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CASE STUDY

Frimley Health and Care ICS roll out successful COVID Oximetry @home remote monitoring programme demonstrating benefits for patients and clinicians

Frimley Health and Care Integrated Care System (ICS) have worked with Docobo, Graphnet and local providers to implement Docobo’s remote monitoring solution across Berkshire, in order to monitor patients at home with long term conditions who have tested positive for COVID.

COVID Oximetry @home

Frimley Health and Care ICS – a partnership of local health and care organisations – were already working with Graphnet and collaborated to implement the DOC@HOME® remote monitoring COVID Oximetry @home solution. The solution has now provided benefits to over 3,000 patients across the Frimley area, demonstrating a reduction in workload for primary care teams and enhanced patient outcomes.

Docobo is part of the System C & Graphnet Care Alliance. Its DOC@HOME solution seamlessly integrates with Graphnet’s Connected Care Shared Care Record, enabling health and care professionals to access patient information from acute trusts, primary and community providers, remote monitoring and ambulance providers. Connected Care and DOC@HOME are being used extensively across the UK.

Sharon Boundy, Associate Director of System Transformation at Frimley Health and Care ICS who heads up the digital team says: ‘This is an important step in the journey of remote monitoring for us at Frimley ICS- a critical part of our digital health journey, which will allow us to move towards a more integrated and proactive health care.’

Unprecedented demand on services due to the COVID pandemic

With an unprecedented demand on services due to the COVID pandemic – as well as workforce and capacity challenges – the digital services team at Frimley Health and Care ICS wanted to explore different ways of working to support COVID patients virtually, keeping them out of hospital where possible and enabling them to be cared for in their own homes. The digital services team at Frimley worked with providers East Berkshire Primary Care Out of Hours (OOH) and Berkshire Primary Care to deploy Oximetry @home across the area.

What is Oximetry @home?

Oximetry @Home enables patients to self-manage their COVID infection by submitting SATs readings on a daily basis to a primary care clinical hub. It is in line with national NHS policy which aims to increase virtual approaches to care, in order to release hospital capacity and is proven to release healthcare professionals’ time and enhance the patient experience.

Oximetry @home for patients with COVID can help detect the condition known as ‘silent hypoxia’, a dangerous condition which can occur when COVID causes oxygen deprivation. Silent hypoxia is often difficult to detect, as patients do not present noticeable breathing difficulties, whereas the use of a pulse oximeter can identify this and enable quick intervention to avoid patient deterioration.

Local providers Berkshire Primary Care and East Berkshire Primary Care OOH were already providing a paper-based Oximetry @home service to support patients, with skilled teams based in a clinical ‘hub’ phoning up patients daily to check in on their oxygen saturation levels (SATs).

Berkshire Primary Care

Berkshire Primary Care have been running pulse oximetry remote monitoring since November 2020 and – at the height of the pandemic were monitoring hundreds of patients each week, much of which was done through phone calls and spreadsheets. Helen Snowden at Berkshire Primary Care explains: ‘The move to the Docobo platform was a game changer with patients being identified through a risk stratification process in Connected Care and then electronically enrolled into a platform that allowed integrated text messaging.’

Once a patient consents to being enrolled in the service, a volunteer from the local Bracknell Charity ‘The Ark’ delivers the pulse oximeter and patient information pack to the patient’s home address on the same day. To date, they have delivered over 1400 devices – which is incredible!’

East Berkshire Primary Care Out of Hours 

East Berkshire Primary Care OOH already had a clinical hub in place to support their paper-based Oximetry @home service, so their team could start to use the remote monitoring solution straightaway to support their service. Patients are now enrolled onto the service using Docobo and information from Connected Care. Patients are contacted by the team at EBPC OOH as an initial introduction and to ‘onboard’ them to the service. They are then sent a pulse oximeter in the post by next day delivery for them to use and keep.

John Daniels, COO at East Berkshire Primary Care OOH explains how the project started: ‘The Docobo team were nothing short of outstanding on everything – from communication to ability to responsiveness!’

How does Oximetry @home work?

For up to two weeks, Oximetry @home patients carry out daily observations using the pulse oximeter. Patients upload their data via SMS text or they can telephone the clinical hub, who will enter their readings for them. The DOC@HOME platform helps clinicians in the hub to prioritise their caseload as it will automatically alert them to any deterioration in the patient’s conditions, for example, if lower levels of blood oxygen are reported. This means that clinicians can intervene when required, enabling the appropriate medical care to be provided quickly and efficiently.


Benefits that have been realised during this ongoing project include: 

  • Improved quality of care and patient experience
  • Reduced readmission to hospital
  • Improved patient care
  • Timely identification of early signs of deteriorating health
  • Clinicians can access more information about a residents’ health
  • Sharing data across systems: integrated care record
  • Reduction in emergency admissions
  • Ability to care for more patients with fewer clinicians
  • Admission avoidance and earlier discharge
  • Reduced ambulance call outs

Benefits for patients

A patient from Maidenhead says: ‘When I got COVID, I notified the NHS via the app and shortly after received a call from a nurse from East Berkshire OOH who asked if I wanted to be put on the Oximetry @home service, which I agreed to. She explained they would send a text twice a day, that I should respond to giving my oxygen levels with my oximeter. I thought this was really efficient, and found the whole service to be very good. On one occasion, my results were lower than before, and the service quickly called back to ask if I was OK and asked me to carry out an oxygen test again while we were on the phone. This time the results were more in line with what you would expect, but I was impressed this was picked up so quickly. The service was really easy to use and very reassuring to me. At the end of two weeks, the nurses phoned me up to see if I wanted to continue, but as my symptoms had cleared up, I was happy to be discharged. I was really impressed with the service.’

John Daniels at East Berkshire Primary Care OOH: ‘Our clinical teams at the hub have gone from speaking to patients every day for two weeks, to speaking to them only three times throughout the fortnight. We also no longer have to use a paper-based system to log calls and patient readings, and any deterioration is flagged up automatically within the Docobo solution. This has had a hugely positive impact on workforce and improved our capacity to help more patients. It has also improved the patient experience, which is really important, as well as our governance, as we have full reporting capabilities and a very good audit trail. The aim of this service is to recognise when things are going wrong with patients, so that we can intervene rapidly, and ultimately avoid hospital visits, and I really feel we are doing this, thanks to Docobo’s solution.’

Dr Prash Patel, CEO & Medical Director, Berkshire Primary Care says “The pandemic introduced a pace of change that remains largely unparalleled in the delivery of recent healthcare. Ideas and pathways that were being leisurely developed were suddenly thrust front and centre into the spotlight, specifically technology, which as an enabler has allowed us at Berkshire Primary Care to provide solutions to our patients and partners at a scale that is truly meaningful. Pulse Oximetry@Home is a wonderful example of partners from traditionally distinct areas working together in a way that creates care by placing the patient directly at the centre and armed with tools which encourages levels of self-care and autonomy fit for a present as well as future direction of travel in healthcare monitoring.”

Moving forward

The project is moving forward system wide, to expand the remote monitoring service from oximetry and a pure COVID focus, into supporting all areas of work across the Frimley ICS – including care home residents, those with diabetes and patients being managed in the community.

‘With regards to the Docobo Graphnet partnership, integrating a remote monitoring capability into shared care records will transform the way we provide healthcare. This allows any healthcare professional who touches a patient in an urgent care setting to see their vital signs monitoring which will allow them to make better clinical decision at the point of care.’

Sharon BoundyAssociate Director of System Transformation, Frimley Health and Care ICS