Digital technology transformation of outpatient services€¦ · transformation of outpatient...

Digital technology transformation of outpatient services

22 June 2018

#digioutpatients

Welcomefrom

Guy Boersma, Managing Director, Kent Surrey Sussex Academic Health Science Network

&

Nicki Bromwich, Head of Digital, Oxford Academic

Health Science Network

Agenda

10:00 - Introductory presentations

10:20 - Case studies

11:00 - Industry Insights

11:20 - Break

11:35 - Workshop

12:35 - Feedback

13:00 - Next steps

13:05 - Close

13:10 - Lunch and networking

Digital outpatient appointments

Cathy Franciscathyfrancis@nhs.net

22/06/2018

A Digital World. A Shift of Power?

• Where does power lie in 2018?

5

A Digital World….

• Or is it here?

6

A Digital World…People Power?

7

Digital in Healthcare

8

Internet Activities by Year 2007, 2015 and 2016, Great Britain

>50%

9

Nationally, increased from around 1.1m to 1.8m

In the South 1st attendance tele-appointments

almost doubled

Subsequent attendances in the South

increased from around 255,000 to almost

480,000

So… digital outpatient appointments

The proportion of South 1st attendances that

were tele-appointments was around 2%.

For subsequent attendances in the South,

the proportion was 3.2%.

Data source: Hospital Episode Statistics for England: Outpatient statistics (NHS

Digital)

1/2 of tele-appointments in 10 specialties

10

South providers with highest proportion of tele-appointments

11

Berkshire Healthcare NHS

Foundation Trust

Plymouth Hospitals NHS

Trust

Great Western Hospitals NHS

Foundation Trust

Royal United Hospitals Bath

NHS Foundation Trust

Portsmouth Hospitals NHS

Trust

% tele-appointments

8.0% 7.2% 6.4% 5.3% 4.8%

Main specialities (number)

Community medicine;

Nursing episode

Ophthamology;

Paediatrics;

Trauma & Orthopaedics

Trauma & Orthopaedics;

Allied Health Professional

episode;

Nursing Episode

Midwife episode;

Endocrinology;

Clinical haematology

Rheumatology;

Clinical haematology;

Allied Health Professional

episode

Main specialities (proportion)

Palliativemedicine;

cardiology;

GU medicine;

General medicine

Radiology;

Clinical immunology &

allergy;

Nuclear medicine

Clinical pharmacology;

Clinical haematology;

Geriatric medicine

Midwife episode;

Endocrinology;

Clinical haematology

Rheumatology;

Clinical haematology;

Anaesthetics

Variation between providers - Clinical haematology

12

Digital outpatients could also deliver large financial or capacity improvements

13Source: 2012 DH Report

Examples of good practice

Oxford Health – Telepsychiatry in ED

Emergency 24/7 psychiatric service at John Radcliffe Hospital and Horton

General Hospital (25 miles away)

Oxford Health: Telepsychiatry in ED

16

• Quicker response, facilitating

faster discharge from ED

• Convenient appointments

• Care can continue when

patients are on holidays

• 50% of patients seen remotely

• Saving estimated 444 hours of

clinical time annually

• Not dependent on availability of

outpatient rooms

Oxford Health: Telepsychiatry in ED

17

“It really helped me cope with my

emotions better”

“…really just surprised how personal

the experience was”

“I found this extremely useful,

convenient and actually enjoyed my

session”

“It is brilliant that there is no travel or

expense involved”

Surrey and Borders Partnership –IAPT

Surrey and Borders Partnership: IAPT

19

Patient feedback

“I was not entirely sure about Skype Therapy and what it would be like. However I have found the experience of video sessions great as if I am in the room with the therapist.”

“I use Skype regularly to talk to my colleagues and for meetings so

having therapy sessions on Skype has been really convenient.”

“Having skype sessions give me flexibility to attend more sessions as I can have them in the comfort of my own home.”

IAPT E-Consultation Goals

People

Improve quality of care

delivery

User friendly platform

Improved flexibility for

clients

Improved clinician/client

connectivity

Improved flexibility for

clinicians

Improved Value

Surrey and Borders Partnership: IAPT

20

Unexpected benefitsClinician feedback

“A young Surrey man who is at university in another part of the country was able to be supported immediately by Skype which allowed for continuity of care.”

“More clients are choosing SKYPE over face to face when I assess them as they have busy

lives and are used to this platform.”

“With the introduction of Skype for business I was able to be more flexible to client need.”

Live document sharing with clients

Use of whiteboard to support discussion

Clinical benefit of non-verbal communication

• Start somewhere

• Ambition/targets

• Learn from each other

• Join digital outpatient learning network

cathyfrancis@nhs.net

21

The Challenge

Thank you

Timely care of long-term conditions

Dr Azhar Ansari

Dr Antony Aziz

Dr Patrick Kerr

Mr Jeremy Hyde

22nd June 2018

Normal colon Severe colitis Ileostomy

Blocks

Reliance

on

healthcare

Capacity

vs

demandRescue

vs

prevention

Flar

e

Poor experience

Poor outcomes

Mild/Moderate

Flare

Delay in

advice

and treatment

Assessment

Severe Flare

Delay in

disease-

modifying

treatment

Stable

Pathway map

DELAY

Core elements

Patient

activation

Flare to

care

Disease

modifying

therapy

Flar

e

Poor experience

Poor outcomes

Mild/Moderate

Flare

Delay in

advice

and treatment

Assessment

Severe Flare

Delay in

disease-

modifying

treatment

Stable

Pathway map

DEL

AY

Open access:

telephone, email, PKB

FAST

Mild/Moderate

Flare

Timely advice

and treatment

Severe Flare

Timely

disease-

modifying

treatment

Good

experience

Improved

outcomes

Flar

e

Good

experience

Improved

outcomes

Mild/Moderate

Flare

Timely advice

and treatment

Assessment

Severe Flare

Timely

disease-

modifying

treatment

Stable

Pathway map

FAST

Open access:

telephone, email, PKB

Patient activation

• Non face-to-face service• Web-based patient portal (PKB)

• Self management

• Patient taking responsibility

Flare to care• Strip out complexity

• Simplify communication

• Early identification and treatment

• Clinician skillset mapped to patient need

Disease modifying therapy• Low dose azathioprine with allopurinol (LDAA)

• Well-tolerated, safe and effective

• Reduced use of expensive monoclonal therapy

• 90% reduction in admissions and

80% reduction in operations

Key learning• Conceptual buy in to new model

• Patient activation with PKB

• IBD nurse capacity to match open door

• Training and support for nurses/admin

• GP engagement for shared care prescribing

Change resistance• Improving outcomes reduces trust income

• In 2015 – 80 less admissions, 132 less ED attendances, 440 less OPD attendances

• Clinician fear of open door access

• Lack of commissioning and funding model

• Investment required for IT solutions

Thank you - any questions?

For further discussion

Provider Centred

Patient Has a Flare

between appointments

GP

Referral

IBD Service

12

wks

Treatment failure

and or

Hospitalisation

Treatment success

1-2 wks

LATE INTERVENTION

Report need

for Help

Improved Outcomes

Early

confirmation

of Flare

• Email, Telephone

• Patients Know Best

• IBD Registry

Pathway: patient reported and open access

Report stability

Patient with

IBD

Record

stabilityDefer scheduled hospital

apptEarly Intervention:

Out patient appt,

Medicines,

Operations,

Hospitalisation

Record

instabilityTrigger action

for help

0

10

20

30

40

50

60

70

2009 2012 2015

Crohn's Disease Ulcerative Colitis Pouch Surgery

Ulcerative colitis

Pouch surgeries

Crohn’s Disease

0

100

200

300

400

500

600

700

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Azathioprine+Allopurinol use

Azathioprine

Surgical rates

60%

34%

6%

71%

23%

6%

83%

11%6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Yes No Not sure

Do you believe that your IBD has been well controlled in the past two weeks?

Prospective 0 months Prospective 4 months Retrospective

60%

29%

11%0%

34%

29%

23%

14%

23%

11%

40%

26%

0%

10%

20%

30%

40%

50%

60%

70%

1 (low) 2 (low) 3 (medium) 4 (high)

PAM level

prospective 0 months prospective 4 months retrospective

PharmaceuticalsPharmaciesSecondary care/

Hospital

Specialist services

Community teams

Employers

RelativesGP

Charities & Patient Advocacy

Groups

Government & Commissioning

bodies

Researchers

Mobile device and

app developers

Patient

Social services

Primary care

services

The current service structure

Patient becomes a stakeholder in their own health

Pharmaceuticals

Pharmacies

Secondary care/

Hospital Specialist services

Community teams

Employers

Relatives

GP

Charities & Patient Advocacy

Groups

Government & Commissioning

bodies Researchers

Mobile device and app

developers

Social services

Primary care

services

Patient

Optimum Architecture for PHRs

Feb 2018

Adrian ByrneCIO at UHS

Chair of CIO networkINTEROPen board member

Occasional sock wearer

@adebyrne

PHR - A new future ?

• Set out our vision for PHR in 2012

• Implemented an “untethered” model

• A patient centred approach

• Work across the UK – various hospitals

• Have led the development for Prostate Cancer UK programme

Digitally Mature Personal Health Records (PHRs)

Open Platform

PHR

Front EndApplications

Open APIs

Specialised

Interactive

Broad

Digital Maturity Model for PHRsbased on KLAS model

Basic

• View information• Newsletters • General Trust

communications• Appointment

reminders

• Gathering patient input e.g.

demographics• General surveys e.g.

PREMS• Provide results

• Condition specific • Targeted surveys

e.g. pre appointment

• Educational Videos • Reminders for tests/

medication checks• Protocol driven

information push• Wearables

• Pre op assessment • Consent

• Post discharge follow up

• Support self management

• Virtual interactions• Customised surveys

and feedback loops (red flag questions)

Enabling patient centred care

Open platform

Open platform

xn

UHS

My medical record

The transactional record

Appointment cancellations, updated demographics, allergies, medications etc.

Journals and surveys, secure messaging

Appointments, documents, Lab results & Radiology result messages, secure messaging

PatientUHSFT

Open Platform PHR

• If every app has it’s own data platform you will have chaos

• If every app has its own user account process you will have chaos

•NEED:•PHR platform like a vendor neutral archive•A federated identity scheme

The OpenPHR

• NHS Brand (Trademark)

• Based on a US product• Connected Health Base

• Hosted in Azure

• Has open connectivity (FHIR)

• Allow federated identity for apps

• Control proxy access

• Provide APIs to apps/developers

• Security

• Test environment

OpenPHR is Light on Function

Supported Self Management (SSM) Workshop

• 3.5 hour workshop

• 8-12 men

• Way of working (Ground rules)

• Introduction to SSM (quiz)

• PSA Tracking & Surveillance

• Health MOT

• Fear of recurrence

• How to contact the clinical team?

Challenges

• Working with the clinical teams – time to develop content

• Patient engagement

• Patient registration / consent

• Technology

• Lack of national standards

Improved care for staff

New roles

Faster

recalls

Safety netMore

effective

Where Next?

• Spread of the existing use cases

• Growth in UHS• Part of GDE programme reduces outpatients 20%

• Growth in STP• Maternity

• Encourage others to connect• University developers

• Other apps

“I was invited to use My health record and asked to

weigh myself using the digital scales once a week.

As I was going through a rough patch it was good

to know that there were people keeping an eye on

how I was doing. If my weight went down too low

then I would automatically get contacted by a

member of the clinical team.

I also used the messaging function in the system. It

is comforting to have a simple way of telling people

you are not feeling well” – IBD patient

Frugal innovation: Videoconferencing in

practiceDarren Woodall

Trust Innovation Lead

Frugal innovations

Frugal innovation responds to limitations in resources, whether financial, material or institutional, and using a range of methods, turns these constraints into an advantage.

Drivers for Change

• New Models of care

• Reduced resources in both financial terms and specialised personnel

• An Ageing population

• Drive towards a single point of care

• Technology savvy consumers

• Geography

Vision of Our Trust

• Be empowered to manage their own health and care needs

• Work in partnership with professionals

• Only tell us their story once

• Access seamless care easily

• Have care in or close to home, whenever appropriate

• Work together as a community to look after health and care needs.

Video conferencing….nothing new!!

Creating the value… The journey

Without a value based network …there is no network!

• Peer to peer

• Clinician to Clinician

• Patient to Clinician

• Education

End user Design

Example of a value based video conferencing solution

The vision of Video conferencing

• Create value based networks in all areas of healthcare delivery

• Create a controlled interactive sign posting service for healthcare providers ( air traffic control analogy )

• Creating a culture change in communication lines

• The right people at the right time making healthcare related decisions in real time

Current Statistics

• Current platform is IOCOM Visimeet

• GP Practices across Torbay and South Devon 18 practices with 75 licences

• Care Homes across Torbay and South Devon 18 care homes with 23 licences

• ICO staff 340 licences across more than 23 teams

• Other For example Rowcroft Hospice, South Devon and Torbay CCG, Devon LMC, SWAHSN, RD&E, DCC, DPT, Torbay Pharmaceuticals

• April 2017- March 2018 over 2000 V/C Meetings

Questions

Industry Insights

The 2 Minute Challenge

Name: Big Hand

Local HQ: London

Website: www.bighand.com

Twitter: @BigHandHealth

Presenter: Daniel Eyre

Email: daniel.eyre@bighand.com

Name: Cerner

Local HQ: London

Website: www.cerner.com

Twitter: @Cerner

Presenters: Isabel Drake & Wale Lawal

Emails: isabel.drake@cerner.com & wale.lawal@cerner.com

Name: Cievert

Local HQ: London

Website: www.cievert.co.uk

Twitter: @CievertLtd

Presenter: Alex Blakoe

Email: alex.blakoe@cievert.co.uk

NHS HSCN

doc@HOME – Out of Hospital Remote Monitoring

CarePortal™

Tablet/Phones

ADT data

ClinicalDatabase

doc@HOME®

Various Patient Interaction Options• Patient Need

• Technical and Cognitive Ability• Video consultation, e-PROMS, Chatbot,

etc

Clinician Access

Hospital EPR/PAS

Patient Portal

Name: Docobo

Local HQ: Surrey

Website: www.docobo.co.uk

Twitter: DocoboUK

Presenter: Adrian Flowerday

Email: adrian.flowerday@docobo.co.uk

Name: DrDoctor

Local HQ: London

Website: www.DrDoctor.co.uk

Twitter: @WeAreDrDoctor

Presenter: Mark Bartlett

Email: mark.bartlett@drdoctor.co.uk

Name: Healthcare Communications

Local HQ: London

Website: www.healthcare-communications.com

Twitter: @healthcommuk

Presenter: Mike Cunningham

Email: mcunningham@healthcomm.uk

Name: Health & Care Videos

Local HQ: Torquay

Website: www.healthandcarevideos.com

Twitter: @hcvlibrary

Presenter: Hugh Kelly

Email: hugh@healthandcarevideos.com

Name: Physitrack

Local HQ: London

Website: www.physitrack.com

Twitter: @physitrack

Presenter: Rosalind Heys-Limonard

Email: rhl@physitrack.com

Name: Synopsis Healthcare

Local HQ: London

Website: www.synopsishealthcare.com

Twitter: @Synopsis_Health

Presenter: Mike Applewhaite

Email: michael.applewhaite@synopsishealthcare.com

Problem Solving and Analysis Roundtable Workshop

Table themes

• Referrals: from GPs, other referrals

• Appointments: booking, rearranging, cancelling, emergency, last minute

• Wayfinding: tracking, signage, check-in

• Information gathering/ dissemination: pre-appointment questionnaires, e-letters, PROMs

• Remote/ digital consultation: video, phone, chatbots

• Portals: patient portals

Next steps and actions…

Enjoy your lunch and networking!

Contact your local AHSN for support:

www.kssahsn.net

www.oxfordahsn.org

www.swahsn.com

www.oxfordahsn.org

www.weahsn.net

You can access 3 feedback questions by going to:

http://digitaloutpatientsevent.typeform.com/to/XAff7b

….and all resources using this link:

https://www.swahsn.com/event/channel-shift-to-digital-outpatients-event/