Digital Health & Care Institute (DHI) Call for Innovation – Outpatients Redesign

This call seeks innovative projects and technologies to support the redesign of Outpatient Services, focusing on improving the patient experience through enhanced logistics, communication and joint care planning.

We encourage applications from multi sector teams (Academic, Business and Civic perspectives) as these tend to demonstrate the innovation and industry-led impact at the heart of the DHI values. However, as explained in the application form, only one team member needs to apply on behalf of the whole team.

Please refer to the DHI call for innovation proposals Guidance for applicants – June 2015.

Please note that when applying to the call, you will need to provide your membership number. You can apply for a DHI membership at www.dhi-scotland.com/sign_up

Application Form

DHI Intake Process
The DHI operates a developmental intake model. This means that we prefer to see early draft proposals while an idea is still forming. We can then support applicants by demonstrating how our services might help the innovation progress. We then accept the final draft proposal, based on that feedback and make a final decision about what services and / or funding the DHI can contribute based on the strength of the proposal against our Academic, Business, Civic and Innovation Value Criteria. The application form is designed to tease out these value propositions and includes more detail on the DHI intake process.

Due to the nature of the developmental model, we strongly urge applicants to submit early drafts well in advance of the deadline. The DHI can work with you to mature your proposal while awaiting the close of call, avoiding delays at a later stage. Final decisions can be made only after the call closes in either case – this is a competitive call and the DHI will be prioritising its support and grant funding allocation.

Key Dates
Opening Date: Friday 5 June 2015
Closing Date: Monday 7 September 2015 – 17.00
Call briefings – Dates TBC

Introduction – The Challenge
Across Scotland each year hundreds of thousands of patients are provided with advice, reassurance and health monitoring through the delivery of outpatient services.

Outpatient clinics can be demanding environments. The treatments offered across specialities may vary but the way they serve patients share many steps in common. To provide patients with safe, high-quality care, it is important that clinics run efficiently.

At a glance many outpatient clinics look fraught with disorganisation. Patients can find their appointments cancelled or rescheduled for no apparent reason, or appointments can be wasted when patients fail to show up. When they do attend, patients can find their appointments delayed, they can be asked to repeat answers about their medical history or be sent for unnecessary tests.

Questions arise: In what way can the system be improved? What is the real capacity of an outpatient clinic and how can the staff ensure that processes run smoothly and safely? What can be done to improve the patient experience through enhanced communication and what can digital technologies do to enable these developments? What can we do to ensure the patient feels in control of their own health and can manage their link into outpatient services to support that?

The current model of delivery of these services has not changed significantly for many years and is now facing an increasing demand due to demographic changes and improvements in available treatments. The scale of the challenges is highlighted below.

Health Service Journal – Scottish Outpatient Trends (ISD Data)
To return to 12 week compliance in December 2015, Findlay estimates that outpatient activity needs to rise by 7 per cent this year, compared with 2014 activity levels. That is a 2 per cent recurring increase, and a further 5 per cent nonrecurring activity to shrink the list.

Meanwhile, inpatient/day case activity needs to rise by 11 per cent – that is 4 per cent recurring, 5 per cent non-recurring to keep up with the outpatient surge, and a further 2 per cent non-recurring to shrink the list. (Rob Findlay, Health Service Journal. http://www.hsj.co.uk/comment/the-explosion-in-scottish-waiting-times-is-a-political-timebomb/5082922.article#.VWA1rU9VhBd)

Scotland’s Response
1. Scottish Government Focus – “Technology enabled integrated outpatient pathways to support people at home”
Scotland’s Response can be best understood with reference to the Transforming Outpatient Services (TOPS) 2020 Vision with key activities outlined here. A refreshed Outpatient Programme is due to launch in the coming months.

Achievements 2014 – 2015 - Key achievement to-date include:

  • Patient Reminder Services Change Package to support NHS Boards to reduce the number of Did Not Attends (DNAs)
  • Pathfinder projects to use advice instead of referral, optimise outpatient clinic resources, test digital technology prototype and use of letters and video to support self-management
  • National Return Outpatients Data Group to increase the quality and use of data for peer review to understand and reduce unwarranted variation and to inform and test improvements

Priorities for 2015/16 - The key areas of focus for the coming year will be:

  • Design new and sustainable person-centred models of outpatient services
  • Adoption and spread of five high impact changes: use of advice only, clinical dialogue and referral feedback, centralised and e-triage, improved booking practices and use of reminder services, direct access to diagnostics and musculoskeletal redesign
  • Increase the quality and use of data for peer review to understand and reduce unwarranted variation and to inform and test improvements

2. DHI Acceleration
In March and April 2015, the ‘Revolutionising the Outpatient Experience’ and the ‘Technology & Outpatient Services Ecosystem’ events took place, involving over 250 individuals (domestic & international) from Academia, Business and Civic sectors. The purpose was to inform DHI innovation projects that could help support the Outpatients Redesign agenda.

DHI Outpatients Redesign Call
This call aims to create DHI facilitated innovation projects that create technologies and services to meet the challenges raised, and support outpatient redesign in line with the approach described above. This section highlights some potential high value areas technology could support (based on the recent DHI Ecosystem event outputs).

General - The call seeks innovative project proposals or technologies that:

  • Support patient, carer, relatives, professionals, and the broader systems managing care, including outpatient, primary care and any relevant community care services.
  • Move care into the community, taking advantage of existing home visits enabling non-hospital locations to handle outpatient ‘lite’ activities – e.g. pharmacies, supermarkets, libraries
  • Enhance and enable non-statutory community services and networks to support people who might otherwise attend more acute services
  • Give patients access to their record, a clear care plan, guidance and educational tools which they can refer to throughout their Outpatients journey, with patients able to self-manage, interact and have an opinion
  • Give professionals across the system (Outpatients, Community Care and Specialties) access to that same care plan, creating a seamless patient experience where patients don’t have to repeat their story to many individuals
  • Offer multimodal communication / attendance options for patient, carer and professional
  • Support the organisation in workforce management, workflow, logistics, & information share, leveraging analytics and computer modelling capabilities where possible.
  • Help to educate people to understand treatment and recovery, supporting self-management and proactively signposting them to appropriate care settings when necessary.

Patient Flow the call seeks solutions to address needs in the following outpatient service stages:
In Advance of the Appointment

  • Digital triage via web help interfaces
  • Clear process, what patients and carers should do in advance e.g. checklists.
  • Tools to avoid ‘Did Not Attend’. Reminder messaging, traffic & parking information
  • Better booking systems to avoid overbooking / double booking

At the Appointment

  • Airport check-in model - while waiting there should be more customer focus and engage patients in managing their own place in the flow e.g. queue management technologies with interfaces to check appointment status and manage expectations during delays
  • Workflow and logistics tools to support efficient running of face to face interactions
  • Offer alternatives to face to face – virtual / digital interactions by default
  • Tools to capture true patient opinion and uncertainties – avoiding repeat visits

After the Appointment

  • Two way follow up communications to handle ‘oh I meant to ask’ moments
  • Patients should leave with instant summary, and next steps in clear language - available before the patient leaves the consult room
  • Referral letter processes need to be redesigned using modern technologies
  • A means of offering a ‘warm’ transfer back into outpatient services when a patient’s situation changes quickly, rather than going back through GP and awaiting appointment.
  • New methods and technologies for review and follow up – discharge and allow patient to self-refer when they need to with minimal barriers rather than the system enforcing continuous review.