New Concept Fully Connected Mobile Medical Screening (#2025)

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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
We have a fully developed managed service ready to provide connectivity to mobile screening vans; automatically wirelessly transfer images to hospital PACS; remove outdated paper based processes and transform the metrics of breast screening.
Overview of Innovation:
For 25 years mobile breast screening vans have operated in isolation from Hospital HQs. Every day hard drives full of patient images are transported by taxi, courier, or most commonly fully trained radiographers between the van and hospital. Appointment lists are closed well in advance to allow them to be physically transported to the van and they are therefore outdated by the time they arrive. Clinical and administrative notes are made on paper which is also physically transported before the notes are transcribed into application software. Targeted turnaround time between screening and result has been 14 days for over 25 years.

​Our managed service revolutionises this process and can reduce the steps involved from 42 to 21.

​We transmit images directly from the van to hospital PACS in as little as three minutes. We make appointment systems live on the van and synchronise them with HQ. We create access to clinical applications so that all notes can be entered directly at point of need. We provide on board access to email, internet and intranet which has never been provided before.

​We give the HQ real time visibility to the van enabling them for the first time ever to see that staff have arrived safely and that screening has commenced on time. Our service can transform the metrics of screening and open the doors to radical overhaul of efficiencies and turn around times for results. We can remove all paper based systems and transform the reading and reporting process.

​All of these things can be achieved to deliver a better working environment, more efficiency, greater flexibility, better data accuracy and much improved data security and could normally be funded by cost savings that the service itself will generate.

We need help to accelerate the pace of adoption.
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
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Innovation 'Elevator Pitch':
Docly is the leading digital health provider in Sweden, founded by a practicing GP in 2013 to deliver greater efficiency of use of clinician time, better quality of care and better patient experience using algorithm supported online consultations. 

Overview of Innovation:
Docly has been in use since 2013 in Sweden, with over 250k patients consultations to date.  85% of patients prefer it to conventional appointments due to quality of service they receive and the ability to access care how and when they prefer.



Clinicians choose to work in the Docly service (we employ 120 Doctors in Sweden) as they have greater flexibility of time and location and with the security provided by integrated decision support tools.

Efficiency gains are significant with approximate halving of the clinician time taken per consultation.
 
Work Flow

Docly consultations take place securely online: patients fill out a guided questionnaire for the health condition they seeking help for, then submit their case to our Digital Waiting Room.  They can do this via an app or web tool.  These notes become part of the patient’s record, reducing downstream administrative workload.

The questionnaire provides automated triage, refernig the patients to appropriate levels of care. This could be to eg self referral to physiotherapy, or if  the information the patient enters indicates a more serious problem, then the patient is instructed to seek urgent care.
 
The Docly clinician uses their web tool or app to select patients from the Digital Waiting Room according to condition, location, time waiting etc.

Typically a consultation is starts 3-4 minutes after a patient submits their case, with the patient informed of this by a prompt in their app. Most communication between the clinician & patient then takes place asynchronously (ie not real time) in writing.

Doctors can choose to use images, video or phone calls, during the consultation.  They can as would be the case in any normal consultations request tests to progress the consultation to arrive at a diagnosis, decide on any treatment & follow up with the patient, replicating the steps in conventional care but taking the experience online.
 
Quality tools

Decision support tools are integrated into the clinician app are derived from national guidelines and are written and maintained by doctors with significant experience in writing clinical algorithms.

All activity is recorded and reports of clinicians’ work are displayed via dashboards that can also be used as input into appraisals.  The service encourages online peer support from other Docly doctors to pose questions and gather rapid feedback.

Every 20th case a clinician sees, they are prompted to review an anonymous peer’s case to provide a quality feedback mechanism.

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: 
Digital health / Innovation and adoption
Benefit to NHS:
The demands on primary care services are at an all-time high with the number of consultations occurring in general practice, estimated to have increased by 19 per cent between 2008-09 and 2013-14; against a backdrop of a recruitment crisis in where the UK is estimated to be short of 6k GPs. Non-attendance is estimated to be 5% of appointments further compounding the pressures on primary care.
 
At the same time 75% of the UK population go online for health information & 50% use the internet for self-diagnosis (Department of Health & UK Trade & Investment 2015). 71% of those aged 55-75 have a smartphone (Deloitte 2017)
The traditional models of primary care are less aligned to expectations of patients & are increasingly difficult to access. 
 
Patients

Docly offers high quality, modern & accessible healthcare.
  • Patients are connected through our service to a clinician - usually a GP - within 3-4 minutes (median) without having to leave their home or office, contributing to a better quality of life for patients and improved service over conventional care
  • Net Promoter Score of 45.
  • 85% of patients choose to use Docly for subsequent appointments.
Clinicians

Docly increases capacity for a GP to serve their patients through
  • Faster consultations, typically taking 50% of the clinician time over a conventional appointment.
  • Increased attractiveness for GPs working clinical sessions due to greater flexibility : Doctors can work where and when it suits them, working around other commitments and increasing the available workforce.
  • Triage of patients directly to alternative services without the need to directly engage with the practice
  • Remaining capacity is focussed on those patients who really need to see a doctor in person.
  • High Patient satisfaction
NHS

Docly (known as Min Doktor) is part of the public healthcare system in Sweden, providing online consultations for national & regional public healthcare providers.
  • Cost savings from increased capacity to serve a given population through the efficiencies of increased patient throughput
  • Working alongside existing services in a given geography enhances and augments the total capacity in a given area.
  • Patients stay registered at their own practice
  • Patient satisfaction
  • GP workforce capacity and satisfaction
  • Quality of care: we have reduced antibiotic prescribing driven by guideline derived algorithms by 50% over the last 18M, and similar reductions of referrals to specialist secondary care services also using guideline structured algorithms.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
The West Midlands region is an area of contrasts. It includes densely populated conurbations such as Birmingham, Coventry and Stoke-on-Trent, as well as beautiful areas of remote countryside within the counties of Staffordshire, Worcestershire, Warwickshire, Herefordshire and Shropshire.
 
Sparsity and the increasing scarcity of public transport links are recognised as having a significant impact both on daily living costs of rural households and on access to services.  All of the Sustainability and Transformation Partnerships (STPs) in WMAHSNs rural areas have identified these challenges as priorities in their transformation plans.
 
NHS England is using technology to empower patients and make it easier for clinicians to deliver high quality care and enabling patients to seamlessly navigate the service as part of its digital transformation strategy. The Online Consultation programme is a contribution towards this ambition.
 
Online Consultations are part of the Midlands and East GP Forward View (GPFV) Digital Implementation Strategy.
 
Video consultations can overcome geographical boundaries and provide access to services in remote areas or those with limited numbers of healthcare professionals.  These are however not suitable where low bandwidth mobile networks exist as is the case across much of the west Midlands area, so text based and asynchronous consultations suit this environment well. Currently only 2% of Docly consultations require a video call.
 
Patients using the Docly service do not need to take time away from work to have an appointment, and without the need to video call the doctor, the process is much more appropriate to a work environment.
 
We anticipate that doctors providing the Docly service  would come from within the area contracting with us. If there is insufficient capacity within the local geography, doctors from outside the area can support local patients, and in a reciprocal manner, doctors in the West Midlands could treat patients in other parts of the country.
Current and planned activity: 
The GP Forward View announced £45m to support the uptake of GP online consultation systems. The General Practice Development Programme will help practices lay the foundations for new models of integrated care & play their part in delivering a sustainable & high quality NHS as part of the Sustainability & Transformation Plan process in which general practice has a key role.
 
Docly would like to engage with WM CCGs, Federations and large GP partnerships to explore accessing the above funding to establish the Docly solution across the region.
 
We want to ensure the Docly service is visible to organisations considering online patient triage and consultation tools.
 
In other areas we are working to deploy Docly into practices in Leicester and are designing an evaluation with a large GP federation to quantify the value in an NHS primary care environment.
What is the intellectual property status of your innovation?:
IP Held by MD International (parent company).
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
2
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Innovation 'Elevator Pitch':

Proximity Patients uses RTLS & current NHS data feeds to track, inform, guide & notify patients of the nearest non-urgent service required with capacity or the shortest waiting times. It also tracks patients throughout the facility to avoid delays.
Overview of Innovation:
Proximity Patients is a secure solution for hospitals, medical centres and elderly care, amongst others. Whether locating critical staff in A & E, vital ‘missing’ equipment or absent patients across each site, we help optimise staff, patient and provider benefits whilst offering the opportunity to inform and engage with the patient.
Our software can be linked to other systems such as Vital Signs Monitoring or Asset Management software whilst our hardware can be built into the fabric of the building, added at a later date or simply carried by staff and equipment unknowingly using long life power sources.
Real Time Location Services (RTLS) provide up to the minute details of the whereabouts of all entities ensuring efficiencies and care are optimised by the highest utilisation of hospital resources. Recorded information facilitates process improvements based on actual data, not anecdotal evidence. Periodical reviews of this data encourages optimisation and reduces staff transit times between duties; average patient progress throughout their care can be measured and patterns of behaviour established to reduce long term staff and monitoring costs.
Patients are easily located to ensure their operations start on schedule; after a simple electronic registration they are treated as a valued ‘customer’ by all staff who approach them with a smart device, whether previously known or unknown, immediately putting them at ease and reducing anxiety. Patient services can add revenue streams from hospital shops or other pay to use services, via mobile devices.
For added security, the ‘I Need Assistance’ button can be activated by staff or patients to call for help, either from Security or medical staff, without having to clearly identify who and where they are, saving vital seconds in an emergency.
Patients can also use this infrastructure / data for indoor navigation, finding departments or the nearest useable facilities (toilet, shop, car park, etc), communicate with staff.
Stage of Development:
Trial stage - Trial stage to prove that the idea actually works as intended
WMAHSN priorities and themes addressed: 
Education, training and future workforce / Wealth creation / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Scalable roll-out starting with a low investment for single ward / treatment centre.
We do not rely on BLE (Bluetooth Low Energy) beacons but accurate locators working on 2.4GHz can track people, assets, mobile phones and any other Bluetooth enabled devices to with 10cm accuracy. We have 2-way communication with mobile devices and as such can save on the hospital buying multiple solutions. Utilising the same locators for multiple platforms ensures minimal IT installations and maintenance. Studies in airports have shown that BLE beacons cost an average of £220 pa to maintain whereas maintenance for Proxicon locators’ costs less than £30 pa. Less Proxicon locators required to provide a more accurate tracking solution than beacons; this provides the NHS with multiplied savings over other technologies.
No need for additional user hardware if already using other existing NHS systems such as Systems C VitalPacs and Safe Patient Systems; Proximity Patients utilises the same devices. If no other systems are currently in use we need only use a wifi enabled smart device (tablet, smartphone) or a Bluetooth enabled device for lower level functions which can owned by the patient.
Provides simple interrogation of data in 4D; a 3D environment visible in real time replay. This shows hotspots, such as queues waiting for X-Rays or areas where equipment is constantly being used / left unused, optimising the deployment of life saving assets without the unnecessary and labour intensive time studies through manual observation.
Start to build full electronic patient records of essential data across all departments so clinicians can see the full patient picture at a glance.
Enabled ID cards which can also contain a single use panic button function can be traced to anywhere covered by the locators (internally and externally). A discrete emergency signal can be sent with staff ID and location, cutting security response times significantly.
Essential staff can also be located and deployed via a group message, for example in the case of a major incident, staff can be notified that they need to be on standby to report to A&E or go there immediately. All staff communication can be issued irrespective of their location.
Asset tags can be used to track equipment and provide the latest and up to date operating and maintenance instructions to any smart device saving operator and maintenance staff time.
Case studies can show utilised assets and staff during treatment to identify true costs of care.
Initial Review Rating
3.40 (2 ratings)
Benefit to WM population:
Improved customer experience, whether as a patient, visitor or employee:
  • Patients can be prepared for arrival prior to physical presence being observed. Patients can be sent travel plans via SMS, email, push notification. These can include expected travel times and bus routes, for example, to ensure the patient arrives in plenty of time for their operation / appointment reducing anticipation and anxiety.
  • Voice or visual guidance for all patients and visitors to help plan their arrival route and find
    • Wards
    • Departments
    • Parking
    • Shops
  • Patients already familiar with other NHS mobile platforms can be easily tracked and therefore useful location information provided: whether for appointment / health benefits for the patient or for informing accompanying visitors about available facilities. These include the nearest toilets or food outlets; provides wealth generation such as providing hospital shop offers or pre-ordering food from the hospital cafeteria / restaurants.
  • Patients can notify the facility of special dietary and personal requirements (such as an allergy to nuts) prior to arrival and get confirmation that these requirements have been actioned; saving staff time upon arrival. Staff merely confirm the knowledge on arrival that the patient has previously supplied.
  • Patient experiences can be tracked by an ‘opt-in’ to a “Help the NHS to help you survey” built into the platform, making the patient feel part of an inclusive community with their and the NHS interests at heart.
  • Patients can provide their friends and relatives with their unique patient ID to allow them to be located during visiting hours. By using this service, the patient agrees to allow the NHS to post patient specific notifications to those visitors such as:
    • ‘Patient is nil by mouth’
    • ‘Patient may only have 1 visitor at a time’
    • ‘Please use the Hand Sanitizer upon entering and exiting the ward’
  • Patients who are not nil by mouth can order food and drinks from shops for delivery to their ward and pay by mobile platform such as Android Pay, Apple Pay or Paypal. Similarly, they could order books and newspapers from the shops inventory. This provides comfort to the patient and a feeling of some level of self-control boosting their self-esteem.
Current and planned activity: 
We participate in the Serendip programme in iCentrum, run by Innovation Birmingham. We work with the WM Combined Authority on various transportation solutions & have had several discussions with the WMAHSN team there regarding applying our solutions throughout the NHS in the WM region.
As a result, we have made contact with the Local Eye Health Network to expand on our guidance for those with visual impairments from transport into the healthcare environment. We are open to collaborations with other NHS providers and are currently awaiting a couple of introductions to two of those key established providers previously mentioned.
We require assistance to network and find a suitable sponsor to trial the system. We know our technology works in other environments and there are examples where it has been used successfully in healthcare situations in other countries but not attempting to incorporate all the functions we believe should be built into a NHS / patient tracking / engagement system.
What is the intellectual property status of your innovation?:
The IP of the hardware is owned by our Finnish supply partner Quuppa Oy. The IP of the software belongs to Proxicon.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
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