eConsent: a unique digital solution which individualises and enhances the patient ‘consent to treatment’ process. (#1833)

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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
eConsent is a unique electronic patient consent solution; the result of collaboration between NHS and industry. It improves patient experience, saves time and reduces risk.
Overview of Innovation:
Wellbeing Software Group collaborated with inventor Mr Stephen Lake - Consultant Surgeon at Worcestershire Acute Hospitals NHS Trust - to commercialise the trust’s ‘home grown’ IT solution, which is proven to streamline the patient consent process.

eConsent helps support clinicians in adhering to GMC guidelines as highlighted in the recent (Mar 15) Supreme Court judgement (Montgomery -v- Lanarkshire Health Board), which sets out that doctors must ensure patients are aware of all material risks, and provide documentary evidence of a structured discussion between a competent healthcare professional and the individual patient, for the specific procedure being considered.

Digitising the patient 'consent to treatment' process enables nationally recognised procedure consent forms to be created dynamically, pre-populated with individual patient demographics and presented to the patient in the context of the proposed procedure, along with the associated information leaflets during the individual patient discussion.
 
Clinical ‘risks’ and ‘benefits’ are automatically populated based on the individual patient and the planned procedure from a pre-determined and clinically approved ‘library’, to provide agreed, standardised and relevant clinical information. This enables consistency and accuracy, providing all relevant risks and benefits and thus ensuring the patient is comprehensively consulted, with readily accessible evidence should it ever be required.
 
Patients undergoing planned procedures have more time to review documentation either personally or with carers, to understand the risks and benefits before agreeing to proceed. Having a standardised approach enables auditing of clinical practices with the additional benefit of reduced risk of litigation.
 
100% improvement
 
Yearly consent audits for surgical and investigative procedures undertaken by Worcestershire’s clinical governance department demonstrated substantial improvements. Prior to the introduction of eConsent:
 
• Only 49% of medical notes had documented evidence that benefits and risks had been discussed with the patient
• Only 69% of consent forms recorded the date consent was obtained
• Only 63% had the patient’s NHS number

All of these indicators (and others) were corrected to 100% by the introduction of the digitised system.

The above audit data is representative of the current process throughout the NHS (Bulletin of Royal College of Surgeons: 97(3); March 2015).
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:
Stephen Lake, a consultant at Worcestershire Acute Hospitals NHS Trust, had the idea to create an eConsent software application. There are many factors that could cause problems when clinicians are writing up risk factors for patients, for example paper-based consent forms are open to increasing errors - handwriting may be unreadable, doctors could miss out crucial parts of patient data and patients may not understand abbreviations.
This led to the creation of the eConsent form, which MidTECH supported with its development and commercialisation.
 
Challenge identified and actions taken :
A consent form fully-informs patients and their agreement to proceed with a surgical intervention. The problem was that these paper-based forms had become complex and open to errors.

Stephen’s vision was of a structured digital version, supporting communication with individual patients. His initial approach was through his Trust’s IT project team, with whom he built a database in Microsoft Access. He and his colleagues used this to select and enter all the necessary fields clearly. The final form was printed out and signed by the patient.

After successful use within the Trust, the idea was ready for further development and commercialisation. This was a challenge that Stephen faced, he was having difficulty finding the right partner.

Action:
MidTECH was approached:
  • Their experienced consultants were able to call on their contacts in order to understand which firms had the expertise, experience and interest in a product like eConsent that would be able to take it to the next stage.
     
  • They also advised both parties on right agreements, from confidentiality agreements through to licence negotiations and contract drafting- striking the best shape for partnership.
     
  • Their wide network of clinical and commercial contacts meant that the project was uniquely placed to find the right collaborator, eHealth Innovation.
Impacts / outcomes: 
One of the outcomes was that with several years of success within the Trust behind the project (which became a Health Service Journal Award finalist in 2008); it was clear that the idea was ripe for further development and commercialisation.

In less than a year, the contracts were signed. Matthew Smith, Business Strategy Manager for Wellbeing Software Group, believed this process was crucial to successfully taking eConsent to market.

eHealth Innovations had the know-how to take a Microsoft Access database and turn it into something slicker and more intuitive to use. The package now runs off a hospital server and displays in an attractive user interface optimised for mobile devices, such as tablets. The process is fully digital too – the paper form is being finally consigned to history.

MidTECH are continuing to consult with e-Health Innovations and the Worcestershire team, supporting eConsent in its broader adoption. Via its links with the West Midlands Academic Health Science Network, MidTECH has encouraged regional adoption through workshops and launch events.

eConsent is a software application that originated within Worcestershire Acute Hospitals NHS Trust, resulting in a licensed commercial product which is now available on the market.

Such has been the success of the partnership that was facilitated by MidTECH that the adoption of eConsent doesn't stop there. "Only months after the official launch, we were invited to tender for introduction in thirty-eight hospitals in the USA," says Chris. "As of now, we've made it through to the shortlist”.

“We wouldn't have even heard about eConsent without MidTECH – and now we're working to market it the world over. Their networks have helped to make this happen."

Therefore, MidTECH has helped this project take international adoption.
 
Which local or national clinical or policy priorities does this innovation address:
Issues around the proper consenting of patients.
Supporting quote for the innovation from key stakeholders:
“I didn’t know then that this idea might be considered worthy of a prize, but it did seem an extremely useful time-saving, and quality–improving, concept.”
 
"What emerged from the MidTECH introduction was a really productive partnership. Both Stephen and the Trust were really keen to get the product out there – and so were we.”

“We wouldn't have even heard about eConsent without MidTECH – and now we're working to market it the world over. Their networks have helped to make this happen."
Plans for the future:
Chris Burdett is the Product Manager at e-Health Innovations and responsible for eConsent: "We're developing new functionality for eConsent all the time. Stephen's original idea has been totally reworked using our expertise into eConsent 2.0. The product emails a link of the form to a patient, so they can review it at their leisure – and they simply sign on the device the next time they're in the hospital. It's a huge move forward for the patient experience."
Tips for adoption:
If this is a system you would like to adopt in your organisation then please contact e-Health Innovations - http://e-healthinnovations.com/ 
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Innovation 'Elevator Pitch':
Aptvision is revolutionary to the radiology sector providing a paperless & cost effective workflow.  Designed with radiology experts, practiced in-depth and customised to meet the specific needs of today’s modern & demanding radiology environment.
Overview of Innovation:
Total Radiology Solution including RIS and other innovative solutions has been designed to increase efficiency in hospitals and clinics - not just to store patients’ data. It’s unique innovation can be seen in:
  • Cost savings and increased productivity
  • Increase revenues for hospitals and clinics: web booking, schedule optimisation
  • Reduce errors and staff duties
 
Aptvision RIS is the most innovative RIS on the market offering fully paperless workflow from start to finish: eReferral letters automatically attached to the RIS, e-consent forms, Online Results, etc. Aptvision RIS also assures:
  • Electronic access to all documentation and forms
  • Quick access to all medical history
  • Fully web based, no installation - just the web browser
  • Ability to report on studies from any location without a need of installing dedicated software on individual doctor’s PC.
 
Much more than a standard RIS, Total Radiology Solution offers:
  • Fully integrated Web Booking in which patients can book their appointment like a seat on an airplane. From the clinic’s website patients can see which appointments are available for the type of exam they need and book it immediately.
  • Aptvision’s system automatically provides a call back from a clinic’s Call Centre, to verify the selected appointment and go through safety questions. The operator is prompted by the system to ask the appropriate questions.
  • This feature has reduced the 40% dropped calls rate to zero and practically eradicated no shows and errors.
  • Before the appointment, the patient receives a SMS Reminder of their visit and gains access to the Online Consent Form. They can complete it on their phone or computer before their visit day.
  • On the appointment day, patients can use Online Registration in the clinic using the interactive kiosk or tablet & without the need to stand in a long queue at the reception. They can also monitor their live updated waiting time on dedicated monitors.
  • The electronic consent form as well as all previous medical history is attached to patient’s record in Total Radiology System leading to completely Paperless Workflow. Once the appointment is completed, patient is informed with an SMS telling them their results are ready and can be viewed in the Online Results portal if this is appropriate.
  • Voice Recognition to more quickly create medical reports
  • Scan Audits to improve the quality of the reports and enable sharing of expertise.
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: 
Advanced diagnostics, genomics and precision medicine / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Patient and medicines safety
Benefit to NHS:
Revenues increase
  • Across 16 clinics in Ireland we have facilitated savings of up to €600,000 per clinic through reducing no-shows, errors and through modality optimisation
  • We have also increased revenues by €2.4 million in an 18-month period through web-booking and e-referrals
 
Efficiency increase and cost reduction
Through fully paperless workflow
  • An advanced, configurable, fully integrated e-referral platform feeding actual availability of modalities
  • E-referral letters automatically attached to the RIS, e-consent forms, Online Results, etc
  • Electronic access to all documentation and forms
  • Quick access to all medical history
  • ensure scan is possible and safe for patient (availability & safety questions)
Reduction of manual processes
  • Fully business rules driven without manual intervention
  • Built-in processes for auto scheduling and bulk appointment operations
  • No re-typing of information
  • No web booking missed
  • Medical call centre takes over all calls so reception could focus on patients and their needs
  • Interactive kiosks, tablets and monitors allow patients to register online without a need to come to reception
Improved Patient satisfaction
  • Reduced waiting times for scans and results
  • Ensures patients safety and enhances patient experience at all stages of their appointments (web booking, online forms and results, SMS notifications, online registration etc.)
 
Quality improvement
Peer review feature that allows anonymous review of radiology reports by random peer
 
Better hospital/clinic management
Live updated personalized dashboards for quicker decision making and detailed reporting: revenue reports, comprehensive operations reports, etc.
 
Savings in time
  • Quick system implementation - within few days, not months
  • Easy and intuitive up and running in 30 mins
  • Improvements visible from day one
 
Existing customers have reported statistics of:
  • Modalities capacity increase of 30%
  • 1 extra scan per hour
  • 10 more booking per day
  • Reduced reporting time 20min -> 4min
  • 50 reports per day vs 15
"Aptvision is revolutionary to the radiology sector and is the key to a paperless workflow. It improves daily operations and leads to quicker reporting times and early diagnosis. My experience suggests that Aptvision RIS increases a clinic's efficiency and bottom line from day one and has been the answer to our digital problem in one step."

Prof. Michael Maher
Consultant Radiologist, Cork University Hospital
Professor of Radiology, University College Cork
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
With rapidly increasing demand for diagnostic imaging and hospital and clinics workflow heavily relying on paper and manual duties radiology providers are sometimes unable to cope with that increased demand and provide their diagnostic in efficient and timely manner which can result in patient dissatisfaction and in some cases even lost lives.

Aptvision Total Radiology Solution offers a solution that can revolutionize radiology industry by promoting efficiency and paperless workflow that increases productivity in hospitals and clinic and ultimately benefits patients and their lives.
Our innovative features can benefit patients in numerous manner including:
  • Better and quicker access to radiology
     
  • Reduced waiting times for scans and results which can save lives
     
  • Ensures patients safety and enhances patient experience at all stages of their appointments (web booking, online forms and results, SMS notifications, online registration etc.)
     
  • Quality improvement - Peer review feature that allows anonymous review of radiology reports by random peer. It improves the quality of the reports, enhances share of expertise and allows discussion of interesting cases with experts in anonymous manner. This hugely benefits patients and again helps to save lives
     
  • Make use of modern ecommerce technologies to patients
Current and planned activity: 
Aptvision has just completed the Serendip programme.

We have applied for late inclusion into supplychain RIS/PACS frameworks.

We are actively engaging with Queen's hospital (BHR hospitals trust). We have presented the system and received a very positive response and we are currently organising a full day workshop with all staff.

We are presenting shortly to Black County Alliance.

We are seeking to work in partnership with an NHS Trust to deliver an early demonstrator for the NHS.
What is the intellectual property status of your innovation?:
Full intellectual property of all applications and solutions is owned by Aptvision Ltd.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
2
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Overview summary:
The Secure Clinical Image Transfer app (SCIT app) was developed at University Hospitals Birmingham NHS Foundation Trust (UHB), and was officially launched at the Trust in February 2017.

The aim of the project was to create a secure app for use on mobile phones, which allows clinicians to take clinical photos in a secure way. The images taken and some identifiable patient data are then stored off the device into the secure UHB network. Once the image has reached the hospital system it automatically attaches the image to patient’s records.
Challenge identified and actions taken :
In 2013 challenges arose concerning the risks of clinical staff using their own mobile devices to photograph patients during out-of-hours and in emergencies when professional medical photographers were not available.

At the same time a ‘Do It Yourself’ camera, managed by the Medical Illustration department, continued to be returned containing images that could not be matched to a patient as standardised operating processes were not being followed correctly.

SCIT was designed to address the issues outlined above, and continues to provide a simple solution. The secure app available for both Apple and Android allows clinicians to take photos of patients and have them immediately stored off their device in a secure UHB network. Once the image is taken SCIT does not allow the image to be viewed on the mobile device and instead clinicians can view images only once they are passed to the Image Management System (IMS) which is accessible via the electronic patient record. Images are never available on the device even if the device is lost or stolen. As the app does not allow any access to the images on mobile devices or independent cloud systems, it therefore conforms to the NHS governance criteria and data protection.
Impacts / outcomes: 

The SCIT app is designed to be simple, straightforward and above all safe, and there are many positive outcomes from its development outlined below:
  • The app ensures that when the Medical Illustration team are not available, clinical images can still be taken of patients in a secure manner. It allows clinicians to send images to patient records which can be reviewed by other clinicians via the Clinical Portal
  • The SCIT console gives a real-time view of all user activity, provides a control mechanism to authorise new users, monitors activity, and assesses the quantity of images and data flow

     
  • SCIT has allowed for faster patient diagnoses and consequently quicker treatment plans
  • The SCIT app is unique as it only allows images to be taken and sent to the patient record system without them being accessible on any device 
    • This also makes it ideal to be developed into a patient app to avoid patients sending on their own clinically sensitive images through insecure and unsuitable electronic routes which is occurring regularly, especially in dermatology
       
  • There is no cloud involved, which means that the image is transmitted directly from the device to a Trust server, therefore making it secure enough for the NHS.
There are many other benefits of adopting the SCIT app:
  • The app can be used on clinicians’ own mobile devices or tablets to securely take and sent clinical images
  • The app works with iOS, Android and Blackberry
  • The app is fast and hassle free
  • The app eliminates the risk of sending un-secured images and protection from large fines for non-compliance on clinical information governance issues
  • Military level encryption means patients’ images are always secure
  • The app streamlines diagnosis, improves efficiency and reduces paperwork
  • The app can be used offline in areas where wifi connectivity is poor
  • The console monitors all activity and provides robust audit trails every time the app is used.
Which local or national clinical or policy priorities does this innovation address:
The SCIT app has been utilised at UHB and other NHS trusts such as Coventry and Warwick NHS Trust, who purchased the SCIT app in 2017 and have adapted it to link with their secure Wi-Fi network, to provide vital evidence at the most appropriate part in the care pathway. It supports safer working practices, telemedicine, teledermatology, remote community- based working and addresses the current data protection and information governance risks. In addition 30 other organisations are also enquiring about SCIT Version 2, ranging from Dermatologists, Trauma specialists, GPs and the Information Governance groups.
Supporting quote for the innovation from key stakeholders:
Jane Tovey UHB Medical Illustration Services Manager: The SCIT app will enable the NHS to securely capture clinical images and send them direct into the patient’s electronic record. The encrypted data package is monitored to ensure it is delivered to the correct patient notes and all parts of the pathway are safe and auditable.”

Chris Coulson UHB Consultant Ear, Nose and Throat Surgeon: “Whilst we all know that a picture can speak a thousand words, the majority of clinical findings are currently recorded by hand drawn pictures, or by text. The SCIT app will give clinicians the ability to document visual findings using photography, which can then be securely uploaded into the patient records. This will undoubtedly lead to an improvement in patient care, using the cameras on mobile devices most of us carry around every day.”
Plans for the future:
We are already in the planning stages of SCIT Version 3, which will include bar-code scanning to speed up patient data entry, the ability to take small video clips and confirmation emails that will hold direct links to the Trust’s IMS. These can only be opened on a secure networked computer within the Trust but could speed up image sharing.
Tips for adoption:
If you would like to learn more about the SCIT app then visit our website and try out the free demo: www.scit.nhs.uk

Or you can simply contact the SCIT administration team on:  SCIT@uhb.nhs.uk
Contact for further information:
Contact the SCIT administration team on:  SCIT@uhb.nhs.uk
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