Docly enables online clinician-patient communications supported by guideline derived algorithms through text,voice, and video. (#2935)

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Idea Description
Supplementary Information
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)
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Fact that it has been running in Sweden since 2013 - means there will be useful  analysis on how it has performed.  Has there been case studies on when it has worked well, and importantly when there have been errors made?
Is an exciting innovation - which i suspect would be welcommened by many people due to the flexible nature of the app, allowing users to take better ownership of their health.

Hi Ravi - yes we do have a lot of experience in running online doctors service now having just hit the 300,000 consultations mark and growing very quickly.

The publications we have are in Swedish - I am looking at getting some selected translations completed. 
We have an economic analysis in English available here: https://link.springer.com/article/10.1007/s41669-017-0059-7  looking at the relative costs of a Swedish digital model of care vs traditional, showing approximately 40% cost reduction.

We are planning our UK evaluations now. We see the Docly service as a way of deploying evidence based medicine at scale through clinical algorithms written by doctors.  The platform also allows us to measure quality markers such as appropriate antibiotic prescribing.

Regarding errors, we have had for some time a substantial set of QA and QC processes, including clinicians working in our service peer reviewing their colleagues work.  This enables us to refine the service and clinicians to improve their work as digital doctors. 

Barnaby Poulton, Managing Director UK
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