Special report: pathways, cross-organisation workflows and region-wide projects

The latest edition of our special report series focuses on pathways, cross-organisation workflows and region-wide projects.

We are joined by Open Medical as they share their work unifying trauma pathways throughout the Lincolnshire region, and we take a look at some of the latest news and resources from the health tech industry in this area.

In this special report we also focus on the role of digital in transforming pathways including dermatology and ophthalmology, as well we highlight examples of new models of care, community diagnostic centres and sharing records.

On improving pathways in Lincolnshire, a case study from Open Medical highlights the need for cross-organisational workflows that improve collaboration and coordination.

United Lincolnshire Hospitals NHS Trust (ULH) has two main trauma units, which receive between 1,200 and 1,500 referrals per month from seven virtual fracture clinics dispersed throughout Lincolnshire.

ULH previously received referrals through various ungoverned and non-standardised means, including phone calls, emails, and faxes. Trauma lists were manually managed using legacy processes like whiteboards and paper, and they lacked time-references, patient status, or tags. This led to difficulties tracking patients along their pathways and made processing referral information, and gathering and analysing data highly time intensive. The major contributors to their challenges were the fractured communication and minimal visibility across sites. It exacerbated challenges in case-load management and impacted their trauma workflow efficiency.

A transformative digital solution

To address these challenges, ULH planned to harmonise and streamline their orthopaedic trauma processes across the region to improve data quality, security, and collection, and boost regional collaboration and visibility. They achieved their progressive vision with the help of Open Medical’s digital solution PathpointⓇ eTrauma, a cloud-based, end-to-end platform designed to optimise cross-organisation trauma coordination.

Open Medical employed a collaborative approach to ensure the solution was tailored to the specific clinical workflows; Mr. Kulandaivel Sakthivel, Consultant Orthopaedic Surgeon and Divisional Clinical Director at ULH, and Mr. Thomas Cheung, Clinical Director for Urgent and Emergency Care (UEC) at Lincolnshire Community Health Services (LCHS) both played a pivotal role ensuring eTrauma effectively addressed the challenges that they sought to overcome.

Thomas Cheung, Clinical Director UEC at LCHS, said: “I have worked at different LCHS sites, each had its own legacy referral pathways to Fracture Clinic. eTrauma provided consistency across all sites as well as improved accountability and governance of the referral process. This is the cornerstone to developing a beautiful collaboration between UTCs and the T&O team. The data from eTrauma will be invaluable to streamline the process and providing evidenced feedback to both the Orthopaedic Consultants and UTC ACPs.”

Optimised referral management

Virtual fracture clinics can submit referrals via eTrauma’s centralised interface, which offers referral templates with mandatory fields and integrates with the Patient Admission System. This allows clinicians to access essential clinical information on a single system, streamlining referral management. With eTrauma, ULH actioned 99.7 percent of over 33,700 referrals within the mandated 72 hours. In addition, with an average referral assessment time of 10.7 hours, the trust was able to maintain the same admissions rate despite an increase in referrals.

The platform displays an automated trauma board with a list of scheduled, unscheduled, and pending patients and provides real-time oversight of the trauma department. The patient status is highlighted with tags so that clinical teams can readily monitor and prioritise patients throughout their care pathways. These functionalities, coupled with optimised referral management, helped the trust preserve efficient referral to theatre times, with a median of one day for inpatients and 3 days for outpatients.

eTrauma captures SNOMED CT coded clinical data at the point of entry which can be viewed on the system’s dashboard. The platform captures high-quality data, which in turn gives the trust granular care metrics they can use meaningfully, such as for future service planning.

eTrauma is cloud-based and user access is regulated; multidisciplinary teams have access to relevant information whenever and wherever they need it. eTrauma provides visibility of the end-to-end patient journey between geographically dispersed sites and sub-specialty teams, significantly enhancing collaboration and resource allocation.

HTN on other work in the area

Firstly, NHS England Transformation Directorate has shared a step-by-step guide to a dermatology pathway, describing the journey from self-management to patients capturing their own clinical images, to advice passing between primary and secondary care, to referral supported by the digital images, and onto virtual consultation.

NHS England has also shared information on improvements made to regional pathways, with a focus on improving ophthalmology care in Greater Manchester and progress made on cancer diagnostic waiting lists in Cheshire and Merseyside.

NHSE describes how an enhanced Electronic Eyecare Referral System is helping improve eye care in Greater Manchester. The system, introduced in February last year, has functionality enabling primary care optometrists to send high resolution photos to ophthalmologists at the hospital to gain diagnosis, advice and guidance. NHSE says that the system is “helping to reduce patient waiting times and unnecessary hospital appointments”, with changing practice resulting in “creating additional capacity to see and treat patients who require specialist hospital care.” Between February and November 2022, over 25,000 referrals were made.

Looking at the work in Cheshire and Merseyside, NHSE notes that there are a number of initiatives in place across the region to manage demand and reduce waiting times. Liverpool University Hospital has established a nasal endoscope service, for example, as an alternative to the usual gastroscopy procedures, which has seen a 35 percent reduction in the number of patients on the list between December 2021 and June 2022. Another initiative involves 50,000 patients undergoing a faecal immunochemical test (FIT) as an alternative to being listed automatically for an endoscopic procedure, with NHSE pointing out that 67 percent of patients undergoing the FIT needing no further secondary care treatment as a result of the test. 

In West Yorkshire, funding was granted for the creation of four new community diagnostic centres (CDC) to provide “one-stop shops for checks, scans and tests” which are to “help staff diagnose a range of conditions including cancer, heart and lung disease” with more speed, to help patient get the care they need in a more timely manner. With the locations for the centres based upon where they are most needed to support existing NHS services and set to provide additional diagnostic capacity, the centres begun to deliver services at the start of this year.

Elsewhere, a case study has been made available on the delivery of a community diagnostic centre at Finchley Memorial Hospital, described as “a good example of what can be achieved by working in partnership across an Integrated Care System, and linking additional diagnostic capacity into an existing, vibrant and important local care facility to meet many of North Central London ICS’s strategic priorities and the needs of local patients.” The case study explains how partnership working, delivery, capability and flexibility of existing good quality estate have been “critical factors in overcoming challenges and successfully delivering the CDC.” Outcomes include patient benefits with faster movement through pathways and increased capacity for the hospital.

In September we covered the news of Birmingham and Solihull ICS, Coventry and Warwickshire ICS and Herefordshire and Worcestershire ICSs joining forces to deliver shared care records; the programme includes 365 GP practices, hospital trusts, mental health and community trusts, local authorities, an ambulance trust, hospices and a prison service.

The ICSs agreed that individually-held datasets from the providers should be viewable, such as medications, allergies, emergency contacts and safeguarding information. The work builds on the region’s mental health record blueprint MERIT, which integrates mental health  diagnoses, treatments, risk assessment plans, care team and crisis intervention plans across five mental health trust systems.

Using data to generate insight and interventions across North East and North Cumbria ICS

Looking back at a previous HTN Now session, we heard from North of England Commissioning Support Unit on their experiences working across the North East region to use data to generate insight and interventions, along with their work around population health management.

Speakers discussed data management and the importance of having a single point of truth for to provide healthcare professionals to secure access to a wide variety of information for planning, redesign and operational reporting.

They also discussed their use of a dashboard and artificial algorithm to segment patients into populations, explaining: “What the segmentation tool enables you to do, from a population health management perspective, is to start to understand segments of your population and their usage of activities and services across your system, rather than doing more traditional style analytics.”

The full discussion is available to watch back here, along with a demonstration of the tools used.

Digital ICS interview series 

Last month, we held a number of interviews with health tech suppliers on all things digital ICS, with many of our interviewees discussing the benefits of cross-organisational working.

Open Medical shared thoughts on transcending geographical barriers, encompassing barriers between organisations, clinicians and patients alike. You can read the interview here.

Alcidion highlighted key opportunities for patient flow and the importance of joining data across regions here.

InterSystems discussed the importance of innovation within ICSs to create “fresh pathways and workflows that can drive new and transformational methods of delivering care” here.

Clinisys focused on how the Integrated Clinical Environment can support efficient pathways by ensuring that results can be shared between sites and care teams here.