First up, let’s take a look at the finalists from the excellence in innovation and change category.
Islacare and Nottingham University Hospitals
Overview: Islacare and Nottingham University Hospitals have created an automated approach to constantly prioritise the patient caseload and optimise clinical decision-making.
Why? Psoriasis is a chronic auto-immune condition affecting 2-3 percent of the UK population and can have a significant impact on quality of life. There is no cure, with a range of treatments including creams, oral medications, biologic drugs and phototherapy traditionally used to manage symptoms.
What happened? The current process for treating psoriasis patients at NUH involves a letter, telephone appointments and several face-to-face appointments each year; the goal of this project was to convert the majority of this work to happen through the Isla platform. Isla is a secure platform for the capture, storage and sharing of photos, videos and structured assessment forms between patients, carers and clinicians. Through the new pathway, treatment consists of four digital submissions each year including photos of affected areas and in-depth forms. Clinicians can directly compare visual submissions side-by-side and can zoom in and filter based upon psoriasis biologic form scores for caseload management and triage. New functionality has been built to give greater visibility of patients with new submissions or those who haven’t responded to a request, and the schedule submission requests is automated.
Looking ahead. Once piloted, the pathway will be rolled out to all appropriate psoriasis patients at NUH and likely onwards to an additional 500 patients being treated for other conditions in dermatology. The model can be replicated across all major Acute Dermatology Centres and there is scope to implement the pathway in other low-risk systemic treatment pathways involving immunosuppressants.
Leeds Teaching Hospitals NHS Trust and Elsevier
Overview: Leeds undertook digital transformation of nursing documentation with Elsevier’s Care Planning.
Why? There are over 6000 nursing staff at Leeds Teaching Hospitals, all writing on over 200 different pieces of paper; each patient currently has at least 85 percent of nursing care manually documented with the remainder electronic. The trust note that this poses potential risks to patients because their health record is fragmented. It impacts patient experience, staff workflow, and has a negative environmental impact.
What happened? Working in partnership with Elsevier, the trust plans to integrate Elsevier’s 312 plans into Leeds’ self-built HER, allowing patients to have single, clear digital record of all nursing care they have received which can also be viewed by other organisations. It will be available across their patient journey, reducing repetition, improving patient confidence in the team and mitigating the risks of miscommunication. Elsevier’s care plans follow a review of the literature and national guidance, are regularly updated and can be tailored to the patient and their unique care needs. Staff will be able to take a mobile device to the patient’s bedside, better involving them in their care. Information captured by the care plan will flow into the data warehouse as structured data items. It will also allow the trust to collect information about the impact nursing care has on patients in order to improve reporting, with a live feed of acuity, metrics and ward assurance data.
Looking ahead. The project is currently in the planning stage and will be launched early this year.
Spirit Health and NHS Leicester, Leicestershire and Rutland (LLR ICS)
Overview: LLR ICS has partnered with Spirit Health to deliver an ambitious virtual ward rollout, supporting virtual wards up in scaling up and improving long-term condition management across 16 clinical areas.
Why? With the current national NHS ambition stating a need to provide 40-50 virtual ward beds per 100,000 patients, LLR recognised the potential for digital technology to transform care and tackle capacity issues.
What happened? System leads and clinical teams identified where virtual wards could have the biggest impact, with pathways including respiratory, heart failure, frailty, diabetes, colorectal cancer, haematology and ambulatory jaundice. The Clinitouch remote monitoring app from Spirit Health is being used across all 16 pathways for system-wide continuity. Patients answer question sets and record vital signs using a tablet device at home; the data is then sent onto clinicians and a RAG rating indicates where care is urgently required, allowing clinicians to intervene or escalate as appropriate. The technology can also link into all respective clinical systems through FHIR integration, enabling quick and secure data sharing. This partnership is built on years of collaboration between LLR and Spirit Health, with some evidence from a Clinitouch virtual ward indicating a 40.3 percent reduction in average length of hospital stay and £1047 savings per patient.
Looking ahead. The next phase will see services deployed across primary care in Leicestershire as well as a focus on improving long-term condition management using digital technology.
Synopsis
Overview: Synopsis used tailored algorithms to tackle the elective surgery backlog and provide clinical decision support.
Why? The global pandemic has increased pressure on the backlog and it continues to grow. One of the major bottlenecks in the pathway to surgery is the pre-operative assessment (POA) process, which is traditionally paper-based with patients awaiting a letter to invite them to a face-to-face appointment.
What happened? Synopsis replaced the resource-heavy and time-intensive paper-based POA process with a digital solution. Using a link sent to their phone, patients can complete their digital pre-op health questionnaire from home. Synopsis fully integrates with Patient Administration Systems, joining up siloed data systems and reducing administrative time, and harnesses the power of data to support clinicians. Over 250 tailored algorithms are used to generate clear outcomes during a full risk assessment to produce a collection of published clinical scores. Synopsis also generates calculated cardiac risk and lung risk levels along with a mortality score. Staff can gain information on the patient’s comorbidities and general health from their questionnaire and guide into the appropriate pathway of care. One NHS trust reports productivity savings of 47 percent, with another indicating that capacity has increased by 7000 patients.
Looking ahead. By streamlining the pathway to surgery, Synopsis continues to time, creates efficiencies and improves patient experience. Reducing unnecessary hospital visits also supports the NHS in reaching its Net Zero Target by 2040.
The Princess Alexandra Hospital NHS Trust and Leapwork
Overview: As part of the Quality Assurance role within Princess Alexandra Hospital, various testing processes have been automated in the Nervecentre Emergency Department along with data flow in downstream systems.
Why? The trust is working to implement an agile approach and shift away from traditional manual testing.
What happened? Leapwork, a visual, no-code test automation tool, was used for the test automation. By switching to Leapwork, the trust employed 60+ critical day-to-day processes as test scenarios to ensure that assessments, observations, admissions and discharges within the emergency department worked as expected. Data from these systems is sent to relevant downstream systems such as Sunquest ICE, JAC, Chemocare, e-letters and Dr Doctor. As a result of this project, Quality Assurance teams have been able to build seamless test flows and shift expertise away from manual testing. Daily reports are now run which are sent to stakeholders to ensure that the environment is stable, and pre-regression and post-regression testing is taken care of by scheduled runs. As a result, the trust can introduce more and more critical workflow use cases and increase coverage to include almost all possible scenarios in the ED.
Looking ahead. The trust plans to cover inpatient and outpatient workflows along with patient registrations. Using a patient engagement platform to make data-driven decisions, activating patients through self-booking and providing remote care further demonstrates the goal of increasing hospital efficiency.
Antser
Overview: Councils in three London boroughs – Redbridge, Waltham Forest and Enfield – partnered with Antser to use VR technology with young people identified as being at significant risk of Extra-Familial Harm (EFH), along with their parents, carers and the professionals working with them.
Why? The biggest concern for practitioners was young people’s involvement in drug dealing and other criminal activities, so it was hoped that the VR films could be used as an intervention tool.
What happened? Immersive VR films were used as interventions for 34 young people to date. Discussion then followed in which participants were encouraged to consider what they had watched, with topics such as what exploitation looks like, how signs can be recognised, and reflections on own behaviour. In 30 out of the 34 cases, practitioners said it helped them feel more confident in discussing related issues with the young people and their parents. When used with parents, 16 out of 18 said they had a better understanding of the experiences their child may be going through, and 15 said they felt better equipped to talk to their child about it. 17 of the 18 parents said that they now feel more able to discuss how to protect and support their child with the practitioner since using VR. Antser notes the joint working approach as particularly innovative in this area.
Looking ahead. VR has been shown to be an effective, efficient and engaging way to educate young people and the individuals supporting them, offering ‘perspective-taking’ and simulating real-life experiences.
C2-Ai and Cheshire and Merseyside
Overview: The Cheshire and Merseyside (C&M) model, built around an AI-backed prioritisation system from C2-Ai, was commissioned by NHS England and implemented by the team at St Helens and Knowsley NHS Trust.
Why? The current approach to position patients is a manual process which indicates whether patients should be seen in the next month, one to three months, or four months onwards. It is time-consuming and can be inconsistent. The aim of this system to ensure that the right patient is seen at the right place at the right time with the right team.
What happened? The C2-Ai system risk stratifies the elective surgical waiting list based on clinical risk (for mortality and morbidity risk) and urgency (risk of deterioration), as well as incorporating the impact of social determinants of health. C2-Ai has combined and automated existing AI-backed systems in use by the NHS and globally, building on 30 years of research and around the world’s biggest referential patient dataset. Historic hospital data is used to consider permutations to derive each patient’s medical conditions. The data is then combined with the prospective operation to achieve a priority score based on detailed calculations for risks for the patient today and if the procedure is delayed. NHS reporting indicates an 8 percent reduction in emergency admissions; 5 minutes saved per triage per patient every time the list is reprioritised; opportunity cost savings of £187k across 20,000 patients; and more.
Looking ahead. The C&M model has been deployed at multiple trusts and ICSs and the approach has been submitted for publication in the Annals of the Royal College of Surgeons.
The Princess Alexandra Hospital NHS Trust and NDL
Overview: Introducing fully autonomous referrals, The Princess Alexandra Hospital NHS Trust implemented end-to-end processing through a combination of robotic process automation and e-Form technology.
Why? Through the trust receives referrals electronically, inputting these into its EHR was a manual process. Admin teams faced a very time-consuming tasks and sometimes could not meet demand.
What happened? The trust identified that the process would benefit from end-to-end processing. Collaborating with NDL Software and following a joint project delivery methodology, it began to investigate and scope opportunity to implement a combination of technologies – RPA and e-Forms. Bots now feed referral information into the EHR in real time, making information instantly available to clinicians. Bots now complete 89 percent of all admissions automatically, saving 14 hours per day on average. A bespoke e-Form was created to ensure that automations can be managed and controlled easily without needing to understand code. Process controls allow users to start and stop the overall automation, and job control provides transaction status which allows individual referrals to be stopped or reprocessed where required. During the pilot and subsequent development, a programme governance structure, process evaluation and RoI calculation mechanism were established to ensure that the trust only evaluates processes meeting a minimum RoI hurdle rate. Tangible benefits include improved staff and patient experience and improved data quality.
Looking ahead. The trust plans to recruit a specialist team to focus specifically on end-to-end projects and is currently focused on sharing their methodology across the NHS to contribute to sustainable transformation.
Open Medical and The Royal National Orthopaedic Hospital NHS Trust
Overview: The Royal National Orthopaedic Hospital NHS Trust (RNOH) transformed their model of care including referral management, patient-reported outcome measures and elective surgical care pathways with Open Medical’s Pathpoint platform.
Why? RNOH needed a robust digital solution to optimise their referral triage and management process; prior to Pathpoint, they received referrals via many different means including phone, faxes, emails and letters.
What happened? Pathpoint is spanning 15 subspecialties and more than 50 different pathways across the entire trust, tailoring for each speciality so that every department receives an agile interface that fulfils their need. All referrals are now received through Pathpoint’s single unified portal which integrates with the national electronic referral system and captures real-time, granular, structured clinical data. Referrals from secondary to tertiary care have mandated fields that provide all relevant clinical information, eliminating back-and-forth conversations and saving time. The cloud-based system enhances visibility across departments and teams to facilitate effective planning. The system is fully automated with updates and triggers depending on the date of the operation and uses conditional logic to send patient questionnaires based on the type of pathway and prior scoring.
Looking ahead. RNOH will soon be going live with Pathpoint Surgicare to digitally transform their end-to-end surgical care pathways, connecting every step from decision to operate through to post-operative discharge. Open Medical can update the platform as clinical and system requirements change to ensure that protocols and care models are rigorously followed as they evolve.
Intouch with Health and University Hospitals Dorset NHS Foundation Trust
Overview: Intouch with Health worked with University Hospitals Dorset NHS Foundation Trust to create a remote outpatient assessment clinic on the top floor of a department store, delivering high-volume, low complexity face-to-face outpatient screening and appointments.
Why? The purpose-built centre plays a vital role in tackling hospital waiting lists and increasing the volume of life-saving screening as part of the trust’s ThinkBIG initiative.
What happened? End-to-end digital patient flow pathways and PAS integrated data management were key to the daily operation of the remote clinic to ensure that all appointment and associated outcomes data was integrated fully. To facilitate this, the trust collaborated with digital patient flow solution providers Intouch with Health. Intouch with Health extended the use of its Flow Manager dashboard from the trust’s main hospital sites to the remote clinic, ensuring full PAS integration. The project opened in December. In the first nine months, 8442 patients were seen across nine services; there was a 52 percent reduction to the orthopaedic elective non-admitted waiting list; and dermatology nearly tripped their pre-pandemic capacity, seeing up to 96 patients in a three-hour morning clinic compared to a previous average of 33 per clinic.
Looking ahead. It is hoped that the project will form a blueprint for similar projects nationwide, helping to deliver an expansion of community testing centres that will significantly increase NHS capacity to deliver critical diagnostic services to tackle the backlog of appointments.
T-Pro
Overview: A number of NHS organisations have selected T-Po’s speech and natural language processing technology and robotic process automation (RPA) to support their digital transformation inititives.
Why? T-Pro provides flexible, cloud-based digital solutions that save time for healthcare staff with administration tasks. Technology such as speech recognition, natural language understanding and workflow automation tools mean that each workflow can be tailored for the individual user.
What happened? Kent Community Health NHS Foundation Trust uses T-Pro’s Virtual Consultation Platform, eClinic Manager, which assists them with automatic scheduling, patient communication, waiting room management, and updating attendance and outcomes back in the EPR. Rotherham NHS Foundation Trust chose T-Pro to improve speed, accuracy and quality of documentation, with T-Pro’s digital dictation workflow platform handling all stages of documentation process from creation to distribution and every step in between. Staff have been provided with an intuitive interface enabling them to create, track, transcribe and manage workloads centrally, as well as leveraging additional options such as AI-powered speech recognition. This has led to greater efficiencies and has reduced the workload for all staff involved in the production of medical letters.
Looking ahead. T-Pro was recently awarded the contract to provide its speech-to-text solution to Practice Plus Group, England’s largest independent provider of NHS services, with the project commencing in October 2022. As part of this, the speech recognition software will support the capture of more detailed, accurate notes and documentation in real time.
PredicAire
Overview: PredicAire provides an outcome-based solution for care providers. Launched in 2021, its holistic care management system uses artificial intelligence to provide better outcomes through better data.
Why? Part of the CQC’s new assessment framework includes six new categories of evidence to be collected, including people’s experiences, feedback from staff and leaders, observations of care, feedback from partners, processes, and outcomes of care. PredicAire was built on the fact that observations and outcomes are to play a greater role in the delivery of care. Changes in the social care sector and costly delivery of care to a rapidly ageing population puts care providers under extreme pressure and PredicAire sought to challenge the traditional model by focusing on outcomes through use of AI to predict and prevent proactive interventions.
What happened? The team took their own experiences of care and applied it to produce an AI-powered end-to-end solution focusing on efficiency, comprehensiveness and affordability, aiming to provide the best outcomes for all stakeholders in the value chain. The system is an AI-enabled, single-sign-on integrated CMS that optimises resident and staff wellbeing within an intuitive, secure and safe digital environment.
Looking ahead. PredicAire’s founders are to participate and lead sessions in innovation and digital theatres at trade shows, sharing their vision of the adoption of AI technology in social care. They are also in advanced discussions with several universities regarding the possibility of collaboration on a key research project.
