Best Use of Technology Nominations

Using intelligent automation to improve patient flow and maximise ‘time to care’

Birmingham and District GP Emergency Room (Badger), a leading provider of OOH and Urgent Primary Care, and Ummanu, a fast-growth healthcare technology company are working together to improve the patient journey and system productivity for Badger’s 1.4 million patient population.

Ummanu’s advanced enterprise SaaS telemedicine platform already serves over 7 million patients and uses intelligent automation to optimise the clinical workforce, reduce operational costs and improve patient flow. 

Ummanu’s predictive dialler and automated queue management with clinical prioritisation maximises ‘time to care’ and supports a sustainable workforce. 

Ummanu’s technology has had a profound impact on Badger’s service provision:

• The automated queue management system eliminates the need for clinicians to review patient lists to identify which case to deal with next.
• The predictive dialler automatically calls the next patient on the list that has been created according to Badger’s assigned clinical prioritisation which ensures urgent
  patients go straight to the front of the queue improving patient safety.
• This call automation has also removed the burden on the clinician to find a number, dial it and wait for the patient to answer, saving an estimated average of 2.5 minutes per initiated call attempt meaning clinicians ‘time to care’ is maximised allowing more
  patients to be seen, faster. This estimated 2.5 mins equates to approx £233,402 per annum even as a conservative estimate. 
• The predictive dialler has reduced the time taken to complete as well as the clinical time used in completing.

“ Following the Adastra outage, we are unable to currently have a complete access to data to analyse, however, at one point during the pilot we saw an unexpected increase in demand from NHS111 which was managed using the same number of clinicians. I sense Ummanu's Virtual Waiting Room is enabling us to cope with an increasing number of cases,” Fay Wilson.

Ummanu’s intelligent automation technology improves the processes in delivering teleconsultations, optimising the clinical workforce and improving productivity. It has enhanced workforce processes, and enabled more time to be spent on patient care. The patient flow is now more efficient and enables clinicians to deal with more patients without raising pressure. This, at a time of clinical workforce shortage and burnout and a stressed system, is an exceptional use of technology.

Supporting video file: https://youtu.be/xSlGnkZEv20

Kernow Health CIC provides an out of hours service where clinicians undertake home visits to those requiring urgent medical care. Until recent recently Diesel-powered cars were utilised to provide transport for clinicians when attending patients. This form of transport has a significant impact on the organisations carbon footprint and green agenda. 

In response to this Kernow Health CIC has begun trialling Electric Cargo Bicycles as an alternative transport option. 

The bikes don't have conventional gears, so they are easy to ride even for the novice cyclist. While the idea is very different to previous approaches undertaken, they offer us the ability to cover new areas, especially those where we do not have vehicles currently based and we lose hundreds of clinical hours every year in travel to the visits. We see the Electric Cargo bicycles offering benefits of increased volume of clinical visits, reduced carbon emissions and improved staff wellbeing and health. The electric cargo bicycles have a large front compartment which allow the clinician to carry the equipment and medications to deliver our service in the same capacity as a conventional vehicle. 

On completion of the trial Kernow Health hopes to increase the fleet of Electric Cargo Bicycles to further extend our range across the county and provide and increasingly green service. 

Winner:

In June 2019, Mastercall partner with Norwegian Vital Signs Monitoring solutions provider DIGNIO Mastercall’s Technology Enhanced Living Service provides a combination of Virtual Wards, Remote Monitoring, and hospital at home treatment, be that a care home or in the community.

In 2019, Stockport’s Local Authority commissioned Mastercall Healthcare to explore how remote monitoring technology (provided by Dignio) coupled with an urgent clinical response service could curb high patient flow to hospital in their locality.

In December 2019, the first patient was onboarded, and the ‘Technology Enhanced Living Service (TEL)’ was born (now having delivered over 30,000 virtual bed days). Each patient is assessed holistically, and an individual management plan is developed which addresses frequency of vital sign monitoring and/or the need for a completion of a soft sign questionnaire to proactively monitor patient’s needs.

Our service problem statement: We noticed many patients with chronic long-term conditions and comorbidities did not always manage early indications of exacerbations, thus creating higher demand on the health & social care system leading to increased GP appointments, increased risk of hospital admission and increased use of urgent & emergency care services.

Our service goal: To explore the use of technology (specifically, Bluetooth enabled remote monitoring and intervention) to reduce non-Elective admissions to the local acute trust

• Improve patient care across the system
• Empower patients and community staff to better manage people safely in their own home rather than an acute setting
• Enable efficient and effective care This model has proved highly effective in terms of admissions avoidance and cost saving, identifying patient groups (specific groups) who benefit in the main from monitoring with advanced technology.

Return on Investment SAVINGS ON:

• Calculated system saving of £6.84mil based on 55% admission avoidance for a sample of 1180 patients (av. age 70+); savings and patient numbers continually increase.
• Ambulance dispatch& conveyance time
• A&E arrival time and tariffs
• A&E avoidable admission bed days tariffs
• Average Length of stay once frail patients are brought to the Acutes
• Exacerbations brought on from avoidable Hospital Acquired Infection
• Primary Care impact on time from early intervention and monitoring
• Future admissions avoided via timely stabilisation

Stockport Findings:

• 22days average LOS on virtual ward
• Growing admissions avoidance rate (c55% presently)
• 10,500 bed days over 2years on low estimate of 2 admissions avoided/patient medically audited as a guaranteed urgent admission avoidance; elderly admission and LOS rate used https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016

Highly Commended:

Suffolk GP Federation decided to go through the challenging introduction of SystmOne as the operating IT system for its out of hours service.  The implementation was extremely difficult as there is very little SystmOne expertise nationally and virtually none in the out of hours space. TPP which own SystmOne have historically been uninterested in the market and have left it to the two largest incumbents – Adastra and Cleo.

Whilst the implementation was painful, the outcomes have more than exceeded this:

• Clinicians are much happier to work in our service as they perceive less risk than in other similar services with no direct view of the notes.  This has resulted in many more clinicians happy to work for just a session or two each week because working out of hours is similar to daytime general practice.  As a result, the Federation’s rota has been consistently good and we have, so far, not faced the issues of many similar services.  We believe this is largely because we use SystmOne (alongside our Rota Team which also delivers brilliant support).
• We are able to communicate directly with surgeries through the S1 module which means there is a single patient record that reduces risk across the system.  This includes using safe prescribing which reduces prescribing risks, for example:
• Our clinicians are able to view all existing medication and recent prescriptions.
  • It is very easy to view recent blood test results without the hassle of opening a different system – this is essential for safe prescribing of many medications.
  • Can identify the pharmacies that are open and closest to the patient’s location.
• In the OOH period we support both the DN and hospice teams. A large part of this work is generating drug charts for EOL patients- this is done straight into S1 and then can be accessed and printed off by those teams gibing them quick access which is vital for the care of this group of patients.

From a strategic perspective using SystmOne has many benefits: 

• Out of hours is perceived to be an equal partner with daytime general practice and community services (which also use S1). This means we are invited to all the developmental forums that they attend.
• Commissioners and daytime general practice like us using the same system and would not want the service to transfer to a provider which did not use it. This will be a major help when IUC contract is re-procured.