Connected City

People First : Digital First is a Bradford City District initiative that means all health services working collaboratively to share information as part of a new tech-driven health improvement programme.

Designed around the needs of local communities, People First : Digital First will put de-identified medical information to work, turning under-used and routinely collected health data into better health and care services for patients.

By securely linking information together from across primary, secondary and community services, research teams based in Bradford can better understand how patients move across and through the local health system. This ‘big picture’ perspective will allow services to be re-designed, offering more personalised and prevention-focused support to patients.

A Bradford Health Vision

People First: Digital First provides a vision for the Bradford City District where;

• There are fully interoperable electronic health records
• Staff and citizens are equipped and prepared to use digital tools in health, wellness and care.
• Clinical engagement in digital initiatives ensure solutions are helping clinicians to better care for patients.
• We continue to be a vanguard for telemedicine in care homes which means care homes have video conferencing access to clinicians
• By using artificial intelligence to analyse our data we can assist in determining when patients would do better with other interventions than coming into the hospital;
• We are able to use tele-medicine and technology to ‘see’ patients where they are and help them manage their conditions better outside of hospital with and without our virtual help
• We employ home monitoring devices instead of in-hospital monitoring to keep people at home

Transforming Health

In January 2019, NHS England published the NHS Long Term Plan (LTP), developed in partnership with frontline staff, patients and their families, and other experts. It promises an additional £20.5 billion (2019 – 2024) to aid the transformation of care. In return, NHS England expects all providers and commissioners to become part of an integrated care system (ICS) based around population health and prevention. The LTP proposes a key role for primary and community care services, which will receive an additional £4.5 billion to establish a digital first primary care sector, expanding community teams to work alongside new primary care networks. In return, primary care is expected to create joined-up systems and digital patient records, link genomic and clinical data and improve the use of ‘apps’ and advanced technologies such as artificial intelligence (AI)

Online Health Tech

Specialist Gastroenterology staff at Bradford Royal Infirmary are incorporating digital health technology into their daily practice. They use Tablets from the Trust Library in clinical sessions with patients to show them useful apps and how to best use the Gluten Free Food checker from Coeliac UK. This helps a patient understand how by scanning barcodes in supermarkets it can show them foods that are gluten free.

The team also use video conferencing technology to run patient sessions where they are able to confirm which foods are suitable for those with coeliac conditions. This saves patients time and allows them to confidently shop outside of the gluten free section. One of the dieticians has created his own YouTube Channel to answer frequently asked questions and help patients troubleshoot a few common challenges, such as knowing how to read a food label.

Online Health Tech

The Nutrition & Dietetics team at St Luke’s Hospital are harnessing a range of digital health apps to empower patients to manage their own health conditions.

Diabetic patients, for example, are provided with a mobile app which gives access to huge database of food and drink items with detailed nutritional profiles. The app enables the patient to accurately monitor their carbohydrate in-take which they can also adjust to reflect the actual portion size consumed.   Patients are taught, by Dietetics specialists, how they can use the app to understand and monitor their blood glucose levels and make changes to improve the control of their diabetes.

Public health data

Analysing our population’s data to provide intelligence that local organisations can action through the Connected Bradford initiative at the Bradford Institute for Health Research. Findings have included to date, for example, that most deprived communities in Bradford have highest air pollution rates.

The Bradford Institute for Health Research (BIHR) have led the development, validation and implementation of the award-winning Bradford Electronic Frailty Index (eFI) which helps calculate an elderly person’s risk of disability, impairment, falls and complications of chronic diseases, as well as, their diminishing independence and capability. This is now being used by 98% of all GPs across the country.

Born in Bradford (BiB) is a long term study of a cohort of 13,500 children, born at Bradford Royal Infirmary between March 2007 and December 2010, whose health is being tracked from pregnancy through childhood and into adult life. The information collected from the BiB families is being used to find the causes of common childhood illnesses and to explore the mental and social development of this new generation. The Bradford community provides a unique setting for a birth cohort study exploring the determinants of childhood and adult disease because of its diversity of population and high levels of ill-health.

Remote Patient Monitoring Technology (tele-health)

The Paediatric Ambulatory Care virtual ward (called ACE) service works with GPs to allow specialist following of paediatric asthmatic patients at home, improving outcomes and avoiding hospital admission. This service won the Health Service Journal Improvement Award in Emergency and Urgent Care in November 2018.

Virtual GP Practices

 The new Saltaire and Windhill surgery website helps patients manage their interactions with the healthcare system via new digital channels that offer added convenience.

The new site gives patients access to health records and enables them to schedule and manage appointments for physical in-person or virtual tele-health consultations.  This gives patients more control but also helps the surgery to manage resources more effectively. 

Interactive symptoms checkers

The CCG in the District has invested in an online consultation platform called e-Consult. This service is embedded in all the GP Practices and eConsult enables NHS based GP practices to offer online consultations to their patients. This allows patients to submit their symptoms or requests to their own GP electronically, and offers around the clock NHS self-help information, signposting to services, and a symptom checker.

Patient Monitoring

Bradford Command Centre is a European healthcare first. It monitors patients via an air traffic control-style hub, allowing staff to determine rapidly when diagnostic tests are needed or people are medically fit to be discharged.

Alongside a number of other digital initiatives brought to life at the trust, the command centre has triggered international interest with healthcare leaders from Sweden and Belgium among those paying a fact-finding visit to Bradford.

A new study has identified Bradford Teaching Hospitals NHS Foundation Trust as one of the most-improved digital pioneers in the NHS.

And it is one of only two trusts across England to feature in the top ten without being part of the NHS’s Global Digital Exemplar (GDE) programme – which awards hundreds of millions of pounds’ additional funding.

“Thanks to the expertise of our people, and their appetite for making the most of the potential of digital innovation in healthcare, we are thrilled that our hard work has reaped benefits” said Chief Digital and Information Officer, Cindy Fedell.

The Virtual Ward

Bradford Teaching Hospitals, houses, in conjunction with a number of local partners, operates an Elderly Virtual Ward and Intermediate Care Hub with over 200 beds, caring for people at home who would otherwise be admitted to hospital or remain in hospital longer.

The Bradford Virtual Ward began in 2012 as a discharge-to-assess model, relying from the outset on working together across organisational boundaries of health and social care teams. The team is multidisciplinary, comprising therapists, qualified nurses, advanced nurse practitioners, rehabilitation support workers, local authority colleagues and consultant geriatrician input. In 2015 we developed an integrated hub with partners, and new pathways taking direct referrals from community matrons, general practitioners and local ambulance services.

Within hours, on any day of the week, the hub can escalate community support, initiate rehabilitation-at-home, or directly admit to community hospital rehabilitation or a nursing home flexi-bed. Multiple hospital admissions have been entirely prevented, and length of stay in hospital further reduced. Bradford Teaching Hospitals is now in the top 5% of trusts across the country for shortest length of stay. More importantly we have also demonstrated significant improvements in patient quality of life and high rates of patient satisfaction. We proudly present this model, which champions integrated delivery of high quality seamless services to our patients. These embody key principles of the NHS Five Year Forward View, in a replicable way.

Digital Treatment

The region has a long history of joining up health and care information, enabled by digital technology, having been one of the first areas to work with the SystmOne integrated record.
The IDCR was developed out of a successful bid for the NHS England Safer Hospital, Safer Wards Technology Fund. SystmOne was chosen as the basis for the IDCR solution because it was already widely used in the area. It is now in place in all 85 GP practices, Airedale Foundation Trust, Bradford District Care Trust (Community and Mental Health), Bradford Council (Adult Social Care), as well as the region’s hospices, supporting seamless information sharing between organisations and along care pathways.

Despite the prevalence of a single system, Bradford and Airedale’s strategy has always been one of interoperability. In September 2017, Bradford Teaching Hospitals NHS Foundation Trust went live with Cerner Millennium as its electronic patient record, with a view to exchanging data with SystmOne via Cerner’s Health Information Exchange. The integration will mean users of Cerner Millennium will see a combined view of data sourced from SystmOne in a tab in the hospital record. Similarly, SystmOne users will be able to see a summary of Bradford Teaching Hospitals NHS Foundation Trust data in their records.

Online or App Enabled Rehabilitation

The Cardiology team at Bradford Teaching Hospitals has created a Virtual Angina Clinic for those specifically diagnosed with Microvascular and Vasospastic angina. The online workshops have been designed to patients understand more about their condition and how to manage it.  One of the Consultant Cardiologist (Dr Paul Sainsbury) explains through a series of ChromeKey filmed videos, some important information about an angina diagnosis and ways of managing the associated pain. There are also a number of interactive Frequently Asked Questions about Angina as well as a link to video conference directly with the Consultant rather than having to come back into Hospital.

Online Condition Management

By using a handheld, modular examination device that enables comprehensive and clinical grade physical exams of the heart, lungs, skin, ears, throat and abdomen, and measures body temperature and heart rate, teams at Bradford Teaching Hospitals have been able to deliver remote home diagnosis of some acute care situations. During a virtual consultation, clinical visual and audio data is captured by the device and transferred either online or offline to a clinician. The all-in-one solution enables care providers to deliver a full, guided examination 24/7, as well as a one-to-one consultation easily, in real time or as a deferred, planned review by a remote clinician.

A partnership between Tyto Care and ACE at Bradford Teaching Hospital brings together two healthcare leaders,” said Cindy Fedell, the Trust’s Chief Digital and Information Officer. “This ‘digital-first’ approach to care, where we put health in the hands and homes of patients, is a lynchpin of the NHS’s long-term telehealth plan.

Assistive Living Technology

Bradford Council’s Safe and Sound team are implementing a new programme of assistive living technology to deliver their vision for all residents of Bradford to be happy, healthy and at home.  Assistive Technology solutions can support people to live in their own homes for longer and safer, while supporting their general wellbeing through maintaining their links with their friends and local communities. For service users and staff this means having the confidence in being able to select solutions that can safeguard living at home, through the monitoring of emergency events, supporting the management of long-term conditions and even giving feedback to occupant’s that supports them to live healthier lives – e.g., timely reminders on taking fluids, food, medication and switching off appliances and closing doors.

A simple to use telecare home unit supports independent living, by enabling the home environment to be monitored 24 hours a day, through a mobile network. The Lifeline hub can provide reassurance and confidence. Its flexibility means that it is suitable for a wide variety of individuals including older or vulnerable people, individuals recuperating after a hospital stay and anyone with reduced mobility, physical or sensory impairments or long term health conditions such as dementia, heart disease or COPD.