HTN Now: optimising referral management with NEC Rego

For a recent webinar, we were joined by David Ezra, managing director of NEC Rego, to discuss the ways in which the platform can help NHS organisations in optimising their referral management process.

David started by offering a brief introduction to the Rego platform and the challenges that it was designed to solve. He shared that work on the platform began around 16 years ago, with the ambition of using innovative technology to streamline the referral management process.

“We started initially looking at telemedicine and the ability to store and forward data and images from GPs to consultants, to make it easier for them to provide their opinion and to better manage patients in primary care. That developed into a fully-fledged referral management solution, using algorithms, integrations, interoperability with existing clinical systems and smart pathways, in order to make sure patients are seen in the right place, at the right time, and using the right resources.”

Key features and benefits of NEC Rego

For context, David went through some of the key features of NEC Rego and the benefits for NHS organisations.

From a primary care perspective, David shared how Rego can help to simplify the referrals process, especially when it comes to navigating e-RS and identifying the right places for them to go.

“GPs often defer that to their administrative staff, because it is very time consuming. We’ve developed smart pathways which, with a single click, launch from the record system, populate key demographic information and pull in key clinical information from the record system. Against each reason for referral there are criteria that are easy to navigate through. That means that the process can be completed within 60 seconds. You’ll end up with a completed referral letter, in a structured format; then it provides a directory of services, because we integrate with e-RS at points of referral, and we can shortlist them according to what has been locally agreed. Then it is just a case of pressing send.”

The challenge that Rego can help tackle within secondary care, David continued, relates to the “multitude of referrals” coming in from a variety of different sources, and needing a single source of truth to cover everything.

“Through the APIs that Rego has with e-RS, we can pull in whether it’s advice and guidance on e-RS,” he explained, “whether it’s direct bookable or RAS referral. That all comes through onto one list. We mirror e-RS in real time, and we also then provide a platform with the ability to bring in other sources, email, fax, and so on, to create one list that can then be managed by administrators and consultants to instantly triage. Once they triage those referrals, they’re down-streamed to the clinical system where everything is stored, and can trigger off a number of different messages to perform a number of different actions on the back of that.”

David also highlighted that “because we get everything in structured format and every click is a data point, we can provide valuable and essential business information and reporting for unprecedented insights into what’s going on day-to-day, to be able to performance manage and improve”.

Transformation and implementation in NHS organisations

When it comes to the NHS’s limited resources for transformation projects, what kind of resources would be needed for a provider to explore or adopt the Rego solution?

David took the opportunity to commend trusts, NHS organisations and staff for their ongoing commitment and dedication towards transformation, which he acknowledged is “not an easy process”.

When the solution was being rolled out at London North West University Healthcare NHS Trust last year, David described how they were in the process of migrating to another EPR alongside various different upgrades. “It’s evident just how many people that necessitated – the professionalism and skill was incredible. The reality is that referral management is such a core component within the NHS that it does require a significant team on the ground, who need to be really well coordinated by a strong project board. Fortunately, we have a wealth of experience and a highly effective team to help support them and ensure delivery is on time and within budget.”

David added that during the discovery phase, the team at NEC Rego collaborate with organisations to put together a plan which works for that specific organisation in terms of capacity and available resources, rather than approaching the project from a one-size-fits-all perspective.

“We’ve learnt a great deal from a diverse set of implementations across multiple organisations – taking an agile approach in being able to respond to their pressures is integral.”

David elaborated on the work that NEC Rego has been doing in North West London, discussing how the project involved the four major trusts across the ICB, the eight boroughs ( formerly CCGs) covering GP practices, and dental practices as well.

“The idea is to have a single point of truth for all referrals within the trusts themselves; one single view of everything that’s coming in to them, whether that’s from GPs, tertiary referrals, and so on,” he explained. “Our system draws everything into one place, and we’ve done that through relying a lot on the APIs that NHS England provide for e-RS. It’s being able to downstream that into their processes, into an existing system such as their clinical system, so that everything is synchronised. From a patient safety perspective, everything is in good shape. The project has been huge and complex but extremely rewarding, and it is yielding a lot of benefits.”

Using systems to their full capability

Our discussion moved on to whether NHS organisations and providers are currently using systems to their full capability, and whether David had any insights around how to ensure that systems are being used in a way that will promote the realisation of all of their benefits.

He pointed out that Bill Gates once made a comment suggesting that generally we are only using 20 percent of the capability that our existing technology can offer us.

“I’d like to think with Rego that they’re probably using about 70 percent of its capabilities,” he said. “We have done a great deal of work to replace or augment what they currently have, and that is delivering a tremendous amount of value, but we also have plans to go beyond that.”

He added that the appetite of staff to learn more about what the solution can potentially do, and where they can take it next, is something that keeps momentum going – especially as they begin to see the benefits.

“The innovation that comes from within the NHS is incredible, and we learn so much from them. We like to think our solution is built ground-up and it is highly configurable; so if they have a problem, we have an off-the-shelf solution that can solve maybe 90 percent of their issue straight away. The remaining 10 percent takes that bit of extra time to try and figure out, but we’re extremely agile in that respect and together we’ll come up with a solution that works for them.”

Supporting implementation

On the way that organisations are supported through the implementation process, David shared how in the weeks leading up to the launch, he and his team put together a “war room” combining key stakeholders from both sides, to help make sure that the go-live is a success.

“There are always some teething issues in the initial phases, but the ability to respond quickly is what matters. You can do as much user acceptance training as possible, but when you go live there will always be people saying, ‘I don’t know how to use the system’, or ‘how does this work again?’, and so forth. You have to go and be present and show them that support. They are going out of their way to change their processes and for a lot of clinicians it’s not really what they want to be focusing on – they want to focus on managing their patients.”

David also noted that his team can help providers to support a funding case for expansion. “To say that we can make cash-releasing savings from day one is a challenge,” he acknowledged, “but there is such long-term tangible value here for organisations.”

Sometimes it is a case of working through it together to see what is equitable going forwards, or David noted examples of situations where the team has part of the solution in so that clients can see the benefits and test it ahead of a wider roll-out.

“Whatever happens, however, there is going to have to be a commitment, because there is a significant change here. That impacts on a variety of elements within an organisation, even if you put in a small part of the solution; because you will have to change what you’re currently doing. So we are very flexible, we are listening to what our clients are saying, and we will work collaboratively with them to get to where they need to go.”

We’d like to thank David for joining us, and for sharing with us his insights and information around the NEC Rego solution.