The adoption of digital solutions to transform clinical pathways is gathering pace as NHS trusts across the country look to the latest digital and technology-based solutions to address the challenges of meeting the demand for patient care. Last year we announced 35 successful applications for the Adoption Fund to support innovation around current priorities in elective care pathways.
In January 2022, we invested an additional £5.2million to build on and expand this approach to enabling digital clinical pathways. The funding was aimed at areas where there is an urgent need to create solutions for pathways that are overwhelmed with demand. The allocation of monies was overseen by a panel of clinical experts from around the country and supports three priority pathways: perioperative, musculoskeletal (MSK) and gastroenterology. The details of each project which received funding within these pathways is set out below.
Our long term aim is to build a community of practice across all successful Adoption Fund bids in order to support implementation and problem solving at a national level and to provide a forum for shared learning between ICSs. These programmes will also be independently evaluated to understand the impact on patient and clinician outcomes, and whether they are value for money for the NHS.
Perioperative pathways
Five more ICSs have been funded to implement digital perioperative care solutions which will ensure that patients can undertake key parts of their pathway at home as well as providing a mechanism for gathering patient-reported outcome data.
Patients, who are assessed as low risk, will be able to complete their pre-operative assessments at home and where possible they will also be able to participate in virtual post-operative follow ups without the requirement to attend an outpatient appointment in the hospital setting. They will also be supported with curated information and advice on self-care and post-surgical recovery.
This approach will enable trusts to manage surgical waiting lists by using data-driven decision making to prioritise patients and ascertain risks.
Re-engineering High Volume Low Complexity (HVLC) preoperative care pathway
Lead NHS Organisation
- South East London Acute Provider Collaborative (APC)
In partnership with (partner type and lead organisations)
- Guy’s and St Thomas’ NHS Foundation Trust, Lewisham and Greenwich NHS Trust and King’s College Hospital NHS Foundation Trust
Details
Development of a new digital platform to support the redesign of the HVLC Pathway across three acute South East London Hospital trusts. The new platform will deliver a patient facing portal (linked to the NHS app) to support pre and post operative care.
The platform will also allow clinicians access to richer patient information ahead of appointments and will reduce appointment times and support faster decision making. The technology will bring improved data management tools to allow better utilisation of operating theatres across the trusts.
Machine learning decision aid for pre-assessment
Lead NHS Organisation
- Northumbria Healthcare NHS Foundation Trust
In partnership with (partner type and lead organisations)
- Newcastle Hospitals,South Tees Hospitals and North Tees Hospitals as part of North East North Cumbria ICS.
Details
Use of machine learning as a decision aid for pre-assessment tool before major orthopaedic surgery across three acute hospital trusts in North East North Cumbria ICS.
The technology will accurately classify hip and knee replacement patients into high, normal and low risk for operations using state of the machine learning techniques.
There will be an ability for clinicians to utilise a digital preoperative assessment tool to ascertain a patient’s fitness for the procedure.
The project will increase patient safety by reducing complications with better identification of high risk patients. It will also reduce costs by better utilising beds across hospital trusts.
End-to-end digital journey for patients on elective surgery pathways
Lead NHS Organisation
- NHS Devon
In partnership with (partner type and lead organisations)
- Torbay and South Devon NHS Foundation Trust (TSDFT)
Details
Providing patients (and carers) with access to high quality accredited digital perioperative information and shared decision making (SDM) aid to check surgery is still the right choice for the patient. Delivered through existing TSDFT platforms; CONNECTPlus app and Torbay Charts website.
Focusing on pathways with highest volumes of patients waiting (hip and knee / cataracts) but developing a model that is applicable across other high volume low complexity procedural pathways. Using TSDFT as a proof of concept site will provide transferable learning in order to support later spread and adoption across Devon ICS
Digital consent supporting remote preoperative pathways
Lead NHS Organisation
- Integrated Care System for Devon (ICSD) / NHS Devon Clinical Commissioning Group (CCG)
In partnership with (partner type and lead organisations)
- University Hospitals Plymouth NHS Trust
Details
University Hospitals Plymouth NHS Trust will introduce a digital platform enabling to roll out procedure specific digital consent forms across all departments in the trust.
The use of the “Concentric” digital consent platform will deliver remote pre-operative pathways, support patient-centred care, increase operational efficiency, release clinician time, and reduce cancellations and delays.
Digitally optimised preoperative assessment and theatre scheduling
Lead NHS Organisation
- Chesterfield Royal Hospital NHS Foundation Trust
In partnership with (partner type and lead organisations)
- University Hospitals of Derby and Burton NHS Foundation Trust
Details
Implementation of “My Pre Op” and “My Endo” electronic Pre assessment systems.The systems will allow clinicians to prioritise tasks in order to maintain a flow of patients ‘ready’ for surgery or endoscopy. The majority of patients will be able to complete the questionnaire remotely to simplify and standardise the patient journey reducing face to face pre-operative assessment to a minimum.
Patients will have the opportunity to complete their questionnaire in the presence of or with the support of carers or relatives thus enabling them to be involved in decisions made around their care.
Preoperative to discharge digitally supported patient pathway
Lead NHS Organisation
- Bedfordshire, Luton and Milton Keynes (BLMK CCG)
In partnership with (partner type and lead organisations)
- Bedfordshire Hospitals NHS Foundation Trust (BHFTs)
Details
Implement two digital platforms “Lifebox” and “Concentric” across multiple surgery pathways. This will help support shared decision making with patients completing remote questionnaires completed ahead of meeting clinicians preoperatively to manage risks, education and consent. This will be followed with outcome scoring and monitoring of the patient post discharge.
Benefits expected are a reduction in the need for physical appointments, allowing richer information available to clinicians to monitor patients at higher risk. Longer term, it is hoped the information will also be available to more clinicians in the ICS portal.
Patient portal for preoperative patient preparation and assessment
Lead NHS Organisation
- Milton Keynes University Hospital
In partnership with (partner type and lead organisations)
Details
Milton Keynes University Hospital (MKU) will use the funding to digitise pre-habilitation, pre-operative assessment, digital consent and digital monitoring of recovery to improve elective treatment pathways. This includes the expansion of existing technology and new applications to provide a complete patient record on patients through “Patient Portal UK”. The application will allow viewing of pathology, microbiology, radiology reports, viewing of other documents, access to questionnaires for pre-op assessment, eConsent, and secure two way messaging between clinician and patient.
This will help improve waiting list monitoring, delivery of remote care and optimise operational capacity. For patients this will lead to an improved consent process with clear information about the procedure; risks; benefits and alternatives.
Gastroenterology pathways
The demand for gastroenterology outpatient services and endoscopy service has been high for many years. Endoscopy is the route for diagnosing a range of conditions including bowel cancer and waiting times for this procedure are extensive. New technologies to find ways to address this have been successfully tested, and the Adoption Fund investment aims to promote their roll-out across the country.
We now have 8 teams using a home based non-invasive stool test. This test empowers patients with inflammatory bowel disease to monitor and control their symptoms. Two teams are also piloting digital support to prepare and increase knowledge of patients where the need for endoscopic evaluation is indicated. This has been found to increase the accuracy of the procedure and reduce non-attendance.
These initiatives support home-based care where appropriate, avoiding the need for patients to undergo endoscopies for their long term condition
Integration of faecal calprotectin home testing into the virtual management of patients with inflammatory bowel disease
Lead NHS organisation
- Salford Care Organisation
In partnership with (partner type and lead organisations)
- Salford Together (Salford CCG)
Details
Salford Care Organisation are planning to integrate home faecal calprotectin (HFC) testing into their already established patient-led pathway, complimented by the My-IBD portal. Patients will be able to update their results into the portal to generate individualised information. This will include, but not limited to, advice on self management and accessing patient-led follow up. Use of FCP testing will also enable an administrative team to identify patients who have not responded, losing response or are not optimised to their medication to then modify their treatment.
Pre and post implementation of domestic faecal calprotectin monitoring and virtual management across the Hampshire and Isle of Wight ICS
Lead NHS organisation
- University Hospital Southampton NHS Foundation Trust
In partnership with (partner type and lead organisations)
- Hampshire Isle of Wight Integrated Care System
- Hampshire Hospitals NHS Foundation Trust
- Portsmouth Hospitals University NHS Trust
Details
University Hospital Southampton (UHS) will be integrating home faecal calprotectin testing (HFC) into their existing IBD pathway which uses My Medical Record (MyMR). Having already undertaken a local exploratory study using HFC and MyMR they plan to extend the pilot from UHS to across the whole ICS. Carefully selected patients, who have electively stopped medication or are starting on new long term treatment, will have their HFC results securely transmitted back to the trusts IBD nursing team through the MyMR portal for review and to decide on next steps.
Musculoskeletal pathways
We have supported five further teams in the MSK pathway to adopt technologies that can support patient self-management through the use of evidence-based decision support tools. These technologies can also enhance recovery, reduce length of inpatient stay and monitor rehabilitation at home through the remote capture of patient-reported outcome and experience measures.
Supporting the capture of patient outcome and experience along a pathway of care
Lead NHS organisation
- Northumbria Healthcare NHS Foundation Trust
In partnership with (partner type and lead organisations)
- North East and North Cumbria ICS
- North East North Cumbria Orthopaedic Alliance
- Apperta Foundation CIC
- The National PROMs Network
- Sandwell & West Birmingham Hospitals NHS Trust
Details
The project team will be developing the use of OpenOutcomes, an open source platform, to capture patient-reported outcome measures (PROMs) to support provision of efficient and effective patient care along the MSK pathway. PROM capture can be flexibly captured by the patient themselves or a member of the healthcare team on a mobile device of choice (e.g. ipad, laptop or phone) giving real time access to this data for analysis, benchmarking, service improvement and population health data analysis.
Supporting self-management of MSK conditions
Lead NHS organisation
- Mid and South Essex ICS
In partnership with (partner type and lead organisations)
- Mid and South Essex NHS Foundation Trust
- Connect Health Provide
- Thurrock Health Hubs
Details
The project will be utilising an MSK self-management app that introduces a single platform to deliver standardised care across the whole ICS. It empowers patients with expertise and knowledge to self-manage MSK conditions and rehabilitation where it intends to reduce variation in accessing MSK services. The app will be embedded within services across the system to support primary care, first contact practitioners, community therapies, outpatients and therapy services supporting the management of long-term conditions.
Supporting patient self-management through an online portal
Lead NHS organisation
- South Tyneside and Sunderland NHS Foundation Trust
In partnership with (partner type and lead organisations)
- All Together Better
- North East and North Cumbria ICS
- Sunderland CCG
Details
The project aims to improve MSK health outcomes by utilising an online portal and patient-facing app to transform and improve the full musculoskeletal care pathway by providing digitally enabled rehabilitation and class education.
Providing pain management education through digitally-enabled MSK care
Lead NHS organisation
- Guy’s and St Thomas’s NHS Foundation Trust
In partnership with (partner type and lead organisations)
- South London ICS
- Leva Clinic
- getUBetter
Details
The project will support the redesign of the MSK pathway to incorporate an online pain management programme through the Leva Clinic. The existing personalised triage and self-management platform ‘getUBetter’ will coordinate MSK patients who develop persistent pain in primary care to have digital access to an initial specialist pain informed clinical triage providing access to a multi-professional clinic or a 12 module management programme, via the Leva Clinic.