Feature Series: #HealthTechToShoutAbout

Over the past few months we have been speaking with NHS providers and suppliers, hearing about their case studies and success stories in 2019. In this new #HealthTechToShoutAbout Feature Series we highlight 6 health tech projects that have made an impact across health and care.

Please click on an image below to view the case study or scroll to read on below.

 

Allscripts clinical wrap approach delivers for trusts

An eye on HIMSS EMRAM Stage 7 in Gloucestershire

Gloucestershire Hospitals NHS Foundation Trust contracted with Allscripts for Sunrise Acute Care as a wrap around its existing third-party PAS in March 2019 with an implementation that followed impressively quickly after in November 2019.

Beginning with a two-ward pilot project, more than 60 nursing documents were completed in the software the first morning. By early December 2019, just a few weeks later, Gloucestershire Hospitals NHS Foundation Trust went live with Sunrise in remaining wards.

Mark Hutchinson, the trust’s chief digital and information officer, explains aspirations to reach HIMSS EMRAM Stage 7 within five years. He also explains how the clinical wrap is a repeatable approach that other ambitious trusts can follow.

“If you buy a PAS and an EPR as one system, you always have to deploy the PAS first, and that can take two years. Instead of doing that, we are going to let our PAS do its thing and use clinical solutions to start helping our clinicians to improve care for patients as quickly as possible.”

“A PAS allows you to see where patients are in a hospital, to manage your waiting lists, and to send information to the central bodies that request it. All of that is important, but the clinicals are where you get the benefit.”

Richard Strong, vice president and managing director, EMEA, Allscripts, said to HTN “We have developed a clinical wrap approach that enables trusts to retain their patient administration and other systems and add clinical functionality at their own pace. It’s great to see many projects realising significant benefits like in Gloucestershire.”

View more Allscripts projects here.

 

Reducing outpatient appointments using digital information

Torbay and South Devon NHS Foundation Trust is the country’s leading organisation when setting the pace for integrated care.  It is also a leading trust for innovation, with many initiatives reaching across the hospital and the community it serves.

One area that has been particularly successful has been the use of digital information to transform pathways of care, resulting in reduced demand and costs.  This has been achieved through a partnership that was set up between the Trust and Rocklands Media Ltd. to form Health and Care Innovations LLP (HCI).

HCI has produced and implemented an online library of over 500 health information videos that support and educate patients across a range of care pathways. They are now a key partner in the Trust’s transformation programme with significant reductions being made in outpatient appointments, spanning multiple specialties including cardiology, maternity, physiotherapy, seeing savings of £350,000.

Angiogram pre-admission assessments is one particular pathway that has seen outstanding results through one video alone, ‘Having an Angiogram’.

Patients were provided with a link to the video and were given the option to watch it at home instead of coming in for a face to face appointment.  By offering patients a choice, this simple digital intervention achieved a 22% reduction in outpatient appointments.

For those that still opted to come in for an appointment, the cardiac centre at Torbay Hospital replaced one-to-ones with group clinics and played the video followed by Q&A.  This resulted in an 85% reduction in nurse time each week.

This is a cost saving of £20,676 in one year alone from just one video.

Similar results have been seen in podiatry, where 80% of follow-up appointments are now avoided after nail surgery. Likewise, in physiotherapy, providing patient information digitally has reduced Band 5 face to face follow-up appointments by 30%, as patients are now able to follow a virtual rehabilitation programme at home.

It is clear how the provision of digital information through the videos and online libraries has been key to reducing outpatient appointments, but the rheumatology department identified that being able to communicate with and manage their RA patients online would create more capacity and the patients themselves feel more supported. The ‘Rheumatology Connect’ app was commissioned and now neurology are following suit with MS Connect, and other ‘Connect’ apps are now in the pipeline for the management of long-term conditions.

Dr Matt Halkes, Clinical Director of Commercial Services, Innovation and Digital Transformation at the Trust says “Digital transformation is integral to our success as trust.  Like everyone, we’re struggling with increasing demand, especially in outpatients, but we are performing better than the national averages.  We want to make digital information standard practice within our health system so that we can deliver even more savings in the months to come.”

Director of HCI, Richard Wyatt-Haines, sees the impact that his team are having every day in pathways of care and says “The opportunity for trusts is enormous, and the question is not whether an impact can be made, but how much of a reduction in demand and costs should be targeted?”

HCI are keen to help trusts grasp these opportunities. Find out more about their work in transforming healthcare using digital information at www.hci.digital or start a conversation by emailing info@hci.digital

 

Chelsea and Westminster Hospital NHS Foundation Trust has utilised Lumeon’s Care Pathway Management platform to gain efficiencies in their busy postnatal maternity service and improve the experience for patients, their families and staff.

Dr Sunita Sharma, Consultant Obstetrician and Gynaecologist explains “Through studying women and staff surveys we identified that the stay and the care delivered on the postnatal ward can be enhanced with better systems in place. The ward has a hectic pace, which needed good communications and operational systems for all the people involved. This also needed to happen without increasing the workload on the team.”

Lumeon’s Care Pathway Management solution digitises the hospital postnatal operational pathway. All activities and tasks are orchestrated and automated in real time, with the ability to get a good overview of the care being delivered. Digital dashboards allow multi-disciplinary team members to quickly see the next steps required in the care of mums and their babies. Staff are able to communicate more effectively with new mums and the dashboard also provides a more holistic overview of steps remaining, which mums and their partners can also see because of the traffic light system on the ward TV screen.

Lumeon partnered with CW+, the charity of Chelsea and Westminster Hospital NHS Foundation Trust who funded this project, to co-create, test and embed the digital end-to-end care pathway. The project is one of over 70 innovation projects within the CW Innovation programme, a joint initiative run by the charity and the Trust to implement new high-impact innovation initiatives that improve patient care and experience.

Dr Sharma continues “We decided to digitise – and automate where possible – some of the steps in the postnatal process in order to improve the experience for women and staff on the ward.”

“The advantage that the tool has offered is improved communication between team members. There are times when there are up to 13 professionals coming onto the ward and a lot of time was previously spent trying to get information or give information to another team member.”

“The Lumeon system is very intuitive, it is very easy to use and we are also helped by the fact that we have a digital-savvy workforce, so in terms of implementing a new system it’s been great.”

The platform has automated and streamlined activities in the department, Elizabeth Stewart, Senior Midwife in Charge of Examination of Newborn (EON) service says, “I can get the history of the baby and mother instantly, do the baby check, upload to the system and make referrals with a click of the button, without having to leave the room.”

Solutions designed by staff

Dr Sharma said “This project has been helped by the fact that staff have been involved right from the start when we interviewed them and understood their pain points – a lot of the solutions have been proposed by the staff so it’s been a great implementation exercise.”

“It’s been an exciting opportunity for us to energise post-natal care and innovate to make experiences better for families and staff, and for them to see the difference. We are working to reduce delays once they are discharged by the clinical team, so the mums can take their babies home as soon as possible.”

To watch a video on the project or download the case study, please click here.

 

GP Federation uses RIVIAM’s Secure Video service with TPP SystmOne™ integration to deliver video consultations

RIVIAM Digital Care started working with a forward-thinking GP Federation in Hampshire in summer 2019 to add secure video consultations that allow integration with TPP SystmOne™ to their capabilities. RIVIAM uniquely delivers this.

The NHS Long Term Plan states that over the next 5 years ‘digital-first’ primary care in England will become a necessity and every patient will have a right to choose this from their own GP practice.  Mobile phones and apps have transformed every other industry; patients now expect the same experience from their GP practice.

The GP Federation wanted to deliver the clinical services themselves and were looking for a focused, proven technology platform and video service provider to host and manage the calls.

They chose RIVIAM’s Secure Video service firstly because of its high-definition innovative video conferencing expertise and secondly, RIVIAM’s direct interface with their clinical system, TPP’s SystmOne™.

The GP Federation has in mind a number of different uses for RIVIAM’s service:

• Giving students virtual access to a GP video consultation using a mobile device, providing them with easier, accessible healthcare.
• Enabling nurses in care homes to consult clinicians remotely in real-time about patients.
• Supporting virtual multi-disciplinary team meetings.
• Providing remote consultations across geographies with highly skilled staff.

RIVIAM said to HTN, “The Secure Video service is available now to other primary and community care providers in the UK.”

“The technology service from RIVIAM provides a real-time secure video and audio-conferencing call for the Federation and is 100% part of RIVIAM, meaning it doesn’t store or process any video information outside England.”

“Customers can fully customise the patient experience including the digital waiting room that allows patients to see where they are in the queue as well as potentially answer pre-consultation questions. The waiting room is integrated into TPP SystmOne™’s diary to provide the patient with a realistic waiting time.”

“The interface with  TPP’s SystmOne™ means a GP or clinician user can book appointments using their regular clinical rotas. Post-consultation, relevant information is written back into TPP SystmOne™ automatically.”

Paul Targett, Managing Director RIVIAM Digital Care said, “We’re delighted to see RIVIAM’s video service and NHS integration supporting the future of healthcare.”

“Our mission is to improve people’s lives by providing our customers with secure and interoperable digital technology to help them co-ordinate care better and give patients convenient access to advice and care. We will be developing the video service so it enables multiple users to have an audio or video conference call together. This will be ideal for virtual multi-disciplinary meetings, saving teams time.”

Booking a video consultation triggers an email invitation to the patient containing a URL link and pin code. The patient is able to access and launch the video with RIVIAM’s mobile app using any connected device.

During the call, the GP user or the patient can save the video and audio recording. Afterwards, RIVIAM keeps a secure copy of the video consultation in the patient record for later reference and access by the user.

For further details, please contact ptargett@riviam.com. Read more about the Secure Video service.

 

Connecting live health and social care data across Cumbria

Healthcare professionals across Cumbria are benefiting from bi-directional data flows using technology from Healthcare Gateway.

Since launching in the region in 2011, The Medical Interoperability Gateway has provided live information and datasets for health and social care, when they need it. Part of a regional record sharing project, live data is now being viewed by health and social care professionals over 90,000 times per month.

Dr William Lumb, GP Sedbergh and Clinical Lead East integrated Care Community, Clinical Director Integrated Services Care Group, Bay Health & Care Partners “To provide the best care possible for citizens we (health & social care) need to be able to share the right information in real time to our front line staff. Working with our Adult Social Care colleagues in Cumbria and utilising the MIG functionality has realised the vision of bi-directional real time record sharing and will clearly benefit service users and staff, helping to make us a great place to be cared for and a great place to work.”

“We now have bi-directional social care data, going from health to social care we provide a view of the core record such as demographics, allergies, medical problems, care plans and end of life datasets. We also have some special patient notes, such as notes for a vulnerable patient, child etc. and we share all that in real time. Social care datasets also come back towards health and we are currently in pilot for this.”

“The integration with Liquidlogic, the system used for social care services in our area means system data can be joined-up. The MIG provides HTML views from the Liquidlogic Adult content store system as a specified dataset. Real time feeds of social care data include patient demographics, allocated case worker, associated carer, disability, risk type and case details.”

Enabling feeds of social care data will help frontline staff to understand the full context of a patient’s care and will aid co-ordination between different teams, preventing escalating social care needs.

Liam King, Director of Commercial and Customer Experience “The programme of work in Cumbria demonstrates the value of social care data and how it is essential to join up care to provide better patient experience. We are proud to be the first offering this dataset in real time to provide integrated care between the NHS and Local Authorities. At Healthcare Gateway we strive to extend our offering of health and care datasets to support healthcare professionals working more closely and effectively together.”

The Liquidlogic Social Care dataset is designed to provide clinicians with a more comprehensive view of a patient’s medical history; offering the following benefits:

• Better co-ordination of a patient’s care
• Enables informed treatment decisions
• Improves patient safety
• Better management of challenging situations
• Provides more satisfying clinical encounters
• Improved data sharing between health and social care

To find out more please contact enquiries@healthcaregateway.co.uk

 

Luton & Dunstable University Hospital’s rheumatology department embraces innovative technology to improve patient care

The Rheumatology service at the Luton and Dunstable University Hospital (L&D) has evolved with medical advancements to offer local patients a high quality experience.

A few years ago it became apparent that demand was outstripping the capacity, especially with the need to respond to the challenge of delivering outcomes, the impetus to provide an EA pathway and to ensure annual and regular outpatient reviews within appropriate timescales. Capacity was poor at 42.8 % of national average. Mean wait for EA patients was 45 days. This led to 29% loss of referral activity from Bedford CCG and poor patient experience with 26% of patients not recommending the service.

In line with NICE RA guidelines and DOH BPT pathway for EA, an attempt was made to accommodate EA patients in general clinics. However, only 9% (14/157) patients achieved the desired time frames. Hence Early Arthritis Service (EAS) was established to reduce time to diagnosis, start of definitive therapy and accomplish good outcomes by introduction of dedicated Early Arthritis Clinics (EACs) to ensure achievement of BPT and facilitate medicines optimisation.

Treatment to Target (T2T) in inflammatory arthritis led to unprecedented improvements in not only the signs and symptoms of disease but also radiographic damage, functional outcomes and even improvement in mortality. It was only possible if every such patient could be monitored effectively. The Rheumatology team won capital bid for installation of an electronic database system and chose a tailored solution from InfoFlex.

InfoFlex is a leading digital healthcare management solution with a slightly different approach. Rather than imposing a rigid IT system, it models clinical patient pathways with clinician’s specific and individual needs which is why it worked well here.

InfoFlex helped achieve not only T2T for our patients but also acquire live quality data thereby fulfilling a number of the priorities as outlined by the King’s Fund:

• Secondary prevention – by identifying and inviting patients for annual review.
• Improving the management of patients with both mental and physical health needs – by monitoring patients regularly, escalating treatment accordingly, recognising poor treatment responders and adjusting their treatment efficiently.
• Care co-ordination and active support for self-management – by identifying patients who need to see the nurse specialist for education and case co-ordination.
• Medicines management – improved long term patient outcomes from the treat to target approach helped by this database will reduce the biologic use compared to routine care.
• Managing ambulatory conditions – by categorising patients with well controlled disease who do not need frequent monitoring thus allowing integrated approach to urgent and managed care. It will help avoid unnecessary clinic visits and admissions with disease flares.
• Improving referral quality – by providing feedback to commissioners and GPs generated from the database to help improve the quality and speed of referrals.

Implementation of InfoFlex in the department also helped with the delivery of an effective Early Arthritis Service. Nearly 80% of our cohort attained remission or low disease activity in less than six months. This was despite a significant delay in patients presenting to their GPs and moderately-high disease activity at presentation.  100% of our patients were treated to target facilitated by protocol driven escalation of therapy in these clinics. Patient experience also improved (94% would now recommend the service compared to 76% prior to the initiative).

Total savings for the year accounting for most generous cost estimates were £136,973. In addition, there was 42% reduction in biologic use in this group compared to the previous year.

Our care model attracted 48% growth in referrals confirming the confidence of subscribers to our service. Despite that, our waiting times remain the most competitive regionally and nationally. There has not been any 18-week or 3-week breach. Our patients F&F recommendation of service increased from 76 to 94% in the year. Compared to 495 overbookings prior to InfoFlex installation with poor feedback due to delays and hasty service in clinics, there were no overbooks. This also avoided premium rate initiative clinics to meet 18- week target costing £26,500 in the previous year.

Our EACs had 100% clinic utilisation leading to maximum productivity and efficiency. A new partial booking system was introduced which achieved reduction in cancelled appointments, less re-scheduling and lower DNA rate of 5.4% compared to 8.6% previously. This is one of the lowest DNA rate in the Trust. There are currently 5000 patients enrolled with regular reporting on disease indices, patient tracking and achievement of CQUIN by providing outcomes data to CIRCLE (Bedford MSK provider).