May 17, 2020

Online consultations: disrupting rather than destabilising

Digital health
Dan Worman, CEO of Refero
6 min
In primary care, GPs are under increasing pressure as numbers decline while the population grows, along with the complexity of cases. It’s clear that...

In primary care, GPs are under increasing pressure as numbers decline while the population grows, along with the complexity of cases. It’s clear that change is absolutely necessary; the future of primary care must be technology enabled.

In November 2017, NHS England launched a £45mn fund to contribute towards the costs for GP online consultation systems, as part of NHS England’s GP Forward View. This money will be split over three years, giving CCGs an annual budget of £15mn. Divide this number by the UK’s 58mn registered GP patients and you get a figure of 26p per patient per annum. This might not sound like much but with the most basic services available for as low as 2p per patient per annum, this fund could revolutionise the delivery of primary care.

Appetite for disruption

We’ve already seen that there is a huge appetite for disruptive technology in GP practices. Usually involving a website or app, online consultations increasingly serve as the first point of contact between a patient and a GP, improving patient access to care and making best use of clinicians’ time.

While there has been controversy surrounding GP at Hand, the free NHS service powered by Babylon, the model has demonstrated the desire for digital-first services from both patients and forward-thinking GPs. In its first seven months, a staggering 40,000 London based patients applied and 200 GPs signed up to the service.

Patients were drawn in by the speed with which they could book appointments (an average 38 minutes) compared to waiting a week or more in traditional practices and the potential to get a same or next day face-to-face appointment with a GP in one of five London clinics.

So far so good but, unfortunately, there’s a flipside; by signing up to GP at Hand, patients were automatically deregistered from their GP practices. And, because Babylon set a stringent set of rules around the patients it would accept, i.e. no long-term conditions, no mental health or pregnancies, they were accused of ‘cherry picking.’

When the ‘worried well’ moved over to the service, GPs were left with only the most complex and challenging cases. Because of the way funding is allocated, as registration numbers declined, this model destabilised rather than disrupted traditional models.

Leave that aside for the moment, and what GP at Hand undoubtedly demonstrates is the appetite for a revolution in the way patients want to access primary care going forward and, moreover, GPs’ willingness to embrace technology to harness new care models. So, with this mind, where do we go from here?

Bridging the gap between disruptive and traditional models

At Refero, we embrace technology that enables new ways of engaging people and connecting them with public services; we firmly believe there is a need to bridge the gap between disruptive technology and the more traditional primary care models by combining the two to deliver the best of both worlds – adding to, rather than taking away from, more established ways of working.

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Ultimately, we believe it’s about arming GPs with the right tools to meet patient needs and improving access to and quality of care. It’s also about driving efficiencies in primary care and easing the growing burden on those at the coal face – the GPs.

Digital all the way…until the virtual door shuts

Today, patients are able to sign up to an online service, send requests to their GP practice such as “do you have my test results?” or “what are your opening hours?”. These non-clinical engagements can be picked up and responded to by a receptionist or administrator. But, the real value comes from the clinical engagements, i.e. the potential for patients to enter their symptoms into an app or web-based portal which, using their demographics, presents back a list of possible ailments (taken from fully ratified and managed NHS information). Patients are then able to click on these links to find out more.

These digital services usually rely on some sort of triage system with red, orange or green flags determining next steps. For example, a green flag might signify a minor ailment and sign-post the patient to a pharmacist for medication, while an orange or red flag would be directed to a practice coordinator to determine whether an appointment is required with a nurse or GP. It really depends upon the individual practice.

However, many online consultation services end there. Because very few platforms on the market today offer virtual appointments, the engagement reverts back to the well-trodden and offline pathway. Take eConsult, for example; it allows patients to submit their symptoms, and offers self-help information, signposting to services, and a symptom checker. But, if an appointment is required, it’s back to the GP practice for a face-to-face consultation. eConsult want to put a stop to unnecessary visits – an admirable cause but, at Refero, we believe there is a vital piece of the jigsaw missing.

We’ve seen that there is a real appetite for virtual appointments in the market. For example, we know that it’s more difficult for older people in care homes to see their GP. Across the board, patients are looking for more agile access to their GPs and many primary care providers are keen to harness the power of technology to drive efficiencies. So, why close the virtual door after initial online engagement?

One platform, multiple uses

We believe the ideal solution is one platform that enables GP practices to pick and choose from a catalogue of services that they might wish to trial or introduce: from messaging and self-help to symptoms checking and consultations (virtual or otherwise), as well as Artificial Intelligence (AI) and analytics.

We like to think of these services as being like a bag of marbles – you could pick up a small one representing basic online engagement or a larger one representing virtual appointments. The key thing is bringing the many services that fall under the umbrella of online consultations together into a single platform, combined with the ability to switch elements on or off according to need.

Joining the dots between primary and secondary care

Patient facing technology is a key part of helping ease the pressure on GP practices but we believe it could and should go above and beyond that to help join the dots between primary and secondary care on the journey towards integrated care.

Today, it’s fair to say that the lines of communication are disjointed. But, looking forward, it is expected that these one to one engagements between patient and GP could become one to many, involving secondary or specialist care providers. This would enable GPs to seek advice and collaborate with healthcare providers outside of their practice. This is a real game changer in the delivery of patient care.

To achieve this, Clinical Commissioning Groups (CCGs) need to take more holistic view when it comes to procuring services. They need to avoid siloed solutions that meet one particular need and instead focus on solutions that can be rolled out regionally, within their Sustainability and Transformation Plan (STP) footprint areas.

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Jun 11, 2021

How UiPath robots are helping with the NHS backlog

6 min
UiPath software robots are helping clinicians at Dublin's Mater Hospital save valuable time

The COVID-19 pandemic has caused many hospitals to have logistical nightmares, as backlogs of surgeries built up as a result of cancellations. The BMJ has estimated it will take the UK's National Health Service (NHS) a year and a half to recover

However software robots can help, by automating computer-based processes such as replenishing inventory, managing patient bookings, and digitising patient files. Mark O’Connor, Public Sector Director for Ireland at UiPath, tells us how they deployed robots at Mater Hospital in Dublin, saving clinicians valuable time. 

When Did Mater Hospital implement the software robots - was it specifically to address the challenges of the pandemic? 
The need for automation at Mater Hospital pre-existed the pandemic but it was the onset of COVID-19 that got the team to turn to the technology and start introducing software robots into the workflow of doctors and nurses. 

The pandemic placed an increased administrative strain on the Infection Prevention and Control (IPC) department at Mater Hospital in Dublin. To combat the problem and ensure that nurses could spend more time with their patients and less time on admin, the IPC deployed its first software robots in March 2020. 

The IPC at Mater plans to continue using robots to manage data around drug resistant microbes such as MRSA once the COVID-19 crisis subsides. 

What tasks do they perform? 
In the IPC at Mater Hospital, software robots have taken the task of reporting COVID-19 test results. Pre-automation, the process created during the 2003 SARS outbreak required a clinician to log into the laboratory system, extract a disease code and then manually enter the results into a data platform. This was hugely time consuming, taking up to three hours of a nurse’s day. 

UiPath software robots are now responsible for this task. They process the data in a fraction of the time, distributing patient results in minutes and consequently freeing up to 18 hours of each IPC nurse’s time each week, and up to 936 hours over the course of a year. As a result, the healthcare professionals can spend more time caring for their patients and less time on repetitive tasks and admin work. 

Is there any possibility of error with software robots, compared to humans? 
By nature, humans are prone to make mistakes, especially when working under pressure, under strict deadlines and while handling a large volume of data while performing repetitive tasks.  

Once taught the process, software robots, on the other hand, will follow the same steps every time without the risk of the inevitable human error. Simply speaking, robots can perform data-intensive tasks more quickly and accurately than humans can. 

Which members of staff benefit the most, and what can they do with the time saved? 
In the case of Mater Hospital, the IPC unit has adopted a robot for every nurse approach. This means that every nurse in the department has access to a robot to help reduce the burden of their admin work. Rather than spending time entering test results, they can focus on the work that requires their human ingenuity, empathy and skill – taking care of their patients. 

In other sectors, the story is no different. Every job will have some repetitive nature to it. Whether that be a finance department processing thousands of invoices a day or simply having to send one daily email. If a task is repetitive and data-intensive, the chances are that a software robot can help. Just like with the nurses in the IPC, these employees can then focus on handling exceptions and on work that requires decision making or creativity - the work that people enjoy doing. 

How can software robots most benefit healthcare providers both during a pandemic and beyond? 
When the COVID-19 outbreak hit, software robots were deployed to lessen the administrative strain healthcare professionals were facing and give them more time to care for an increased number of patients. With hospitals around the world at capacity, every moment with a patient counted. 

Now, the NHS and other healthcare providers face a huge backlog of routine surgeries and procedures following cancellations during the pandemic. In the UK alone, 5 million people are waiting for treatment and it’s estimated that this could cause 6,400 excess deaths by the end of next year if the problem isn’t rectified.

Many healthcare organisations have now acquired the skills needed to deploy automation, therefore it will be easier for them to build more robots to respond to the backlog going forwards. Software robots that had been processing registrations at COVID test sites, for example, could now be taught how to schedule procedures, process patient details or even manage procurement and recruitment to help streamline the processes associated with the backlog. The possibilities are vast. 

The technology, however, should not be considered a short-term, tactical and reactive solution that can be deployed in times of crisis. Automation has the power to solve systematic problems that healthcare providers face year-round. Hospital managers should consider the wider challenge of dealing with endless repetitive work that saps the energy of professionals and turns attention away from patient care and discuss how investing in a long-term automation project could help alleviate these issues. 

How widely adopted is this technology in healthcare at the moment?
Automation was being used in healthcare around the world before the pandemic, but the COVID-19 outbreak has certainly accelerated the trend.  

Automation’s reach is wide. From the NHS Shared Business Service in the UK to the Cleveland Clinic in the US and healthcare organisations in the likes of Norway, India and Canada, we see a huge range of healthcare providers deploying automation technology. 

Many healthcare providers, however, are still in the early stages of their journeys or are just discovering automation’s potential because of the pandemic. I expect to see the deployment of software robots in healthcare grow over the coming years as its benefits continue to be realised globally. 

How do you see this technology evolving in the future? 
If one thing is certain, it’s that the technology will continue to evolve and grow over time – and I believe there will come a point in time when all processes that can be automated, will be automated. This is known as the fully automated enterprise. 

By joining all automation projects into one enterprise-wide effort, the healthcare industry can tap into the full benefits of the technology. This will involve software robots becoming increasingly intelligent in order to reach and improve more processes. Integrating the capabilities of Artificial Intelligence and Machine Learning into automation, for example, will allow providers to reach non-rule-based processes too. 

We are already seeing steps towards this being taken by NHS Shared Business Service, for example. The organisation, which provides non-clinical services to around two-thirds of all NHS provider trusts and every clinical commissioning organisation in the UK, is working to create an entire eco-system of robots. It believes that no automation should be looked at in isolation, but rather the technology should stretch across departments and functions. As such, inefficiencies in the care pathway can be significantly reduced, saving healthcare providers a substantial amount of time and money. 

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