Improving the quality of care delivered to patients remains a significant challenge for the NHS. However, the arrival of a ‘mobile-first’ culture of work has the potential to transform the delivery of healthcare, using a device that over 99% of medics already own and use at work.

Clinicians and academics at Imperial College Hospitals NHS Trust (ICHNT) and Imperial College London are continuing to work in partnership with Google Health to roll out a secure smartphone app for healthcare called ‘Streams’. The app integrates with electronic health record data and supports workflow management, delivering clinical information like lab results and vital signs securely to clinicians’ smartphones when they need it and flagging patients at risk of harm.

The aim of this parallel study was to undertake an organisation-wide evaluation of the implementation and effects of Streams. ICHNT comprises five hospitals in North West London, and Streams has started to be implemented across each site incrementally. The team provides ongoing feedback on the app using qualitative and quantitative analyses against the principal components of healthcare quality: safety, experience and effectiveness.

In February 2019, the first users began using Streams at ICHNT with an initial rollout amongst the surgery team at St Mary’s Hospital, London. Deployment has been growing steadily, with new users being added every month. By full implementation, the project should help staff across all five sites, treating more than 1 million patients per year.

A benefit of the partnership approach is that Streams continues to improve, with new features like customisable patient lists and structured medical notes being added on the back of user feedback. Clinicians have found the app useful because they can now triage decisions on the move, review results at the bedside and therefore spend more time with patients, as well as view results for specific colleagues moving between sites.

For the quantitative evaluation of the app, the Imperial team has created an anonymised database of clinical events, lab results, demographics, clinical documents, prescribing and administration data for all inpatients to make queries again. This database will be used for analysis when a sufficient number of clinicians are using Streams at all five sites.

The collaboration between Google Health and ICHNT has also has a Clinical User Group which is cross-speciality and meets monthly. The Group feeds into feature prioritisation and rollout planning.

The partnership has successfully rolled out the Streams app and embarked on the first known deployment of widespread Bring-Your-Own-Device technology in the NHS supported by a robust security and privacy policy. The priority is full deployment across all five sites of ICHNT with iterative improvements in functionality based on the evaluation.

The Streams app aims to reduce delays in the detection of patient deterioration, enhance productivity, reduce staff workload and stress, and improve knowledge on affordability and scalability of technology across the health system. It has the potential to revolutionise our understanding of the physiology of patients in real time and the project will deliver important insights into the opportunities and challenges of delivering this type of innovation across the NHS.

Partners: Imperial College London – Institute of Global Health Innovation (IGHI), Imperial College Healthcare NHS Trust, Google Health

Read more about the Health Data Research UK Sprint Exemplar projects, funded by the UK Research and Innovation Industrial Strategy Challenge Fund (ISCF), here.