DLS Access (#1923)

Creation
Draft
Initial
Detailed
Accepted
Adoption
Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
DLS Access gives patients same-day access to their healthcare professionals via the web/smartphone/Skype or telephone achieving savings of £15 per patient with additional benefits.
Overview of Innovation:
DLS Access allows healthcare professionals to deal with increasing patient demand more efficiently and delivers a clear return on investment.  DLS Access is a cloud based service which is purchased on an annual per patient licence basis across the whole patient population.  The service is backed-up with executive level support and access to a DLS Client Delivery Manager to ensure successful deployment into your organisation.
 
Consultation requests are made by registered patients using their phone, a smartphone app or via a web form.  All requests are directed in to the ‘Health Hub’ and handled by trained call centre operatives.
 
The Health Hub team puts each patient on a call-back list for the requested healthcare professional who then aims to call the patient back within an hour, either by phone or Skype, whichever the patient requested.  This system provides same day primary care access for the group’s patient population, without opening for extended hours.  Out of hours demand is managed better and patients are seen quicker.
 
Results from the first deployment of DLS Access, which was through their partnership with Modality (previously Vitality) Partnership in the Prime Minister’s Wave 1 Challenge Fund programme have been more than hoped for.
 
DLS Access has demonstrated a £15 saving per patient across the group.
  • Over 65% of all health concerns are now dealt with remotely, within the hour.
  • Practices within the group have seen between 5-10% reduction in A&E attendance as a result of the DLS Access Service.
  • The Group have seen a 72% reduction in missed GP and ANP appointments. 
Many other benefits have been seen across Modality’s business as well as a return on investment from the savings the DLS Access project has achieved, these are outlined in the ‘Benefit to the NHS’ section below.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content3
Innovation 'Elevator Pitch':
Aptvision is revolutionary to the radiology sector providing a paperless & cost effective workflow.  Designed with radiology experts, practiced in-depth and customised to meet the specific needs of today’s modern & demanding radiology environment.
Overview of Innovation:
Total Radiology Solution including RIS and other innovative solutions has been designed to increase efficiency in hospitals and clinics - not just to store patients’ data. It’s unique innovation can be seen in:
  • Cost savings and increased productivity
  • Increase revenues for hospitals and clinics: web booking, schedule optimisation
  • Reduce errors and staff duties
 
Aptvision RIS is the most innovative RIS on the market offering fully paperless workflow from start to finish: eReferral letters automatically attached to the RIS, e-consent forms, Online Results, etc. Aptvision RIS also assures:
  • Electronic access to all documentation and forms
  • Quick access to all medical history
  • Fully web based, no installation - just the web browser
  • Ability to report on studies from any location without a need of installing dedicated software on individual doctor’s PC.
 
Much more than a standard RIS, Total Radiology Solution offers:
  • Fully integrated Web Booking in which patients can book their appointment like a seat on an airplane. From the clinic’s website patients can see which appointments are available for the type of exam they need and book it immediately.
  • Aptvision’s system automatically provides a call back from a clinic’s Call Centre, to verify the selected appointment and go through safety questions. The operator is prompted by the system to ask the appropriate questions.
  • This feature has reduced the 40% dropped calls rate to zero and practically eradicated no shows and errors.
  • Before the appointment, the patient receives a SMS Reminder of their visit and gains access to the Online Consent Form. They can complete it on their phone or computer before their visit day.
  • On the appointment day, patients can use Online Registration in the clinic using the interactive kiosk or tablet & without the need to stand in a long queue at the reception. They can also monitor their live updated waiting time on dedicated monitors.
  • The electronic consent form as well as all previous medical history is attached to patient’s record in Total Radiology System leading to completely Paperless Workflow. Once the appointment is completed, patient is informed with an SMS telling them their results are ready and can be viewed in the Online Results portal if this is appropriate.
  • Voice Recognition to more quickly create medical reports
  • Scan Audits to improve the quality of the reports and enable sharing of expertise.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Advanced diagnostics, genomics and precision medicine / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Patient and medicines safety
Benefit to NHS:
Revenues increase
  • Across 16 clinics in Ireland we have facilitated savings of up to €600,000 per clinic through reducing no-shows, errors and through modality optimisation
  • We have also increased revenues by €2.4 million in an 18-month period through web-booking and e-referrals
 
Efficiency increase and cost reduction
Through fully paperless workflow
  • An advanced, configurable, fully integrated e-referral platform feeding actual availability of modalities
  • E-referral letters automatically attached to the RIS, e-consent forms, Online Results, etc
  • Electronic access to all documentation and forms
  • Quick access to all medical history
  • ensure scan is possible and safe for patient (availability & safety questions)
Reduction of manual processes
  • Fully business rules driven without manual intervention
  • Built-in processes for auto scheduling and bulk appointment operations
  • No re-typing of information
  • No web booking missed
  • Medical call centre takes over all calls so reception could focus on patients and their needs
  • Interactive kiosks, tablets and monitors allow patients to register online without a need to come to reception
Improved Patient satisfaction
  • Reduced waiting times for scans and results
  • Ensures patients safety and enhances patient experience at all stages of their appointments (web booking, online forms and results, SMS notifications, online registration etc.)
 
Quality improvement
Peer review feature that allows anonymous review of radiology reports by random peer
 
Better hospital/clinic management
Live updated personalized dashboards for quicker decision making and detailed reporting: revenue reports, comprehensive operations reports, etc.
 
Savings in time
  • Quick system implementation - within few days, not months
  • Easy and intuitive up and running in 30 mins
  • Improvements visible from day one
 
Existing customers have reported statistics of:
  • Modalities capacity increase of 30%
  • 1 extra scan per hour
  • 10 more booking per day
  • Reduced reporting time 20min -> 4min
  • 50 reports per day vs 15
"Aptvision is revolutionary to the radiology sector and is the key to a paperless workflow. It improves daily operations and leads to quicker reporting times and early diagnosis. My experience suggests that Aptvision RIS increases a clinic's efficiency and bottom line from day one and has been the answer to our digital problem in one step."

Prof. Michael Maher
Consultant Radiologist, Cork University Hospital
Professor of Radiology, University College Cork
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
With rapidly increasing demand for diagnostic imaging and hospital and clinics workflow heavily relying on paper and manual duties radiology providers are sometimes unable to cope with that increased demand and provide their diagnostic in efficient and timely manner which can result in patient dissatisfaction and in some cases even lost lives.

Aptvision Total Radiology Solution offers a solution that can revolutionize radiology industry by promoting efficiency and paperless workflow that increases productivity in hospitals and clinic and ultimately benefits patients and their lives.
Our innovative features can benefit patients in numerous manner including:
  • Better and quicker access to radiology
     
  • Reduced waiting times for scans and results which can save lives
     
  • Ensures patients safety and enhances patient experience at all stages of their appointments (web booking, online forms and results, SMS notifications, online registration etc.)
     
  • Quality improvement - Peer review feature that allows anonymous review of radiology reports by random peer. It improves the quality of the reports, enhances share of expertise and allows discussion of interesting cases with experts in anonymous manner. This hugely benefits patients and again helps to save lives
     
  • Make use of modern ecommerce technologies to patients
Current and planned activity: 
Aptvision has just completed the Serendip programme.

We have applied for late inclusion into supplychain RIS/PACS frameworks.

We are actively engaging with Queen's hospital (BHR hospitals trust). We have presented the system and received a very positive response and we are currently organising a full day workshop with all staff.

We are presenting shortly to Black County Alliance.

We are seeking to work in partnership with an NHS Trust to deliver an early demonstrator for the NHS.
What is the intellectual property status of your innovation?:
Full intellectual property of all applications and solutions is owned by Aptvision Ltd.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
2
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Innovation 'Elevator Pitch':
DLS Supported Self Management puts patients in control of their own health; connecting lifestyle goals to health benefits, sharing data with health professionals and making virtual clinics a reality. 
Overview of Innovation:
DLS Supported Self Management consists of two modules which are both available through the web, android and iOS apps.
 
The first, prescribed by health professionals or through self-referral, is a lifestyle plan, which will help patients, and their health professionals map out important lifestyle goals related to specific conditions and pathways.
 
The lifestyle plan will connect existing monitoring devices and lifestyle apps, and allow this data to be shared with care teams and health professionals, giving them the visibility to provide professional support, encouragement and advice to the patient when it is needed most.  Once set up, it will become the coach needed to help the patient stick to their plan offering reminders, encouragement, advice and feedback based on progress, as well as access to a range of prescribed self-care courses and condition focused support groups.
 
The second module will bridge the gap between the patient and clinical worlds, integrating directly into Primary care clinical systems and providing a seamless workflow. This includes:
  • visibility on each patients lifestyle plan, patient collated data and comments made by the patients care team (including non-medical data).
  • A virtual clinic with a dashboard of patients within that specific clinic (e.g) diabetes and a RAG view of the patient data within each record.
  • Easy access to communications tools such as video calls and the phone, the ability to prescribe self-care content and the facility to send, receive and record patient messages.
Both modules will sit on a platform that will provide secure identity management, deliver robust management of patient consent and through a developer platform, will allow third parties to build against the system, enable access for open and paid API’s and deliver bespoke websites to be delivered against it. 
Stage of Development:
Trial stage - Trial stage to prove that the idea actually works as intended
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Person centred care
Benefit to NHS:
The systems have not yet been built, or trialed, that is in progress as we speak. Therefore the hard evidence, figures and statistics behind these assumptions are yet to be quantified.
 
The lifestyle plan module is designed to promote patient self-management, leading to less dependency on the health system as a result of pro-actively improving lifestyle factors that reduce the re-occurrence of acute episodes for patients with a long-term condition. This promotes improved health outcomes for the patient and decreased cost to the health system as a whole. 
 
Healthcare professionals have a clearer, more informed view of the patient between consultations, leading to more informed consultations at more appropriate times (via the RAG and alert system). This increases efficiencies as patients can be monitored remotely with consultations as and when they are required, rather than at regular intervals.
 
Healthcare professionals will be able to set-up alerts based on the data patients shared, supporting proactive healthcare and decision making.
 
Virtual Clinics mean that when a consultation is required, it can be conducted quickly and efficiently for both the patient and clinician, remotely via video consultation, telephone or message, with face-to-face consultations only when they are required. Patient measurements are submitted in advance via the lifestyle app. This will likely show a favorable improvement in the efficiency of clinician time as well as providing a more convenient, modern service for the patient
Online Discussion Rating
5.00 (3 ratings)
Initial Review Rating
3.00 (1 ratings)
Benefit to WM population:
The innovation will drive positive outcomes for the West Midlands health economies by impacting patient demand.
 
In promoting self-management in this way, we are asking patients to become more responsible personally for their health and less reliant on the health system to keep them within the healthy parameters of their conditions. By supporting patients to be involved in managing their own care, we help to improve Patient Activation Measures (PAM).
 
In doing this, we expect to see:
  • a reduction in patient demand for primary and urgent care services;
  • efficiency savings from managing the patients that are seen in a more timely manner;
  • Improved clinical capacity;
  • better patient outcomes;
  • fewer missed appointments
Current and planned activity: 
We’re working with primary care partners and CCG payers to define the product scope and will involve patients/clinical users to better understand specific functionality and usability.
We have spoken to
  • Diabetes UK to ensure we’re contributing to Diabetes prevention and treatment strategies and to user test our products.
  • GPSoC framework providers to find the most efficient way to integrate our professional tools directly into the primary care clinical systems.
  • Health Exchange in Birmingham to balance our digital provision against face-to-face options so we can reach more patients, particularly those most in need of help.
  • Commercial technology providers to leverage the best the market has to offer, instead of reinventing the wheel. This, for example, will provide a simply way to harvest data from 3rd party devices and apps, allowing us to focus on the patient experience and engagement. 
The product will be trialed with a co-hort of diabetes patients through Aylesbury Vale CCG.
What is the intellectual property status of your innovation?:
The IP is owned by Digital Life Sciences and is in the process of being trademarked. 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
3
Co-Authors:
Regional Scalability:
Supported Self Care is designed to be delivered at scale to Primary Care populations. The product sits on the DLS patient platform, which is already supporting 70,000 patients in the West Midlands, 82,000 in Worcester and is about to bring on an additional 200,000 patients in Aylesbury Vale CCG area and 300,000 in Chiltern over the next year.
 
When it is launched, the innovation will be available commercially to any organization, in the West Midlands, or other regions, who wishes to purchase it. 
Measures:
The success of the supported self-care product will be measured by;
  • The sales revenue generated
  • The clinical patient outcomes (yet to be confirmed)
  • The reduction in patient demand for primary and urgent care services;
  • Efficiency savings from managing the patients that are seen in a more timely manner;
  • Improved clinical capacity;
  • Better patient outcomes;
  • Fewer missed appointments.
 
Prior to implementation of the first pilot, we will undertake a benchmarking exercise which will define the exact outcomes we want to measure and reporting will be put in place to track improvements.
 
This will include a patient / user survey of existing services to gauge satisfaction levels, which will be repeated towards the end of the project.
 
As part of each deployment register we put a risk register in place, which will highlight any project risks encountered along the way in terms of quality, safety, cost and people. In addition our clients have their own clinical recording methods to keep abreast of any patient safety and or quality issues. 
Adoption target:
Yr 1 SSC deployments include the technology/ product license fee and the business change and transformation required to embed the product sufficiently to deliver a return on benefits.
Rates of adoption are: 
 2018  4 projects, £50,000 licence revenues
2019  8 projects, £70,000 licence revenues
2020  9 projects, £100,000 licence revenues
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Innovation 'Elevator Pitch':

Kinesis lets clinicians (mostly GPs) request expert clinical advice from consultants at their provider trusts as an alternative to making a referral.

Find an expert – ask for patient related advice – receive a rapid reply – treat locally/refer
 

Overview of Innovation:

​Evidence shows that around 65% of referrals to outpatient clinics are 'inappropriate' [1. NHS Institute for Innovation and Improvement. Delivering Quality and Value – Focus on: Productivity and Efficiency. April 2009.], resulting in unnecessary delays to treatment and avoidable costs.

Kinesis is a browser-based application that allows clinicians to request expert clinical advice as an alternative to making a referral. It is most commonly used by GPs, who request advice from consultants at their provider trusts, though this can be extended to a wide range of healthcare professionals.
High level process:
Find an expert – ask for advice related to a patient – receive a rapid reply – treat locally/refer

Kinesis has a number of unique features that: drive rapid replies to requests for advice (typically within 24 hours), notify users of requests and responses, tracks outcomes, allows tariff payments, supports real-world work patterns.

Kinesis is fully encrypted, runs securely over N3, is very simple to set up and use.
Kinesis delivers improved clinical outcomes, fewer referrals (50% saved), improved primary-secondary engagement, referral cost reduction.


In practice, CCGs adopt Kinesis and set up all their GPs and engage consultants in specialties at their provider trusts in a phased approach to provide a responsive service. As adoption grows, more specialties and providers are added, often based on the demand from GPs.
Initial set up is rapid, requiring only a list of the names and email addresses (usually NHS email addresses) and their role (and optionally further profile information) to bulk add users, plus agreement on the configuration and preferred message text in the system. Typically, this takes around 2 weeks to complete, following which the system is announced as live to users and they can log in at the URL they are given, add further information to their profile (work days, mobile number, notification preferences, interests etc) and start using the system.

Administrators are similarly set up and have access to manage users, run reports, download data and provide general system management.
​The supplier runs all the servers etc. that make it work, help with set up, support &advice on getting the most from the system.
Kinesis is under active development and this is driven by the Steering Group, consisting of representatives from all the CCGS, providers and the supplier. New features are added on a rolling basis and made available to everyone.
 

Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Education, training and future workforce / Digital health / Innovation and adoption
Benefit to NHS:

For Patient

  • Provides confidence that their needs are being quickly assessed by experts.
  • Minimises waiting time for appointments and delays in treatment – reduced Time To Treatment
  • More convenient locally based treatment where possible
  • Can lead to a more urgent referral.
  • Saves NHS Money

For GP

  • Keeps GP’s at the centre of referral decisions and improvers patient care
  • Provides easy, quick and certain access to clinical specialists
  • Provides significantly improved care and treatment options for patients
  • Builds relationships with secondary care
  • Provides opportunities for joint education & joint working
  • Minimises unnecessary referrals, can trigger more urgent referrals
  • Opportunity for learning
  • Saves money for practice and CCG

For CCG

  • Improves the efficiency & effectiveness of the referral management process
  • Provides direct savings through a reduction in unnecessary referrals
  • Reduces waiting lists and waiting time for specialist assessments
  • Stimulates and improves direct communication between primary and secondary care
  • Improves governance through the auditable tracking of advice
  • Provides an inbuilt reporting and administration system

For Specialists

  • Uses knowledge and expertise efficiently and effectively
  • Saves wasted time with unnecessary referrals & improves utilisation of clinics
  • Extends their sphere of influence
  • Provides income and improved service levels for the trust
  • Enhances relationships with GP’s and primary practice
  • Provides opportunities for joint education & joint working
  • Improves governance through the auditable tracking of advice
  • Can enhance/expedite necessary referrals
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:

As above

Current and planned activity: 

Fully implemented in a number of South London CCGs, with substantial clinical, financial and operational success.
Active engagment with GPSoC
​Ongoing Steering Group driven enhancements
Active discussions with DXS around integration and synergy
Ongoing disucssion with eRS around use of the eRS APIs when published
Pilot use with prison service

What is the intellectual property status of your innovation?:

We have full ownership of IP

Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
Regional Scalability:
The solution has been scalable to a national level.
Experience has shown that it takes around 2 weeks to deploy per CCG and that CCGs take around 6 months to scale up to widely engaged GPs and a representative selection of specialities.
Strong ramp up in usage continues into year 2 in most cases, as new specialties and providers are brought on and as GPs and consultants habituate inclusion of Kinesis in their personal workloads.
Measures:
The CCGs who currently use a system track a number of measures, predominantly:
  • number of referrers
  • number of advisers
  • number and type of messages,  by date, practice  and specialty
  • referrals avoided and detailed outcome status
  • percentage of requests answered within 24 hours
  • percentages requests answered with a single exchange of information
  • total savings
For Example

Wandsworth CCG Kinesis analysis April 2014 - March 2015
Advice requests sent = 2869
Referrals Saved = 1660
% saved = 57.9%
Total Saving £239,590
 
Top specialties by Messages sent
Haematology 383
Paediatrics 304
Gastroenterology 280
Diabetes and Endocrinology 249
Gynaecology 248
Cardiology194
 
 Active Users = 269
79 users sent 12 + messages
 
59% of messages answered within 24 hours
53% of messages answered in 1 exchange
 
Adoption target:
We seek a 50% adoption by CCG with a stretch goal of 80% (we recognise that some CCGs have other priorities or have address this need with locally developed solutions)

Within a CCG, 100% of GP practices to have use on the system and 30%+ of GPs to become active users.

Suggested usage targets of 10 conferrals per 1000 (weighted) population.



 
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