NHS England's vision for integrated urgent care is a demanding one, but the technology already exists to make it a reality, explain Phil Rawlinson, healthcare lead at Microsoft, and Pippa Rhys, market and product director at Capita Healthcare Decisions
NHS England has raised the bar high with its vision for out of hours (OOH) and urgent care healthcare. Its Commissioning Standards for Integrated Urgent Care report, published in September 2015, talks of “opening the front door” to highly responsive care, taking the patient from the first contact to the appropriate clinician as quickly and conveniently as possible, or providing expert advice on self-care.
The NHS also wants a fundamental shift towards delivering more care closer to home rather than in hospitals, and that will need a network of 'clinical hubs' that can lead patients to care and check that it has been delivered.
It will place heavy demands on the clinical commissioning groups (CCGs) that are responsible for OOH and urgent care services in their areas, and on the IT that supports the operations. But it will not require a leap in technology to make it possible; the systems are already available.
Since February 2014, NHS 111 has been the most widely used route to unscheduled urgent care services; but the service has not been the same for every patient. CCGs have signed their own contracts, some have gone a long way towards integrating care, while others have been much less ambitious. Many have limited access to data on patients and have no standard procedures for handing off patients to clinicians or healthcare professionals. Many are using legacy or custom built software that is difficult and expensive to integrate into other healthcare systems to pass vital information about patients and the required care pathways.
It creates a number of priorities in choosing the technology. One is to provide multi-channel access, so people can make contact by phone, video link, email, web chat or text messages. This is the first step towards making the process as convenient as possible for the patient - a single point of access to care services, whatever channel they use.
Another is for the system to recognise the patient and any factors that should influence their care, even if they have not been treated locally before. An important element of this would be for clinicians to have access not just to the notes provided by the call handler, but summary care records and special patient notes, providing a full picture of the individual's health.
Then comes the ability to support the triage process with a clinical decision system (CDS) that integrates with the care record for individual patients. A high quality CDS can go much further than providing a script for the call handler; it can draw on smart algorithms to analyse the patient's healthcare record, suggest questions appropriate to a specific patient, provide risk alerts of specific problems and guidance on the appropriate steps.
The key point is that this will be tailored to the patient. For example, if a young person with a history of sports injuries complains of leg pain, they would be asked about musculoskeletal symptoms first; whereas a patient with alcohol and weight problems would be questioned on their cardiovascular condition; or a person with diabetes might be transferred to a clinician because of the dangers of thrombosis.
The software does not necessarily make the decision for the call handler, but it can make quick connections between different symptoms and a patient's history, and provide crucial support in deciding on the next step. This becomes even more effective if the CDS can learn as it goes, constantly adapting with the changing conditions.
Then comes the need to know how to advise the patient to look after themselves – maybe with over-the-counter medication or simple exercises – or if necessary what resources are available locally for support. This might lead to dispatching an ambulance or scheduling a field nurse, checking waiting times at local hospitals, or directly booking an appointment with a GP or specialist care provider.
Again the CDS has a vital role to play in matching the patient with the most appropriate local service to fit their needs. A patient who has called several times about the same symptoms would be better served by recommending a different treatment or level of care, as the initial advice was obviously not appropriate.
The potential becomes even greater when the system can be used as a virtual clinical hub, providing call handlers with access to specialists from a range of healthcare disciplines as diverse as physiotherapists, dentists, pharmacists and mental health nurses. Presence status indicators can show the call handler who is available to receive a call and transfer the caller seamlessly, so the patient's needs can be resolved immediately.
The important point is that the call handler has access to the Directory of Service – the full record of who is available to provide acute or primary care or community services. Combining this with a smart CDS and integrated systems can provide a truly patient centric service. They are not just passing the patient on but coordinating their care, ensuring that each stage is integrated with the others and carried out as quickly as possible.
In addition, the system should be able to monitor the patient's progress, record the stages of care and provide alerts when the process goes off track. And it should be able to provide anonymised data that enables CCGs to assess performance on urgent care and identify where improvements could be made.
It is an exciting vision, and a realistic one. Microsoft and Capita have collaborated to provide the solution, using Microsoft Dynamics customer relationship management (CRM) as the basis for the Salus care management system. It has all the necessary capabilities: multi-channel contact; an extensive, secure patient record; integration with other healthcare provider systems for booking, scheduling, accessing directories and available care resources; inbuilt clinical decision support with Capita's Decision Management System; and extensive performance monitoring and healthcare analytics.
All of this can be tailored to locally available services, and promises significant benefits for CCGs. It can help to cut out waste, save on costs, provide data used in long term planning, and contribute to the campaign to shift care away from hospitals and into the community.
For patients, it can help to provide a responsive service for those who need urgent care, delivering it as close to home and as conveniently as possible. As more people use OOH and urgent care services supported by this technology they will become increasingly confident, and this will encourage wider take-up.
Microsoft and Capita have taken account of the NHS vision and can support CCGs in opening the front door to integrated, 24/7 urgent care.
Watch the video here to learn more about the Microsoft and Capita vision for integrated urgent care.
Healthcare leaders have the opportunity to explore the full potential of the new approach for integrated urgent care at two seminars, taking place at:
Manchester (Old Trafford Football Stadium), 09:30-13:30, Wednesday 27th April
Reading (Microsoft Offices), 09:30-13:30, Thursday 28th April
The events will cover the concepts and reality of the new approach, using technology that is already available, and include a presentation from an NHS client that has created savings of more than £250,000 per annum.
Places are limited. For more information and to register, please click here.