Continuing Healthcare Workflow Software: CHC2DST to underpin service transformation (#2875)

Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Currently Continuing Healthcare Assessments are often paper and phone based, involving multi-disciplinary teams across different organisational silos. Our intuitive Continuing Healthcare tool transforms the CHC & DST process for safe and better care.
Overview of Innovation:
The current process of Continuing Healthcare Assessments is often paper and phone-based and involves the co-ordination of multi-disciplinary teams across different organisational silos.

A lack of transparency in the assessment process can lead to unnecessary delays. One team’s uncompleted task can halt the entire process; whether it be because of admin delays on missing paperwork, incomplete assessment information or delays in communication.

Delays, lack of progress and poor visibility cause considerable distress to patients and their families as they wait for funding assessment, decision and care provision.

NHS England has introduced new quarterly CHC reporting in order for CCGs to monitor performance as many fail to achieve the National Standard turnaround of more than 80% of eligibility decisions within 28 days. On the reward side, NHS England has made the annual achievement of the National Standards for CHC subject to a valuable Quality Premium.

Continuing Healthcare assessment transformation starts right here.

CHC2DST eliminates paper from the Continuing Healthcare assessment process. It provides a single point of entry for assessments into your organisation. From Day 1 you begin to control the CHC workload and workflow, rather than the other way around. Through the elimination of paper and the automation of communications between process stakeholders, CHC2DST provides CHC leaders with the transparency they require to improve their service levels.

CHC2DST increases the productivity of stakeholders within the CHC assessment process, reducing time spent on low-value admin tasks and allowing them to focus their time, knowledge and skills to drive improvements and generate value into other Continuing Healthcare areas.

With CHC2DST user organisations are able to configure the solution to the assessments, permissions and workflows that suit their local situation.

Benefits of CHC2DST
  • Improve the assessment services to patients and carers and staff
  • Improve communication across stakeholders
  • Improve decision making speed and accuracy
  • Reduce Delayed Transfers of Care numbers
  • Improve work allocation and follow-up scheduling
  • Improve accuracy and retrieval of completed CHC Checklist and DST
  • Reduce legal appeals through better record keeping
  • Reduce processing costs by eliminating inefficiencies
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)
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Overview summary:
Continuing Healthcare is a complex multi stakeholder assessment and funding decision making process. It has been the subject of NHS improvement programmes, National Audit office scrutiny and patient group pressure which led Simon Stevens to make a commitment to Improve the service whilst reducing the cost to the NHS. We focused on developing a solution to improve efficiency and chc2dst was identified as one of ten high impact innovations in 2018. The solution was co-designed with the NHS.
Challenge identified and actions taken :
In late 2016 IEG4 ran an open event for NHS staff to come and discuss where improvements in efficiency through digital could make most impact. Two nurses were very clear that if we tackled the very inefficient process, paper and complex assessments for continuing healthcare we would improve the service for families and patients and dramatically improve the efficiency of the NHS workforce.
Continuing Healthcare improvement is also the focus of the NHS through a strategic improvement programme and a Quality premium payment scheme for CCG’s.

We took on the challenge and with the support of the Cheshire and Wirral Continuing healthcare team developed an end to end digital referral, assessment, workflow and decisions software solution.

Over an 8-month period the software was developed as part of an “agile” project to the stage we had an operational solution which the NHS in Cheshire and Wirral implemented.

Dramatic improvements in quality and performance have shown through with the Cheshire and Wirral CCG’s achieving NHSE targets. The solution is now market ready for rapid adoption across the whole of England to deliver widespread benefits.
Impacts / outcomes: 
Tracey Cole - the Head of CHC in Cheshire has presented at events with the NHS England SIP team with the following messages from utilising our solution.  These will be presented again at the Kings Fund Digital Health and Care conference in July 2018.
  • Single point of entry of referrals into the process offers control and transparency over the work load
  • Improved quality of assessments received – particularly checklists being digital
  • Reduced volume of cases by better and quicker assessment and education of referrers at the checklist stage
  • Reduced paper and postage costs
  • Reduced admin time for the operations team
  • Reduced admin time spent by clinical team – quicker completion of DST’s
  • Better allocation of positive checklists to the clinical leads
  • Automation of communications across stakeholders reduces delay
  • Improved morale in the team – people doing a better job
  • Improved delivery of 28-day standard
  • Digital checklist supporting discharge to assess to achieve the 15% standard
  • Full transparency of patient progress through the CHC system
Cheshire and Wirral CCG’s performance against an 80% target has improved from 66% to 82% during the period of implementing chc2dst.
Which local or national clinical or policy priorities does this innovation address:
Strategic Improvement Programme for Continuing Healthcare, Paperless 2020 as part of the 5YFV, Quality Premium scheme for CCG’s
Supporting quote for the innovation from key stakeholders:
Reviewers for the NHSE software applications assessment:

“A much-needed system for improving efficiencies in the CHC process”
“A high-scoring, eminently usable system that greatly impressed all three of our assessors in terms especially of clinical efficacy, safety, security and privacy”
Plans for the future:
Collaboration with AHSN’s and STP organisations to deliver the innovation across the NHS and build the digital solution for CHC and Complex care.
Tips for adoption:
The adoption process is very straightforward – One demonstration to frontline CHC staff and administrators, arrange a site visit to see the software in action, deploy an “instance” of the software into a test environment, configure the users and release the software to a live environment. Ongoing operational support from a Superuser/admin lead.
Contact for further information:
Charles MacKinnon
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Innovation 'Elevator Pitch':
Future-proof blockchain based provenance solution for CGT. Our digital service creates an efficient & transparent chain of identity/custody/condition & diagnostic, address compliance burdens, reduce cost & enable co-operation in a competitive arena.
Overview of Innovation:
FarmaTrust have used blockchain to create a tracking service for the latest cell & gene therapies.

Our solution is a working prototype that is able to track chain of identity, custody, condition and diagnostic for autologous cell therapies. It ensures transparency for regulators, enables efficiency by reducing HIPAA compliance requirements and records are ultimately more secure. All with the ultimate aim to support improved patient outcomes.

We also believe that the blockchain will be a key enabler in decentralising the manufacturing process to ultimately take these new therapies closer to the patient.

Because of this we are developing significant knowledge and skill based on these new technologies for the digitised healthcare and medicines agenda, and specifically in the smart and connected logistics supply chain that are applicable globally, thereby making the UK the go to place for this type of expertise.

View the FarmaTrust Explainer Infographic – click here.

Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Advanced diagnostics, genomics and precision medicine / Clinical trials and evidence / Digital health
Benefit to NHS:
The features of our solution will provide the following benefits:
  • A foundational system that is interoperable with the multitude of hardware and software systems which are used in many healthcare settings around the world, including the NHS
  • By ensuring data integrity between the various systems, scanners and data input devices without having to make substantial integration changes
  • By creating efficiencies through automating payment processes, regulatory reporting, compliance and audit
  • By utilising blockchain with AI to mine data collected in order to maximise cost savings and delivering improved services with the same budget or less
  • By providing a truly connected and smart data collection system across the multiple stakeholders to benefit the research teams, NHS, regulators and ultimately patients
  • By providing a real alternative way to do things differently to the traditional legacy cloud-based technologies that will start to struggle with the increasingly digital future of healthcare and medicines/devices
  • By leveraging the innate properties of blockchain to enable effective co-operation between competing CGT manufacturers
  • Enabling future readiness for a world that moves from the current increasingly resource hungry and inefficient supply chain model to a decentralised efficient (on) demand driven chain reality!
Initial Review Rating
3.80 (1 ratings)
Benefit to WM population:
Our Innovation will:
  • Develop an effective and robust CGT supply chain solution for any research team in the WM involved in CGT development, eg Midlands & Wales ATTC
  • Expose and eliminate inconsistencies and errors, thereby give therapy quality assurance to WM researchers and patients involved in trials
  • Have the potential to remove product loss completely from the high value supply chain
  • Support on outcome based value proposition for precision medicines and high value therapies based on blockchain smart contracts
  • Be interoperable with blockchain advances, incumbent cloud technology providers and the latest IoT sensors used in the WM – less money spent on tech integration and more spent on patient care
  • Leverage machine learning for data analytics which provides predictive and prescriptive insights to allow greater efficiency, cost saving and demand planning for supply logistics
  • Help make the WM and the UK a global thought leader for blockchain (enabled by Internet of Things and Artificial Intelligence) developed healthcare services!
Current and planned activity: 
We have a working solution that is:
  • Already available through our US partner. As of late 2018 Systech One are white labelling and marketing our linear small molecule supply chain solution in the US and Europe. Systech One powered by FarmaTrust!
  • A fully working blockchain based needle to needle tracking solution prototype as a result of a significant commercial partnership with a German cell & gene therapy solution provider.
  • Creating increasing interest with the Innovate UK Catapults. Namely the Digital Catapult, Cell & Gene Therapy Catapult and Centre for Process Innovation.
  • Going to be a pilot in a province of Mongolia as commissioned by their Govt – this will be our small molecule linear track and trace solution
  • Going to provide track and trace services for medicinal cannabis plants. Work that has been commissioned by Peterson One for the Thai Govt
We are also working with a senior Oncologist from Birmingham to spec our new clinical trial tracking solution.
What is the intellectual property status of your innovation?:
Core IP belongs to FarmaTrust.
Return on Investment (£ Value): 
Return on Investment (Timescale): 
1 year
Ease of scalability: 
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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: 
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.
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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