Alongside my clinical activities, I work closely with the Institute of Digital Healthcare at Warwick Manufacturing Group, University of Warwick. I’m also really fortunate to be working with the Faculty of Clinical Informatics, where I am part of a group of likeminded trainees who established the Faculty of Clinical Informatics Early Careers Group. This Group looks to support those of us at an early career stage who are interested in digital health and health informatics. I’m sure I’ll talk more about the Faculty of Clinical Informatics and Early Careers Group in future blog posts!
The Topol Digital Fellowships Programme is an incredible opportunity for fellows to have protected time alongside their training or clinical work to develop and deliver a digital health project. In developing that digital health project we are able to gain skills and experience that help establish ourselves as future digital leaders. Overall therefore, it is quite an ambitious programme! The application process was straightforward but very competitive. I believe they are hoping to run the programme again next year, so perhaps nearer the time of applications I will recount my experiences of the application process and interview in case that is helpful to others.
At the absolute core of each Topol Fellowship is the individual project, which is used as a vehicle to both improve care provision and also act as an educational tool for the fellow. My project looks to explore the use of a smartphone-based app for supporting remote monitoring and remote consultation of diabetic foot disease. This is delivered in collaboration with the MedTech Company Medopad (https://medopad.com/) who are very kindly supporting me with the development and customisation of the Medopad platform for this purpose. My involvement with Medopad started through their Greatest Minds Competition, which was a great opportunity to promote closer working between clinicians and the Digital Health Industry.
Alongside the fellowship projects are a series of fellowship workshops, organised by the central fellowship team. These happen across the United Kingdom, and the first kick-off meeting was held in central London in September. The first meeting was of course a really exciting event, with the opportunity to meet the central team and the other Topol Fellows. The event kicked off with an introduction via video from Professor Eric Topol himself and there was an overview of the NHS digital landscape by Dr Harpreet Sood. It was quite remarkable to see the diversity of fellows from across the country and from across different clinical contexts. Similarly, as we each presented our own digital health projects it was evident there was both breadth but also the potential for significant shared learning. The Topol Fellows have divided into separate groups to mentor each other, and we all left energised for our next workshop in November.
Undoubtedly however, the hard work began after we had left the kick-off meeting, returning to our clinical environments to develop, deploy and evaluate our digital health interventions to the direct benefit of patients and staff in the NHS.
In the West Midlands I was really honoured by the support provided to help me deliver the project. This includes direct support from the Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism at University Hospitals Coventry & Warwickshire NHS Trust where we are piloting the tool, as well as support from the Health Education West Midlands Deanery, where we have regular fellow meetings to meet other trainees on out-of-programme related activities.
I would argue that perhaps one of the most important things in developing any digital project is to remember the involvement of patients. I have worked directly with Medopad to meet with patients to discuss their needs of smartphone-based diabetic foot disease monitoring. This is very similar to what we would define as patient and public involvement’ (PPI) in the research context, but was actually described as ‘Guerrilla PPI’ by the Medopad team, which is a term I absolutely loved! This approach to PPI effectively means taking the opportunity to talk to patients as they use a service about that service, and how that service could be improved by digital health approaches. Whilst much less structured than the formal research-based PPI, it is an enormously useful approach to rapidly gain insight into what patients want from digital health innovation. The most notable learning from this exercise was that we had some anxiety that our patient population with diabetic foot disease (who tend to be a little older, and unfortunately diabetic foot disease is also associated strongly with deprivation) may not have access to smartphone devices with high quality cameras. This was almost universally proved wrong, as we repeatedly asked patients if they had devices and patients would show us some of the very latest devices on the market (far better than our own personal or professional devices!) or on one occasion actually produced two smartphones as they said they struggled with just one! This was very much a learning point not to make assumptions about patient populations you are hoping to collaborate with to achieve digital innovation, and is supported by a range of recent research. The next innovation steps are to pilot, evaluate, customise and widen the pilot group, which I will write about later.
One of the great opportunities of the Topol Digital Fellowship Programme is the protected time to pursue digital health innovation. It also clearly defines the Topol Fellows as individuals who are interested in digital health innovation. This has allowed me to pursue a number of projects alongside my ‘core’ Topol Project. One of the most exciting of these is the development of a Foundation Priority Programme Post in Digital Health and Entrepreneurship. The Foundation Programme is the first 2 years of medical training that junior doctors complete following medical school, and in the West Midlands region we have developed the first Foundation Priority Programme post specifically badged around digital health and entrepreneurship. This programme is supported by The Institute of Digital Healthcare (for the digital content) and Warwick Business School (for the entrepreneurship element). The UKFPO (which coordinates applications to the Foundation Programme) has this month opened applications for the programme and it will be really interesting to track the applications and trainees starting at University Hospitals Coventry & Warwickshire NHS Trust in August. We hope that this can be the first step towards integrated training in digital health and informatics for junior doctors. To be truly successful, this integrated training in digital health should be delivered alongside similar schemes for other clinical roles in the healthcare service. It is my hope that through participation in the Topol Digital Fellowship Programme, I will be able to develop the necessary contacts and networks to achieve this.
Overall therefore, it has been an enormously exciting and busy time starting as a Topol Digital Health Fellow and there is so much more I could write about! This has been achieved alongside maintaining clinical activity and competencies in both Diabetes/Endocrinology and General Medicine. Looking to the future, I’m excited to be developing the next steps of my Topol Diabetic Foot Disease Project, whilst also continuing to build collaborations with the other Topol Fellows and widening my breadth and understanding of digital health delivery.
My next blog post will have a truly international flavour as I spend time in the Basque Country in Spain exploring some of their world-leading approaches to digitally delivered integrated care solutions for multi-morbid populations.
To close though I would like to thank the entire Topol Fellowship Programme Team, alongside my clinical and academic mentors at University Hospitals Coventry & Warwickshire NHS Trust (Prof Harpal Randeva, Prof Sailesh Sankar & Dr Narasimha Murthy) and the Institute of Digital Healthcare (Prof Theodoros N Arvanitis & Sarah Lim Choi Keung). Without their support this would not have been possible.