NHS Digital Pioneer Fellows are working on a range of projects to drive transformation in the NHS across London. Below is a list of some of the key projects.
You can find out more about each of the projects by clicking on the tabs below.
Prescribing errors in general practice are a preventable cause of safety incidents
Reducing the need for hospital attendance for routine clinics for young people with Cystic Fibrosis, through developing a mobile phone app that can monitor young people with Cystic Fibrosis at home. This has the potential to act as an early warning system for lung exacerbations.
Lead Fellow: Claire Edmondson
Organisation: Royal Brompton & Harefield NHS Foundation Trust
Trusted mental health support online
18% of Londoners will meet the criteria for suffering from a low level common mental health condition such as low mood, anxiety, stress or poor sleep but will not be diagnosed. Digital discovery work found many of these people are searching for help online but confused as to what help is available and what can be trusted.
Digitising patient notes and dictation systems into one system
We are moving to a digital solution which will digitalise patient notes and amalgamate the various dictation systems onto one clinical system. The change will affect workflows for both clinicians and administrative staff but will increase efficiency.
Redesigning outpatient pathways using digital technologies
The project entails redesigning certain outpatient pathways using digital technologies and scale up the use of virtual consultations across the Bart’s Heart Centre. This project aims to achieve:
• Greater access to patients and their families
• Improved efficiencies and productivity for clinicians
• Cost-savings in the delivery of care
• Overall greater quality in care and patient satisfaction
Delivering an LMS system to Primary Care across the collaboration of 8 CCGs in North West London
Delivering an LMS system to Primary Care across the collaboration of 8 CCGs in North West London. The LMS called the “NWL Learning HUB” is for GP surgeries and will enable them to train their staff on Mandatory and Clinical courses which will help them meet their CQC and other requirements.
NWL also delivers classroom training on the 2 main clinical systems, ‘SystemOne’ and ‘EMIS’ and these courses are now bookable via the site.
The project is in its infancy and has been tested with one CCG to iron out any glitches. In the future we will be adding training programmes aimed at staff roles such as HCA’s and nurses etc., All of our elearning courses are from the eLFH website but in the future we hope to create in-house training.
Care compass: digital nursing solutions
Over the forthcoming year Digital Nursing solutions will be implemented across Barts Health that will radically change the way in which we interact, communicate and record patient information.
My project is to lead a cross site team, including Lead Nursing Information Officers, in the delivery of our digital nursing documentation programme which includes the implementation of care compass, vital links and integration of the ePMA project. The programme is to be delivered across all 4 hospital sites on all Adult wards (c94) to create a paperless environment. We will optimise our use of Cerner Millennium and create a seamless opportunity for multi-professional teams to communicate.
The programme is key to the Trust’s informatics and improvement strategy and paves the way for further digital development. Across the wards there are 6500 Nurses & 2500 AHP’s plus wider multi-professional team members that will be engaged in the programme. The programme will require a significant build of digital capability and confidence. It is our aim to impact positively on the efficiency and effectiveness of care and to create auditable data that enables us to deliver targeted improvements. We plan to use agile mechanisms that enable us to inform our quality improvement activity and drive positive change.
Our programme design builds on shared principles of care so that person centred behaviours are modelled by teams rather than a focus on being IT centric. Our informatics solutions and skills are there to enable outstanding practice co-designed with our service users. The programme will enable a multi-professional voice in the design and delivery of digital solutions in practice and will build on an informatics governance framework. The initial scope for Nursing has been developed that will be tested during the summer for planned implementation from the autumn with evaluation.
Technology and tobacco treatment services
The project will centre around bringing technology into the prevention field, specifically focusing on tobacco treatment services. Our company currently offers these services via traditional face to face cessation processes and we wish to bring the service to the user, where it suits best and using tried and tested behavioural therapy coupled with Nicotine Replacement Therapy.
This will be delivered through a mobile application developed by Quit Genius and essentially looking to offer this as an additional pathway to our patient group with the aim of improving success rates (Quit Rates). The intended output of the project is to create a case for development of a model to roll out to a wider population group to develop real system change.
Addressing alert fatigue
With five years experience with several e-prescribing systems, IMayce Alyousif has noted a very important common issue that needs to be addressed intensely which is “Alert Fatigue” this is as a result of systems containing a large number of alerts consisting of either system default alerts or ones that have been requested specifically by system users. Without having control over this, prescribers and system users are then exposed to many alerts which increases background noise in the system. Eventually alerts get ignored/skipped or overridden accidently due to pressures and time constraints, this ultimately increases the risk of important alerts being missed and in a worst case scenario leading to a serious incident.
Therefore a project that I will be undertaking is with the clinical decision support aspect of the system whereby the aim is to make alerts “more meaningful”, building on the fact of “less is more”. The module that will be implemented is the Medication Clinical Decision Support tool by Cerner Millennium which after a having successfully been the test partner with Cerner, I have learnt so much about the wonderful capabilities and customisation levels available within this module, therefore I am extremely looking forward in engaging with senior clinicians to customise the system in supporting prescribers at the point of prescribing with effective clinical decisions to enhance care and improve patient safety to its utmost.
Digital Citizen Education Programme (DCEP)
The Digital Citizen Education Programme (DCEP) was born from a series of feedback received during deployment of Health Help Now in NW London CCGs. Lessons learned indicated a need for an educational platform and structure to complement the digital technology being deployed.
Feedback from our Digital Survey also showed that 50% of residents were more likely to use digital tools to manage their health and care, if they were shown how to use the technology behind it.
As health and care move further into a digital age, there is an important need for our patients to become digitally mature, so that they can benefit from various health and care services, not just for accessibility, but for self care/management, and prevention.
DCEP initially started with one workstream (Digital Ambassadors), but has now further developed into four:
1- Digital Ambassadors (Citizens)
2- Digital Ambassadors (Workforce)
3- Digital Healthy Schools
4- Care Homes
COMPASS to improve patient and service provider outcomes
Joanna works as part of a team on the COMPASS – Navigating your Long-Term Condition online Cognitive-Behavioural Therapy (CBT) programme for managing depression and/or anxiety in the context of physical long-term condition(s).
COMPASS was developed by a team of researchers, clinical health-psychologists, and patient and public involvement representatives led by Professor Rona Moss-Morris and manged by Dr Katrin Hulme, at the Health Psychology Section, Institute of Psychiatry, Psychology, & Neuroscience, King’s College London. COMPASS puts the long-term condition at the heart of the CBT treatment. It was developed by adhering to the UK Medical Research Council complex intervention development framework. This resulted in eleven online CBT treatment sessions which are “transdiagnostic”. This means that COMPASS can be offered to people with any type of long-term condition to improve its reach. COMPASS is designed to be supported by a guide who is a therapist or health care professional that has extensive training to support patients in using COMPASS.
COMPASS is about to be launched as a quality improvement project in two NHS Trusts thanks to our funders King’s Health Partners. As part of this early implementation phase, I have worked closely with the COMPASS team and NHS colleagues to design appropriate ways of evaluating the impact of COMPASS using both quantitative and qualitative research methods. These outcomes will help refine and update COMPASS to improve patient and service provider outcomes. It will also help to begin considering ways of sustaining and rolling out COMPASS to other care contexts.
Digital solutions to hospital initiated cancellations
Hospital initiated cancellations affect the productivity and capacity of NHS Outpatient & surgical services across the country, and most importantly, cause unnecessary inconvenience to patients & delays to their treatment. If we look at the wider picture wastage occurs not just in terms of hospital resources, but in public time and lost opportunities for trainee clinicians who could’ve have potentially covered activity that was unnecessarily cancelled due to miscommunication.
My project aims to implement a digital solution to automate leave management and ensure communication being passed on immediately and seamlessly through to support services that manage clinical activity, taking into account the operational detail affected by planned leave. Hospital cancellations not only affect patients but drain staff morale who deal with concerned and upset patients regularly.
From a patient perspective, this would reduce hospital cancellations for outpatient appointments and surgeries that could have been avoided in the first place, and mitigate patient inconvenience and ensure timely treatment. From a provider perspective, this would hopefully empower clinicians to manage their clinical activity and release operational managers to focus on other areas that need just as much attention, bring in an element of accountability towards activity performance.
Using the Whole System Integrated Care dashboard to solve fragmentation of healthcare delivery
With the Whole System Integrated Care dashboard, we are trying to solve the issue of fragmentation of the health service. Often health service users will go to different health care settings or providers and find themselves continually frustrated at having to repeat the same information to various health professionals. The WSIC dashboard provides an integrated health record of patients, the data for the dashboard is fed directly from all GP practices across North West London (NWL), social care providers, mental health trusts and community service within NWL.
The electronic record can be reviewed by a range of health care providers or professionals who are directly involved with the patient’s care. The scale of the project, currently WSIC stores up to 2.4million patient records across NWL (94% of the NWL population), we are collaborating with all eight CCGs within NWL (Brent, Ealing, Harrow, Hounslow, Hammersmith and Fulham, Hillingdon, West London and Central London). With this project, we hope that health professional and providers are able to use the WSIC dashboards to identify gaps in a patients care pathway and be proactive with interventions that may be required. We also hope that WSIC can help towards case finding and care planning as the dashboards provides visibility across all care settings
The Digital Me programme
The Digital Me programme has been initiated to empower staff in the use of technology. Where we want our staff to be fully digital-empowered with the right information at their fingertips including clinical records and increased productivity through the adoption of cloud-based collaboration tools. The aim is to embed a culture shift in the use of technology and information across and beyond our Trust.
To do this we have created streams:
- Replacement Stream – End of Life Devices to be replaced
- Digital Personas – Personal identifiers for roles within the Trust, to understand day to day working patterns, to advise on the best type of devices, access and coaching
- Digitisation of the Staff – enabling with correct equipment
- Coaching – providing all training needs for use of technology, Office365 and Clinical Systems in a variety of forums
Scale of the programme is 1270 devices for the replacement stream. Approx. 4,500 permanent members of staff to be digitised, across 60 locations.
Desired impact to is to have a fully Digitally transformed workforce by April 2020
The biggest challenge with the programme is Culture . Changing the way in which people work. This is where the coaching element is key for the programme and its success.
Maximising clinical capacity in Inflammatory Bowel Disease (IBD) outpatient services
The current problem in our local Inflammatory Bowel Disease (IBD) outpatient service is of clinic capacity. Clinics are currently running over capacity, and many patients who are stable are being seen, whilst a significant proportion of patients having a flare in the community are waiting weeks or even months for an appointment. This problem has been seen on a national scale in the NHS in management of all chronic diseases.
The solution is to transfer stable patients (using validated criteria) to a remote, app-based monitoring system. This has the dual benefit of reducing unnecessary appointments for well patients, whilst freeing up clinic capacity for patients requiring an urgent appointment.
This project is being piloted at one site, within a 3000 IBD patient cohort. Following a successful pilot it will be introduced into our sister site in the Trust and opened up to other disease areas where there is great potential and support for expansion.
The desired impact is to create a remote monitoring service for stable patients, whilst allowing immediate clinician access to patients with an acute exacerbation.
This project has gained external funding of around £80,000 and we have created a bespoke mobile app for patients and online clinician platform for remote monitoring. We have identified our first cohort of patients and the service launched in February 2019.
Implementing an Electronic Prescribing and Medicines Administration (ePMA) system across inpatient and community services
The Trust will implement an Electronic Prescribing and Medicines Administration (ePMA) system across our inpatient and community services aimed at enhancing accuracy, visibility and consistency when prescribing, dispensing and administering medication. Our current paper-based system will be gradually replaced with the new electronic solution, supporting clinicians to be better informed and able to manage medication more effectively and efficiently. Service users will also benefit from an improved service, as an electronic record of past medications will build up over time. This will minimise the risk of them receiving a previously ineffective medicines or those they cannot tolerate due to side effects.
The current process of prescribing and medicines administration is entirely paper-based, labour-intensive, and as a result is vulnerable to errors of all kinds due to poor handwriting, unclear abbreviations and/or dosages as well as unclear/ambiguous records of medicines administration as well as charts going missing. In addition, when prescriptions are phoned-in or scanned to Pharmacy, misunderstood verbal instructions, vague orders and scanned-related problems cause more issues. As a result, patient safety can be compromised. This results in adverse drug events that cause medical complications for service users. Published studies have shown ePMA systems can reduce error rates by 50%.
Population Health and Care Management in South East London
Initially piloting in the Borough of Lewisham, population 375,000.
The project aims to deliver transformational change centred on the identification of people with higher or emerging needs and delivering better outcomes and proactive care. To support this it will develop a range of tools and processes to provide the evidence base and insight to inform the necessary system changes and to support better care to be delivered.
Population health management will help health and care professionals identify and quantify the drivers and outcomes for addressing local population health, and it has a significant role in new care models.
Data analytics will be delivered for whole populations, segmented (risk-profiled) populations and at an individual patient level. This will require data acquisition, processing and management from multiple providers.
Data analytics and reporting must also serve commissioners at the local level. Technology and service offerings must therefore be tailorable, and when deployed as close to the patient as possible enable clinicians to take decisions that help to deliver on the transformation aspects of commissioning. Software and services that serve population health management should be flexible enough to allow local experts bring their experience and local knowledge to bear.
• Understand the health status of the local population
• Identify potential areas for change
• Monitor the effects of change through outcomes
Web based platform for children and young people with ADHD
The project developed, and implemented, a web based platform for children and young people with ADHD, their families and professionals. The platform provides access to self-management tools and resources and enables children and young people, their families and professionals to communicate with the ADHD clinical team in order to improve care and collaborative working.
The project was funded by The Health Foundation and the platform built upon an existing platform, My health Locker that was developed by South London and Maudsley NHS Trust. The platform was launched just over a year ago and is being used by approximately 70 families and six schools. We have received positive feedback from families and schools. The team was shortlisted for an HSJ award in the category of improving care through technology.
Transfer of Care Around Medicines (TCAM)
The Transfer of Care Around Medicines (TCAM) project aims to improve patient safety and experience with medicines when moving between care settings through establishing robust communication pathways between hospitals and community pharmacies.
Patients are at an increased risk of medication-related harm when returning to the community following a hospital admission, due to failures in communication. Miscommunication often results in inadequate or inappropriate provision of medication and inconsistent messaging around the reasoning for changes and onward plans. This has significant safety and cost implications.
Community pharmacists have demonstrated that they are able to play a much greater role in promoting the safe use of medicines when provided with appropriate information from secondary care. Currently, communication between hospital and community pharmacy only occurs routinely for a small number of patients and often relies on the use of fax machines which need to be phased out.
Through the TCAM project, we will be implementing a web based portal to share information securely with community pharmacists and facilitate timely feedback on action (or inaction) in order to improve the process and evaluate impact.
Improving patient compliance rate with their rehabilitation
The question we are trying to answer is how to improve patient compliance rate with their rehabilitation and how to best incorporate digital technology across therapies along with being in sync with current technological advances that could improve the quality of care delivered. To self-empower & engage patients so they are actively involved in their rehabilitation.
One way to gain increased patient engagement is using gamification of their exercise program. We have successfully purchased the MIRA exergames software in collaboration with UCL partners and Digital Health London and trialled with a cohort of paediatric inpatients whereby they received extra exercise sessions playing on the MIRA as part of their rehabilitation showing some initial positive results.
We are hoping to roll this out to adult inpatients, outpatients and exercise classes in the future along with an option of a home version. Hence, encouraging patient compliance with their rehabilitation.
The Royal Marsden has made progress towards a paperless system, there are still significant areas where paper remains the predominant clinical record. This poses a number of issues and potential clinical risk. Implementation of an electronic content management system in the Trust is a key enabler towards ‘paper-light’ working alongside making administrative processes more efficient and reducing clinical risk. The system forms a critical component of the RMH IT Strategy for 2015 – 2020 and is forecasted to be used throughout most of the organisation.
Responding to the needs of the front line staff has been a focus of mine with the desired impact not only addressing the mandate to be paperless by 2020, but also in reducing variation in working practices across the Trust where it is unwarranted. This will all allow for a more seamless implementation of the future EPR which is currently being procured, and ensure efficiencies are realised across the organisation. To date, the EDM system has gone live throughout the Trust with the Rapid Diagnostic Assessment Centres being the forerunners in adoption.
As part of the work programme in tackling medicines waste, polypharmacy and de-prescribing, I wanted to also incorporate an electronic method that will help practices identify patients in need of a medication review because of their current medicines management.
The CCG doesn’t currently utilise other patient specific medicines safety electronic software such as Eclipse or Pincer and hence has a potential quality and safety gap. The CCG does have the tools produced by the Clinical Effectiveness group (CEG) a local Academic Unit which provides call/recall functions, EMIS searches to identify specific cohorts of patients, dashboards etc.
The CCG has been using Scriptswithch for several years which has now developed a function to identify patients at risk of hospital admissions (RADAR) which incorporates PINCER. This will be a new element for practices to focus and undertake. The aim is to get practices to focus more on the proactive approach to prioritising medication reviews.
The method I am initially using to try to steer this quality aspect is through the GP improvement scheme, where I am proposing will incentivise practices to utilise the system. It will cover all 36 practices or 330,000 patients.