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Our data helped deliver life-saving treatments for COVID-19 patients

Alison Ward describes NHS Digital’s Therapeutics team’s role in helping COVID-19 patients receive life-saving treatments during the pandemic.

A variety of new antibody and antiviral treatments were approved for use in 2021 and 2022 for people with COVID-19 who were at highest risk of becoming seriously ill. Some of these treatments were as simple as taking a pill at home.  

A patient takes anti-viral treatments at home

In December 2021, our Therapeutics team launched the new Population Health Platform to support the rapid deployment of these treatments.

In essence, the Platform is a series of simple screens that present a list of patients eligible for treatment, their relevant contact information, and the means to record contact with the patient.  

But behind those screens is a host of complex code that represents hundreds of hours of discussion, research, and development from our technical, clinical and governance specialists.  


How the journey began

The work started just over a year ago when inhaled budesonide was being trialled as a treatment for COVID-19. Knowing that, if approved, the treatment would need to be implemented quickly, NHS England asked us to begin work on a solution to support this. 

Trials for inhaled budesonide were inconclusive as a COVID-19 treatment so our technology wasn’t needed as quickly as first thought. Soon after though, multiple types of monoclonal antibodies and antivirals came along as possible treatments for non-hospitalised patients and that's about the time that I joined the programme last August.

I've worked within the NHS for more than 13 years, and with programme teams for the majority of my career. The work was closely aligned to what I was already doing in COVID Oximetry@home, which is an NHS service to monitor patients with COVID symptoms in their own home or care home.

The scope of work for COVID Therapeutics was directed by NHS England and my role was to oversee every aspect of us fulfilling that. NHS England required us to provide digital services  to support 3 different workstreams:

1. The targeted deployment of monoclonal antibodies and antivirals to those patients at highest risk of hospitalisation or death from COVID-19

2. The PANORAMIC trial to help find effective early treatments for COVID-19

3. The wider deployment of antivirals in the community following successful clinical trials and a change to the clinical commissioning policy.

Making sure we had the right expertise meant gathering colleagues across NHS Digital's Platforms and Data directorates, consultants from our partner organisation BJSS (a technology and engineering consultancy), expert clinical leads, and information governance specialists to name just a few.

Many of the team had already been working on the Risk Stratification programme, who were brought together in May 2020 to create a way of predicting the risk posed to individuals from COVID-19. So the knowledge and skills available within the team was vast and incredibly well placed for the challenges that lay ahead.

 


Our challenges

As the pandemic evolved, and trials for monoclonal antibodies (and then antiviral treatments) continued, the priorities and requirements we worked to changed rapidly.  

There were a lot of unknowns. We didn’t know which treatments would be successful through the trials or when, which patients would be suitable, how treatment would be administered, and what direction the pandemic would take next.

These are all important variables which would usually form the foundations of an initial programme brief. But we knew a solution would be needed imminently so we worked with the information we had, filling in the gaps as soon as new information was available, and changing our course as and when needed.  

An extra challenge was the parameter that patients would need to be given treatment within three to seven days of their symptoms starting, meaning a totally new approach was needed to automate identifying patients for rapid assessment by a clinician.  This gave even more sense of urgency; as soon as the treatments were approved, our solution would need to be ready. 


The solution

We remained laser focused on developing a tool that gave clinicians and patients the best chance of utilising the new treatments quickly and safely.  

Consequently, the Population Health Platform launched on 16 December 2021 at the same time as the targeted roll-out of the approved treatments to people at the highest risk of becoming seriously ill from COVID-19. The platform offered:

  • identification of people who had have received a positive COVID-19 test and who had at least one of the conditions considered to put people at the highest risk of becoming seriously ill from COVID-19
  • sending patients an SMS and email to let them know what would happen next
  • the contact information for these patients so they can be assessed by newly formed COVID-19 medicine delivery units (CMDUs)
  • a record of which patients had been treated

Using NHS digital data, we also worked with NHS England to send letters and emails, along with pre-emptive priority PCR tests from the UK Health Security Agency UKHSA, to 1.27 million people in high-risk categories to let them know they could be eligible for treatment.  

The NHS Business Services Authority also supported us with the set-up of event-driven SMS and emails from the platform, so we could automatically let eligible patients know about the treatments if they tested positive.  


Lessons learned

Navigating an ever-changing environment threw up lots of challenges. We were faced with new courses of action daily, working at speed, on top of coping personally with the first pandemic any of us had ever experienced.

Working collaboratively is always a good thing, but absolutely imperative to developing a useful and clinically safe solution at speed. Technical experts working with clinical leads has been especially key to ensuring our solution does everything it needs to, while ensuring clinical safety.  

We also built a really good relationship with NHS England, being open and honest about challenges, timelines, and decisions needed. 

Embedding an open, no blame culture, has been massively important too. If one of the team faced challenges, or if something unexpected happened, we needed to know. Working in a culture where people felt they needed to hide problems would have made things a lot harder. To encourage this, we’ve kept a clear focus on looking for solutions, learning from mistakes and moving forward.


Proudest moment

Hearing about the first treatments being administered and then actually seeing the first patient appear on BBC news was just brilliant. 

We only had so much time to celebrate on launch day, as our focus very quickly changed to maintaining the platform, answering queries, and working through a backlog of changes and enhancements.

Soon after launch, we developed an additional part of the platform to support PANORAMIC, a UK-wide clinical study.

Volunteers could sign up to participate in the study independently or could be referred by GPs who used our platform to view a list of patients who were potentially eligible to take part. Event driven messaging was activated, which means that eligible patients were automatically sent an email or SMS to let them know about the study if they test positive for COVID.

Following the results of PANORAMIC, deployment of the treatments to additional groups of patients will be considered and we’ve already started discovery and development work to ensure our technology will best support this.  


Results

More than 60,000 non-hospitalised COVID-19 patients have been treated and an average of 1,000 individuals are identified as potentially eligible each day. Participation in PANORAMIC has doubled since our event-driven messaging was enabled and has so far reached 26,000 participants.



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Last edited: 5 August 2022 1:31 pm