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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
CaDDI provides ‘live’ capacity and demand information across the Mental Health Urgent Care Pathway through an internet based dashboard. This provides a realistic resource and bed capacity and referral demand across the urgent care pathway and beyond.
Overview of Innovation:
The Midlands and Lancashire Commissioning Support Unit (MLCSU) , in partnership with Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT), have developed a live Capacity and Demand Dashboard Information (CaDDI) system for use across the mental health urgent care pathway. It delivers improved patient pathways by providing managers and operational staff instant access to ‘live’ patient flow information, allowing them to make more informed decisions on staff deployment and onward referrals based on data-led assessments.

The CADDI package consists of two elements:
  • A mobile APP solution to collect ‘live’ data from operational teams, on their current capacity, and progress of their patients’ journey throughout the referral process;
  • A ‘live’ dashboard providing an overall capacity and demand summary status across the Urgent Care pathway, with drill down functionality to a service/team level.

The CaDDI system can be populated from any source that can send live structured data or can use the app developed to enable the live gathering of data.

Currently the data capture systems options include:
  • Rapid, Assessment, Interface and Discharge teams (In-reach service hosted within another organisations)
  • Decision Unit (location based service, with defined number of places available)
  • Place of Safety (specialised location based service, with defined number of places available)
  • Street Triage Team (Out-reach service in partnership with Ambulance and Police Service)
  • Bed management (populated through PAS) – Inpatient demand and capacity, key metrics on patients waiting for a bed, occupancy rates, patients waiting for discharge, and patients out of area.
The CaDDI mobile app enables urgent care teams to access an ‘at an glance’ worklist view of the referrals currently open on their team, including at which point each patient is in within the referral process. The staff can then record timely information in the app any action taken, what is the next action and if patient is waiting for services. This chronological record of the steps from when the patient enters the system until departure helps in the completion of the patient’s clinical record and can be can be accessed by all team members until patient has been discharged.

The 'live' dashboard will then display this information obtained by the mobile app and bed management system, providing a holistic and comprehensive view of capacity and demand across services.
    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
    Similar Content3
    Innovation 'Elevator Pitch':
    eCAS Card simplifies recording activity data at point of care in busy A&E Departs.  This data is available to all clinical staff with associated patient safety checks. Patient record is more complete accurately reflecting activity & improving coding
    Overview of Innovation:
    Paperlite - The eCAS Card system is a replacement for the paper Casualty Card used in an Accident & Emergency Department and focuses on simplifying activity recording so the patient record contains rich clinical and nursing content. 
     
    Data Collection – The eCAS Card system simplifies and streamlines data collection by reflecting the processes and work flow within A&E Departments whilst integrating with the Trust’s PAS and key IT systems to ensure administrative functions are minimised.
     
    Accessibility - No longer are nurses and clinicians required to search for a single paper record as they will have access to the latest patient information anywhere within the hospital where there is browser access to the network.  The same patient record can be viewed with the capability of updating different parts of the record by multiple people simultaneously.
     
    Accessible via multiple devices including Tablets, iPADs and C.O.Ws utilising NHS security protocols.
     
    Monitoring - the system monitors “wait times” and provides simple, visual updates on screen to assist with meeting targets.  Utilising the data provided by nursing staff, Sepsis, VTE, Child and adult safeguarding checks are undertaken and appropriate alerts raised if the data meets certain parameters.
     
    • nursing staff report that their capacity to treat patients and record their activity increases with the use of the eCAS Card service
    • clinicians benefit from having the latest patient information to ensure appropriate and timely treatment.
    • administrative staff note a significant reduction in time spent chasing paper notes, scanning CAS Cards and completing activity data not entered prior to discharge.
     
    Data Sharing – the eCAS Card service ensures accurate and complete activity recording that results in an improved patient record which is then used for;
    • automatic production and e-mailing of GP attendance letters
    • all necessary reports and correspondence
    • A&E data available for Inpatient episode where a patient is admitted
    • simplified coding
    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: 
    Wealth creation / Digital health / Person centred care
    Benefit to NHS:
    The use of eCAS Card system improves patient care, efficiency, and improves activity reporting by:

    Patient Care
    • Improved patient flow facilitates quicker turnaround
    • Ensures that the right care is delivered as the clinical staff has the most up to date information at hand
    • Sepsis Screening, VTE, Child and adult safeguarding checks removes the potential for a condition/issue to be overlooked  
    • Accurate record keeping ensures episode details can be relied upon for any follow-up treatment and as part of the patient’s medical history.
    Provides Efficiency
    • Increase in productivity from nursing staff who are able to Triage and stream patients quicker.
    • Information can be accesses by the clinical staff via a mobile device reducing time locating the patient record or the correct form to complete.
    • Removes the necessity for double entry and transcription errors this can cause.
    • Reduction in administrative tasks, including scanning of paper Casualty Cards, production and postage of Attendance Letters
    • Facilitates direct communication and documentation with patients GP’s
    • Interfaces with PAS and Ambulance information systems for seamless transfer of patients
    • Integrated with Referral Management services to allow for the Demand Management to ensure patient is treated in the most appropriate location by the optimum service
    • Key step in becoming a paper-lite NHS organisation
     
    Improved Data Quality
    • Improved recording of activity to allow for more accurate charging and ensuring the Trust is paid for all its activity and improves CQUIN Reporting
    • Outputs audit data for department requirements and allows for the management of A&E Services based on accurate, up-to-the-minute information.
    • Integration with Primary Care to share patient data
    • Integration with Secondary Care to maintain Care Pathway if an attendance leads to an admission
    Initial Review Rating
    5.00 (1 ratings)
    Benefit to WM population:
    Patient Benefits
    • Improved patient experiences at A&E
    • Streamlined and efficient patient triage & treatment delivery via clear trust pathways reducing time in department
    • Consistent level of service and treatment
    • Safeguarding and inbuilt alerts for Sepsis and VTE ensures important checks are not missed
    • Reduced anxiety as clinical and nursing staff do not need to ask the same question multiple times
    • Greater confidence in the service as professionals have the information they require
    • Improved communication allows for seamless follow-up care if required
     
    Trust Benefits
    • Most efficient use of resources including physical locations, equipment, staff, patient information etc.
    • Improved data collection for each episode ensures patient data is both complete and accurate, increasing confidence in nursing care and clinical decisions
    • Activity accurately recorded improving CQUIN reporting and ensuring all attendances are correctly charged
    • Clear management and audit data to allow for proactive management of the A&E Department and assessment of process efficiency.
     
    Regional Benefits
    • Opportunities to manage demand of urgent care services by sharing load across Healthcare Economy as part of Sustainability & Transformation Plan.
    • Significant Patient Safety benefits by being able to consistently monitor and review vulnerable children and adults across the region.
    Current and planned activity: 
    Current Activity
    eCAS Card used successfully by East Kent Hospital University NHS Foundation Trust since 2015.

    WASP has developed additional innovative products and services for other NHS Trusts, inc. London North West Healthcare & Northampton General Hospital NHS Trusts.

    WASP is undertaking  Marketing Campaign to raise awareness of products and services that support improved operational efficiency of trusts, but which can be tailored to meet the demands of STPs & Local Digital Roadmaps.

    Planned Activity
    • Promotion - Meet with region’s senior managers involved with Local Digital Roadmaps to raise awareness of WASP’s current capability & strategic ambitions.
    • Adoption - Additional adoption sites within the West Midlands for the eCAS Card service.
    • Innovation –Work with an Healthcare Economy in order to implement new technology to join up the patient, GP, OOH services, NHS 111, CCG and Acute Trust providers to co-ordinate & manage Urgent & Emergency Care services demand.
    • Resolve the issues below.
    What is the intellectual property status of your innovation?:
    The eCAS Card Service has been specified, developed and supported by WASP Software.  The software “Code Base” is managed by the WASP Development Team and released in compiled form through our Operations Team.
    On this basis, all Intellectual Property and copyright (although not registered) resides with WASP.
    Return on Investment (£ Value): 
    high
    Return on Investment (Timescale): 
    6-12 mon
    Ease of scalability: 
    3
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    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
    WMAHSN priorities and themes addressed: 
    Mental Health: recovery, crisis and prevention / Digital health / Innovation and adoption
    Benefit to NHS:
    Integration with the PAS and the staff rostering system into the MISS to intelligently create the appointment schedules has a whole range of benefits for the NHS provider and patients.  In summary:
    • Improve caseload management using skills, knowledge and training to best effect.
    • Help release and focus capacity due to ‘live’ organisation wide view of demand and capacity.
    • Reduces time in morning meetings at start of day as these can be electronically received by staff.
    • Automatically scheduling based on an algorithm, reducing staff scheduling time and leaving them to just approve and make manual alterations to this schedule.  
    • As referrals come in during the day, they are automatically added and scheduled dependent upon priority.  If they require a visit within the day, the system will automatically add the job onto the most efficient round and dynamically reschedule other appointments effected.
    • Route optimisation, reducing time spent travelling and cost of travel.
    • Automatic mileage expense claims based on these routes.
    • Release time to care improving patient and staff experience.
    • Patient feedback mechanism to report satisfaction with the service.
    • Analysis of patient/community nurse combinations - eg where a patient dislikes a particular nurse and so is regularly out for their visits
    • Ability to send telephone and text alerts to patients reducing likelihood of DNA and leading to improved timeliness of visits including administration of medicines. This will also result in giving patient a narrower window of likely nurse arrival.
    • Ensure prioritisation of patients that need to be seen today and those that can be deferred.
    • Ability to redirect workforce to high risk patients in an emergency, therefore preventing admissions.
    • Ability to provide continuity of care as system logs number of previous visit during allocation process.
    • Benchmarking performance across the team members or indeed whether the team as a whole is underperforming against an external benchmark with full visit history for each patient and by each staff member. Spot trends and improve resourcing.  Examples include identifying where a patient doesn’t like a particular nurse and so is regularly out for their visits, or to quickly identify training needs where staff are regularly underperforming for particular types of visits.
    • Lone worker risks prevented with mobile app and nurse tracker board.  Silent panic alarm button within the app can send to office or escalate to emergency services.
    Initial Review Rating
    4.20 (1 ratings)
    Benefit to WM population:
    MISS can help the NHS to deliver better care at a lower cost by freeing up capacity to meet ever increasing demand.
     
    Based on in-depth research on site with 4 NHS Trusts, West Midlands NHS Community Service providers can reduce the following by deploying the MISS:
     
    Reduce senior nursing non-clinical contact time: It is forecast a service/locality with 20 FTE staff, with one locality manager and two senior triage nurses, could reduce 109 hrs/month of senior nursing non-clinical contact time by automating the patient allocation process with MISS (3.6 hrs per day of senior nursing time 7 days per week; service running at 50% at capacity the weekend).
     
    Reduce Community Nursing/HCA non-clinical contact time: It is forecast a service/locality with 20 FTE staff and 16 community nurses/HCAs could reduce 416 hrs/month of non-clinical contact time (1 hour a day per nurse - 7days a week; service running at 50% capacity at the weekend).
     
    Reduce DNA rates by 50%: Although one Trust we have worked with reported a DNA rate of 10%, we have little hard data with regard to current DNA rates and the cost of each DNA to the Trust, the view is DNA rates could be significantly reduced by adopting MISS’s integrated automated patient appointment reminder system (text and voice calls). Other NHS Trusts have analysed how much each DNA costs, reporting an average of £80 per DNA. Reducing DNAs would also have a significant impact on improving the efficiency of the service/locality and reducing patient complaints.
     
    Other potential cost savings include (more detailed analysis required): Overtime; Bank and Agency; Travel; DNA; Replace incumbent standalone lone worker system in two of the Trusts; Replace current standalone expenses system; Admin.
    Current and planned activity: 
    Nov 15: 1st NHS customer 

    Nov 16: Agreement from GM NHS Trust to deploy MISS in their District Nursing service across 6 localities and their District Nursing evening service, pilot funded by the GMAHSN Momentum bid. 

    Dec 16: Other pilot start; deploy MISS in their District Nursing service in two localities.

    There are a number of other NHS organisations who are interested in MISS.  We are looking for further pilots or early adopter profile Trusts, which due to recent funding we are able to part fund internally.

    We would like introductions to (Deputy) CIO or (Deputy) DOF roles within West Midlands and nationwide to NHS Trusts which provide community services, including mental health.
    What is the intellectual property status of your innovation?:
    The IP is held within Liquid Bronze.
    Accredited with Information Governance
    Accredited with ISO27001
    Return on Investment (£ Value): 
    high
    Return on Investment (Timescale): 
    2 years
    Ease of scalability: 
    Simple
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    Innovation 'Elevator Pitch':
    Using pathways and simulations to generate a synthetic population, informed by known population and health statistics, to act as a safe and effective testing environment for digital health solutions.
    Overview of Innovation:
    We are using pathways and simulations to generate a synthetic population, informed by known population and health statistics. This is intended to act as a testing environment, providing evidence for the decision-making, implementation and evaluation of all policies that impact health, whilst eliminating the risk of using real patient data.

    The process involves conducting a document analysis on relevant documents, clinical guidelines and standards to set the scope of the project and identify the important information items that need to included in the model. Existing pathways can be used or, based on evidence from the document analysis, new pathways created to include care, disease progression or system management pathways. A synthethic population is then generated using Census data for the specific locality, to reflect the same demographic distributions of the real population. This population are then run through the pathways and at each clinical interaction on the pathway, a digital exhaust can be produced that reflects those seen in real systems. The pathway execution stage also produces an event log detailing the steps and relevant information (e.g. costs and waiting times) for each individual in the population. These outputs can then be analysed using data visualisation tools to provide an interactive dashboard that visually tracks, analyzes and displays they key performance indicators (KPI), metrics or key data points needed for the project.

    This approach can be used to support service design, business case development, clinical engagement, user prototyping, supplier testing, training, demonstration, software product testing and resources for hackathon events.

    This is a scalable and reusable approach that will be of particular value following the implementation of the GPDR in May 2018 when anyone interested in data-driven improvements for health will need synthetic data.
    Stage of Development:
    Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
    WMAHSN priorities and themes addressed: 
    Digital health / Innovation and adoption
    Benefit to NHS:
    This approach has many valuable use cases for the NHS, including:
    1. Service design 
      • Building pathways in a standard format and using a realistic synthethic population, the workload, outcomes and risk factors affecting the service can be illustrated and reviewed
    2. Business case development 
      • Running the model twice, once with and once without a planned service change, allows the delivery, benefits and risks of a new service to be monitored
    3. Clinical engagement 
      • Engaging pathway diagrams and credible synthetic health records bring a project and the use case to life, helping to engage clinicians throughout a project, enabling issues and misunderstandings to be identified and resolved early
    4. User prototyping
      • Providing realistic data for early prototype screens and documents to verify user needs and set expectations will facilitate an easier, quicker and cheaper process of iteratively building, testing and adapting ideas
    5. Supplier testing
      • Providing an extensive set of synthetic data is able to simulate a wide range of scenarios for system testing, without using real patient data that has privacy restrictions
    6. Training 
      • Generating live synthetic data that is close to the real population in terms of age/sex/household composition/clinical history can be used to train clinicians on how to use the current systems, without using real patient data
    7. Demonstration
      • Using a population and clinical pathways that are relevant to the specific customer is more engaging and better for demonstrating the value of the product for the clients use case
    8. Software product testing
      • Synthetic data, that replicates real patient data but is free from privacy restrictions, can be generated to provide software developers with a rich testing framework, allowing them to build, test and improve their products before deployment
    9. Hackathon resources
      • Providing a synthetic population and library of pathways prior to an event will help to set the scope of the hackathon
      • A toolkit to generate relevant test data can then also support projects that emerge during the hackthon, improving the productivity and value of these events
    Initial Review Rating
    3.00 (1 ratings)
    Benefit to WM population:
    This approach will improve the safety and efficiency of patient care in the health service in the West Midlands, support interoperability and innovation and ensure patient data is protected from privacy and confidentiality issues. This will have a huge range of benefits for the West Midlands population, from better care to more control over the use of their data.
    Current and planned activity: 
    We currently have two proof-of-concepts projects;
    1. Supporting a business case for a Fracture Liaison Service 
    2. Generating the FHIR resources and profiles for a synthethic population of asthma patients
    We are looking for research partners or Trusts interested in putting together a joint-bid for some EU funding to explore and assess the technical feasibility and commercial potential of this approach. We would also be interested in working on individual use cases with digital leads or with standards development organisations to develop this as a system-wide approach.
    Return on Investment (£ Value): 
    high
    Return on Investment (Timescale): 
    0-6 mon
    Ease of scalability: 
    Simple
    Regulatory Approvals:
    Please describe any current regulatory approvals you have achieved and how they were met/ in progress/planned.
    Commercial information:
    Please describe how the product/service is being developed commercially, whether in development, trials, pilot or full commercial delivery. Include the results you have from any market/demand surveys and forecasts . Please include any research you have on the broader commercial opportunity for the innovation both within the health sector nationally and internationally.
    Investment activity:
    Please describe what stage of investment you have reached and whether you are seeking additional rounds of investment. Please include cash investment as well as investment of soft assets such as access to specialist equipment, knowledge, trial base etc. and indicate the types/sources of your investment such as grants etc.
    Regional Scalability:
    Please describe how the innovation could be scaled across the WM region. Have you implemented at scale in any other regions?
    Measures:
    What outcomes are you hoping to achieve and what are the measures that you will use to gauge the success of the innovation and how will these assessments be made? Please ensure that you have quality, safety, cost and people measures.
    Adoption target:
    What are the targets for adoption across the WM and what are the minimum viability levels?
    Investment sought:
    What investment are you looking for in order to support wider adoption of this innovation and what have you managed to secure to date? Please provide a breakdown of these costs if possible.
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