Dynamic Health Systems uses Microsoft Cloud for Healthcare to reduce clinical workloads and deliver better patient outcomes

Dynamic Health Systems (DHS) is an ISV with a mission to address the big problem in healthcare today: the immense pressure on the healthcare system from rising demand due to aging populations and lifestyle changes. Overworked clinical staff and slow efficiency improvements further strain the system, leading to long waiting times and services that fall short of expectations and need.

For a large part of the workload, the solution is clear: engage patients in co-creating their health through motivational care planning and implementation. DHS clinicians have successfully applied this method, achieving better health outcomes with significantly lower clinical input. With its VitruCare 365® patient engagement platform, DHS aims to transform healthcare at scale, so all patients benefit from proactive, integrated, motivational care planning. Released clinical time will enable healthcare providers across the UK and beyond to achieve their clinical goals.

Published research shows care improvements

The inspiration for VitruCare was sparked in 2010, when Prof. Shahid Ali BSc. MB., Ch.B., PhD., FICR., FRCP and now Business Director for DHS, began assessing the impact of more proactive, patient-centric care planning in the context of his own primary care trust in Bradford and for the wider Yorkshire and Humber strategic health authority.

Of the 3,600 patients served by his practice, 40% had a long-term condition and 25% had two or more long-term conditions. His work reviewed the impact of care planning consultations on 50 patients with long-term conditions over a 12-month period.

For the cohort of 50 patients, healthcare contacts declined by 46% in the 12 months following care plan implementation compared with the previous 12 months. There were 71% fewer A&E attendances and 83% fewer acute admissions after patients had adopted care planning. Based on the unit costs for each type of contact, total costs dropped from £97,534 in the 12 months before care planning to £42,752 after care planning—a 56% cost saving for the NHS. It takes no imagination to understand what successful scale-up could mean for healthcare.

The need to scale up results

Around the same time, Ir. Axel Schulte, MBA, Managing Partner of DHS and Service Design Architect, was developing a new healthcare solution based on Microsoft Dynamics 365.

He says, “I realised that existing electronic patient record (EPR) systems were not much more than something akin to a maintenance logbook for a machine. A machine has a standard maintenance plan. But a human is so much more complex and people find themselves in very different circumstances. So a Care Plan is put together by the—often multidisciplinary—care team that serves as an instruction on how to care for this patient. It is stored as a document. But with thousands of personalised care plans it is simply impossible to be proactive. Technology is used to create them, but the mental model has not moved on from paper. They tell you what has been and should be done to the patient—but today there’s no anticipation or planning and no long-term relationship service tools that can make care proactive or dynamic. With the VitruCare 365 technology, the person with the greatest interest in the outcome is now empowered to co-create their health. This is the dynamic change we aim to achieve, hence the name of the company.”

When Axel Schulte met with Shahid Ali and Dr. Richard Pope MD FRCP, also working at the Yorkshire and Humberside SHA at the time and now Clinical Director for DHS, at the Microsoft offices in Reading, the team realised that they shared a vision for a more proactive, holistic approach to healthcare delivery. Axel Schulte’s Dynamics-based solution offered an opportunity to scale up the work of Shahid Ali and Dr. Richard Pope on a regional, national, and international basis.

Shahid Ali recalls, “This is where Axel, Richard, Douglas [Dr. C Douglas Muir BEng, PhD, MBA and now CTO for DHS] and I got together with a view to building something that could enable the NHS as a whole to engage with patients much more effectively.”

Developing on Microsoft Azure with Dynamics 365

“For me, it was always going to be Microsoft,” says Axel Schulte, as he recalls the early decision to develop the new DHS software platform on Microsoft Azure, drawing on much of the functionalities of Microsoft Dynamics 365 and the Microsoft Cloud for Healthcare.

He explains, “We knew we needed a cloud infrastructure for extensibility and scalability and there was—and is—only one cloud provider with a business or enterprise-oriented approach. That professionalism, the capabilities of Azure around data governance and data residency, the Microsoft support, and the technology of Dynamics 365 made building our solution on Azure the only choice.”

“The ease with which we can manage the Azure infrastructure, the extensibility of the solution, the support we receive from Microsoft and the continuing development of Microsoft’s product offerings have justified that decision,” Axel Schulte continues. “I love rummaging around in the kitbag of Microsoft to see what new capabilities we can add to our solution. We had a bot for patients before, but now with Azure OpenAI we were able to give every patient a personalised bot that knows about their conditions and motivational care plans and acts as a realistic assistant!”

Testing the VitruCare platform with patients and practitioners

The initial cohort involved in using the VitruCare platform for motivational care planning included 144 patients with diabetes registered across ten GP surgeries in Bradford. Patients could use the VitruCare app to invent personal life goals, be guided through the creation of action plans based on their integrated health record, and progress towards their achievement. The underlying psychological model employed to create motivational care planning is the Theory of Self Determination (SDT), which has been proven to work very well in healthcare.

“Our solution has the flexibility to enable each patient to create and execute their care plan in a way which is meaningful to them,” explains Axel Schulte. “For example, one of the patients at Shahid’s practice tracks his diabetes by counting the number of slices of bread he eats. It’s not always engaging to compare against a scientific population average that means little to patients. Enabling them to create personal plans is so much more effective because, as the SDT tells us, the goal is personal and motivating and it is the outcome that matters, not the manner of getting there.”

With little to no involvement from practice staff, the cohort’s use of the app led to a dramatically reduced workload. Even when telephone consults were counted as practice “visits,” the survey cohort recorded a 40% reduction in the number of contacts with the primary care teams.

Most importantly, after six months, the cohort of 144 patients demonstrated significant health benefits. While the patients tracked their progress in terms of slices of bread or walks around the park to achieve their personal goals, over the cohort, the practitioners reported:

• HbA1c fell by average 16 mmol/mol in glucose blood tests for patients with diabetes. This is equivalent to the change seen following introduction of a new hypoglycaemic medicine (none had been introduced).

• A fall in mean blood pressure 5.5 mmHg—which pointed to a 50% reduction in stroke risk.

• Weight fell by an average of 2 kg—reducing diabetes risk of between 25-50%, depending on a person's body weight.

Building out apps for a holistic approach to patient care

Today, the usefulness of the VitruCare 365 platform has extended beyond the management of chronic conditions in primary care. It has been deployed within a wide array of healthcare settings, including to manage palliative care with Sue Ryder, to manage student community health services at the University of Lincoln and in the NHS and in adjuvant chemotherapy for breast cancer.

In a palliative care setting, VitruCare 365 enables patients to make carers aware of their biomedical and psychosocial information in near real time. The app helps patients to feel much less worried about their situation. One patient says, “Some of the things I have written on VitruCare I have never told anyone before, mostly because nobody asks. Doctors and Consultants don’t realise how draining it is to keep on repeating my story. I feel tired easily, I forget, I simply don’t have the energy.”

Another patient responds, “I forget what has happened in the past, even if it was yesterday. I do tend to recall the bad things, so this might help me to see the good things that have happened too.”

Including the family in the extended care group has also proved beneficial for boosting peace of mind for patients and their families. One relative explains, “Being able to keep an eye on things at a distance is really useful. I struggle more than my sister because I’m a nurse, everyone expects me to know what’s going on. I don’t see Mum often; that makes it difficult.”

In an NHS Oncology department a patient said, “I feel so well cared for, like a private patient.” The Oncologist reports that, “I start my consultations from a totally different place.” Whilst the Oncology Nurse says, “I know my patients so much better."

Improved engagement for co-creating care led to a reduced length of stay. It reduced total bed days by 50% compared with a parallel cohort not using the technology. This deployment was selected winner of the “Patient Safety in Cancer Care” awarded by MacMillan Cancer Support charity.

Built on the Microsoft Cloud for Healthcare

“From one platform, we provide many services and apps,” explains Axel Schulte. “A patient may be provided with digital health services by multiple clinicians to help with several diseases, or co-morbidities, but the patient experiences it as a single, highly personalised app.”

“It's all wrapped around Dynamics 365 with apps, services, and clinical components that we built ourselves to deploy on the Dynamics 365 platform,” he continues. “We draw on all the capabilities of the collection of technologies that make up Microsoft Cloud for Healthcare, including Azure OpenAI and Azure Health Data Services.”

Azure Health Data Services is a suite of purpose-built technologies for protected health information (PHI) in the cloud. It's built on the global open standards Fast Healthcare Interoperability Resources (FHIR) and Digital Imaging Communications in Medicine (DICOM). It makes it easy to ensure data privacy within compliance boundaries, share data securely across healthcare organisations, and generate insights with analytics and AI tools. With Azure OpenAI Service, one can build custom generative AI solutions.

To secure interoperability, VitruCare 365 includes Azure Health Data Services as the safe storage for all PHI. Alternatively, for healthcare providers that have this in place, VitruCare 365 is designed to work directly with the Shared Care Record already in place for NHS regions, avoiding the need for data duplication. This ensures that patient data is kept safe, fully within existing information governance arrangements and available to clinical systems.

An integrated approach to care

Secure data sharing and Microsoft 365 integration enables the platform to compliantly enable three tiers of engagement: patient engagement and activation into co-creating health (PEACH); care innovation and health work integration (CIHWI) at care organisation level; and continuity of care and interoperability (CooCI) at a regional health level, aiding commissioning and clinical analytics.

Sophisticated reporting is simplified for healthcare organisations through the integration with flexible Microsoft reporting tools and automated dashboards powered by Power Apps and Power BI.

At a patient level, the personalisation of data, individualised content, features, and communication leads to better engagement, resulting in better health outcomes. At the organisational level, the platform offers an opportunity to achieve clinical systems integration offering continuity of care, improving automation and enabling virtual wards and neighbourhood care.

Pushing at an open door

“When we first started more than 10 years ago, we encountered a lot of resistance,” admits Shahid Ali. “Colleagues would say to me ‘you’re fundamentally changing the way we work.' I would reply, we need to change the way we work because we’re not patient-centric enough. We’re not really addressing the needs of the patient. We’re just reacting to a set of circumstances.”

“We need to be more proactive and to treat patients as individuals. We need to support patients in a much more proactive way.”

With the new Labour Health Secretary Wes Streeting’s emphasis on three big shifts UK healthcare must make—from “from hospital to community,” “analogue to digital,” and “sickness to prevention”—UK national healthcare strategy is finally aligning with the DHS founders’ original vision.

The Microsoft Dynamics-based VitruCare 365 platform is an enabler for this vital transition.

Ongoing future innovation

“I’ve been a GP for more than 30 years,” says Shahid Ali. “Motivational care planning works: it engages the population and produces better health outcomes at reduced clinical workload.”

“We’d love to see this implemented across the NHS,” says Axel Schulte. “But why stop there? The whole world should be using technology like this.”