OptiMine Digital Blueprint

Introduction
The OptiMine study was run collaboratively between UEA and West Suffolk NHS Foundation Trust (WSFT) in 2019/20. The study
investigated the feasibility of using an acute hospital’s electronic health record to identify people with lifestyle behaviours which
put them at risk of cancer – in this case smoking and drinking alcohol – and to proactively promote publicly available digital
interventions to them via electronic outreach. The protocol paper was published in December 2020 and the results paper is
currently in preparation.
In 2018, 14.7% of adults 18 years and older in the United Kingdom smoked cigarettes, roughly 7.2 million people
. In England,
smoking led to 77,800 deaths and 489,300 hospital admissions in 2018
. By 2035, reducing tobacco use to under 5% across all
socioeconomic groups in the United Kingdom would prevent 35,901 new cases of tobacco-related cancers, 28,997 cases of chronic
obstructive pulmonary disease, 24,854 cases of stroke, and 7594 cases of coronary heart disease
.
Alcohol consumption above 14 units per week for men and women is known to increase risk of alcohol-related harm
. In the
United Kingdom, 28% of men and 14% of women, accounting for 21% of adults 16 years and older, drank more than 14 units per
week in 2019
. In 2018, there were 7551 alcohol-related deaths in the United Kingdom
. Cigarette smoking and alcohol intake
above the recommended amount vary by gender, age, location, socioeconomic status, employment status, race, and ethnicity,
and as such are important drivers of health inequalities and disparities in life expectancy.
Scalable public health interventions are necessary to reduce the impact of tobacco use and risky drinking. The NHS incentivised
hospital trusts to routinely give health promotion advice to people who were identified as smokers or risky drinkers through the
national Commissioning for Quality and Innovation scheme in 2018-20
. The traditional approach to health promotion in the
hospital environment relies on health professionals giving verbal advice or providing information in leaflets, with or without the
offer of referral to a lifestyle service. The experience in WSFT was that this method was vulnerable to a number of barriers
including clinician knowledge, skills and confidence, time and the availability of health promotion literature.
With the OptiMine study, we sought to create a lean, proactive outreach method which would supplement face-to-face
interventions, using the entry-level digital technologies which are increasingly being adopted in NHS trusts. The intervention we
developed used the electronic health record to identify people who smoked and/or drank at risky levels and had recently been
admitted to hospital, and a simple text message system to send a message to their mobile phone promoting the free, publicly
available NHS app relevant to their behaviour, either NHS SmokeFree or Drink Free Days.
The clinically meaningful effect size that was determined a priori was a 5% clickthrough rate. The study used focus groups to
assess acceptability and design the message modality and the content of the text messages. We achieved a clickthrough rate of
14%. Based on these results and the proof of the concept, the trust is going to implement the initiative as business as usual to
routinely deliver health promotion advice using this approach, using quality improvement methods to see if the effect size can be
further increased.

Proposal
In order to disseminate the results of the study and encourage uptake and adoption by other NHS trusts in England, alongside
achieving academic publication, the trust and research team formulated and submitted a Digital Blueprint to the NHSX Blueprint Library.

This dissemination route will reach the digitally-engaged NHS audience directly and is designed specifically to
help achieve quicker and more effective diffusion of digital innovations.
A Digital Blueprint is a structured collection of knowledge assets and the associated methodology to make use of them, published
in a Blueprint Library by the national NHS England Global Digital Exemplar programme on the Future NHS platform (in the Global
Digital Exemplar community workspace)

. Digital blueprints are intended to help secure spread of digital innovations and to enable
NHS trusts to implement and embed digital technologies or services more quickly, easily and cost-effectively than has been
possible in the past. A blueprint comprises three parts:
1. The core blueprint, which is a step by step guide to how to plan, design and implement the digital initiative
2. A technical annex, which provides the technical detail
3. A blueprint on a page, which is a one-page summary of the blueprint (the template is provided in appendix 1 for
information) and is accompanied by “artefacts”; documents and other types of collateral which were generated by the
original project and are shared in order to help other sites implement the initiative more easily. Examples include project
plans, job descriptions, data privacy impact assessments, standard operating procedures and so on.

The Blueprint Library currently contains around 180 blueprints. Members of the digital team at WSFT have authored five:
 Allied health professionals EPR implementation
 Change control process
 Integrated devices
 Making alerts count – exploring new ways of working
 Removal of bleeps – implementing a clinical instant messaging app
The blueprints are curated under topics; the OptiMine blueprint would fall into the category of Clinical care/safety > Self care.
Comprehensive guidance and advice are provided on the method and process for developing a blueprint and the Future NHS
platform hosts all the resources for authors as well as the library itself