Understanding how and why the NHS adopts innovation: Healthier Lancashire and South Cumbria’s adoption of ORCHA

Adoption journey

ORCHA had previously engaged with the Digital Health Leaders for the ICS. Initially this was to test the product concepts, understand the need for such a solution, and then to identify market applications for ORCHA.

The digital lead for the ICS, local GPs, and other clinical leads recognised the immediate need that ORCHA addresses in aiding frontline staff and patients to more efficiently find and prescribe or access quality apps. As such, they have worked collaboratively with ORCHA to identify a range of opportunities to trial ORCHA with different communities including:

• Schools: Engaging with schools to adopt ORCHA as a platform through which to better understand how children and young people might engage with health apps. Through the school curricula (full lesson plans have been devised and shared), assemblies and hands-on workshops, young people are encouraged to learn more about health conditions whilst exploring the topic of app development and app reviews during lessons
• GP practices: Local GPs have recognised the benefits of ORCHA – faced with a rise in long-term conditions and limited resources, they have identified health apps as a branch of ‘treatment’ that could deliver improved care.  They have taken the lead in introducing ORCHA to their surgeries, patients and clinical colleagues
• Sustainability and Transformation Planning (STP) Primary Care Digital Exemplar Programme: A channel to promote innovations including ORCHA to practices across the STP, and to support and recognise early adopter sites. For example, apps are now used by the eating disorder team to support, supplement and back up sessions

The local digital leaders also see the potential for ORCHA to be part of the STP’s much broader vision around digital transformation, and better understanding the interaction between patients, the public, healthcare and technology.

It offers a tangible platform that digital leaders can show to people, who can then interact with it. The ability to demonstrate both the platform and the apps has facilitated engagement with frontline staff about the concept of how apps can support self-care.

In addition to responding flexibly to the local priorities of these digital leaders, the ORCHA team has personally engaged with sites; providing support, training and helping with promotion to both patients and staff. As digital transformation is still in its early phase within the NHS, work within the STP is focusing initially on the enthusiasts and early adopters.

Enablers

Local digital leaders have been critical in identifying applications for ORCHA and finding routes to engage adopter sites (e.g. the Digital Exemplar Programme). Furthermore, these leaders have spent time helping ORCHA refine and identify market entry opportunities. In addition to recognising the immediate needs for digital, the focus of these leaders on a broader digital transformation vision has helped to explore a range of partnership opportunities for ORCHA. The leaders understand the barriers to using ORCHA, for example, clinicians being concerned about promoting an app which they have not personally assessed. Furthermore, they see pragmatic solutions to these, such as being open with patients about the recommendations and highlighting the opportunity through ORCHA – akin to TripAdvisor – to review others’ comments.

Partnership approach: The NIA Fellow and company CEO comes from the healthcare system and worked as a clinician within the NHS. She therefore had real credibility to draw upon when engaging with potential adopters. She has also been very open-minded and flexible about the approach taken, continually seeking input from a wide range of stakeholders in development and delivery of the platform. Given that the ORCHA platform may be a stepping stone to the wider adoption of apps, this flexibility and ability to collaborate with stakeholders is key.

Multiple applications of the innovation: The platform offers many advantages over less systemic interventions. One aspect is in data collection and reporting. ORCHA has provided data collation and reporting of app usage by population, patient and professional group, to help assess and prove digital strategies, investment and outcomes.

Impact

An increasing number of GPs are now recommending an app to patients, which bolsters the care advice or prescription given. They are also recommending apps to patients who visit with routine matters.

Since the start of the programme in February 2018, school pupils have discovered and downloaded more than 88 different apps onto their phones and 50% of pupils who participated now use a health app. Pupils have reported changing a range of behaviours, from swapping car journeys to walking, drinking more water and going to bed earlier.

Thanks to the work conducted in Lancashire and Cumbria, ORCHA has been adopted by other NHS organisations. More than 20 CCGs and NHS Trusts are using ORCHA app assessments to help professionals and the public to make better, informed app choices.

Implications

ORCHA is an example of an approach that evolves as further insight is acquired. Having a supportive environment in terms of pull for the innovation, and a flexible and collaborative innovator in terms of push has allowed continual negotiation of the intervention.

This flexibility and collaboration is particularly important in the fast-paced area of apps. Apps as interventions are not like drugs that remain stable for years. Technology is constantly evolving as are people’s interaction with it. ORCHA recognises that the interface between this fast-paced world and that of the clinical intervention needs a collaborative model to mesh the clinical push with the citizen pull.

ORCHA demonstrates what can be done with apps if they are developed in sympathy with practice. This is an important model for introducing apps both to clinicians and the public.

Interviewees

1. Liz Ashall-Payne, Founder and CEO of ORCHA, NIA Fellow
2. George Dingle, General Practitioner
3. Declan Hadley, Digital Lead for Lancashire and South Cumbria Change Programme (Integrated Care System)
4. Mike McGuire, Chief Officer, West Lancashire CCG
5. Cath Thompson, Service Redesign Manager, West Lancashire CCG
6. Amanda Thornton, Digital Health Clinical Lead for Lancashire and South Cumbria Change Programme (Integrated Care System)