Q&A with… director of healthtech Neal Herman, ETC

Barely a week passes without a news story involving hospital waiting list backlogs or patients that can’t get an appointment at doctors’ surgeries.

One report published this week by Diabetes UK showed that diabetes related deaths were up by 7,000 a year compared to pre-pandemic levels – a rise that the charity attributed to “a backlog in routine diabetes care checks caused by the pandemic when services faced huge disruption”.

Etc. – an innovation hub within BT – wants to “reimagine healthcare” by developing tools and partnerships with specialists and start-up partners. Founded by the UK telco two years ago, Etc spans healthtech, drones, fintech and factory 4.0.

According to the hub’s health tech director Neal Herman, Etc. is currently involved in three pilots – all aimed at relieving some of the pressure on the UK’s public healthcare system.

There’s a health navigation system in Warrington, designed to help doctors triage and signpost patients better and direct patients to specialists when needed.

While Herman acknowledges that not all interactions to book appointments at GP surgeries are digital (“the reality is that 95% are still by phone”) he adds that the system helps direct patients online to use booking tools for blood tests, repeat prescriptions, physio or accessing medical notes.

Another virtual ward project involves remote care – helping the NHS to identify and monitor high risk patients – such as diabetics – by giving them the hardware and software to track and monitor patient health vitals in real time.

Clinicians can view a dashboard which gives alerts on at risk patients so that any deteriorations in health can be picked up sooner.

The current target is to have 1000 patients on the remote care platform by the end of June, says Herman, by which point Etc. can work with a viable proof-of-concept that can add value and enable it to further scale across the UK – hopefully starting from September.

A third project addresses patient flow and is intended to help hospitals make better use of bed space.

How will virtual wards help the NHS and other healthcare providers reduce their backlogs?

We know that people living with long-term conditions – diabetes, heart conditions, asthma – are consuming a huge amount of NHS appointments: 50% of GP appointments and 70% of hospital appointments – so if you can stay in touch with those patients – and alert them before their conditions escalate – you can have a really big impact on the health system.

Which health professionals will be responsible for monitoring on virtual wards?

Typically, it will be an advanced nurse practitioner – a nurse that can prescribe; a blend of these and clinical pharmacists. And some of the admin work – the on boarding of patients  may be done by healthcare associates and the digital ambassadors which talk patients through how to use a SpO2 monitor, the hardware and the native apps on their devices. GPs are hard to find and expensive, so we try to avoid using GPs unless there is an escalation.

How do you identify who to monitor on a GP’s list?

Through risk stratification using a mix of objective and subjective data to assign risk levels. So, on a list of 10,000 patients there will be certain markers that make them ‘high risk’ and so they are ringfenced. So, A&E visits will be a factor; have they attended more than six times in the last 12 months? We identify the ongoing risk stratification and then we target those heavy users of the health system. In theory everyone is eligible, but we’re focused on high-risk patients as we think that’s where we’ll have the most impact.

Do you have impact evidence from the trials so far?

In terms of the escalations, of the 200 people involved in the Warrington trial so far we typically see 5% (20) patients requiring an escalation where you’re intervening. And what that does effectively is keep them out of A&E and prevents them from having a more catastrophic event like a death or a long stay in hospital.

There are lots of providers operating in the virtual ward space – what’s your USP?

We’re really focussed on the preventative stuff. To enable these patients, they get a smart phone and a piece of hardware – that use BT connectivity in terms of being able to communicate. In terms of what differentiates us: we carry out the risk stratification on the patient list and we can provide the workforce. So, if a practice or a primary health trust is understaffed, they can effectively outsource the prevention to us.

Is BT looking to sell this platform/service to other healthcare providers outside the NHS?

There’s potential for this to be white label. For me it’s how can we reach as many people as possible on the platform, so we have the biggest impact. But different routes to market are open.

If a device manufacturer like Omron wanted to white label our platform and make it part of a sale to a big health system, we could defiantly go down that path.

How far off are we from GPs to being connected to our consumer wearables like Apple Watch etc.?

It will take a couple of years at least. Devices like Apple Watch aren’t yet medically approved for many health readings – typically you have to have a medically MHRA regulated device. In the US Apple has been cleared by the FDA for its built in ECG and irregular rhythm notifications which can alert uses to signs of heart conditions such as atrial fibrillation, but not for pulse readings or other vital signs.

Apple has stated its intent for its watches to become medical devices so as we move forward your wearables and your Fitbit will most likely move into that medical zone which means there will be a huge audience that will eventually benefit from this stuff.

In professional healthcare the proactive monitoring space in typically occupied by Omron. Our platform is device agonistic – people often have things at home – we can literally integrate with any device.

You’re utilising technology from start up partner Febris to measure biometric data remotely. Are you working with other firms?

We’re looking at companies where you don’t have to use any hardware at all – there’s a start up called Happitech which we are a client of, which provides medical grade heart and pulse monitoring using a smartphone camera with light diffraction technology. The smartphone its going to be another vector for remote monitoring.

Prior to BT you worked as a chief product officer at online appointment platform Push Doctor – how did you cope when things exploded during Covid?

Effectively it introduced telemedicine and digital GP appointments over video for practices that were failing to recruit locums so they could back off demand. Usage increased five-fold during the pandemic. The technology – powered by AWS cloud platform – was built to be scalable so the issues we had again came back to staffing. Because if you need a clinician as part of an escalation – that’s where the bottlenecks occur.