December 2024 marked the grand finale of the University of Warwick and the University Hospitals Coventry and Warwickshire (UHCW) NHS Trust’s Digital Consent and Health Inequalities Innovation Programme. Over 11 weeks, this programme brought together brilliant innovators - including CardMedic and VirtTuri - to confront the challenges of health inequalities from the consent perspective. With Concentric leading the charge as the core digital consent application, this well-timed opportunity allowed us to explore and experiment in an area we have always wanted to dive deeper into.
What have we been up to?
Although Concentric is a proven product deployed in over 30 NHS trusts, used by approaching 1 million patients per year by now, there are a few things we keep circling back to over the years from the feedback we have received:
Some pictures would help me visualise the procedure better.
Can the content be presented in other accessible formats, such as sign language?
Changing languages could be more intuitive in a clinical setting.
A content challenge - volume and flexibility
Our vast library of 2,500 treatment templates, coupled with the flexibility to tailor information to the individual patient, poses a challenge in transforming that content into different content formats.
The man who moves a mountain begins by carrying away small stones
To limit the scale of the challenge, we turned our focus to the top-level procedure description. This relatively static content element forms an important foundation for the consent information and conversation, making it the ideal starting point for us.
A picture is worth a thousand words
Until now, Concentric has almost exclusively used words to convey information. Joining Concentric earlier this year, Dr. Terouz Pasha isn’t just a talented surgeon but also a gifted science illustrator (scalpel in one hand, sketchpad in the other). Known for her artwork in The RCS England Trainee Bulletin and ASiT’s yearbook, her warm and engaging style was exactly what we were looking for to add images to those words.
I’m looking forward to creating illustrations that help patients feel truly empowered in their care journey.
Terouz Pasha, on joining Concentric Health
During the programme, Terouz experimented with and refined her illustrations for various procedures, creating a style guide and initial portfolio of images that combine visual clarity with a thoughtful touch. This is just the beginning - we plan to iteratively introduce these across Concentric templates over the coming months and years!
Breaking down barriers with CardMedic
We pride ourselves on being PIF TICK certified, demonstrating our dedication to providing accurate and accessible health information. However, we acknowledge that there is room for improvement in the complex area of health information accessibility. Cardmedic are the experts in this space, and we’ve long talked about a collaboration. The programme got us over the start line, and it’s a collaboration that is already deepening post-programme.
Over the 11 weeks, we gained a shared understanding of each other’s strengths, development plans, and technical architecture to understand where long-term collaborations could work. An example is access to Concentric content in British Sign Language, an area where we have no experience.
It became clear that for a collaboration to work it would need to be possible for patients to access any content managed by Cardmedic remotely, to align with the way patients can access their Concentric consent information remotely. This had not previously been possible in Cardmedic, as it has historically been used to support direct patient and clinician interactions. This became a key project for the programme, and the end result is that a content element within Concentric can now be linked to the corresponding Cardmedic card, and that can be accessed by patients from anywhere 🎉
[An] accessible communication partner. For us and for them, we are hugely complimenting what each other is offering!
Dr Rachael Grimaldi, CEO and co-founder of CardMedic
Professional interpreter with a click of a button
Cardmedic’s translated and easy-read scripts have been demonstrated to deliver significant value in supporting clinical interactions where there is predictable information to be conveyed. However, both sides agree that consent conversations cannot, in the main, be scripted. The programme coincided with parallel Cardmedic development work with language service providers such as LanguageLine, leading to the feature I am most excited about as a clinician - the integration of CardMedic’s ‘Call an interpreter’ function directly into Concentric.
The use of language service providers (LSPs) is widespread, but the frustration of getting to an interpreter when needed and with the departmental code (used for billing purposes) is even more widespread! In many clinical settings the LSPs number and required department codes are on a piece of paper “somewhere”. Words are simply not enough to describe the frustration of trying to track down that piece of paper amidst a busy clinic. This often leads to inappropriately using friends or relatives as an interpreter, rather than a professional. That presents a number of problems, such as a lack of appropriate language skills or terminology, being unable to relay complex information correctly, and a potential breach of patients’ confidentiality.
Concentric already knows the specialty of the consent episode (i.e. can automate department code entry), and Cardmedic can know which LSP to direct the clinician to (for example, based on which NHS Trust they are from or additional logic such as which day of the week it is etc.). Bringing the two together means that with two clicks (‘Call and interpreter’ button and a language selection field) the clinician can access an interpreter from within Concentric.
Having easy access to professional interpreters will make such a difference in helping patients feel listened to and involved in decisions about their care, as well as supporting clinicians to deliver the quality of care they strive for, regardless of the patient’s language.
Putting words in the avatar’s mouth
With our ever-expanding consumption of video media online, it is now a preferred content format for many, both due to accessibility reasons such as poor literacy and purely by preference. As part of the programme we experimented with converting our content into video format with the help of VirtTuri. Their AI-generated avatars, designed to be ethnically appropriate, can present information visually and in over 150 languages. It is fascinating to see our content come alive in this format.
Final thoughts
Innovation doesn’t happen in a vacuum. It has been inspiring to work alongside some of the most innovative minds – across both the involved healthtech startups, the NHS Trust, and the University – to shape a better healthcare future, grounded around the specific pain points of UHCWs clinicians and patients.
Language barriers remain a significant contributor to health inequalities. Our partnership with CardMedic is another meaningful step towards making health information more accessible and tackling these challenges head-on.
How do you think technology can bridge the gap in health inequalities? I would like to hear your thoughts; I am at bowie@concentric.health.