MISS (Malinko Intelligent Scheduling System) for NHS Trust community services for efficient patient appointment scheduling (#2246)

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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Integrate with PAS and rostering systems, to bring together capacity and demand; automating manual processes used to judge which staff ought to be scheduled to which patient appointments with dynamic rescheduling throughout the day via mobile app.
Overview of Innovation:
NHS community services are one of the last industries to adopt an automated and intelligent appointment scheduling system to help manage their field based (community healthcare) staff. Significant improvements can be made in the way community workforce are managed by optimising the patient appointment booking (scheduling) process.

Initial research indicates that there are few Trust with systems in place to effectively and efficiently schedule which staff should visit which patients at which times. Our objective is to work with NHS Community Trusts to develop MISS (Malinko Intelligent Scheduling System) to systemise the current informal and ad-hoc processes used to do this.

Malinko is a scheduling system with mobile app to allow staff to check in and out of visits which is already used in other sectors. It requires some additional work to ensure that it works well for the healthcare sector. These elements are:
  • Integration with the PAS (Patient Administration System) to bring in patient appointment requirements and with the rostering system to for staff capacity. By taking this information, along with predefined parameters based on provided KPIs, Malinko’s scheduling algorithm will ensure that the rostered staff attend the optimal visits.
  • Mobile app to enable staff to communicate live back to the main system any issues that would result in their visits to require rescheduling that day. The Malinko system would then automatically reschedule these and let any affected staff know.
  • The office staff have a live nurse tracker board, enabling them to see last known locations of all nurses out in the field.
  • The nurse can send a text message or voice message to the patient to let them know they were on their way to avoid DNAs (Did Not Attends).
This would enable substantial productivity gains and cost reductions within NHS community services with marked reductions in non-clinical contact time as Nurses on average spend 19% time in administration includes office visits. It would also result in significant service improvements being achieved as it would allow community nurses to both spend more valuable time with patients and enable them to see more patients. In turn, we would expect to see a reduction in acute activity and pressures. Additionally, by optimising the appointment booking process there is an opportunity for NHS Community services to make direct cost savings in area’s such as travel, administration, staffing and the costs associated with DNAs.

Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
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Overview of Innovation:
Significant improvements can be made in the way community workforce are managed by optimising the patient appointment booking (scheduling) process.

Proven in other sectors, Malinko is a scheduling system with mobile app to record staff visit check in/out. Additional work is being carried out to ensure a better fit for the healthcare sector.  These elements are:
  • Integration with the PAS (Patient Administration System) to bring in patient appointment requirements and with the rostering system to for staff capacity.  By taking this information, along with predefined parameters based on provided KPIs, Malinko’s scheduling algorithm will ensure that the rostered staff attend the optimal visits.
  • Mobile app to enable staff to communicate live back to the main system any issues that would result in their visits to require rescheduling that day. The Malinko system would then automatically reschedule these and let any affected staff know. 
  • The office staff have a live nurse tracker board, enabling them to see last known locations of all nurses out in the field.
  • The nurse can send a text message or voice message to the patient to let them know they were on their way to reduce likelihood of DNAs (Did Not Attends).
The core system, along with these improvements would enable substantial productivity gains and cost reductions within NHS community services with marked reductions in non-clinical contact time; on average Nurses spend 19% time in administration includes office visits (RNC 2013). It would also result in significant service improvements being achieved as it would allow community nurses to both spend more valuable time with patients and enable them to see more patients.  In turn, we would expect to see a reduction in acute activity and pressures.  Additionally, by optimising the appointment booking process there is an opportunity for NHS Community services to make direct cost savings in areas such as travel, administration, staffing and the costs associated with DNAs.

Based on in-depth research on site with 4 NHS Trusts Community Service providers can anticipate the following by deploying the MISS:
  • Reduce senior nursing non-clinical contact time
  • Reduce Community Nursing/HCA non-clinical contact time
  • Reduce DNA rates by 50%
Other potential cost savings include (more detailed analysis required): Overtime; Bank and Agency; Travel; Replace incumbent standalone lone worker system; Replace current standalone expenses system; Admin.

Investment Slide Deck available upon request.
Initial Review Rating
1.00 (1 ratings)
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Innovation 'Elevator Pitch':
The Zesty patient portal is simple to use, designed for mobile devices first and very cost effective. Patients love to use it, with adoption rates by specialty of more than 50%.
Overview of Innovation:
At Zesty we've been working hard with a group of NHS trusts to digitally transform outpatient appointment management.

Our patient portal has been built from the ground up with appointment management as its core function, ensuring a secure, robust and friction free patient experience. We deliver significant cost savings and overall efficiency gains via -
  • Full EPR integration – our system is read & write enabled.
  • A best in class user experience – support for all devices with a strong focus on smartphone.
  • Complex workflow management support, including support for integrated reporting and other downstream process management.
  • Support for first appointment, follow ups, remote consultations and ERS.
  • e-Broadcast – fill cancelled slots with patients further down the waiting list.
  • Intelligent SMS and notification support.
  • N3 secure hosting and access.
  • Complete control of RTT target times and slot publishing rulesets, customisable by specialty.
Digital Letters 

The Zesty patient portal provides patients access to their letters instantly and give them the ability to ‘opt out’ of paper completely.
  • Seamless integration with your existing HL7 messaging or document management system.
  • Instant document view on any device – optimised for smartphones.
  • Support for all letter and document types.
  • Automated suppression of paper letters, for those patients who have opted to go paperless.
 
Real world savings
 
We're committed to driving both tangible cost reductions and incremental revenue via the use of our portal. We can support the business case process with independently verified cost saving data, based on the % of patients who use our portal. We target a minimum 3:1 ROI.

We enable savings via
  • Less phone calls
  • Less paper, stamps and associated fulfilment charges
  • Lower in person administrative support
  • More accurate patient pathway management
  • More accurate patient demographic data
We generate income via
  • Increased attendance rate (lower DNA's)
  • Enabling remote appointment management – at the new tariff rate
Zesty is live across 11 NHS Trusts, our flagship NHS Trust is Milton Keynes University Hospitals.
 
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 / Person centred care
Benefit to NHS:
We don't measure success on paper based savings, we deliver actual, real world, cost reductions.
 
We're committed to driving both tangible cost reductions and incremental revenue via the use of our portal. We can support the business case process with independently verified cost saving data, based on the % of patients who use our portal. We target a minimum 3:1 ROI.
In addition to the significant benefits for patient experience, the main financial benefits being realised are :
 
  • Reduction in paper letters, stamps and fulfilment costs;
  • Reduction in administrative head count;
  • Lowering inbound call volumes and reducing time to answer calls;
  • Capacity and efficiency improvements around outpatient appointment slots;
  • Reduction in DNA’s;
  • Increase in perceived transparency surrounding medical record access.
Online Discussion Rating
5.50 (2 ratings)
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
The Zesty patient portal supports the delivery of the Five Year Forward View at both a local and national level. Our portal completely supports the ability to deliver better health, better patient care and improved NHS efficiency.
 
Zesty understand Acute NHS Trusts face ongoing financial pressures, therefore they need to take action as soon as possible to ensure patients, their families and carers are empowered to take more control over their own care and treatment.
 
For example… 
 
Better Health– 
 
Improve access to secondary care, acute and outpatient services
 
Increasing the ability to support people in their own homes
 
Better Patient Care– 
 
use of digital technology for pre visit and post treatment. Enables care providers to deliver better care by capturing both clinical and non-clinical data from patients.
 
Providing digital solutions for self-care, virtual consultations and interoperability to increase patients’ access to information and reduce duplication and travel.
 
Improved NHS Efficiency– 
 
unlocking cash saving benefits 
  • Less phone calls
  • Less paper, stamps and associated fulfilment charges
  • Lower in person administrative support
  • More accurate patient pathway management
  • More accurate patient demographic data
 
Current and planned activity: 
Zesty are currently engaged in a number of direct conversations with NHS Trusts and via channel partners. We are planning to exhibit at and attend the main NHS focused conference and events in 2019.
What is the intellectual property status of your innovation?:
Zesty Ltd owns 100% of the IP for our products.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
Regional Scalability:
The Zesty portal could be scaled across WM once direct EPR/PAS integrations have been acheived.

Zesty has experience of scaling products regionally, for example in 2017 Zesty was part of the consortium that won the 9 Year Pan London Sexual Health Digital Transformation Programme.

The new service is the result of a unique collaboration of 29 London boroughs who commission sexual health services and has been developed following comprehensive consultations with patients and clinicians.

http://ssha.info/london-sexual-health-transformation-programme-may-briefing/
Measures:
In addition to the significant benefits for patient experience, the main outcomes we focus on are :

* Reduction in paper letters, stamps and fulfilment costs
* Reduction in administrative head count
* Lowering inbound call volumes and reducing time to answer calls
* Capacity and efficiency improvements around outpatient appointment slots* Reduction in DNA’s
* Increase in perceived transparency surrounding medical record access
 
Adoption target:
Adoption rate targets are 30% of patients within 6 months.
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Innovation 'Elevator Pitch':
Combining patient demand, workforce availability & skills to deliver care, eCommunity supports right skill, right place, right time in the community, identifies daily & broader skill mix gaps, reducing time & improves quality of visit allocations
Overview of Innovation:
District and community nursing have unique pressures in terms of identifying and coping with high demand across a wide range of care needs. Service demand, rosters and skills have traditionally been held in separate systems, many of which are paper based. Bringing all this information together into a single visual solution enables service managers to make faster, smarter decisions ensuring quality care is delivered and the workforce isn’t burned out.
 
The additional released administration time for senior team members enables faster visit allocation and allows them to spend more time supporting their staff and patients.
 
eCommunity is a web based solution www.qes-online.com that enables visit allocators to rapidly plan days for frontline staff in under 30 mins, something that currently takes 2hrs +. This new allocation process is supported by supplying recommended best fit treatment by continuity, acuity, skills availability and location.
 
For the first time a team or whole service has a forward facing view of capacity and can create a roster to meet demand, be well informed of capacity gaps and proactively even out demand rather than react to circumstances.
 
Utilising a “care catalogue” dictating time and skill needed to deliver treatments, eCommunity ensures that the workload given to a member of staff is both appropriate for their skill mix and can be delivered within the allotted shift time, two advantages other services cannot evidence. “Actualising” the actual time it takes to deliver care and updating the care catalogue is a vital to ensure capacity and demand is based on real life evidence.
 
eCommunity is web based, making it accessible from home enabling staff to be well prepared for their first visit the following day, removing the need to “go to base” at the start of a shift saving hundreds of care hours a day.
 
Utilising smart capacity, demand & caseload allocations means fewer people can manage greater demand and larger teams. This further frees up often highly skilled team managers to focus on delivering care and supporting frontline staff.

eCommunity is the first dedicated operational tool designed by experienced, practicing community nursing teams to improve both the care delivery and working practices for staff.  This level of dynamic, real life operational support and intelligence has not previously been possible using existing clinical tools and systems.
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: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Education, training and future workforce / Wealth creation / Digital health / Patient and medicines safety / Person centred care
Benefit to NHS:
The quality of care delivered will be significantly improved via the “care catalogue” that ensures that the nurses assigned to deliver treatments have the appropriate skills. This not only improves care quality but also improves job satisfaction and role engagement as staff know the scope of care is within their capacity.
 
One of the largest efficiency savings will be the releasing of time available to care. This is possible by pre-planning, enabling care delivery to commence immediately at the start of a shift, not requiring a pre-meeting at which the visits are allocated. Hundreds of hours of additional care time will now be made available.
 
Business intelligence is key to optimising available capacity and demand, identifying skills gaps and aiding training & recruitment. Team differences in care delivery are identified through visit ‘actualisations’ and an accurate picture of what treatments are being delivered. This smart business intelligence can be used to drive discussions with commissioning organisations.
 
Significant reductions in travel mileage will also be realised by ensuring smart navigation and scheduling of visits that optimise travel. Given the huge mileage covered in delivering care, even a small saving in distance travelled delivers big financial and carbon footprint savings.

eCommunity can deliver these advantages for large teams or small teams delivering specialised services via a single license for unlimited use.
Initial Review Rating
3.40 (1 ratings)
Benefit to WM population:
eCommunity is flexible and adaptable able to work effectively with any kind of mobile workforce that includes a variety of skill mixes and challenges, where capacity and demand are under pressure.

Although primarily designed for use in community and district nursing, its value would be realised across any health or care service.
Current and planned activity: 
eCommunity now 12 months old and benefits in use are being collated
(See attached Appendix ‘Testimonials’ for NHS user testimonials)

eCommunity solutions have been trialled and liked by frontline staff and team leads. However, many care providers struggle to formulate suitable business plans to support investment, despite obvious savings, lacking adequate baseline data and IT support to evidence impact.
 
eCommunity development is ongoing to enable a ‘live view’ of workloads for all staff delivering care and flag when visits need re-allocation to ensure assigned visits & tasks can be delivered. This development is only possible by effecting cultural change to complete information immediately at the end of each visit, not waiting until return to base.
 
Work ongoing to integrate eCommunity within a clinical tool. Current tools are mis-perceived as the “be all and end all” of IT solutions by both frontline staff and senior management, despite their lack of support for operational needs
What is the intellectual property status of your innovation?:
IP is fully owned by QES
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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