness tracker.

• IoT providers thinking of entering this space should design their technology with busy healthcare professionals in mind, highlighting the useful information that their technology can capture.

• Technologies should be user friendly and hardware should require infrequent upgrades to avoid having to retrain busy healthcare professionals.

• Software updates should be seamless and data needs to integrate easily with electronic health records used by healthcare professionals.

Lessons learnt

• This project gave researchers the opportunity to work together more closely with the RCGP and University of Sheffield on a project that aligned with their individual and joint interests – namely, how they could use technology to promote health.

• It would have been beneficial to engage more patients and patient groups in workshops. While there was great clinical and commissioner input, there wasn’t a wide enough group of patients for workshops.

• Talking to users (customers) and providers (the market) delivered valuable insights that can help a new market evolve.

• From the focus group and workshops it was apparent that healthcare professionals were not aware of the benefits that IoT could provide. One potential reason for this may be that IoT technologies are not currently designed to meet the needs of healthcare professionals and healthcare professionals may also be unaware of the benefits IoT can offer them.

Connecting capabilities

The three core partners in this project brought a complementary set of expertise and resources to make this project a success. Researchers at the University of Oxford and University of Sheffield brought expertise on the practice and use of social prescribing as well as extensive experience on the practical uses of IoT in healthcare, respectively.

This practical expertise was complemented by the RCGP’s detailed understanding of the primary care landscape in the UK, particularly with respect to the use of social prescribing. Furthermore, the RCGP’s extensive network within NHS England’s primary care services was essential for us to recruit participants for the workshops and focus groups. The University of Oxford and RCGP also contributed their venues for holding the workshops and focus groups.

What happened next?

The initial Pitch-In project, has resulted in a number of follow-on projects and activities:

1. A £300k grant from the European Institute of Innovation and Technology (EIT) led to a follow-on project exploring how GPs can be trained to use digital therapeutics. For this, the RCGP and University of Oxford Department of Primary Care designed and delivered a training course aimed at educating GPs about the use of technology in improving patient care. This work was part of a health-funded project called Prescribing Digital Therapeutics PREDIGIT, run by the University of Oxford alongside RCGP, IESE business school and the University of Grenoble. It expanded the team of collaborators to include pan-european partners.

2. Insights from the focus group and workshops were used to successfully approach NHS England with an idea to use the RCGP’s Research Surveillance Centre, a network of 1,900 nationally representative GP practices (approximately 25% of the total practices in England), to create a social prescribing observatory. This is updated weekly with information on social prescribing use across the country and for different segments of the population. This can be found on https://clininf.eu/index.php/social-prescribing/

3. Another follow-on project is looking at the general barriers and facilitators for using IoT to support health and social care: Social prescribing at Blenheim Palace estates.

4. Papers have been in published in the Journal of the Royal Society of Medicine:

• Using technology-enabled social prescriptions to disrupt healthcare

• Digitally enabled social prescriptions: adaptive interventions to promote health in children and young people

5. This work has fed into a successful social prescribing trial undertaken by Aspire, a provider of mental health services. This involved walks to improve mental wellbeing around Blenheim Estates. One participant walked from John O’Groats to Lands End, following their participation in the trial.

Dr Anant Jani, University of Oxford said:

“Funding from Pitch-In gave us the chance to come together more formally to explore this important area. Given the number of people involved in social prescribing care pathways, it was essential that we had a multi-stakeholder group to explore how IoT could play a role in supporting social prescribing throughout the care pathway. The flexibility of the Pitch-In programme allowed us to do just that.

The insights gained from this project helped us to better understand the key areas where IoT could provide value in social prescribing care pathways as well as some of the barriers and facilitators involved in making this happen. These insights will be invaluable in future trials that we organise to explore how IoT can facilitate social prescribing.

Given the increase in social need across the country, which is even more pertinent in light of the negative effects of the COVID-19 pandemic, interventions like social prescribing are of the utmost importance.”

Pritesh Mistry, Clinical Co-lead said:

“Facilitated by Pitch-In, the project brought together key healthcare stakeholders that usually don’t have the time or opportunity to inform areas as a group. Clinicians and commissioners have been engaged with charities, link workers and companies. This has led to three workshops that had the immediate impact of improving knowledge and awareness of the digital tools that are already available for social prescribing and being used in pockets. The insights from commissioners helped to inform the social prescribing observatory project.”

Contact:

If you are interested in collaborating with the team involved in this project for future work on social prescribing, please contact:

Dr Anant Jani, Co-lead, Oxford University of Oxford

Email: anant.r.jani@gmail.com