Using HCI in Rheumatology in Torbay and South Devon Foundation NHS Trust to educate, inform and support patients.

The outcomes

• Lower cost or higher value
  • Fewer calls and appointments
    • 42% reduction in daily helpline calls - 70 a day down to 40
    • 90% removal of face to face sub-cut methotrexate appointments
    • 100% of new start patients for DMARDs, sub-cut methotrexate and biologics educated remotely through the app
    • 75% reduction in appointments for patients stable on biologics
  • Releases nurses from patient education to patient care
    • 75% weekly saving in nurse time educating patients - 16 hours a week reduced to 4 hours
  • Conditions better controlled requiring fewer interventions
    • 25% improvement in terms of their understanding of how to manage their condition
    • 28.5% improvement in their confidence in undertaking physiotherapy independently
  • More efficient preparation for treatment
• Better care/better outcomes
  • Reduced waiting times
    • Rheumatology medication start time down from 3 weeks to 1 week
  • Multi-morbidity data from the patient’s home enabling more precise interventions and remote care
  • Consistent information provision
    • Patient feedback averages 9 out of 10
    • Patient and clinician feedback video - https://vimeopro.com/healthandcarevideos/connectplus/video/617901842
• Better patient/staff experience
  • Visibility of the whole patient, not just a disease
  • Dashboards for individual patients and cohorts
  • Time created to care for those in most need
  • Personalised to your local clinical and system needs
• Better staff patient/quality of life
  • 3Es - Educated, Empowered and Engaged patients participating in their own care, at home
    • 100% of new start patients for DMARDs, sub-cut methotrexate and biologics educated remotely through the app
  • Feedback loop for their disease progression though the symptom trackers
  • Sense of connection to their own health providers

Using HCI for colonoscopy pathways in West Hertfordshire Hospitals NHS Trust to educate, inform and prepare the patients for their procedures.

Project objectives

• Enhanced efficiency from:
  • Better prepared bowels leading to fewer repeat and aborted procedures
  • Better educated and prepared patients resulting in shorter appointments
  • Released capacity
• Improved patient experience

Outcomes

• Bowel preparation
  • Increase in patients with good or excellent bowel preparation from 79% to 85%
  • Increase in patients with excellent preparation rising from 33% from 24%
• An improvement in bowel preparation reduces the number of repeat colonoscopies by 6%. In a unit undertaking 5,000 colonoscopies a year this saves:
  • 300 repeat visits, and
  • Saving £110,000 each year

Return on Investment

• A 5 times payback every year
• A reduction in the backlog of 300 patients pa by reducing the number of return visits
• A increase in tariff income if paid on a per patient/procedure basis
• Plus an improved experience and reduced number of visits for patients
• Plus a reduction in carbon footprint due to fewer visits to the the Endoscopy Units

Figures based on outcomes from: A Service Evaluation of Patient Educational Bowel Preparation videos- improving the quality of bowel preparation for colonoscopy

Natarajan B, Purkis E, Landy J. Endoscopy Department, West Hertfordshire Hospitals NHS Trust, Watford, UK

The results show an increase in patients with good or excellent bowel preparation from 79% to 85% and an increase in patients with excellent preparation rising from 33% from 24%

The following is an example project that is underway in surgery where we haven’t yet concluded the evaluation. These are the targets that have been set by the Clinical and Operational Teams.

Hip and Knee Osteoarthritis Pathways

Using CONNECTPlus to provide patients with hip and knee osteoarthritis with support in the community and pre and post operatively.

Deploying CONNECTPlus as a Decision Aid for patients with hip and knee arthritis to empower fewer patients to choose non-operative treatment (based on Coulter and Collins (Making Shared Decision Making a Reality: No decision about me, without me (2011)).

• 1 to 2% reduction in operative treatment saving £100,000 to £200,000 per annum
• Release of theatre space
• Improved understanding of treatment options
• Reduction in the number of helpline calls
• Enhanced patient experience and increased satisfaction with treatment decision
• Management of expectations and decreased decisional regret

Structured Exercise and Self-Management Programmes

Digital delivery via CONNECTPlus of Structured Exercise and Self-Management Programmes for patients with chronic joint pain combines education, self-management advice, lifestyle (cessation of smoking, weight loss, avoidance of falls) and coping strategies with an exercise programme plus the ability to track patients completion of exercises.

• Release of staff capacity (self-directed exercise programmes)
• Reduced levels of patients selecting operative treatment
• Improved compliance with non-operative therapies (analgesia / exercise etc)
• Improved patient physical and mental health
• Avoidance of need for patients to travel

Symptom tracking

Symptom tracking through CONNECTPlus (such as pain, sleep disturbance, and step count using an integration with Garmin devices), to provide positive feedback and encourage compliance with their self-management activities and to provide objective data for healthcare professionals to assess disease progression via remote monitoring.

• Reduction in the number of outpatient visits
• Reduction in post-operative admissions and overnight stays per year
• Reduction in long term complications due to earlier intervention
• Improved outcomes through improving health pre-op

Joint School

Hosting the Joint School on CONNECTPlus to enable patients to access this content remotely, share it with their family and review it at any time.

• Release of staff capacity (targeting at least 4 hrs Band 6/7 AHP time per week)
• Avoidance of need for patient travel to hospital
• Improved patient satisfaction and compliance through managing expectations around enhanced recovery pathway

Education and Consent

Assurance to health care professionals that patients have reviewed and understood material relating to a procedure and have had the opportunity to ask questions.

• Supports Montgomery compliant consent
• Reduced risk of patient decisional regret
• Potential reduction in complaints and litigation

Post Operatively

Using the ability to track post operative symptoms through CONNECTPlus (pain, analgesia use, mobility, swelling, wound appearance, and step count using an integration with Garmin devices) to shift to targeted follow up. Only those patients with symptoms scores indicating a delayed recovery will have a follow up consultation in order to identify whether additional input is required.

• 80% reduction in follow up consultations
• Improved patient experience / avoidance of long term complications
• Standardisation of pathway across service

The following is an example project that is underway in surgery where we haven’t yet concluded the evaluation. These are the targets that have been set by the Clinical and Operational Teams.

Objectives

Using CONNECTPlus to digitise high volume low, complexity perioperative pathways to support patients who are waiting for surgery and to establish a digital triage system for pre-assessment:

• Triage patients through appropriate remote pre-op assessment and preparation pathways
• Provide information regarding the day surgery pathway
• Support patients to improve health through prehabilitation (underlying condition management, physical fitness, nutritional status, psychological preparation, alcohol and smoking cessation)
• Enable enhanced recovery after surgery through information provision and remote monitoring

Targeted outcomes

• Improved Efficiency
  • A pool of patients who are confirmed ‘fit to go’.
  • Shorter waiting times.
  • Reduced late notice cancellations.
  • Consistent pathway management.
• Better care/better outcomes
  • Early and improved information sharing pre and postsurgical preparation.
  • Better prepared patients for surgery.
  • Nursing and anaesthetic time redirected to the highest risk patients.
  • Reduction in admission and readmission rates.
• Better Patient/Staff Experience
  • Savings in staff time.
  • Improved patient satisfaction scores.
  • Improved interaction between clinician and patient.

The following is an example project that is underway in surgery where we haven’t yet concluded the evaluation. These are the targets that have been set by the Clinical and Operational Teams.

Objectives

Using CONNECTPlus to create a Colorectal "Surgical School" app which explains the inpatient journey, setting expectations around enhanced recovery and goal setting through:

• Education Support
  • Providing a comprehensive suite of information to enable patients to prepare for and recover from colorectal surgery in video and text.
• Digitised Pathways
  • Providing regular prompts and reminders to patients to complete health questionnaires, tracking or to learn about specific topics related to their surgery.
• Symptom Tracking
  • A selection of questionnaires and trackers to monitor progress and to triage patients.

Targeted outcomes

• Improved Efficiency
  • Increased uptake of day case and outpatient procedures.
  • Standardisation of pathways, removal of variation, equity of experience.
  • Saving staff time through provision of information digitally e.g. virtual surgical schools.
• Better care/better outcomes
  • Reduction in need for outpatient attendances / patient travel.
  • Improved compliance with pre-op instructions (starvation etc) / avoidance of cancellations on day.
  • Improved outcomes through improving health pre-op.
  • Accelerated recovery, improved compliance, avoidance of complications.
• Better Patient/Staff Experience
  • Underpins informed consent (Montgomery standard).
  • Decreased decisional regret with potential reduction complaints / litigation.
  • Improved patient experience e.g. pain relief, managing expectations.
  • Improved patient satisfaction and compliance through managing expectations. around enhanced recovery pathway.

Objectives

• To reduce the number of referrals and outpatient appointments by 30%
• Scale up the use of digital enablers

The Team involved

• National bodies - NHS England, College of Optometrists
• Royal College of Ophthalmology
• Charities - Macular Society, Glaucoma UK, Glaucoma Society
• LOCSU, RNIB
• NHS Trusts - Moorfields Eye Hospital, Torbay and South Devon

Delivering

• Localised and disease specific information to the patient
• An enhanced consent process
• Pathway and symptom tracking tools for patients
• Medication and appointment reminder tools
• Photo upload features
• A clinician dashboard triage and patient comms tools
• Rehabilitation pathways

Example impact in Trust with 3000 procedures

• 50% efficiency savings in pre-op appointment length
  • £142,500 and 200 hours p.a.
• 10% efficiency savings in length of diagnosis consultations
  • £35,400 and 400 hours p.a.
• 50% reduction in patient contact post-op (telephone / appointment)
  • £70,800 and 800 hours p.a.

Multiple conditions

We help people better manage all their conditions in a single place so that healthcare professionals can support the whole person, not the disease.

Patient information

An educated patient makes less demand which reduces the number of appointments and reduces carbon emissions.

Remote monitoring of symptoms

Remote monitoring reduces appoints, travel costs, carbon emissions and frees clinicians to focus on the people in greatest need.

Your clinic contact details

Details about your practice, your team, helplines and contact details, makes health systems more accessible especially for people subject to healthcare inequalities.

Treatment Pathways

Treatment programme guide patients through their treatment or care pathway so they are better prepared, are less anxious and can recover quicker, to improve their wellbeing.

FAQs

Helps people with multiple conditions to better manage their conditions, reducing the risk of exacerbation and preventing resultant costs in terms of appointments, increased medication and hospital stays.

Over 1,000 patient videos

Multimedia information for people with low literacy skills, as well as supporting people from ethnic minority and excluded communities with information in their preferred language in order to make information more accessible.

Medicine management

Reminders improve adherence and disease control, which reduces the impacts of disease exacerbation such as increased medication and hospital stays, which have carbon and economic costs.