Infinity Health is a London-based start-up that has developed a suite of digital tools to improve workflow and task management in healthcare. An alumnus from the Digital Health.London Accelerator, the company has recently implemented its technology in the emergency department of Northwick Park Hospital to successfully improve the portering service.

Here, CEO and co-founder Elliott Engers and Clinical Director Dr Jo Garland discuss the huge potential that digital technology holds for healthcare, the absolute importance of evidence and the exciting digital health community that is growing in London and beyond.

The Infinity team

Infinity Health was founded at the end of 2013 by Elliott Engers and Dr Adam Benton. Engers is an expert in managing software products and services, whilst Benton is Associate Medical Director at the Royal National Orthopaedic Hospital NHS Trust. In 2014 the company won a proof of concept grant from the Technology Strategy Board (now Innovate UK) to develop digital tools for handover and task management.

Over the years this has developed into Infinity Health, a digital platform that provides collaboration and task management for teams at the point-of-care. This takes the form of a suite of digital tools that collect and integrate data, for example patient lists and medical data, alongside tools to communicate this information such as notifications, instant messaging and activity feeds.

Engers takes a very user-centred approach to developing the platform “We want to really understand the problems and the users who face them every day” he says. “We’re not interested in tech for tech’s sake but in solving real people’s problems and having a positive impact.”

Jo Garland joined as a clinical director in 2017. Previously a GP, Garland has a working knowledge of the problems that healthcare staff face day-to-day and brings this invaluable experience to the team. “In every other area of work people have great technical and digital tools to do their job,” she says “but in healthcare this area isn’t so well developed, which affects efficiency and safety but also morale. I think getting good tech for people working on the frontline in healthcare is essential.”

Digital.Health London Accelerator

In 2017 Infinity Health applied for the Digital.Health London Accelerator, a programme that helps SMEs and start-ups working on digital health solutions to navigate the NHS and to demonstrate the evidence behind their solutions. “The people involved in the Digital.Health London Accelerator want to help SMEs who are serious about making a difference in healthcare,” says Garland, “and being part of this programme is a real stamp of approval that opens doors in terms of meeting people. Above and beyond that it was fantastic to work with the other 29 companies on the cohort who were all equally passionate and enthusiastic about what they are doing. We formed friendships but also potential business alignments for joint ventures in the future.”

The company had applied for the DigitalHealth.London Accelerator in a previous year and Engers is quite pragmatic that, at that time, they were not ready to make the most of the programme. “The Accelerator can be really helpful in overcoming barriers in the industry,” he explains. “Especially in terms of demonstrating your value and evidence, but you need to apply at the right stage in the development of the company and you need the right approach to make the most of what it has to offer. A lot of people come into healthcare and use that word ‘disruption’ but healthcare providers have invested a lot of money in their patient record systems, so we see our tools as a layer that sits on top of that, to give Trusts the ability to maximise the capability of their existing data and workforce without having to replace everything that underpins it.“

Implementation at London North West University Healthcare NHS Trust

Both Garland and Engers believe that being part of the Accelerator was instrumental in getting their first implementation at London North West University Healthcare NHS Trust. This was a pivotal moment and, to some extent, was down to meeting the right people at the right time but also due to the company being brave and flexible enough to adjust their technology to the problem in hand.

“We had already approached senior clinicians in the Trust who were interested in using and trialling our tools,” says Garland, “but there are always barriers when you have so many stakeholders involved. Luckily the Chief Information Office, Sonia Patel, was very forward thinking and she allowed us to pilot our technology in Northwick Park Hospital to improve workflow in the emergency department.”

Infinity Health successfully put in place their digital technology to request, prioritise and co-ordinate portering. Since the introduction of the technology, the cancellations of porters have been reduced by over 80%, resulting in a sustained reduction of over 6 minutes per porter request, which translates to a saving of more than 10,000 hours pa.

According to Infinity Health’s evaluation the technology improved not only the logistics of the workflow but also the sense of teamwork and morale within the emergency department. “One of the most amazing things we’ve done is bring everyone together on the same platform,” says Garland. “Before, porters were the unseen backbone of the hospital: people wouldn’t know who they were and porters didn’t know anything about the patient. Now they arrive with all the information about the patient’s needs and it’s much more human.”

Evidence, evidence, evidence

The importance of evidence is well-recognised by Infinity Health and, now that they have their first clinical evaluation under their belt, they feel they have the confidence and security to reach out to other Trusts.

“Our awareness around evidence really started in earnest when we were on the DigitalHealth.London programme and working with MedCity,” says Engers. “We learnt about the importance of evidence in terms of building a robust business case with health economics but also the complexity of gathering evidence in terms of evaluating your products in situ and the impact it has on a wider system. I would encourage anyone in digital health to really invest in evidence and to learn more about tools such as the Evidence Standards for Digital Technologies produced by NICE.”

Both Engers and Garland believe evidence needs to go further than numbers to demonstrate the more human factors such as morale and teamwork, but also sustainability in terms of the behaviour change that needs to accompany any digital health technology.

“Before putting in place our solution at Northwick Park Hospital,” says Engers, “we set up a working group to ask people what they thought about the problem and their expectations around digitalisation to gain some insight even before we launched the technology. Interestingly when we asked people to estimate the current failure rate of portering jobs almost everyone said 40% and, when we measured it for baseline data, it was 39%. This shows that people at the frontline of healthcare have a really good sense of what is going on and it’s essential to get their perspective.”

Behaviour Change

Putting people at the centre of their technology is very much part of the ideology of Infinity Health and this is borne out in their approach at Northwick Park Hospital. They worked very closely with the different professions to ensure they understood the technology. This required working with the different work patterns of the professional groups to provide training and support. Nurses were trained before they started work in the morning and evening, porters were trained in groups in their breaks and doctors were trained when there was time on their shift.

“You have to be very sensitive to people’s reaction to change,” says Garland, “and in order to be sustainable it has to make sense to them. Often there are parts of the original process that shouldn’t be replaced, for example handover meetings are still important to meet colleagues but, as our technology allows access to information in real time, there needn’t be handwritten notes to exchange detailed data. We’re not necessarily replacing existing systems or tools but allowing them be used in better ways.”

On the subject of sustainability, Engers and Garland acknowledge they learnt a lot from being so deeply involved in their first implementation, but they are also aware that there may be more efficient approaches to assist behaviour change in the future. This could involve choosing an individual from each professional group and ‘training the trainer’ to champion the technology. They are also in discussion with management consultancies to manage the behaviour change at scale.

“It’s an interesting learning curve,” comments Engers. “You think you’re going to come in as a SME to solve all the problems and disrupt all the incumbents, but the truth is you need to work with the big IT departments and the slow-moving decision making and the big change management consultancies to make a meaningful difference in healthcare.”

London digital health ecosystem: start-ups and collaboration

Despite this learning about how SMEs need to work in healthcare, Infinity Health haven’t lost the passion that is so inherent in a start-up. On the Accelerator, Infinity Health became part of a community of diverse companies that are working in the digital health space and which seems to have collaboration rather than competition as its priority.

“The ecosystem is great and it’s still growing,” says Engers. “There is so much opportunity and you don’t have to be so wedded to solving every problem. For us it’s about learning what we are best suited to and benefitting from working with colleagues in other companies so that together we can produce something that is greater than the sum of its parts.”

“There is still tension between healthcare research and user-centred research,” he adds. “But what we are finding is the academic environment is really receptive to working with SMEs. There are also rationalising forces like MedCity bringing together the life sciences sector of the Golden Triangle and we are lucky enough to be within this. With the infrastructure that now exists with DigitalHealth.London, MedCity and the AHSNs, the landscape is very competitive and exciting. The methodology is maturing, and great things are happening so we’re very optimistic.”

Digital Health challenges: balancing standardisation and flexibility

There are clearly challenges that still exist in digital health. According to Engers and Garland, buy-in and support from clinicians is not a problem but getting the decision-makers on board is difficult and this challenge is magnified by the fact that the structure and processes in each Trust is different.

“Embracing these challenges has been the biggest shift for us,” says Engers, “and understanding there is a real tension between a start-up wanting to go at 1000 mph and design one product that can be copied and pasted, when the truth is that every Trust is different. If you’re hoping that one size fits all then ‘good luck’ but we’ve found that it is important to be agile in the truest sense. We try to design solutions that are flexible but are also rigid and standardised where they need to be.”

“What we find interesting is making our product bespoke,” adds Garland. “We want to develop the product alongside healthcare providers, in partnership with them. We know there is a massive change coming with digital health and it is exciting to be part of this and a privilege to play our part in making a difference.”

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