Speaking at our latest HTN Now Focus event, which covered the topic of digital Integrated Care Systems (ICSs), the team from Infinity Health delivered a webcast dedicated to practical tools that can help ICSs coordinate care and connect with partners.
Elliott Engers, CEO and Co-founder of Infinity Health, and Dr Jo Garland, the company’s Clinical Director, joined us to discuss task management and ways to tackle the elective care backlog.
Setting the scene, Jo explained: “Staff from multidisciplinary teams and many different organisations are all looking after the same patients. The information from all of them is really important, everyone has relevant expertise, but they all document the information and record the tasks for patients in different systems, or on paper.
“The systems of all the organisations and services are not joined up, so the care is not well joined up. It’s really difficult to share the information, and it’s usually only shared at fixed meetings, or via calls, or bleeps, or emails, or faxes. It means that a task is not visible to the team in real-time, so decisions about diagnosis, investigations, and treatment, are done without the whole picture.”
“It’s really difficult to track and see the status of tasks…prioritise the tasks and allocate tasks. Generally, coordination is very hard, inefficient, unsafe and really frustrating for staff and patients,” she explained, adding, “there’s so much time wasted chasing busy colleagues to see the status of tasks or to get information.”
Jo also highlighted a statistic from NHS England’s Patient Safety Domain, which states that 60 per cent of adverse events are due to poor communication at the point of handover, underlining the scale of the issue.
Elliott then stepped in to explain the structure of the digital health ecosystem. “There are multiple layers. At the base layer there are health record systems, these are normally EHRs [Electronic Health Records], PAS systems, radiology systems, prescribing systems. So, things like EMIS and SystmOne in primary care, and Cerner, Epic and Allscripts in acute, Rio in the community. We see this as the bedrock of digital health,” he said.
“Then you very often have analytics systems that are able to dip into these record systems and bring information together, build dashboards, often predictive analytics – so those are things like population health or business intelligence systems. We then have a workforce layer…there are some really good apps out there now that help support the workforce…and then there are hundreds of thousands of patient apps, one of them being the NHS App,” he added.
The next layer up, he said, was communication – “email and instant messaging, audio and video…what we’d like to talk to you about today is one that you’re less aware of but that exists in every other system, which is task management.”
This level, Elliott explained, was intended to “drive efficiencies, quality and satisfaction, and actually get things done.”
Elliott then launched a short demo that showcased the capabilities of the Infinity Health system, which acts as a platform to log, share and coordinate care in real-time.
Elliott took the audience through the nuts and bolts of the system, showing how Infinity displays lists of patients alongside the tasks associated with them. He added that, in Infinity, a task “describes a piece of activity that needs to be done – what do we need to do? Who do we need to do it for? When does it need to be done? How is it categorised? What team or individual is it assigned to?”
“We also want to track its status, so is it pending, accepted, started, completed or cancelled?”, Elliott said, before going on to detail how the system allows healthcare staff to plan tasks manually through lists to drive consistencies and standardise, as well as filter, search and assign tasks.
“Deep dives” into patient information are also available, as well as notes, but with tasks remaining “front and centre”.
“I think it’s really important to have complete visibility, from the ground all the way up, to know what’s being done, what’s the status of tasks, what’s blocking other things in the system…[this] is particularly important when you’re transferring patients from one part of the system to another,” he stated.
Notifications and the status of tasks in real-time are also able to be sent to people’s mobile devices, and to also be updated from them.
Jo shared a case study of the STARRS team from London North West Healthcare NHS Trust, whose aim is to reduce A&E attendances and length of stay by providing care and treatment in patients’ homes. Before using the Infinity system, staff printed out their task lists each morning, used paper to record information during visits, and physically returned to the hospital to relay information back to team leaders in a verbal handover.
After the implementation of Infinity, staff at STARRS began “sharing information in real-time continuously, so everyone knew what their colleagues were doing. They were connected as a team, senior staff could support junior staff, they could talk to the patient with more information, and [there was] just a massive improvement in patient and staff experience. The impact was huge.”
“In terms of efficiency, we want to save time for staff, we want to reduce time wasted, help people to manage their workload better, and we’re driven by data – we evaluate the impact of Infinity all the time,” she added, noting that in the case study, implementation had led to eight hours saved per day and a 55 per cent increase in capacity, the latter of which meant that up to two more patient visits could be done per staff member per day. With a team of more than 15 staff, this is significant.
The duo added that they currently have seven NHS customers and have completed 12 implementations.
Next focusing on elective recovery, Jo explained that with over 5.6 million patients are currently waiting for care, “we need a different way to manage these waiting lists, rather than just the current manual and time consuming processes.”
NHS England’s strategy, she said, is to validate and prioritise patients, plan and coordinate care, and monitor and support patients while they are waiting. The solution, Jo said, is “multifaceted” and that you need to have “really good data and integration…excellent care coordination…to make sure that the right person is doing the right thing, at the right time, in the right order, with the right priority…and very good patient engagement.”
The journey, she added, should be tracked from referral to triage, management to treatment, and onto follow-up.
Elliott went on to talk more about how patient engagement can be used to obtain consent and schedule appointments, which will make it “key” for “managing ICS waiting lists”.
He also shared an example of adding automation to pathway management, explaining how the system can help the management and viewing of wait times, allow for tracking across specialties, and how automating tasks can assist with patient booking, preparation and discharge.
“Right now, given the state of the waiting list and burden on staff, there’s going to be real pressure to discharge patients this winter and next year, and that means there’s going to be a lot of risk out there. Having better tools to allow you to engage with patients and coordinate care better has got to be a better thing for the system,” Elliott said.
Specifically focusing on ICSs and summing up the benefits of Infinity, Jo added: “Setting up an ICS is a real opportunity to do things differently – sharing information across different teams, organisations, stopping the silos. Infinity can provide visibility of all patients, the status of all the tasks, in real-time, for the entire team, so you have a total picture for the staff.”
To conclude, Jo shared a final case study about the optimisation of workflows, explaining how London North West University Healthcare NHS Trust had an issue with moving patients out of the Emergency Department. Infinity found that how porters were requested – on paper, with no identification – was causing delays.
“We implemented Infinity and digitised the process,” Jo explained, “just some simple measures – making available the name of the patient and the staff member, the location…the status in real-time of the tasks…the ability to escalate…[it] had a massive impact…we reduced cancellations by 80 per cent and had enormous savings in time.”
You can watch the full session through the video below: