Automation for Health

Louisa: Welcome to this episode of Life in Low-code where, today, we’re going to talk all things health regarding low-code and RPA. Joining me is Clare Rafferty, our very own expert in automation for the health industry and also Clare heads up our business development and partnerships. So welcome Clare, thank you for joining us.

Clare: Thank you for having me.

Louisa: So firstly, Clare, I guess in the short time that I’ve worked with you at Netcall, I can tell that you’re really passionate about all things health. So, can you just tell me how that came about?

Clare: Sort of over time, I think I knew I wanted to work in a sort of cutting edge technology, but equally wanted it to be making a real difference. I started working in a public sector and then got more involved in healthcare and got really passionate about the difference that the emerging technology could make in the healthcare market and to the patient experience in general.

And over the years the technology has changed to make more and more things possible. So, it’s really rewarding to be able to see the difference it’s making to NHS Trusts, but also to the patients themselves.

Louisa: Yeah, and I guess particularly at the moment. We could see there’s so many challenges facing the NHS not only in the last 18 months, but before that. What do you see as the key challenges that really they are facing at the moment? Obviously COVID is the main one, but I guess in your words, and being at the coalface speaking to customers.

Clare: I think there’s a lot of big organisational changes going on, which I think leads to quite a lot of different facets of challenges, because these organisational challenges around bringing organisations together under an ICS, trying to unify processes, and what that looks like. But equally within that, you’ve got a really complex technology, an estate that has loads of different systems. Each individual trust we talk to will generally have 300-400 different legacy systems that all have different levels of interoperability. And then we’re adding into the mix trying to join up with different organisations across regions, all with different levels of digital maturity and being at different stages of their digital transformation journey.

So, I think it’s a really exciting time, but also really challenging time for working within “What Good Looks Like” to get to the end goal of having everything unified across an area.

Louisa: I think, as you say, it sounds such a big challenge. In terms of the different systems that aren’t talking to each other, you talked about hundreds of them? How do you even start with something like that in terms of trying to break that down?

Clare: Well, I think a good starting point is actually realising that there’s not a lack of information about patients. So in some industries the problem is having lack of information about the people they’re trying to serve. In the NHS, there’s a lot of information about patients, but sitting across multiple different systems. So, I think by looking at the outcomes that you’re trying to achieve and then working out where that data is and what needs to happen to it to make it usable within processes, you could start mapping out those end to end processes, and working from the outcomes you want, and then working backwards from the technology. As opposed to starting with looking at an individual point problems saying “we can buy a bit of tech to fix this” or “we can buy a bit of tech to fix that”. It’s looking at “What is the total journey?” Do you already have that information and can you expose it? And then, how do you make that usable for the rest of the organisation?

Basically, I guess having the right information, in the right hands, at the right time.

Louisa: Yeah, it sounds simple, but probably definitely not so I think…

Clare: It’s incredibly complex I think. And there’s a lot of different stakeholders who, quite rightly, will all have their individual agendas. They need to make sure it’s right for their individual service areas, which can also be a challenge.

Louisa: Yeah, and I guess there’s also the balance of trying to address the short term needs versus the long term goals, because obviously, things change and you have to react to them from a reactive point of view, like COVID, but there’s also that long term 10 year plan, things like that. So it must be a challenge just for that, really.

Clare: Absolutely. And like you say, with COVID, there’s so many immediate challenges that I think taking a step back and looking at that longer term view can be really difficult. There’s some very immediate, very real challenges to be dealt with today. So, I think that is a really difficult thing, but equally, I think we’re seeing amazing strides being made. You know, the speed of change and digital translation through COVID was incredibly inspiring and some amazing things have been achieved. I think almost that the industry is quite excited about that. It’s proven that some of these things are possible and actually going “well, how do we keep that momentum going” to keep making those really major changes?

Louisa: Yeah, absolutely, we should all be proud of the NHS in the last 18 months or so. I know also you’ve got quite an interest in mental health care planning and how, over time, we want to sort of look to streamline and maybe even optimise that in some way. Can you tell us a bit about that?

Clare: Yeah, so I think it’s a really interesting area. Care planning is really complex and there’s a lot of sort of organisational requirements around it, which sometimes make the process slightly impersonal to the patient. It sometimes becomes almost more about what the system needs and information and targets, rather than really being able to focus on patient care. And again, that’s not through lack of willing at all, because that’s obviously why everybody is in that kind of profession.

So, it’s looking for a way that technology can help by streamlining the process, automatically doing some of that care planning process for them, making sure all of the organisational requirements are handled, but allowing them more time to spend actually on patient care, rather than doing the administration around that patient care.

Louisa: Yeah, and you hear that a lot, particularly in the NHS across the board, really. You know you want to get people to be looking after the patients, rather than the admin. That’s what you want to focus on: that patient. Rather than sometimes a box ticking exercise, perhaps.

Clare: Absolutely. And I think it feeds back into, again, the numerous systems. A new target or a new thing that needs to be worked on comes out, and so a new piece of technology gets put in to do that. But, actually, that’s another system that needs to be administered and needs information put in. So, we talk to Clinicians and back office staff who are saying “I have to enter the same bit of information into 4,5,6 different systems” and, in this day and age of tech, that’s just not good enough really. I think that we need to be able to help the N HS with tools to make that a lot easier.

Louisa: Would you say the NHS is behind in terms of the commercial space? Obviously they’ve got so much to do and big budgets, but it does seem that sometimes they’re playing catch up with the commercial world. Do you have a sense around that?

Clare: It’s a really interesting one, because I think it can almost be argued in both ways. In some ways, if you look at some of the technology in the NHS, it’s cutting edge and incredible advances are being made. If you move away from software into medical equipment there’s really, cutting edge things happening in the NHS as a whole.

But I think the problem is how big the organisations are and how much legacy has gone before. The actual infrastructure that’s in place and so the ability to do things. I don’t think it’s attitudinal, or a lack of willingness or lack of forward thinking within the industry. I think it is people really wanting to push things forward, but sometimes their hands are strapped by what they have at their disposal.

Louisa: Yeah, and I think you can see that the NHS can be so agile in so many ways, on the frontline, but yes, as you say, in the in the back office, I guess just from its sheer size and, as you said, legacy frameworks, it just can’t be as agile, maybe.

Clare: I guess people are also used to putting up with it as it were. Again, because people tend to be very altruistic working in the industry, they’ll put up with a process that maybe isn’t perfect, and whereas it should be automated, they’ll create spreadsheets to fill the gaps where there aren’t systems there. Whereas I think in some other industries, people would say no, this doesn’t work, we need to do something different. Because the outcome is providing good patient care, I think everybody involved will just get on and make it happen.

Louisa: Absolutely, I think that’s a really good point. OK, so we can see, obviously there’s lots of challenges within the NHS in terms of the legacy systems and lots and lots of different systems not talking to each other. Can you explain to us what actually low-code and RPA is and how that can help?

Clare: Yeah, absolutely. We refer to it as our intelligent automation suite. What that means is, rather than introducing come off the shelf solutions for all problems, it allows you to build-out your processes using automation technologies to bring together that end-to-end situation.

We often think of it as Lego, so your existing systems will be all your Lego bricks that you already have in place, and they’re all doing the job for what they’ve been bought to do. But, between them, there are gaps that get left, when the Lego bricks haven’t quite been put in a line. And it’s in those gaps that all the manual workaround processes are happening.

So, what the Liberty Platform allows you to do, is to take a step back and look at what are we trying to achieve. And actually, if there’s information in system A, for example that needs to be in system B, then you can start plugging those gaps and joining that data together.

Now, that that means you have data that’s usable, so you might have all that information about that patient then. And then you can start using that to build-out processes that are very specific to your own organisation, but also very easy to change overtime.

So, traditionally the two options you have, when looking at a new project, would be to buy an off the shelf solution to meet that need. And that option tends to be quite quick and it will meet most of your requirements, so like 80% of your requirements, which sometimes is good enough. But, again, there will be bits that are missing that then leads to work around processes.

The other option, traditionally, would be to hand code a solution. It takes a lot longer. You’re very reliant on the person who’s coded it. And, also, if you look through COVID times, the minute it’s written, the requirements would have changed and it needs to be able to move on up.

So, low-code is sort of best of both worlds of those situations. You can build something to your exact requirements. You don’t have to be a coder, you just have to be business and process minded and basically be able to describe the process. If you can tell us the process, it can be built and it allows you to then tailor everything and pull together all the different bits of your organisation. Then, instead of having your desperate Lego bricks all in different places, you create a big cube where all of the data is usable and you’ve got a complete technology estate.

Louisa: OK, so you can build a bespoke application quite quickly without having to use costly developers?

Clare: Exactly, so I guess a good example would be University Hospital Southampton where we worked with them to develop her a waiting list application to help them validate who was on the waiting list digitally. And that solution was built in five days. So, it’s a much faster way of being able to create things and address problems as they appear.

Louisa: Yeah, that’s amazing. Five days turn around. Particularly at the moment, things like that have to happen in that time frame.

Clare: Yeah, absolutely. And it’s a good example of where the need couldn’t have been predicted. Some systems, when you’re buying them, it’s strategic and you can see that in you’re going to need to buy a new PAS system, for example, and you can plan for that and make sure you’ve got your requirement spec sorted. There are systems that obviously exist to do that.

But through COVID, we’ve seen that actually a lot of the requirements are coming up obviously weren’t predicted at all. There weren’t solutions just there, ready to go. So, everybody had to find ways to be able to create solutions very, very quickly. And low-code is one of the tools that can help you do that.

Louisa: OK, great. When we talk about our low-code and RPA offering, we were calling it Liberty Automation for Health as that overall offering. So, we talked a bit about low-code, but in terms of RPA sitting alongside the low-code, can you talk to us a bit about that?

Clare: RPA is obviously a really useful tool and it’s been used quite widely in the NHS now. It allows you to automate any routine and mundane tasks that a human being is doing but where they don’t need to. It can take that job away. And particularly in the NHS, it’s so powerful, because people buying a new system now, it would have lovely APIs and everything would talk beautifully together, and sometimes RPA might not be necessary. But what it allows you to do is, get into those legacy systems and get the information that you need out, when it might not be possible to get to it any other way.

With the two things sitting side by side, with RPA and low-code, it means you can address all of those automation requirements, because you can do those routine, mundane tasks using RPA. Then, when you’re getting into more complex process redesign and digital transformation and building whole applications, you’ve then got the low-code. So, they tie together really nicely.

Louisa: Yes, and I think I remember one of our customers saying for him actually, with the RPA and low-code element, what it does is, and it’s sort of value-add, is how it frees up his staff to do the more value-add work that needs to be done, and let them upskill and leaves that more mundane, repetitive and sometimes even prone to error work, to the digital workers – the robot.

Clare: Absolutely, I think it makes somebody’s work day a lot more interesting if they can focus on the bits that need their judgment and their skills to do, as opposed to focusing on, for example, moving data from here to there, or processes that just don’t need a human to do it.

Louisa: In reality, it all sounds great, but how does it actually work in practice? Is it quite simple to pick up? Do you need any sort of coding skills to use low-code and RPA?

Clare: You don’t have to be a coder. Our low-code solution, because it is low-code not no-code, means you can basically build any application that you want, using the drag and drop interface.

But, we find there are also a lot of developers who use the platform, and it’s an extra tool for them as there is a code studio if there’s a specific widget or something they want to build that they think would be more appropriate to build in code.

The code studio basically removes the barriers, so that there are no walls. So, you can use the two together, but equally if you don’t have any development capability, then that it’s not necessary. You can build applications, just with the drag and drop type interface. So, as long as you understand the process and then you can build the application.

Louisa: I mean, it sounds really exciting and powerful tool. What sort of early successes have we seen within the NHS, I know you mentioned Southampton as one, but are there any others that we are seeing in terms of trailblazers?

Clare: Cornwall have worked on a COVID mass testing app, so that in the community, if you wanted to have your staff tested, then they could be sent a spit pot and then they could register that to their account and it comes back into the lab and the whole process gets automated end-to-end. They’ve been doing some really exciting things with it.

It’s at the stage now where it’s great, because everyday we will get a phone call from someone else saying “I’ve been thinking could it help me with XYZ”. So, we’ve been looking at the entire patient journey from referrals and then helping organisations cross the boundaries between the different provider trusts. Thinking, actually, how do we work through this across entire ICS region. It’s a tool that basically opens up those conversations to almost the “art of the possible” and seeing what you are trying to achieve, and then working backwards to how we can use the tech to do it? It’s a really exciting time.

Louisa: It’s sounds really exciting, particularly the breadth of what it can do and help and sort of transform NHS Trusts. Really the point of all of this is to make a difference, not only to patients, but to staff workload as well. You know we hear in the news, particularly this week, about another winter for the NHS, that’s going to be quite difficult to cope with, and particularly that staff members are really maxed out. We want to try to support them as much as possible and in what we can offer.

Clare: Absolutely. So there’s definitely two sides. There’s the patient side and the staff side. Anything we can do to make their lives easier. What we always say, about design of these applications, that you shouldn’t have to have extensive training, because if you build and design it well, it’s totally intuitive and staff will just pick it up, use it and it just makes their day to day life so much easier.

Louisa: Absolutely. Where do you see it heading in terms of low-code and RPA, it’s in its Infancy, but where do you see this heading in the future?

Clare: I think it’s going to become really crucial, actually. We’ve seen it with RPA over the last few years, initially it was not understood in the NHS and now it’s quite widely accepted and the benefits of being really realised.

I think low-code is slightly behind in that journey. But again, it those realisations are starting to happen. Whereas maybe a year/18 months ago, we were talking to a lot of people, it would be explaining what low-code IS. Now, it’s a lot more “Yeah we understand what low-code is. Let’s talk about the use cases and how we use it”.

So, I think it’s going to become a lot more mainstream, particularly through the ICS restructure, there are so many challenges that are going to be unique to different areas. Having a tool that allows you to build things to address your specific requirements, I think is going to be crucial.

Louisa: OK, that’s a really great point. Actually maybe we could focus on the ICS’s a bit more in terms of what they are and how that can help, because it’s essentially bringing the healthcare and social services together, trying to streamline services and procurement activities. Is that right?

Clare: Yes, it’s sort of regionalising areas, so bringing together all the different provider trusts, so that things can be consistent across an area. The patient will very often have touchpoints, with different parts of an area, so you’ll have a GP interaction and then you’ll be a patient at the acute trust, but then you might also be in the mental health trust. At the moment those things are all very segregated, so with the ICSs and including social care as well, I think is really, really crucial. It pulls all those things together. I think it allows for even greater levels of change and transformation than is possible at an individual trust level.

Louisa: And what do you think the biggest challenges are to making that successful for the ICSs?

Clare: I think, as you mentioned earlier, one of the biggest challenges is that the NHS is busier than ever doing their day job. And then this is an extra thing, an extra challenge that needs to be addressed, which has within it a lot of challenges its own right. So, that makes it a difficult thing to achieve.

But, I think the attitude we’ve seen to it and how people are really looking forwards to the changes they can make… I think amazing things will happen.

Louisa: Yeah, from personal experience, having someone leaving hospital and trying to organise that follow on social care element, it was very difficult and disjointed. So, I could definitely see that there is a need for that. And not only for the patient, but their families, the emotional side of things. It’s difficult to see and deal with. So, I think if you have a system where it’s a lot more aligned, it flows with information for not only the patient but the family members, I think that’s only a positive thing.

Clare: Definitely and I think being able to make those iterative changes. That’s the other thing, you don’t have to start by 100% knowing what the end goal will look like in 5-10 years’ time. You can take an initial challenge and fix that. And then work out how that ties into other areas and then expand out from there. So I think that’s another really useful way of looking at it – looking at what you’re trying to achieve, picking a starting point, having some quick wins and then then working out from there. You don’t have to eat the elephant all in one go.

Louisa: Yes – start small aim big, something like that.

Clare: Yeah, absolutely.

Louisa: Finally, as we sum up, low-code and RPA, we’re seeing it is a very key thing in the NHS at the moment. The NHS is obviously embracing digital transformation as much as it can at the moment, and in small ways and in bigger steps over time. But how do you see that evolving?

Clare: Well, I think they’ve got quite a lot of challenges just with what they’re taking on at the moment with the ICS change! I think seeing that settle down, when the ICSs get formalised in April, I think that’s going to come spawn a lot of change. And then I think there will be some really, really exciting projects about bringing together the social care and health care elements. I think that’s one of the most exciting things that will be coming up.

Louisa: Agreed. As we said, align and optimise that patient journey, and have that holistic view of the patient and not being so disjointed.

Clare: Yeah, absolutely. And using the best resources where they’re available, at the best time. I think the ICS structure allows that to happen.

Louisa: Absolutely. Clare Rafferty, many thanks for talking to us today. I think that was really insightful and we’re looking forward to seeing what low-code and RPA can do to transform the hospitals going forward.

Clare: Oh, thank you very much.

Louisa: Thank you.