At HTN Now, our live virtual event series, we were joined by David East, commercial lead at NEC Rego, for a discussion on their platform and a demonstration of its capabilities.
What is NEC Rego?
David described NEC Rego as a “referral optimisation solution – an intelligent system designed to eliminate the bureaucracy and treatment delays caused by rejected referrals”. The solution has two main components, the first being a primary care solution with a ‘smart pathway’ or care navigator, which provides instant decision-making support to the referrer backed up by intelligent logic and algorithms.
The second component is a single point of access, typically used by secondary care providers and triage teams. When customers receive referrals, regardless of the source, they are provided with a single case view of all referrals to support triaging in a structured format.
“Bringing the two components together optimises the referral pathway end-to-end,” David said. He highlighted how the solution is essentially comprised of a simplified dynamic referral process; full integration with e-ERS (therefore requiring few interactions from GPs and capable of launching directly from primary care systems such as EMIS); fully compliant referrals fully validated against referral pathways; and real-time dashboards for reporting and tracking along with a full audit trail.
“The key outcome here is the patient being referred to the right service, first time,” David emphasised.
The challenge
David noted some of the commonly raised issues with referrals within the NHS, including referrals ‘bouncing back’, the concept of referrals dropping into a ‘black hole’ and difficulties with the waiting lists causing long delays which can lead to conditions worsening.
He expanded on the issue by highlighting number of challenges that NEC Rego customers have faced and raised in the past, including patients being referred to the wrong service or clinical pathway in the first instance; a complicated directory of service making selection of the correct service difficult; a vast number of referral forms creating a heavy admin burden; referrals lacking information; and difficulties with primary and secondary care communication around understanding acceptance criteria and local guidelines.
“There can be a sense that patients can be passed back and forth within the system, but if we can tackle some of these problems at the first point of contact with the patient, we can alleviate pressure on the system end-to-end,” he said.
David shared an example of how NEC Rego has helped a customer overcome such challenges; in particular, over 25 percent of the organisation’s referrals were being rejected. By following the Rego algorithm, designed and co-created for that particular region, rejected referrals were reduced from 25 percent to two percent.
“One of the biggest successes we have had within the MSK pathway in particular is that typically patients need to be referred to physio as opposed to trauma and orthopaedics, as an example,” David explained. ” We are now at a place with this customer where all physio referrals are at 95 percent acceptance rate. GPs follow the MSK algorithm and that provides them with the correct service each time. We are able to provide the GPs with clinical autonomy, so they can override the system and the decision should they need to; but we can see from the datasets that by following that pre-approved algorithm, we are identifying clinical, operational and financial efficiencies across the system.”
How does NEC Rego work?
Next, David provided a demonstration of the platform, focusing firstly on the smart pathway solution.
He explained that Rego can be launched through any patient record or GP system. “We are validating and populating patient demographics and details in patient context,” he noted. “The user, the referrer, the admin team – whoever is ultimately managing that referral will be presented with their caseload on the homepage.”
He talked through Rego’s functionality to give listeners an idea as to how the system operates, highlighting features such as the ability to create and customise a new patient on the system, and the ability to search for existing patient profiles by name, date of birth, hospital number of a unique reference number generated by the system.
“The referrer then has a number of options to allow them to track their workload and the status of a referral,” David continued. “Referrals are in one single view, whether they require further information, pending, awaiting review or they have been rejected for any reason. All can be monitored in real-time.”
Regarding the smart pathway capabilities, David demonstrated how the referrer will be presented with all of the commissioned services and pathways that NEC Rego has developed for them in their particular region, in line with local and regional guidelines.
He noted that some specialties, such as MSK, can have multiple pathways within them and therefore it can be challenging for clinicians to know which pathway best suits a patient’s particular symptoms and conditions.
“Rego is more than digitising a referral template – the intelligence of NEC Rego is the algorithm that is built in the background. It’s designed to support you, sense-checking throughout and taking into account patient symptoms, previous medical history and personal circumstance. Rego provides instant advice and guidance prompting suggestions of things to look out for, such as tests that may need to be considered prior to referral, treatments and medications and alternative pathways that are more relevant for the patient. These prompts are all customised to reflect rules and services in the region.”
Users will then move on to consider any red flags for their patient, and as they look through their various options, the solution will provide them with another prompt or a suggested next step.
“If there is a history of cancer, for example, this is taken into account and the system may prompt a different pathway for us to consider which reflects possible increased urgency of the referral,” he explained.
With a suggested referral generated, the system then allows free text to be added, so users can add in relevant contextual information about a patient or their care. Attachments can also be uploaded, including images taken by patients themselves. Any image format can be supported, and there is also a clinical grade image viewer built into the system.
If the system is launched through a patient record system, the patient’s consultation history can also be pulled through. Any previous patient information held on the EPR can be included that may be relevant including coded structured data.
“The Rego system is building all of the information and the intelligent logic into a single referral form,” said David. “We aim to provide the triage team or consultant with as much information as possible to meet their acceptance criteria.”
He added that the system also takes patient choice into account, so if the individual has expressed preferred dates or times to be seen, this information will also be provided along with the patient’s preferred method of communication.
“You’re then provided with a simplified directory of service to your local end points such as trusts or community providers. They are displayed in geographical order to the patient’s home address and will change depending on the patient’s condition and its urgency. It also includes updated indications of the providers’ waiting times as that could affect your decision of where to refer. All of this information helps the user select the most appropriate service for the patient in question.”
With the sending of the referral, messages can be triggered back to the GP record or to the triage team, and a copy of the information can also be sent to the patient.
Moving on to the second component, the single point of access typically used by secondary care providers, David demonstrated how the referral is received, how information and imagery can be viewed, and how any advice or guidance, e-RS referrals, internal or tertiary requests can be ingested into a single case view.
When accepting a referral, the system provides options to include consultation notes such as particular outcomes that a consultant might want to confirm as well as discharge options. Further information from the referrer can also be requested through the 2 way messaging capability, along with reporting if a patient did not attend the consultation.
If the referral needs to go to a different provider, the solution can also support in re-directing internally or to an external provider.
Finally, David highlighted how NEC Rego can deliver reports, from simple displays of data at a glance to advanced business intelligence. “Every click of Rego is a data point, which is particularly valuable when we are looking at system level such as an ICB. We can provide rich, real time data to identify performance and potential bottlenecks across the health system”
He demonstrated how users can filter by a number of categories and explore areas such as the number of referrals per area and their status or the percentage of specialties managing referrals. “Each of these is a touch point in itself allowing you to dig deeper into the data. All reports are customisable and we work on that alongside customers to build these dashboards to suit their needs.”
Many thanks to David for sharing his time and insights.
