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Okay. Yeah, there we are. I think we are live. So um good morning everyone. It is a great pleasure to um chair this session today for the Digital Transformation. My name is Theo Foetus. I'm a Reader of uh nursing and this is the health researcher at the University of Brighton. And along with me, uh I have a co chairing the session. Bella Tom's it, Bella, would you like to say a couple of things? Oh, sorry. Hi. Yeah, just I'm gonna be important here and um carry chairing the session. I'll just be mainly hanging out in the chat bit um and throwing out your questions. That's great. Thank you, Bella. So a couple of housekeeping elements before we start the very exciting sessions and uh talks that uh we, we have a schedule for you today. Um uh Well, just to make again, remind you that during the session, uh we would like to kindly ask you to keep your cameras and microphones off and our presenters will present their talks and we will have then the chance to have a discussion Q and A session afterwards. So please do keep your questions to ask anything you want by the end of all the presentations and you can also use the chat box that Bella will be following. And so I think that with no further ado you, we are ready to start the uh first presentations. So I would like to invite Angela Smith from Burma's University where she's going to talk to us about the evaluation and evaluation of the role of uh drones on supporting NHS logistics. Very exciting Angela. The stage is yours. Thank you. Thanks for introduction. Okay. So can you see those slides? I'm not familiar with this platform, I'm assuming you can. Um So I'm Angela Smith. I'm from form of university and I'm going to talk to you today about the drone research project. Let me just turn my camera off so that you just see the slides. Okay. So this is a three year E S RPC funded research project. It uses NHS case studies to understand the potential of drones to support medical logistics and hopefully contribute to efforts to Dick ARB anus transport provision. So this is set against a backdrop of various drone trials taking place in partnership with some NHS trusts, for example, um Northumbria Healthcare NHS Foundation Trust are working with the drone company AP in um and um they're looking at they're exploring these drones to carry chemotherapy drugs, blood samples and other items between sites. So I want to use this brief presentation just to make you aware of the availability of a growing evidence base which provides for an in depth evaluation of the use of drones in medical logistics. So as part of this research, we've undertaken a series of interviews for the NHS with NHS practitioners whose role involves the movement of time sensitive medical items. So for example, we've spoken to pathologists and blood scientists. We've undertaken observational work. I've accompanied a van driver on his daily pathology rounds. And researchers at the University of Southampton have analyzed pathology workload data and they've worked with U C L two model, the energy use of business as usual transport use and I vans and compared this with options which integrate the use of drones. So just a little bit about drones, logistics drones, they're piloted remotely. So the flight is largely automated with a remote pilot being able to monitor multiple drone flights at the same time. So as such, their flown beyond the visual line of sight and the distance that they can fly on what they can carry really depends on the type of drone. The drone train in the photograph was used in trials between Portsmouth and Saint Mary's hospital on the isle of wight. And this one can carry up to 20 kg. So this drone is a hybrid drone that means it's got wings and rotors and it can take off and land vertically and therefore it doesn't need a runway and it is battery powered. So I'm just going to give you a taste of some of our findings. But I hope that you will take the opportunity to read a bit more um in bit more detail by downloading our summer report, which I've made available on pad lit and you'll see a link to at the end. Uh and also our papers are all available on our project website. So, pathology has been the focus of our research and that's due to the daily requirement of transport diagnostic specimens uh to transport diagnostic specimens between community settings such as GP surgeries to pathology laboratories which are typically based in general hospitals. So in England and Wales, around 300,000 pathology tests are performed every working day. Um One trust we worked out worked with estimated that around 50% of their tests were performed in the community. So that's 50% of their tests being transported to the hospital every day. And these samples are collected using networks of fun arounds which are scheduled to ensure that the samples are in transit no longer than two hours. So our research did identify some challenges associated with this existing approach examples of which include the afternoon peaks in arrival of samples in the laboratory. So for one hospital, over half the samples arrived between three and four in the afternoon. So this has implications obviously for managing resources within the laboratory and staff. Um and we spoke to anthology manager who described how he was quite keen to reduce these peaks and demands by providing more pickups. Another issue was that there is a continued need for some patient's to travel to the hospital site to have their blood sample taken or, or to collect other samples. And this included some cancer patients'. And partly this is because they saw a faster turnaround for their results to inform their treatment. And another area is that the fan rounds really were not very responsive to changes in demand. So without you know, if they change, if the demand or the root changed, it would affect the rest of the pickup search schedule. So for example, if a way um waiting for a late running clinic would make the driver for late for the next pick up and could mean that samples would be in transit longer than the maximum allowed tire frame. And what also we observed is the van may still visit a surgery where there are no samples to collect. So um there was nothing urgent that needed picking up. There was no way of communicating that or responding to that. So drones could ultimately offer more responsive service and provide for more frequent collections throughout the day. This potential wasn't explored using empirical data from Southampton, the New Forest area concluding that emissions and time savings could be achieved. However, if we assume the same specification of drone used in the isle of wight trials, um this would result in quite significant increase in costs um in the current situation and there is a need for the deployment of alternative transport and no fly days. So researcher from Southampton looked at the previous years whether records and he found that if we applied them again, the drone um that this was modeled on would, would not have been able to fly on 19% of the days. And on those days, alternative transport would required be required and they would probably be in the form of fans or taxis. So the drain is undertaking further modeling work with data from the Scottish highlands. And that's where trials with more weather resistant drones will take place. And they've also got a much more referral and geographically challenging backdrop. So this will help us develop our understanding of this use case further. Um And we've also undertaken the evaluation of the role of drones in moving chemotherapy treatments or aseptic medicines. Um and that draws on experiences in the isle of wight and some initial transport demand associated. We've also looked at additional transport, transport demand associated with ad hoc emergency transport requirements such as emergency blood and pharmaceuticals. But what we would emphasize from this research is that there are alternative approaches to addressing the challenges associated with the transport of time sensitive medical items. When we, what we propose is that when we evaluate the role of drones, we set it into the context of the whole service area. Um with the scope for non transport interventions explored alongside work to maximize the use of all transport provision, much of which would be needed uh would need to continue even if drones became a reality, therefore, cause something's transporting bulkier items for instance. So just to finish off, there isn't really much time to go into a lot of detail here. But we've produced this summary report which we hope is kind of, you know, quick to read. Um And this just relates to the drones and the use of the medal medical use case. You can access this from our website or you can use this QR code. What we're really keen to do is generate some discussion, receive comments and questions. I'd be happy for these to be directed to me obviously in this session but also outside of the session. Okay. Thank you. Thank you very much Angela for this very interesting approach to transferring um uh samples. And um I would like to invite our next figure which is Rachel helped. It's gonna talk to us about diabetes Fitbit supporting group Rachel. Uh This is your stage. Hello, everyone. Firstly, thank you for having us here today. Um My name's Rachel helped and I lead the digital data and technology team here at three Medical practice. We our own PCM with a population of just under 30,000. Um I'm going to turn my camera off now do the presentation and I'll turn it back on for any questions at the end. Thank you. So I'm here today. Let me present my slides before I get started. Um I'm here today to talk to you about our successful clinical improvement pilot program that explored the impact with type two diabetes patient's and the beneficial effects of healthy lifestyle changes combined with wearable health technology on a patient's ability to self manage and improve their condition. This was a collaborative project with my way, Diabetes fitbit and from medical practice. So the aim of the pilot was to prove that a combination of themed healthy lifestyle, patient education, wearable health technology and preventative apps are used alongside my way diabetes portal gave patient's a greater awareness of an a confidence in their ability to self manage their condition and improve a general health and well being, we ran a report to identify newly diagnosed patients with type two diabetes. Within the last six months, we then sent out bulk communication to the patient cohort for them to be able to self refer into the sessions. And this created a sense of ownership and responsibility. Early on from the patient's, we wanted to measure the clinical impact that these sessions would have. So at the start and the end of the sessions, we took HBA one C B M I and BP. We knew that it would be easy. Wins to collate surveys, prion posts. So ask patient's to complete learning outcome surveys, measuring their level of understanding with how to self manage their diabetes and we also use well being surveys, measuring human needs and capabilities. We created themed resource packs for each of the in person sessions, revisiting education and tapping back into local provision in the community to support the healthy lifestyle changes. We wanted to create a supportive group dynamic using a blended approach of prescribed apps such as my way where they could see both their health record data and Fitbit data combined, giving step by step advice to further explore the links between healthy lifestyles and reduce diabetes risk. We used healthy lifestyle themed education on core areas. So that was movement, activity, food and sleep and relaxation. We had motivational coaching with our health coaches and fitbit which acted as a virtual coach encouraging meaningful but manageable healthy behavioral change. We also made the sessions more accessible by providing free fitbits tablets and digital inclusion. The group around 555 face to face sessions every two weeks with 100% engagement and all patient's finish the program. The program was over three months and ended with post surveys and remeasuring HBA one C blood pressure and B M I. So if we take a closer look at the program, the program delivered five face to face sessions, one every two weeks, pre imposed surveys, measuring patient's level of understanding, track changes in patient's knowledge. Patient's also signed an expectations document outlining responsibilities on both sides and the level of engagement required and all patient's were clinically assessed before being enrolled into the program. And it's important to note that know clinicians were in the sessions. This was done to minimize the impact on clinical demand. And we instead had prerecorded healthy lifestyle education presented by clinicians. And this allowed us to run future sessions with no clinical resource or impact on the patient on the practice. So the first session was an on boarding session and it showed patient's how to use fitbit and fitbit app and then my way diabetes portal and how to understand how to view the health data and how it's being recorded. We also recorded a um video called how diabetes works in the body. And this gave a feeling of clinical support without A G P actually needing to be there. Three sessions on key lifestyle lifestyle themes. Sessions featured a mixture of educational segments including videos, life, practical demonstrations and exercise is promoting healthy behavior and goal setting around small incremental behavior changes. In each session. We tailored our educational manageable behavior change around fit bits functionality using B J Fox idea of tiny habits. We prescribe preventative apps to reinforce self management around key themes in between the formal sessions. The final session, we collected surveys for the final post program results um and to continue the healthy lifestyle behavior change and talk about support. After the sessions, we brought in external speakers on local activity schemes such as SASP, which is the Somerset Exercise referral scheme. With resource time being limited. We were also able to recruit voluntary external community speakers on nordic walking, mindfulness and exercise to construct a varied and engaging program. So let's look at the results. Here are the results of the end of the pilot. 80% of the group made improvements in one or more clinical indicators. 60% improved the HBA one C 40% improved their body mass index. 40% improved their BP. 100% of the group improved their level of understanding of how to manage their diabetes. And 73% improved their social well being factors. Some of the patient feedback, patient feedback from the group was really positive. Patient's felt supported and motivated to carry on with the healthy lifestyle changes. Here's some of the feedback we got life changing. I feel motivated and Fitbit was a great reminder to help me stay on track with my step goals. So the key learning we showed that integration of fitbits struck the lifestyle education and preventative apps encourage meaningful beneficial patient change. Fitbits were are key tool to facilitate and embed manageable behavior change and encourage a culture of self management. In conclusion, this project shows that a mixed model approach in combining patient education with digital health technology is a sustainable approach in primary care, reducing clinical demand and embedding, resilient culture of self management. We've also 1 100 more fitbits and continue to run these sessions successfully. This last slide um talks about how we continue to work in partnership with other green initiatives. And the links to this page are on this light and the full Fitbit report is also available on our website. Thank you for listening. Any questions? Thank you very much Rachel um for sharing with your experience and demonstrating how technologies like wearables they can contribute to sustainable provision of healthcare. Um And may I invite now our next speaker, John Alvarez Rodriguez from the University of Brighton. So she's going to present to us the sustainable value assessment in digital health interventions, hair scoping review. Jonah, the stage is yours. Thank you. So, yeah. Um Thank you for the introduction. So, well, first of all, before start explaining you about uh the disk open review, uh I want to give you a bit of a background on why it's important this the search. So uh since COVID 19, in order to integrate uh you know, uh digital interventions uh increase in primary care and I guess in many other services as well. So in order to integrate them or into the system, uh they have uh to be evaluated. So um at the moment, uh those evaluations are only focused on design clinical outcomes or cost. So if we keep uh evaluating only those aspects, uh then it will be sustainable. Uh We are we actually thinking uh through the system or across the system? So that's why the triple bottom line is important here because uh it seems like digital health interventions are adding social and environmental values but still like in the early stage of this research, especially in evaluation tools. So, um that's why uh the purpose of this um scupper review was to explore evaluation tools of sustainable value uh in digital health intervention specifically in primary care for, for doing that. Uh It was important to split uh into three, that the search strategy uh was uh split it into three aspects. And as you can see, uh to make sure that those concepts were um included into the search. Um uh it had to to, to be like like that. So in order to struck uh the information uh contact analyzes was used and uh it was the guidance was that the Sooskee uh framework which allow us to, to, to strike all the information of the articles. Um These are just like overall results like really brief results of the scoping review. And as you can see here, um most of the evaluation tools were in the, in the economic value because effectiveness then you can see here social value is a really like split into diverse, into different areas. And the less evolution tools like the less common wear uh those that are into the environmental aspect. So something important in the environmental value was that normally the studies uh calculate uh carbon footprint or, or the environmental value, which in normal practice is comparing normal practice but not um into the digital interventions. For example, a wearable devices between uh mobile phones or applications and also most that is adapt uh practiced it, tools that have been used in in normal practice to the digital hair interventions. Other important thing in social value was that um the most common evaluation were comparing socioeconomic status and access. Um And the difference uh in terms of access and education and also uh other important thing was like uh evaluate evaluation of, of satisfaction and trust. Um And the, the financial value was the most common and also the research start to also include uh the social value like the access and patient satisfaction and also start like earlier stage of of comparison between normal practice and, and digital uh technologies. Other that just one last thing is that at the moment, there aren't studies that consider three aspect of the triple bottom line. Um So, yeah, like this is a brief uh information. So thank you so much. Uh Happy to answer any further question. Thank you very much, Joe, I've just lost the connection for a second but managed to reconnect. So, um and may I invite our last speaker for today? Um Or uh can I just come in theo the last week arena? I don't know if you're able to join us on the stage. Um Catherine, the person who is supposed to be presenting, we're doing some troubleshooting behind the scenes is having a firewall issue and is who Catherine? She says she has arrived. Yes, but they come here now. Okay, Serena, if you want to shut your camera microphone off, Mr Ratio, you Catherine is here. Otherwise I was going to say you want to use slides which you were planning on presenting. I have slides and I'm going to share the slides now. And so I will um just see whether this allows you to progress them. I, I suspect not. So I'll just progress when you tell, are you able to push them forward? Kathrin? Um How do I do that? Um Exactly, I think maybe that won't happen. I'm just, I've just tried. So we'll do the, it reminds me the first lockdown period. But remember the next slide, please, please syndrome. We'll do that for today. That's all right. Um So I'll turn my camera microphone off and um just tell me when you want me to go to the next slide. Okay. Yes, I, I was so sorry about the problems we've had NHS firewall issues. We're obviously not going to get around that. Um We wanted to do a presentation on getting an idea of the clinician's perspective of. We're using M S teams outside of the clinical setting. So not looking at patient facing, direct patient facing. Really what we're looking at is all those other things that we do. Um That's what we're going to do our presentation on ourselves just to introduce ourselves. Um I'm Doctor Catherine King, um an S T six in older adults psychiatry. Um, and one of the registrars and I did this when I was working under Doctor Roy is a consultant, older adult psychiatrist as well. Um So would, yeah, would you like to move the slide on Heather? And it is always very clunky when you're having to do that? So, yeah, again, I'm, I'm very sorry. Um So just to give you an idea of where we work and what the issues are with regards to carbon and travel. Um So you can understand why this has such an implication on the, the wider team and, and on carbon travel sustainability. The Humber NHS Foundation Trust, like many mental Health Trust covers a very, very wide area which you can see on the graph there and often quite a bigger area than your two more physical health trust. Uh So we cover about 4700 square kilometers from white right up in Whitby. If anyone knows the locations very well to write down to hold with and see and, and even Grimsby, so across the Humber Bridge. So it's a very wide area and we pull trainees and registrar's in from the Yorkshire and Humber Dean Ary. Um So our trainees are traveling a long way um as is the usual reasonable commute that is defined by the Dean Aries um for both physical and health, both physical health and mental health is, is around 40 miles. So about an hour's commute. Um, mine was about 48.8 miles. So not, not too unreasonable compared to the, what's considered as reasonable. So, mine was about an hour and 20 minute commute there and back when I was working in hall as I live over in Scarborough, um, that's quite a common commute for all trainees. Uh, I think working across the NHS at the moment and that's, that's quite a lot of miles. Um, so if you could move on Heather, that'd be great. Whatever. Thank you. So, outside of the direct patient contact, um and assessments, um, it would be quite typical of any patient for you to discuss them in huddle, discuss them with your team manager and consultant, the nursing staff. Um, that patient might get admitted out of area and there'll be requests for the social workers and care coordinators to attend. They could be traveling again up to 40 60 miles. If they wanted to come and travel in person, we might ask a dietician or psychologist who don't work directly in the area for advice. Um, you might present the case at a weekly teaching which again is uh 96 mile round trip for me to go to. You might attend national teaching on the subject in order to give yourself more information on for personal reasons you might discuss with your supervisor or your educational supervisor. That's a round trip of 100 and 30 miles. So for, in order to, to manage one patient, I could be doing up to perhaps 418 miles and that's just the occasional meeting. That's not the, their entire management. And that doesn't involve the travel and the costs from other members of the team as well. So if you could move on, have a, so we use M S teams in a lot of ways in the mental health trust. Um And it's become the way in which we attend a lot of these meetings, including R M D T s, um teaching management service meeting conferences like this one, well, being, events, supervision, all sorts of reasons. We were using teams and there's, there's widespread benefits in reducing travel and allowing clinicians from other disciplines to attend meetings that they otherwise just wouldn't be able to attend. Um And there, there was a broad estimate that it's over six months. Teams managed to save 2.9 million hours. I was unable to get an idea of exactly how much cost there was and how much the savings are. Um Can you move on again? Heather? So, unfortunately, anecdotally, I find that there's a lot of complaints about teams and we have coming up a lot to comments like this when I go to teaching when I go to eight MG TF. Well, that we're really hoping to be face to face and won't to be nice to see each other. Again, making plans for the the months, months in the future to start meeting up, face to face and a definite complain that no one ever contributes on teaching. So what I wanted to do because I didn't ever really agree with myself with those comments is I wanted to get an idea of really just what other people fought. Um So really simple survey to find out what, what clinicians really fought are on doing all these things on M S teams. Um, so heavy if you could move on. So we surveyed medics of all grades through, through Humber and created a survey on Microsoft Forms. And we really want to know what their force on attendance, uh, their ability to participate in meetings and the quality of teaching because one of the complaints is the quality of teaching has gone down using M S teams and asking really what they wanted to do in the future being as so many people are starting to talk about trying to get back to face, to face and just so that people can have a voice really for future future service development. Um, so if you can move on, so we managed to get 22 people to respond to the survey and I would have liked a fair bit more. Um, and I'm hoping to roll this out again and to try and get more numbers, but it was clear that the use of em esteem among those people. Were widespread and using them across all the areas that I mentioned before, an additional ones as well, um including tribunals and interviews assessments. Um So as a general as a general rule, looking at what people found to be the most beneficial people found M S teams to be neutral, too strongly beneficial in most of the areas that they were using, such as M D T supervision, teaching and leadership and meetings. And the only areas where they didn't particularly like and it did seem to be more negative. Um as I could have probably guessed was for the use of interviews and for examinations. Um People didn't seem to like using M S teams for those reasons. Um If you could move on Heather, so 22 people or everybody who responded to the survey did feel that they attended many more meetings and they did before and prior to COVID, um 20 people felt that attendance on a whole was, was increased throughout and that was in all areas. Um When, when it came to discussion's about contributing on teams like contributing during teaching has seem to be quite difficult. People complain that the people are getting involved anymore. Actually, the more people for the contributing was easier and on, on Microsoft teams fell and with comments that they felt less pressured, um less socially anxious about presenting when they were using M S teams and only six people felt it to be actually harder. Um and 11 11 people. So just over 50% 50% found it to be easy to, easier to present with only six. Again, finding it to be more difficult and on a whole, um only five people felt the quality of the interaction was reduced overall. Um So if you could move on Heather, so the future wishes and look at what people wanted for the future. Um So the blue box is um that they wanted Microsoft teams to continue. Um the gray box that it was a combination and the yellow box that it was it would be optional in future that we could either come face to face or present on teams. So they, the only, the only box that shows no, that they don't want Microsoft teams to continue at all is the orange box, which is quite clearly a lot, lot less than, than the majority. Um And if we could move forward again, finally, so getting on for my last slide nearly, um There was uh two thirds of people felt the training may be required or might be useful. So it might be something that we could look at in future. There were some comments made on the survey that um they didn't know how to do certain things. Some people don't know how to utilize breakout rooms, they don't, you know how to set that up. So when they are presenting that generally isn't an option for them. So although teams has become quite widespread. Um Some of us are very tech savvy, others obviously have more difficulties in doing that and and haven't quite learned that yet. So, so I think there are ways in which teams could be improved in the future. So moving on, um our implications for practice really, uh the commonly heard concerns about reduced quality and participation and quite as widely held as as is heard when we had, when it's been discussed with other people. Um And request for face to face. Um return to face to face is just not quite the majority of people with most people option for a mixture of the two going forward. Um And again, feelings that people aren't engaging when we're teaching online, it is also not a widely held belief. Um And some people will feel more comfortable contributing when online. Um So last one, um I don't know where I am for time, but this is the last slide if you move on. Um So just, just restriction of our, of our survey, we're really that it was a smaller sample than we'd hoped. And obviously, as I've shown the humber Dina is quite big and we would have quite liked a large pool of respondents. And hopefully we will try to get that in future. I'm working for another trust now, which is even bigger the TV trust covers a larger area. Um So hopefully we'll be able to roll out to a larger pool respondents. Um We would like to have an idea with the multidisciplinary team as well and what they're forts are. So I'm finished. I don't know if doctor I would like to add anything to what I've already said. Um, and you were open to questions. So, just that we've, since, um, uh we did this survey, um, the academic program has become, um, they've listened to this research and they've been making it into like a hybrid. So, um so basically people can watch via MST or they can come face to face and that's been kind of working very well and that was the kind of more popular consensus. Um when they have done a few that have just been face to face on their own. People haven't been turning up so much. So I think people really got used to the MST. Um And um and I think for sustainability, I think that's a really good thing that they actually do like it and are using it well. Um So it seems to be, I think more people probably preferring MST than even in the survey. So, yeah, it would be better to get a higher population. Um And then, you know, that's what we're planning to do for the next roll out. Okay, thank you very much. And Rena for your presentation at this point, I would like to invite all our speakers to turn on their cameras and uh to open the table for discussion triggered by the questions that I sneakily see that there are some questions that um Bella, if you may share some of the questions, there are some questions in the chat. So should I just go down through them? Um So first question is to um to Angela. Um And in fact, I think the first two questions are sort of similar questions that kind of aligned together. So the questions about how you plan to offset the carbon quadrant of making and maintaining the drones and some sort of suggestions around um um kind of embodied emissions associated with the drone drone development, but also doing maintenance. Yeah, how you account for that? Could I just come in and just say this quite a bit of background noise? So maybe if you're not speaking just to mute yourself, it's a net get know it stops them. Okay. Yeah. No. Thank you for that question or both questions. Actually, it's quite important to obviously think about the embodied carbon of all vehicles. And I would suggest that drones obviously a lot smaller than vans. But the thrust of my presentation wasn't really about the implementation of drones. It was really about thinking carefully about the role of them. It was really about an evaluation of saying, well, there's a whole evidence base out there that's evolving and saying, well, let me need to think about whether there is actually a role, a big part of that at that because I only really have seven minutes presentation. I couldn't really go into a lot of detail. A big part of that is making sure we consolidate deliveries and we make use of what we've got. But also we change practices so that where things don't need, you know, understanding whether something really is urgent, whether we should be, you know, using careers, whether we know what other network, other transport is on the network. So the NHS has so much transport on the network, but it's all kind of working quite desperately. So I kind of wanted to think about drones in the context of all of this because at the moment, trials are happening and there seems to be a little bit of hype around them and I'd like people to be aware that there is this kind of big evidence base which is evolving. So I acknowledge yes, embodied embodied carbon of the drones, but that's kind of not where I was going with it. I was kind of forced saying think about the whole thing, think about the whole solution, which it's part of that is this kind of carbon um actual carbon embodiment of the vehicle itself, which is a problem for all vehicles. So yeah, that was my response to that. That's great. Thank you, Angela. Um Any other questions on this? Yeah, I wasn't sure how you wanted to play theater. Do you want to just see if there's any other questions to Angela? That was the only one to Angela on the chat. Yeah, I mean, it is good to cover these questions that they have will already asked. And then we can, you know, ask our attenders too, ask any further questions if they have, I have a couple of questions for our speakers also. So, so would you like to, um, share with us Bella? Yeah. Carry on with the, with the questions in the chat. Yes, yes. So the next question is to um to Rachel. Um And the question is from Gabby, who's asking what were the long term effects? Um We did the clinical indicators um of the of the use of the Fitbit and the sort of the the support sessions they last over months and years and what was it also the Fitbit? Do we think it was the Fitbit or the information and support that was given? Um um that led to the change is okay. So, um Gabby, that's a really interesting question. So thank you. Um In terms of the long term effects, we don't know because the the sessions only finished kind of at the end of last year. So they're all going through the annual reviews probably now. Um And you know, they're all based in our practice. So we would need to monitor them over the next 12 months. What I can say is that a couple of the patient's have come off the metaphor mean, so they're coming off the diabetes, drugs. Um, and you could say that the healthy lifestyle education, um, and the fitbits played a bigger part. They kind of played each other really because, because it's about self management of your diabetes and understanding what types of food to eat and what sort of movement activity you need to do and, you know, and how sleep and relaxation can affect your diabetes. Um, but in combination with that, your Fitbit is your health coach. It's the one driving you to say, right, you need to get out, you haven't moved, you know, a well done, you've done 10,000 steps, et cetera. So I think it's a combination of both. Yeah. Yeah, there's more. Um So, so the next, the next question is from Bethan E and she was asking um again from Rachel. Um did you come across any barriers from patient's regarding technologies, example, patient's interest in the diabetes self management program, but put off or intimidated by the need to use absent technology. Um So we're quite lucky here at Froome because if we've got quite a good digital inclusion team. So I've got digital health connectors which we actually employ in the practice. Um And they are there to be able to support those patient's that aren't digitally able to cope with the amount of tools that they're using. Um We also offered free tablets and we also offered like many sessions after with those and those were the, the same people that are in those sessions that just needed to catch up with, you know, how to download the apps, how do they work? And they really appreciated that 1 to 1 support as well. And we also have a digital help desk which we run downstairs, which again is face to face help with digital tools. So, um we will really well equipped as a practice to run it. But if you were going to run it in other practice is you need to make sure you've got digital inclusion in place. Okay. So then the, the, the, the next question is for Catherine and Rena, and it's from Katherine, who's asking, have you considered how you could measure across the triple bottom line, cardboard footprint, social and financial savings savings. And could that be a kind of a motivator for people to continue to use Microsoft teams? You try to, no, you're muted, Catherine now. All right, I've just managed to work out has turned off mu thank you. Um I haven't actually managed to get the information to do that, but it has been in the back of my mind. I think that would be a really, really useful exercise um to do. Um It's, it's how we would work that out with, um working out exactly how much travel each individual person does, how much that costs if that sounds like quite a bit of a bit of work. But again, yes, I think it would be very useful. Um If anyone has any suggestions, I'm taking that up, then that would, that would be very helpful. So Rachel actually put a comment in the, in the chat and I don't know if Rachel, you want to just speak to your comment directly rather than me reading out. I hope I'm happy to read it out. But perhaps, yeah, it was just to say that we use M S teams a lot um with staff and with education and we use a mixed model hybrid approach, but it is really helpful having teams. I think some of the barriers are some time times that the clinicians aren't confident with using the tech. Um And I think once they get over the barrier and they actually learn how to use M S teams, everyone's really on board. Um And also from a tech point of view, we've got really good tech in the practice, like, you know, webcams built into the monitors and all of the rooms and things. So it makes it more accessible to be able to join remotely using teams and the cost implications like uh you could see a huge because even things like just the tribunal's the cost of, you know, the tax and floor. So all the high court judge comes from somewhere else, they're not from hull, they come from a lot further away. Um Sometimes they'll come from Somerset Taunton, you know, all sorts of places and we, and the, and the trust has to pay for that for their expenses. So when, when they're now doing it via MST, it's a lot easier and it's also easier for the clients as well, you know. So, um, not having to wait for somebody to come and see them a dot Independent Doctor from somewhere. Um, it's, yeah, it's a lot better via MST. And then, um, there's a lot of things that have that are now being done by MSD and we were asking even like things like seclusion reviews, whether that could in the future be, be done by um MST as well. Just just save the cost of all the traveling that uh doctors do when they go and see patient's. Um But yeah, so it's huge. I mean, you could just go on and on with how many different things that have been saved with M S T U S. The travel is significant. Thanks, Rina. So um then Gabby is also, so she was asking um to you again, Catherine and Rena. Um she said she missed the part where you spoke about the survey wondering if you could clarify. There was free text qualitative areas in the survey if it was all kind of kick box. Yes, there was, there was, there was some free text areas uh difficult to, to give, give all of it in the seven minutes of the presentation. That's all, there were some quite interesting points brought up in the free text areas. Um So one of the disadvantages that was brought up of, of teams, for example, was that people did find that teams had led to sort of back to back meetings with, okay, as much consideration of other breaks, the people were going from one meeting to another and having meetings during the lunch hour. So that, that was problematic. Um And then, for example, another comment was on a more positive view, which I hadn't thought about. But was that in M D T s teachings, um teams led to want it been less likely for one person to dominate um the group and for the whole group to have a bit more of um an opportunity to speak, which I thought was an interesting point. I don't know whether that's um could, could actually be proved, but it's certainly some Virginia and, and, and, and how they have found. So yes, there were chances for people to offer a bit more of a qualitative and um border response. So uh there's a follow up comment from Gabby about this where she says um that Microsoft teams is important for sustainability, but we also need to consider the drawbacks that might not be immediately apparent. So much efficiency could need to losing other values, ability to interact with people socially. So it's important to have a balance. Hmm Yeah, absolutely. I think that's true. And I think the balance is um it's, it's, it's shown that a lot of people have asked that there would be either a mixture or been optional and I think optional might be a very good way forward in that if, if there was a teaching um at cross lane, which is five minutes away from me, then that I would be, I would probably joy having meet with my colleagues and my um and socialized. Um If the teaching is where we're often is in the area that I am, which is Scots Corner, which is 2.5 hours drive away. Um Much as I love a bit of social interaction, I think I might be less likely to go. Um So I, I think a mixture and uh kind of balance is absolutely right. Yeah. And I think that's they, they've heard that so they've been doing at home, but they've been um doing a mixture. So they've been doing some face to face like once a month so that people can interact and if they want to come, they can come. Um But that hasn't had that greater turn out um The Emmett their hybrid, whether they're doing three times a month more people are turning up for that. So those there is an option to go face to face if you want to. Um But then there are most people are doing it. M it's via MST. That's enough. Lovely. So um there's another question here for Rachel from, from Theresa. So Teresa's asking do you sometimes have patient's who complain of issues with their tech when using the technology? Um Also our family and carers given training, especially those who aren't used, unable to use the technology themselves. Yeah. Okay. So, um we don't have a lot of complaints about the technology. It's more about the fact that they might not not know how to use it or how to get connected or they don't have a device. So it's not so much a complaint as a barrier and it's a barrier that we can overcome and give support with. Um in terms of the um if we give training to carers, um we have the help desk downstairs, it's there for everyone to come to, for us to be able to help, we all should run a digital cafe in the community. So that is for people like carers. It is for the patient's, it's for ever everyone to come and learn more about the technology. And we have in the past given um things like NHS app, you know, you're giving proxy access to carers, for example, for them to be able to act on behalf of the patient with any kind of digital needs that they need. Um NHS happens a good example of that. Um and certainly training their carers in order to be able to use it as well. And I guess this is a little bit, a little bit connected, but she's also asking how you've, how you've dealt with any interfaces between patient with disabilities who have also been kind of using these technologies. So we had to, the patient's that were on the learning disability register and they did um uh struggle with understanding the education because it is quite clinical. Um and um they needed things like pictures and for us to kind of dilute the education and to give some further supports, we use health coach is to do that. Um And to just run through the sessions afterwards and take any questions and also support them with um diagrams and pictures and things like that would make more sense. Thanks, Rachel. I think that's all the questions from your chat at the moment. So, back over to you. That's great. Yes, thank you very much, Bella. Uh I mean, we have a couple more minutes, one question that I have uh for uh Angela regarding the project with the drones. I mean, I know that most of the audience, you know, it's interested on the sustainability point of view. I'm also interested on the digital point of view. So, uh any thoughts on maybe ethical implications or private security implications when uh you know, samples will be transferred in a vehicle which is not, you know, driven by human being, I mean, the human being will be somewhere, you know, uh else. So um uh any thoughts around it? Um Yeah, this is something we've talked to um some practitioners about. So in, in the highlands, they've actually been moving samples and it's something we we discussed and their view as practitioners have to say, I'm a transport researcher was that um as, as the process for, you know, the digitization of samples and kind of limb system and all of the systems to kind of anonymized and make samples consistent between sites means that you won't actually have any personal information on samples other than a barcode, it's very difficult to see that. But also having followed the van round, having accompanied a van around driver, seeing him pick up samples. It's not exactly a closed system, you know, they're coming in bags, he's putting them in buckets, he's walking out to the van. So it's not a perfect system either. But I think really that level of personal data shouldn't be being moved around anyway. Um, at some of the interestings, you know, uh, something, uh, please, Angela, please. Yeah. No, no, you just submit cameras. Yeah. So, um, yeah, cameras kind of come up because often we think about drones in terms of like hobby drones that kind of hover and take photographs and plus camera, you know, drones are used for photography and lots and obviously that kind of, um, it springs to mind. Like, what about the cameras and drones? The drones that you would probably use for this sort of thing would still have cameras, but they're, they're kind of moving across the place quite quickly. So they're not picking up a lot of stuff and that data is managed quite carefully. So I think that's less of an issue. And I think there are, there are delivery systems like commercial kind of food delivery systems in Ireland and Texas and places like that. And the, the camera has a pixelated um data collection. So you can't recognize anybody. It's just to locate the drone, but ultimately, it's done by GPS. Uh And then the element, I think another interesting element with this progress of utilizing this kind of technologies is also the uh where we have been again decades ago when we were talking about who is going to be accountable when the, the drone fails or when the, the person who drives it fails. Because if you are a health professional and you do an error in your work, then you have your identity, you have your insurance, your employer, you know, but when, when the driver of a drone, for example, loses example, what happens or if the, the drone itself stops functioning, you know, who's accountable, then if something happens in terms of harming the patient, you know, but, but, but that, that's the, I think the exciting area that we're getting in that we have these debates and we're building these frameworks and this knowledge as we go along. So, yeah, thank you very much. Thank you Rachel to we have a couple of more Rachel with the, with the fitbits. Uh, I remember one of the first studies 10 years ago maybe, you know, um, it had to do with the attrition levels that the wearables had and they were publications talking about that, you know, they're not achieving what we want to achieve because people, you know, they're getting tired of it. What was your experience with your study in terms of attrition in relation to the, during that they have to use it? Yeah. Yeah. So, I mean, they only, they've, we've only really had them for about six months, but we're able to remote monitor them using the Fitbit on a regular basis by um linking with my way clinical were able to remote monitor them. Um And what I would say is that there was obviously a, you know, a state, a steep incline when they first got them because it was a new toy, it was, you know, something new to do. Um And then it kind of peaks off and then those, that kind of dropped, we then um intervention was happening and then we would talk to them and say, you know, what's the barriers? Why are you not using it? And you know, what can we do to support and help? I think because they were free as well. Then again, it's, you know, they have the opportunity to use it and then kind of, you know, discarded if they wanted to, but everyone was using it. And by the end of the program and we took the results three months after everyone was still increasing their step count, but it wasn't as much of a steady incline as it was at the start. It does start to plateau because they need to put it into their regular day to day life. You know. That's great. Thank you very much. And um uh Joanna, quick question for you also, if I may um I mean, you, you share with us your initial findings from the scoping review. So um what is the feeling of the scanning, the, you know, the horizon of frameworks and evaluation tools, you know, and linking digital health evaluation with sustainable evaluation? What is your, you know, with one sentence, you know, you're feeling at the moment? Well, yeah, there is uh a lot to, to search on that and um it's kind of uh you know, excited because actually there is no like there is in for evaluation tools that evaluate each bottom. But actually the link of these, of these uh of the bottom line, like the triple bottom line is no out there. And I think if we try to, to understand all those links, it's kind of really important to make sure that when we do these digital transformation, we do it really well and really sustainable. Um Yeah, so that's okay. Yeah. And I guess in the fact that there is a gap there in the, in the literature of what is currently been happening, you know, it strengthens your hands and your project by itself. You know, my last question in the last minute of our session, you know, it's for uh the uh team, you know, with the Micro Microsoft teams in Tarina and Catherine, you know, uh and you, you share with us what was the value of how many hours we saved? You know, uh to your, no, let's uh are their studies out there that they check the economic impact and value? I mean, how saving these hours translated to saving more money? Because then we can trigger discussion's what are we going to do with this planning if we can re investment somewhere else? So any thoughts, any about it? I struggle to think, to be honest, I found there was people making a musings that there will be a cost saving and there will be a saving on, on carbon etcetera, but nobody with any actual definite figures of what that looks like. Um And I suppose they may be quite difficult to get, especially when you consider how different different trust work. And from like point of view that I if you work in a physical health trust, you, you might stay more your your base. Uh not a lot of doctors in the general hospital and nursing staff generally stay a base a lot longer where I was obviously community teams front. Um So it would be quite a big undertaking. But no, I couldn't find anything definite. I'm afraid. I'm sorry. No, no, no, that's approved you find and actually probably reflects.