News, NP, Secondary Care

UCLH puts tech at the forefront of new outpatient transformation strategy for a ‘hospital without walls’

University College London Hospitals NHS Foundation Trust (UCLH) has released its new ‘Outpatient Transformation Strategy’ for 2021-26.

Covering the next five years, the document’s title is one of its goals – ‘a hospital without walls’ – with a focus on an ‘integrated future for outpatients’ that has tech and digital developments at the heart of it.

The new NHS strategy also explains its aims in areas such as changes to models of care and pathway redesign, which it hopes will be achieved by utilising the new technologies available, such as automation and remote monitoring.

In a foreword, Tim Jaggard, Deputy Chief Executive and Chief Financial Officer at the trust, explains that the strategy was produced in collaboration with over 750 patients, staff and governors, and sums up the transformation changes that have occurred at UCLH over the past 18 or so months, during the COVID-19 pandemic. These included, he says, the implementation of “video and telephone clinics for around 50% of patients during the first lock down [sic]”, as well as clinics being run by staff from home, remote monitoring, and use of the MyCare UCLH patient portal for “communication with over 80,000 patients”.

However, the Deputy Chief Exec concludes by highlighting that over the next five years, the trust needs to reshape its outpatient services, and rethink “boundaries between specialties, organisations, and between patient and clinician”, thereby “creating a hospital without walls”.

He wrote: “We need to get this right, to offer growing numbers of patients the best possible care, to make the most efficient use of our valuable workforce and estate, and to support our clinicians under pressures that simply cannot be sustained. This won’t be easy, but I think we have a good plan and I’m excited about what we can achieve together.”

To respond to growing demand, and with UCLH now providing over 1.1 million outpatient appointments a year to more than 350,000 patients, the trust has revealed its transformation plan, which has three overall ‘ambitions’ at its core.

The trio of ambitions for the trust – which is comprised of eight hospitals including University College Hospital, Royal London Hospital for Integrated Medicine, the National Hospital for Neurology and Neurosurgery, and the Hospital for Tropical Diseases – are:

  • Patient-centred services – to design services that fit patients needs and provide them with more control over their health, which will involve the use of MyCare UCLH to communicate and book appointments, as well as the development of a pathway redesign programme, expansion of Patient Initiated Follow Up (PIFU), keeping around half of appointments virtual, improving video clinic technology, and more remote monitoring.
  • Integrated care – taking a ‘leading role’ in the North Central London Integrated Care System (NCL ICS), investing in more specialist advice for patients in primary care, improving information sharing, and new population health approaches that utilise patient data to provide more targeted care.
  • Excellence in service delivery and administration – to move away from ‘outdated manual systems’ and ‘streamline and digitise administrative processes’ by introducing automation for routine tasks, thereby freeing up admin staff to coordinate care for patients. The trust also plans to improve customer service training, reimagine patient contact centres, enhance telephone systems, and digitise with moves such as online booking.

The publication adds that transformation will also occur throughout the organisation, in areas such as culture, workforce, data, information, research, space, sustainability, finance and, of course, technology.

The strategy also sets the scene of what a traditional or typical outpatient appointment used to look like, with a “reception desk, waiting area, clinic rooms with a couch, sink, a couple of chairs and a computer” – a model UCLH says is “only slightly updated from the model first created in the 1940s”, before outlining how digital and tech has helped to transform the space in the last two years alone. This transformation included the ‘go-live’ of Epic, the trust’s electronic health record system (EHRS), in 2019.

As for the delivery of the three aims, UCLH has ear-marked an increased roll-out and procurement of a new video clinic solution, remote patient monitoring, virtual reviews, tech buddies to help with  goals around equity of access, and the integration of health records, as ways to help it achieve what it wants over the next few years.

In the administrative sphere, space scheduler software, appointment scheduling, a telephony index, letter batch processes, video and telephone clinic spaces, enhanced clinical admin, automation, dashboards and Epic optimisation, are among the ideas noted to aid improvements – bringing into sharp focus the impact of technology on the trust’s rethinking.

Meanwhile, wider plans for digital healthcare, as detailed in the appendix, include continued use of the Epic EHRS for at least the next nine years, continued investment in Digital Workforce Programmes to improve staff skills, a continued focus on gaining sign-ups for the MyCare portal, adding more tech buddy volunteers to support patients, enhancing the Patient Entered Data programme and progress in the use of wearables and home monitoring, as well as building the use of HIE data into workflows to provide more co-ordinated care.

As for technology as a theme overall, the trust also notes that it intends to support the new strategy by continuing to “invest in and optimise” tech, by “ensuring basic infrastructure is available across all locations”, “integrating solutions to ‘talk’ to one another”, “broadening visibility” of the patient record to other providers, introducing more “wearable and assistive technology” and by building an ‘Epic Expert Community’ of staff.

To read the UCLH strategy in full, click here.