If you’ve been following our features on the Health Tech Awards 2021 finalists so far, you’ll already have read about a broad range of digital and tech solutions that have excelled across the past year.
Now it’s time to turn towards our ‘Efficiency Savings of the Year’ category, which stars submissions from Bolton NHS Foundation Trust, Northampton General Hospital Foundation Trust, Cambridge University Hospitals Foundation Trust, Doccla, and Inhealthcare.
Bolton NHS Foundation Trust
Bolton NHS FT presents its Acute Medicine Referral List – a clinically developed Electronic Patient List that can help save clinical time – as its solution in this section.
The trust designed an Electronic Patient List which automates referrals to Acute Medicine, from multiple admission streams. In just five months, it says there have already been reductions of 34.4 per cent in waiting times for consultant reviews, 19.4 per cent for length of stay, and an average of 298 minutes saved throughout the patient journey. One of the biggest challenges facing the trust, especially during COVID-19, was the volume of work with patients based in multiple clinical locations. The current service relies on a multiple shift-based clinical teams who handover multiple times during the day, and within increasing waiting times, the trust states that “it was evident the current system was not working”.
Patients are admitted to Acute Medicine through numerous referral routes – either through the Emergency Department, from primary care, through clinics or admitted directly through ambulatory care – both planned and unplanned. At any one time, patients who need care can be in any number of locations across the hospital, with varying degrees of illness. Tracking each admission relied on complex systems and non-integrated tracking boards. Consultants were unsure about who to prioritise and had to frequently move between wards. During COVID, this was exacerbated, and Bolton reports that there was also significant variability in standards of clinical documentation during doctor reviews, with documents often incomplete and missing key information.
To combat this, the Acute Medicine team identified an opportunity within their Allscripts Sunrise Electronic Patient Record (EPR), which was implemented in October 2019. The EPR provided the trust with the flexibility to manipulate data and integrate information into a single, automated list, accessible by all clinical staff. The solution required minimal manual intervention, improving data accuracy, and would make redundant existing processes of using pagers, verbal referrals, handwritten patient lists and inaccurate tracking boards. The proposed Acute Medicine Referral List would identify and track referrals to the Acute Medicine team, providing an overview of which patients had outstanding clinical assessments, and update the live location of these patients as they moved through hospital.
In addition, to help standardise clinical variability in documentation, the list was designed to update only if the correct clinical documents were completed during the reviews, eliminating incomplete or erroneous clinical information. The trust successfully implemented the unified integrated automated list in November 2020, and then compared cohorts of patients from February 2020 (pre-implementation), January 2021 (six weeks post-implementation) and April 2021 (five months post-implementation), to evaluate the impact. It was found that the greatest improvements were around consultant reviews, with a four hours and 58 minutes reduction in waiting time, 51.4 percent more patients seen within 14 hours of medical referral, and a 65.7 per cent increase in same day consultant reviews.
Improvements over the weekends almost nullified the so-called ‘weekend effect’ with a 25.1 per cent or 52-minute reduction in the average waiting time for medical clerking and a 28.2 per cent reduction in the average waiting time for consultant review. This equated to an 81 per cent increase in the proportion of patients reviewed within 14 hours.
Among other positive impact, there has also been a 15 per cent increase in patients discharged within 72 hours. While, by comparing length of stay, the annualised reduction in total occupied bed days and associated financial impact has been calculated. For 12,000 admissions, this equates to a reduction of 15,600 total occupied bed days and potential financial saving of £3.12 million.
Northampton General Hospital NHS Trust
Northampton General Hospital NHS Trust (NGH) has also submitted a case study for consideration – a pilot which it says improves throughput in Radiology by 8.6 per cent in 21 days.
NGH had previously used a paper-based tea card system in Radiology, which it says is prone to inefficiencies and human error and required a solution to overcome those challenges.
To provide this, a new digital task allocation system called MyPorter was installed as a pilot in the Radiology Department and created an immediate impact on throughput with an extra 141 transfers completed over the first 21 days.
Northampton General Hospital’s Radiology Department consists of CT, MRI, Ultrasound and X-Ray. The department needed a product that would improve patient flow and reduce lost time for each job in all our four departments and that solution came in the form of a new digital task management system. The system also allows porters to report any delays or cancellation to their allocated tasks.
After implementation on 10 of May 2021, the system has reduced time spent on unnecessary travel. Within a three-week period of using MyPorter, the department completed extra patient transfers and even if that number – 141 – stayed at a similar level, the trust says that over the period of a full year, it would equate to an approximate figure of 2,444 extra transfers being completed in the Radiology Department alone.
Other improvements include resolving the challenges faced in downtime, inefficiencies and porter visibility, and the ability for accepting or declining tasks from devices without having to walk back to the porter’s lodge.
Cambridge University Hospitals NHS Foundation Trust
The MyChart patient portal is Cambridge University Hospitals NHS Foundation Trust’s (CUH) entry to the award. As the trust’s electronic patient portal, it is directly integrated to its electronic patient record (EPR). With over 76,000 users, Cambridge says it has “proved pivotal during COVID-19” by supporting the self-booking of 13,507 vaccination appointments electronically, securely releasing 4,800 swab test results per week to patients and staff personal devices, and also saved thousands in associated time, printing and postage costs.
Prior to implementation of the solution, all letters and clinical correspondence were generated in CUH’s EPR system and then sent primarily to patients via post. With MyChart, which Cambridge says is the first patient portal in the UK to be directly integrated with an EPR, patients receive their hospital information – appointment information, clinical correspondence, test results, conditions, medications, allergies, vitals – in a ‘more timely way’, enabling them to be more involved and informed about their care and conditions.
Over the past two years, the trust has developed additional functionality in collaboration with its MyChart patient group, including the introduction of automatic results release. On average, the trust says that approximately 120,000 test results are automatically sent to patients each month via MyChart, instead of being manually released or posted. In January 2020, proxy access was also enabled to allow parents and guardians to access their child’s hospital health records in a more convenient way.
These developments have been enabled by the trust’s eHospital digital team – a team of staff with combined clinical, operational, technical, analytical, administrative, managerial and training expertise.
Over the past year or so, the benefits of MyChart have included clinicians using the portal to share information about COVID-19 and changes to care, the ability for patients to upload photographs of their wounds and conditions, allowing the workforce to receive the results of a large-scale staff asymptomatic COVID-19 PCR swab testing programme direct to their personal devices, and the self-scheduling of appointments.
New COVID-19 workflows were also designed and built in-house within the trust’s EPR and MyChart to enable the self-scheduling of vaccination appointments by staff, enabling the direct booking of 13,507 COVID-19 vaccination appointments. In addition, the teams also built a COVID-19 vaccination workflow for both CUH outpatients and inpatients to inform, book, document, and track their COVID-19 vaccination status electronically through MyChart. In total 46,138 COVID-19 vaccination doses were administered at CUH (first and second doses).
Doccla
Next we take a closer look at Doccla’s virtual wards, which use medical technology and software to help hospitals alleviate the pressure on resources and discharge patients early, while still providing clinician care.
By using technology to monitor patients remotely and in the comfort of their own home, Doccla aims to give people the freedom and opportunity to manage their own health. The wards aim to: help achieve the NHS’s digital ambition of using advanced technology to enhance the care provided to patients; improve patient convenience and peace of mind in the comfort and safety of their own home; ensure that clinicians can focus their time on those patients that need face to face contact the most and have access to real-time health data; reduce hospital admission through early identification of an acute exacerbation of the underlying condition, promote self-management and ownership in the management of the underlying condition.
Designed for rapid implementation, Doccla uses a mobile app and clinical monitoring dashboard that harness the ‘Information of Things’ technology that patients can wear at home. Once a patient has been identified for monitoring, the company dispatches the devices, along with an encrypted mobile phone and patient information resources, in a self-contained ‘Doccla box’ via the hospital.
Patients use Doccla’s medical equipment to take their vital signs which are then submitted via the provided encrypted smartphone. In addition, patients will answer a bespoke set of questions, asked by their clinician, on their device. Clinical staff can monitor the vital signs of the patient remotely, and can also make the appropriate intervention, change parameters or frequency of recordings and questions, or make contact with the patient should it be needed. A video calling function has also been introduced.
During the pandemic, Doccla’s delivery of virtual wards was fast-tracked at hyper speed in order to meet the immediate needs of hospitals up and down the UK and help healthcare organisations to minimise patient face-to-face contact and ensure that patients could avoid any unnecessary hospital admissions.
Since March 2020, Doccla’s technology has been adopted by a number of NHS trusts including Hertfordshire, Essex, Northampton and Cambridge. NHSX also selected Doccla for its NHSX dynamic purchasing framework and the med-tech startup became the first RPM provider to win an NHSX contract to provide remote patient monitoring for Cambridge Community NHS Trust. Doccla continues to work with NHSX to provide exemplar information about how the technology should be implemented and what the cost-benefits can be for a wide range of pathways.
More than 600 patients have so far been admitted to Doccla’s virtual wards, equating to over 14,000 days of monitoring, and its work with Cambridge Community Trust saw a 29 per cent reduction in Emergency Admissions and a 20 per cent reduction in A&E attendances.
Inhealthcare
Our final entry to this category is the health tech company Inhealthcare. which submits its immunisation service for consideration.
The Inhealthcare’s immunisation solution aims to remove the administration load for staff and increase vaccine uptake, as well as provide parents and guardians with a fully digital solution to enrol their children to immunisation programmes.
The service automates the process of capturing consent, removing the need for paper forms, automates the population into the GP record and gives visibility of uptake across schools and regions.
Inhealthcare provides digital immunisation consent and health questionnaires to more than 150,000 parents and guardians, as part of school aged immunisation programmes at five NHS organisations in the UK.
Common issues in this area include that the manual process of sending and collecting letters from parents and guardians means that forms are often lost or forgotten about, and completion is low. Completed forms can also be difficult to read and paper versions require manual re-entry into clinical record, while Inhealthcare adds that they provide no overall visibility of uptake and can be open to error.
The Inhealthcare digital solution can be used across all vaccinations, enables consent to be gathered at speed, avoids the need for written letters, raises notifications for healthcare professionals to review contraindications, provides a list of eligible children, integrates the results back into the patient GP or community record, gives a real-time status of population uptake via a dashboard, and alerts and lists non-responders for targeted follow up.
After sending an email with a link to an online questionnaire, the responses are fed securely back to Inhealthcare and verified against the NHS Spine. The children eligible for immunisation are automatically booked in and the parent or guardian is informed by an automated email.
On the day of vaccination, staff have access to vaccination lists within a mobile application which works both on and offline, and once the vaccination has been given, the GP record is updated. Customised dashboards provide real-time population uptake across the given demographic and any child who does not turn up or refuses is automatically booked on to the next session, with the parent being notified by email.
After the vaccination has been given, the parent or guardian is sent a confirmation, along with details of the dose and batch number.
The solution has been evaluated by City Health Care Partnership (CHCP) and Dorset Healthcare University Foundation Trust. Findings included that, across schools in Hull, CHCP administration teams saved approximately six hours per session and a 4 per cent increase in uptake in the first wave was noted. While, at Dorset Healthcare University NHS, the service has been running since September 2019 and is now being used in almost 300 schools.
