Development of an app based integrated prehabilitation, perioperative pathway management and patient assessment platform

Prehabilitation is pre-emptive preparation to reduce risks and enhance recovery after a stressful event (e.g. surgery).

It is a process in the continuum of care and the first step of the rehabilitation pathway (preventative rehabilitation).

The University College London Hospitals (UCLH) prehabilitation programme launched in November 2021, using learning from, and collaborating with other established London based services.

The programme launched in the midst of the COVID pandemic.  Travel restrictions and future proofing led to the development of a primarily digital service from launch. This goal was supported by UCLH leadership and especially fell within a local and national drive to enhance and leverage digital health solutions.

With this in mind, the UCLH team explored the key factors needed to deliver an effective digital prehabilitation program and have supported the development of an app-based solution with both patient and clinician facing portals.

Situation

UCLH is a central London hospital with no parking facilities. Private travel and parking is expensive and often difficult for patients who may be struggling with a high burden of travel, busy schedules and financial strain for consultations and treatment, as well as fatigue and side effects from their underlying disease.

The ideal prehabilitation solution would therefore aim to reduce these burdens, while improving efficacy of therapy, quality of life and adherence with complicated treatment pathways.

UCLH's initial solution leveraged existing technologies (Microsoft Teams and Epic patient portal: MyCare UCLH).  The team found that while this hybrid approach was effective in reaching patients, and supporting engagement, they were limited by multiple platforms and the lack of interoperability.

Furthermore, they could not identify existing solutions that would allow them to deliver a flexible but unified pathway that incorporated patient education and information, exercise and nutrition interventions and also facilitated physiological assessments longitudinally through the patient’s perioperative journey.

The UCLH team identified several impediments to the delivery of prehabilitation which they aim to solve using digital means:

• the wide scope of the field, including integration with existing service workflow.
• geographic limitations.
• economic sustainability.
• time (before surgery, clinician and patient).
• human resources in an increasingly expensive health environment.
• translation of research into clinical practice.

Aspiration

To create and deliver a flexible, patient centred digital platform which offers a comprehensive approach to implementation of a modern prehabilitation program and integration with existing hospital electronic medical records.

Furthermore, the UCLH team aim to produce a novel, but evidence-based approach to real time patient assessments and collection of pertinent perioperative data to support quality improvement and research in the field of prehabilitation and perioperative medicine.

Solution and impact

UCLH have partnered with SplendoHealth to develop a thought-leading prehabilitation platform. Together they aim to produce a scalable software and Artificial Intelligence (AI) platform supporting the health and wellbeing of patients requiring surgery, while mitigating costs, risks and readmissions.

They have identified several areas where technology can enhance the perioperative pathway.  Broadly, these are:

• patient pathway management
• communication and engagement among patients and clinicians
• longitudinal patient risk assessment and data collection
• integration, storage, and analysis of patient physiological, health related, and hospital and patient reported outcomes measures
• integration with existing medical health records
• integration of wearable technologies for patient assessment and treatment and seamless integration with existing consumer products
• delivery of behaviour change techniques

Impact

The UCLH prehabilitation programme has shown positive results, particularly;

• 38.5% reduction in EQ-5D (EuroQol-5 Dimensions, validated quality of life questionnaire)
• 64.9% reduction in fatigue
• 39.6% improvement in the 30 second sit to stand measurement

The service has expanded to multiple cancer and benign pathways including maxillofacial reconstruction and complex gynaecological mesh removal patients.

The SplendoHealth platform helps to bridge the gap in the need for regular assessments and targeted exercise programs.  To date they are in the development and early roll out phase of the SplendoHealth platform, the team will be assessing impact as part of the ongoing quality improvement project associated with this program.

Functionality

SplendoHealth is an app with a cloud-based data platform, integrated with a background Machine Learning platform compatible with iOS and android environments.

Patients receive a one-time-link to onboard.  Clinicians have access to a portal which allows them to review system wide and individual patient data through both numerical and graphical interfaces.

The Patient Facing portal includes:

• a calendar function allowing booking of and reminders for future activities and appointments
• questionnaires relating to daily health including, Patient Reported Outcome Measures (PROMS)
• check boxes and goals for daily physical activity and dietary intake

Novel features include:

• ability to perform remote cardio-respiratory fitness assessments
• real-time, remote monitoring amount and impact of any physical interventions prescribed

Advantages of the system:

• allows patients to engage in their own time
• reduces the number of scheduled clinician appointment
• increases patient autonomy
• reduces in hospital space required

In development:

• a goal setting and patient activation centred pathway
• embedded interactive exercise and dietary advice from third party suppliers
• data integration with Epic medical record system

Capabilities

• Allows the team to offer a tailored prehabilitation programme to all patients with a mobile device.
• Allows the team to track patient health data to identify compliance with exercise.
• Allows the team to connect patients to a multitude of third-party service through embedded videos and other resources.
• Gives patients the autonomy to complete their daily tasks at their own pace at their own time, reducing the need for rigid appointments.

Scope

This virtual pathway can support the patient from referral for surgical assessment to optimise health preoperatively, and guide patients through post operative recovery as an inpatient and rehabilitation after discharge.

SplendoHealth allows the collection of health data to guide clinician input during the patient’s perioperative journey.

Key learning points

• Need to have clear process maps or flowsheets in place to make it easy for patients and clinicians to follow.
• Easy to use technology - choose your products or software wisely so it can link with all devices you may wish to use.
• Do not be put off by people being averse to technology. A lot of the time the fear stems from the unknown, taking the time to walk a patient through a process gives them a sense of empowerment.
• Opensource – API available.

Digital equalities

• With 1:1 coaching 100% of patients have successfully been onboarded with digital tools.
• Patient participation is monitored, if their engagement is low their 1:1 check-in is increased to weekly with the Prehabilitation Team.
• Initial onboarding is via a phone call with an assessment of digital literacy and signposting for support available.
• UCLH has digital transformation team which has helped to onboard patients to digital services.

Key figures and quotes

“I am very thankful for all the input from the prehab team. I want to keep on going forwards and this service has given me the confidence to do so. I feel proud when I look back at where I started and realise how far I've come. I feel positive about the future."

Jennifer, Patient

“To be completely honest when I first heard about the whole digital platform, I was a bit sceptical. I had doubts about how it was all going to work. However, since working on the prehab pathway those doubts have been proven wrong. I have found the platform extremely useful as we are able to have regular input with patients without them having to travel into the hospital for yet another appointment.”

Sarah Whitehead, Prehabilitation Physiotherapist

“The clinician facing portal has allowed us to see real time data collected from patients onboarded on the SplendoHealth platform. The patient facing calendar function and goal setting being developed will only enhance the user experience and allow a fully app-based prehabilitation service.”

Nicholas Tetlow, Senior Exercise Physiologist.

Find out more

Splendoo Health website

Key contact

Dr Adam Beebeejaun, Fellow in Perioperative Medicine

a.beebeejaun@nhs.net

Dr John Whittle, Consultant in Anaesthesia, Critical Care and Perioperative Medicine. Clinical Lead for Prehabilitation

john.whittle2@nhs.net

Luc Demarteau (CEO Splendo)

info@splendo.com