Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
CMC is an NHS urgent care planning service designed to capture a patient’s preferences for their care in one single version of the truth. The care plan is available digitally to all the clinicians involved in their care and emergency services 24/7.
Overview of Innovation:
The service was started in 2010 and currently serves Greater London. It is commissioned by the 32 London Clinical Commissioning Groups. There are currently over 50,000 CMC care plans in existence.

CMC fast facts:
  • The CMC service has been developed by NHS clinicians for NHS patients
  • Developed on the foundations of patient centric care, clinical integrity, information governance, data protection and security
  • Helps reduce unnecessary and unwanted hospital admissions, readmissions and associated ambulance transport costs and hospital stays
  • 76% of patient who have a CMC plan and place of death recorded, die in their place of choice
  • Where patients have a CMC care plan 19% died in hospital compared to the national average of 47% and 53.6% in London
  • Data suggest that the NHS saves on average £2,100 per patient who dies with a CMC care plan in place
  • For healthcare professionals it’s the confidence that the important and sensitive work they have documented with the patient is accessible to emergency services who may not know them as well
  • For patients it’s the knowledge that they are at the heart of planning and decision making around their own healthcare and that they will not need to repeat themselves repeatedly

The service is constantly evolving with an ongoing focus on interoperability with other healthcare IT systems and allowing patients to start to create their own care plan on a new patient portal myCMC. For more information please visit or call 020 7 811 8513.
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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Innovation 'Elevator Pitch':
An app, designed by doctors, to promote safe and effective handover both within and between teams. With the inforamtion captured for handoer, clinical leaders can better review and manage patient flow through their team and the wider organisation. 
Overview of Innovation:
Careful is an app designed by clinicians. It helps doctors, nurses and allied health professionals share and protect critical patient information.

At its heart, it answers two pressing questions - who is currently looking after the patient and what is their clinical plan? It uses our Handover® system to keep track of the former and for the latter it provides a job-tracking system, with free-text clinical updates.

It has been designed to be simple, easy to use and mobile-first — so it can replace traditional paper-and-memory handover sheets.

This information, gathered from clinicians at the bedside, provides an exceptionally rich set of data that is currently lost in handover sheets and verbal order, or is buried in notes. By making this accessible, the app provides an overview that allows clinical leaders to review and manage the flow of patients through their team and the wider organisation.

By capturing structured information about actions and patient diagnoses, the system also creates the opportunity for 'clinical coding at the bedside' - a potentially huge cost saving.

Finally, we are developing a patient-centred app to enable patients to access and contribute to their own record and to communicate directly with the teams looking after them.

They will also, in response to the General Data Protection Regulation which comes into force in May, have direct oversight of their own record, ensuring that they can identify who has accessed it, and exercise control over who views the information.

We have tested and revised the first version of the system and are now ready to deploy version 2 of the clinician app. This is developed and ready for deployment in 2018. We need further support so that we can ensure that it is refined in response to customer feedback and to add further features. We also need funding for the patients’ app.
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
WMAHSN priorities and themes addressed: 
Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
The NHS is facing an unprecedented strain on its resources - particularly in secondary care. Many hospitals stuggle with patient flow. The object of this app is to allow doctors, nurses and other team members to share the clincial plan for patients - making the status of patients much more visible and improving the handover of clinical data. It is estimated that in the average 400-bedded trust, as many as 120 patients may be ready for discharge. We aim to improve the visibility of this information.

The cost-savings from effective patient flow managment in secondary care could run into billions, and this app will be a useful tool both to improve trusts' understanding of patients' status and to make handover more effective for the teams involved.
​It will also significantly benefit patients. - We know, from the investigation of serious incidents, that communiation is a prominent factor in around 80% of the thousands of incidents in which patients die each year in hospitals from preventable harm. It is also acknowledged that handover is a time of great risk for the loss of critical information.

The Careful app is designed to improve the communication and handover process between clinicians - and to encourage multidiisciplinary use, where doctors, nurses and other professionals all have access to the same information. We believe that it can save lives - although this will, again, be hard to quantify.

Finaly, the Careful app can help with the transfer of care between organisations. Becasue it is cloud-based, it is 'organisation-agnostic' and can therefore allow the transfer of patient records between organistions as easily as between teams in the same organisation. This is a perennial 'tough nut to crack' - as any clinician will tell you. We belive that the Careful app can do this without the inherent issues found in paper, fax and phonecalls. The cost and patient safety implications of this are significant.
Initial Review Rating
4.00 (2 ratings)
Benefit to WM population:
Our intention is to use this app with Birmingham Children's Hospital. We have contacts there but have not, as yet, secured an agreement - largely because we have other trusts in Yorkshire and the South East who are further ahead in their adoption.

We would use any money raised through this process to ensure that the app was made available to all hospitals in the West Midlands.
Current and planned activity: 
We have recently finished Version 2 of this app - which has significant information governance and privacy improvments (we have attached our Privacy Impact Assessment for more information). The app has also had a complete overhaul of its user interface (UI). We have also recently completed the status-flow elements of the app, allowing us to provide overivew patient-flow data at the organisation level.

We are testing this in two NHS trusts and two private hospitals in the next 3-6 months. These trials are 'pre-revenue', designed to refine the app before being launched on the wider healthcare market. The outline terms and benefits of this trail are provided in one of the attachments.

We intend to use any further funding to expand our user base to organisaitons that will pay, and to start the devleopment of the patient app.
What is the intellectual property status of your innovation?:
We own all intellectual property in the form of code and design. We also own the Careful and Handover trademarks in the UK.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
3 years +
Ease of scalability: 
Regional Scalability:
Our businss model is based on scalablity. The app runs in the cloud (in a Microsoft Azure implmentation) and allows new organiations to be added with no overhead. Moreover, the design of the app is expressly to allow inter-organisational referrals and information sharing across the normally tight boudnaries between primary/community care and hospitals.

Scaling is 'built-in' to this app.

For the business, the main meausre are user adoption and, of course, revenue. However, for the users themselves, the measurable benefits would depend on their role (see below).

Primarily, however, the financial / cost-benefit is improvement of flowand reduced length of stay

Benefits are: 

1) Juniror doctors - pimarily time-saving
  • Less time ‘polishing the list’
  • More accurate and timely communication about patient jobs and patient status / location 
2) Senior doctors and clinicians - primarily patient safey measures
  • More clarity on the individual patient status
  • No more ‘safari ward rounds’
  • Ability to monitor individual clinician activity
  • With ‘action bundles’ - the ability to standardise care for patients with particular conditions 
3) Site practitioners/Bed managers - time saving and improved flow
  • Less walking-the-floors to determine what is happening to patients
  • Clarity on the status of beds and patients throughout the organisation
  • Faster bed-turnaround times 
4) Finanical / service managers
  • Shorter length-of-stay
  • Higher bed utilisation
  • Patients admitted and discharged more efficiently
5) Information governance leaders
  • Ability to provide granular data to patients, in accordance with the General Directive on Data Protection (GDDP)
  • The ability to control which clinicians see what patient data.
  • No more IG breaches from handover sheets 
6) Coding departments
  • Faster coding - using machine-readable medical input
  • 'Codling at the bedside' in later versions
Adoption target:
As described, we want to use this in Birmingham Children's hospital initially, but we would like to see it adopted in all hopstials in the region.
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Innovation 'Elevator Pitch':
ETL is expert in health and care digital transformation developing, digital strategies, creating robust business cases, design and development of solutions architecture, process redesign, training and implementation support and benefits realisation.
Overview of Innovation:
The constant need for change
Underpinning every STP plan is the need for a coherent digital strategy encompassing Record Sharing, Whole System Intelligence, Citizen-Facing Technology, Self-Care Management, Infrastructure Interoperability and Digital Maturity.
What can ETL do for you?

We can provide much needed support around  
Digital Strategy – based on revised STP, ICS, and NHS 10-year plans
Cost to Change – secure funding backed by robust business cases
Programme and Project Management - credible plans with strong governance
Delivery – capacity and capability to ensure full utilisation for Go Live
Competing Priorities - address BAU, STP, ICS, LDR, GDE, LHCRE
Technical - capable infrastructure, applications which support interoperability
Integration - processes and systems, co-operation and collaboration of inter- and intra-organisation boundaries
Timetable for deployment – solutions delivered and aligned to the process and organisational changes.
Benefits Realisation – establishing reliable processes and data for measuring benefits.
How ETL can work in collaboration with you?
We would work in collaboration with you to develop coherent digital transformation plans. The aim is to identify initiatives, prioritising those that provide the advanced care and generate the greatest value.
We would combine resources that can architect solutions and suggest ways in which you can augment resource/services to enable the internal teams to engage with the STP programme.

What are the benefits of working with ETL?

ETL will work with you in an efficient and effective way, providing expertise, support and resource and help guide you through the digital transformation providing:
  • Independent, expert advice and support
  • Delivery of IT projects using proven methodologies
  • Help with creating and presenting robust business cases
  • Programme and project management expertise
  • Process re-design and change management support
  • Effective stakeholder management and collaboration expertise
  • Technical architecture skills and knowledge of new applications
  • Expertise in systems integration, optimisation and interoperability
  • Methodologies for benefits management and realisation
ETL will ensure maximum engagement from staff throughout the STP and provider organisations, ensuring that solutions are used to their full potential and that money is being spent effectively on priority initiatives. 
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:
For every solution we deliver, we focus on the outcomes and work through what is required to deliver them and measured by it. For instance, we are involved in an initiative with South East London (SEL) STP, to establish how remote monitoring and assistive technologies can prevent patients with Type 1 Diabetes, COPD or Heart Failure from deteriorating and being re-admitted into hospitals. Unless we can prove this, the solution will not be fully adopted. This is just one example of many on how we focus on patient health outcomes beyond any other measure.

We start with the health and care processes and map out the current state in order to establish any inefficiencies. We take a holistic view, based on the well-recognised inter connected and inter related six domains of change POLDAT (Processes, Organisation, Location, Data, Applications and Technology). Essentially, we are considering who is doing what Processes in the Organisation and in which Location with what supporting Data, Applications and Technology. This gives us very valuable insight into where current systems aren’t being used appropriately, where enhancements can be made to practices and procedures to add real value or where new solutions will have a greater impact.

We have expertise in developing end-to-end patient pathways, so that we can see the big picture both for current and future states.

We are also able to do deep dives-in specific areas so that we are clear about the impact of particular solutions. This helps us to:
  • Engage with key stakeholders
  • Challenge any assumptions and identify clear metrics
  • Build and validate business cases
  • Establish clear ownership and robust mechanisms for benefits realisation
We also work closely with NHS Trusts to optimise the solution post implementation so that the greatest return on investment is achieved.

We employ experts with in-depth knowledge of the NHS and health and care systems and transforming processes through digital solutions. We therefore focus on solutions that deliver real value for money and the health and care organisations can be confident that the advice and support we provide will be grounded-in-reality.

Any solution we deliver is created in collaboration with senior stakeholders and end-user-buy in.  It is only with this level of support and collaboration can we be confident that any solution that we implement will generate a cost-effective service and experience for the staff and patients alike.
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
ETL with its expertise in delivering transformations underpinned by digital solutions is very well placed to support some of the key initiatives that are underway to improve the health and wealth benefits of the West Midlands and its population. We offer expertise in:
Record Sharing – the ability to make appropriate patient data available to all care settings in the STP.

Whole System Intelligence – the utilisation of health data to provide strategic, operational and real time decision support.

Citizen Facing Technology – the ability for patients to access and interact with their own health data in a secure and seamless way.

Self-Care Management – the utilisation of wearables, apps, telehealth, and telecare.

Infrastructure Interoperability – joining up health care settings e.g. via HSCN (Health and Social Care Network) and providing effective systems access throughout the footprint.

Digital Maturity – providing enhanced systems and functionality for Medicines Management and Optimisation, Transfer of Care, Asset and Resource Optimisation, Orders and Results Management.
We can :-
  • provide assistance to refresh digital strategies, secure funding required to deliver new solutions, backed by robust business cases.
  • support the development of credible and detailed project plans with strong governance regarding risk, issues, and change management.
  •  offer much needed capacity and capability to ensure full utilisation of key solutions for go-live.
  • work closely with the STPs to highlight and help address and gaps, overlaps and competing priorities at the provider, BAU, STP, ACS, ICS, LDR, GDE level.
  • advise you on how capable, are your applications and infrastructure, to support the much-needed interoperability between inter and intra organisation systems.
  • facilitate processes and systems, co-operation and collaboration of inter- and intra-organisation.
  • help you to determine with confidence the speed with which solutions can be delivered and aligned to the process and organisational changes as stated in the STP plans.
  • help to resource and establish reliable processes and data for measuring benefits.
Transforming Healthcare Through Cloud Technology article published in Heatlh Business - read here.

Aligning technology and estates strategies article published in Health Estate Journal - read here.

What should CIOs be focusing on in 2019 article published on - read here.

Implementing Disruptive Technology at Scale in the NHS article - attached.

Current and planned activity: 
In 2018 ETL worked with SEL STP to refresh their Digital Strategy. This was done in collaboration with provider organisations, GPs, CCGs, Community Trusts, Social Services, Third Sector, London Ambulance and 111 Service.
Matt Hancock, the secretary of State, announced £412.5m for Health System Led Investment (HSLI) in Provider Digitisation. This gave the STP the funding to deliver the changes in the digital strategy. ETL facilitated the creation of the HSLI Investment Case for £13.7m funding over 3 years and was hailed as the standard for the whole of London by NHSE.
ETL then worked with the STP and provider organisations to develop the PIDs, Business Cases and Value for Money (VfM) analysis for each of the initiatives.
The plan is to support the delivery of these projects and agree the priority initiatives for FY19/20 based on the ICS and NHS 10-year plans. This will lead to the creation of PIDs, Business Cases and VfM analysis for each of the projects for submission in Spring 2019.
Return on Investment (£ Value): 
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
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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): 
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
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