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Without full integration into trust EPR systems eReferrals fall short

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NHS goals for a paperless healthcare system are well intentioned, but too often there remain gaps in trusts’ electronic capabilities, causing efficiency leaks and hampering overall process transformation.

One of the starkest examples currently is around electronic referrals (eReferrals), an NHS initiative established to streamline the transition of patients from primary into specialist secondary care – from the traditional situation of manual correspondence over the space of several weeks. Managing referrals electronically ought to speed up that process, while giving healthcare professionals continuous and speedy access to all associated notes.

Yet there remains a digital disconnect. Referrals may be coming into trusts electronically now, but too often these are being printed out for circulation with patient records, or re-input manually into clinical or patient record systems. This not only creates extra work for those involved; it also generates new scope for risk if errors are made or printouts go astray – the very eventualities eReferrals were designed to avoid.

Bridging the digital divide

The problem is that there is no inherent way for trusts to connect incoming electronic referrals to their existing clinical or patient record systems, to streamline the onward workflow or accelerate clinical pathways.

Ultimately, the NHS e-Referral Service (e-RS) really only provides a user interface through which hospitals retrieve electronic referrals. What happens after that is down to each trust to figure out. There are third-party tools out there which ‘screen scrape’ the information from incoming referrals and use robotic process automation (RPA) technology to interpret and capture it, but until now there has been nothing that works natively with the NHS e-RS to capture content and metadata directly into hospital systems.

That’s a need we’re meeting with our new SynApps eReferrals Gateway solution. This provides direct, real-time integration and information capture directly into trust’s preferred systems – whether an EPR or other existing clinical system (for instance one holding medical imaging records). And these could be based on Alfresco, Documentum or some other electronic content management platform – the brand or format of system doesn’t matter.

A solution developed with trusts for trusts

We deal with NHS trusts all the time, and it’s through these close connections – in particular our partnership with Sandwell and West Birmingham Hospitals NHS Trust – that we developed our eReferrals Gateway solution. It allows e-Referrals content to be stored and accessed digitally alongside electronic patient records.

Without this capability, the digital benefits of eReferrals stop at the hospital threshold. And, once the content is transferred onto paper, it carries the same risks of the notes going astray, or not being readily accessible, as have traditionally been the case with written or faxed referrals.

The idea of extending the impact of eReferrals end to end across a trust is to give clinicians seamless, immediate and concurrent access to everything they need – on demand – as part of a broader workflow. This will ensure that trusts process referrals reliably and effectively, and are paid promptly and accurately for their work.

Now that we’re actively marketing the SynApps eReferrals Gateway, we’re seeing demand soar. A major London trust is the latest to implement the solution, and broader interest is intense. The need to clear referral backlogs following the pandemic adds to the impetus to streamline their handling across trusts, and we’re keen to help in any way we can.

AI support is transforming early lung cancer diagnosis globally

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Clinical studies show that radiologists supported by software created using machine-learning algorithms detect significantly more cancerous structures or nodules than human-only readings

By Daniel Drieling & Frank Niggemeier of MeVis Medical Solutions

Lung cancer is the number one cancer globally, for men and women combined. Yet it is notoriously challenging to spot early enough for positive treatment outcomes. Usually symptoms occur in late stages of the disease when successful treatment becomes more and more difficult. Unlike various other types of cancer, such as  breast cancer, which can be checked for in a number of different ways, it takes targeted medical imaging to determine what’s going on inside our breathing apparatus.

That’s why governments internationally are increasingly launching targeted screening campaigns – like NHS England’s mobile lung health checks, where portable CT scanners are being driven out to areas of the country where rates of lung disease are higher than average. The idea is that by looking out for the earliest signs of problems among at-risk groups (smokers, those working in potentially harmful environments, and so on), health services will save more lives, and reduce the significant long-term costs of treating late-stage cancer.

Keeping pace with demand

The potential flaw in this plan is that qualified radiologists are not an abundant resource and, as more images are taken, their workloads will soar. Supported by standard, static imaging solutions, even the most experienced radiologists can take up to 10 minutes (or longer) to read a patient’s lung scans in sufficient detail to be able to inform next steps.

It is fortuitous, then, that artificial intelligence is now sufficiently mature and robust to offer a solution. It’s a technology we’ve been working with in a range of cancer detection solutions, and from 2014 we’ve been applying AI and machine learning to reading lung images. By showing the software all sorts of cancer-based images, even the most subtle early signs, we have trained our computer-aided detection algorithm to spot suspicious structures that could be cancer, which even the most expertly-trained eye might miss.

Developed using machine learning techniques, Veolity’s algorithm aims to recognise even the subtlest potential signs of lung cancer, so that it now offers an indispensable and highly stable diagnostic support tool. Combining this technology with radiologists’ own readings  is leading to the best detection rates ever known – an impressive improvement compared to human-based readings alone, according to clinical studies of computer-aided detection success rates. This is crucial – one supports the other: radiologists benefit from valuable automatic features, while retaining complete control of their diagnostic process.

Accelerating diagnosis

Together, human and machine are now detecting even the most difficult to spot signs of cancer – the signals that might otherwise have been overlooked, especially where radiologists are under increased time pressure. Importantly, the software has the potential get through those workloads at high speed too, allowing experienced radiologists to comfortably and reliably assess more cases per hour.

It isn’t only in the reading of baseline studies and complex follow-up comparisons that AI-based technology is leaving its mark, and lightening workloads. Veolity automatically extracts lung nodules and provides comparable volumetric measurements that help to assess findings. It also makes short work of planning further patient treatment, by matching findings and country-specific reporting guidelines including management recommendations.

For hard-pressed health services, and at-risk populations, use of AI-based detection techniques in mass-scale lung cancer screening is a win-win.

Thanks to our implementation of Veolity directly for large OEM healthcare equipment providers, and strategic distribution partnerships including that with SynApps Solutions in the UK, MeVis Medical Solutions AG is the world’s leading specialist in image-based lung cancer screening solutions, with established deployments on every continent. Veolity’s extensive global market penetration illustrates the scale of the technology’s potential in making more of radiologists’ time, and improving outcomes for lung cancer patients.

SynApps Dubbed ‘2019 EMEA Partner of the Year’ by Open Source ECM Leader Alfresco

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Earlier this month, SynApps Solutions was delighted to learn we’d been honoured as EMEA Partner of the Year for 2019 by our key Enterprise Content Manager (ECM) partner Alfresco. Chris Brice reflects on the depth of our relationship – and where it’s going next

Wow – what can we say but THANK YOU.

We’ve been working together for nine years, shifting about seven years into a major joint focus on helping NHS customers, which I’ll say more about in a second. What I can say right now is the things that made Alfresco originally so attractive to us – that it’s a major player in the ECM arena and an open Open Source platform, meaning that ISVs like us can build specific solutions with our customers on it, remains as true now as it was back then: Alfresco is a superb digital transformation platform with truly global reach.

And like I said, it’s in the NHS that we’re seeing the most benefits together of those facts. We share very important customers: Leeds Teaching Hospital, Northampton General Hospital and Sandwell and West Birmingham NHS Trust.

At Leeds we are helping its very dynamic CIO deliver on his ambitious plan to totally digitise the Trust – a task which will improve the working lives of all 20,000 employees. It’s a similar story with Northampton, which has 6,000 team members, and which has a plan to similarly digitally transform, based on implementing the Alfresco workflow solution as it allows them to provide immediate benefits by automating manual processes, making people’s lives easier, and making sure that they minimise the number of risks taken in, in any process. Interestingly, Northampton is working on its Referral To Treatment (RTT) workflow right now, as RTT pathways is a very important tracking solution that tracks every single individual through the entire 18-week cycle through their referral. Finally, over at Sandwell, the Alfresco digital platform is supporting another great workflow improvement, but we’re about to start work on an e-RS triage system there as well.

If you’re not familiar with that latter term, it’s an E-Referral system provided by NHS Digital where referral has to go through a portal. Working with Alfresco tech again, what we can do to help there is capture the content from the portal – be it fax, email, or scanned-in entry – then we deliver it to the right team of clinicians within the organisation, automating the whole process.

That’s a lot of achievement, and it’s so nice that for its 2020 kick-off the company decided to single us out for our great support. But you know what? The best is yet to come, as it’s the future we are creating together that I think is really going to open the next chapter: our joint SCR (Shared Care Record) push, which is what our relationship will all be about in the next few months.

SCR is, of course, a new initiative, funded and sponsored by NHS England ultimately, that is all about joining up care across the community in regional areas, so that if you get referred to a hospital that isn’t your local one, when you walk in the door and they identify you properly, there’s no delay in your treatment.

SynApps and Alfresco are working together on this front – joining together its Open Source digital platform and our VNA (Vendor Neutral Archive) and our Cross-Enterprise Document Sharing (XDS) platform, to provide what we’re calling a ‘cradle to archive’ view of any person – be they a patient, a citizen, or somebody in social care or mental health, with a timeline view.

Our plans now are to do a significant marketing campaign to help Trusts working on their NHS England  Local Health and Care Record Exemplars’ (LHCRE  Exemplar work) – and we think it’s going to be a really big success over the next two years.

And we will make sure it is – as the benchmark our partners like Alfresco measures us by is its license model – and if we carry on making that work for them, I think we’ll become their key partner, not just in the UK, but the whole of Europe.

Chris Brice is Director of Sales & Marketing for SynApps Solutions

Making your Local Health and Care Record initiatives Real in 2019

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2019 is going to be a very important year for the NHS, and I wanted to resume our ongoing conversation here with a timely reminder to all NHS leaders that the clock really us ticking on a very crucial piece of work – what you need around your STP work.

As I won’t need to remind you, STPs – Sustainability and Transformation Partnerships – were set up by NHS England back in 2016, split into organisations covering every part of the country.

The idea is to find new local and integrated ways to improve health and care, with NHS organisations and local councils in England being asked to join forces to co-ordinate services around the whole needs of each person.

STPs are very much part of the idea of delivering against some of the key goals of Simon Stevens’ Five Year Forward View vision of a much more sustainable and digital NHS. But they are also very, very local – the stated aim is come up with plans to plans drawn up in your area that will set out practical ways to improve NHS services and population health where you live.

STPs then in turn have led to another great programme, Local and Health Care Records – an attempt to enable the safe and secure sharing of an individual’s health and care information as they move between different parts of the NHS and social care. To make that idea a reality, a number of a number of so-called Local Health and Care Record Exemplars have been set up that have been given special finding partnerships of up to £7.5 million over two years to put in place an electronic shared local health and care record that makes the relevant information about people instantly available to everyone involved in their care and support.

Exemplars were supposed to be 2018 spend drawing up requirements for what a ‘local health and care record’ is supposed to look like. They were meant to be building a Proof of Concept (PoC) against that definition that can then be proven and tested, leading to building of a full solution by the end of the 2019, and rolling out to all members of their STP during the 2020 Financial Year.

But here’s the problem: A lot of organisations really trying to do the right thing here are a bit stuck, as there are no clearly defined requirements

A ready-to-use Local Health and Care Record Demonstrator

We’ve talked to lots of organisations on the ground on both the NHS and the local council side of this who are struggling to find a suitable technology to use to build their PoCs.

This really does prove how far we are from the days of NPfIT, when the plan was that a central system should have been provided to work with. Now, the onus is on the local teams to find their own best fit for this work – and it’s not easy. A big issue seems to be scale… a lot of the systems people have been testing out seem very precarious at connecting multiple back-end systems together in the secure way that NHS England will want.

So we have addressed this head on.  Working with a number of frontline NHS organisations, we at SynApps have built a Local Health and Care Record proof of concept (POC) to demonstrate how this works.

What that means in practical terms is that we have a testbed ready based off our NHS Integrated Digital Care Record system.  It is proven technology and utilises all of the power of our Vendor Neutral Archive (VNA) and Enterprise Document Sharing (XDS) solution and which you can literally plug in to you and your partners’ systems tomorrow to help you build a convincing PoC.

That also means you will have a system which can support every sort of content a Local Health and Care Record will need – from path lab results to X-ray imagery, NHS Records to GP notes and even your social care records.

So if you are starting 2019 concerned about what you can do to capitalise on the opportunity the Local Health and Care Record programme represents for your area, fear not – we can likely help you.

Get in touch to see what we can do to help you move your Local Health and Care Record ideas off the PPT and into real instantiation in working software.

Chris is Director of all SynApps Solutions’ Sales & Marketing activities

Tackling the referred pain of digital patient referrals

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As NHS England mandates that faxed referrals are phased out, and trusts look to alleviate the grind of manually re-entering details between different IT systems, SynApps Solutions’ Chris Brice charts a practical, pain-free way to exploit NHS Digital’s e-RS referrals service more fully – which delivers for patients, trusts and NHS budgets

On the face of it, NHS trusts are already making progress with electronic patient referrals. Steadily, GPs and patients are defaulting to the NHS Digital’s e-Referrals portal which will soon be mandatory for primary care referrals, to guarantee payment for services. Yet, although this is widely understood – and despite an appreciation that referrals by fax, email or other manual means are not efficient or easy to trace – a large majority of patient referrals are still being handled using complex, time-consuming workarounds. Even where requests are channelled via the NHS e-Referral Service (e-RS).

This undermines the purpose of the NHS e-RS, which is designed not only to provide a single central digital platform for capturing and coordinating patient referrals, but also to streamline associated processes, speed up treatment, and provide reliable traceability of a patient’s progress and status.

So what is preventing total take-up of the broader digital experience – where referrals pass quickly to the right person, and targets of faster patient diagnoses and treatment are met?

The issue is two-fold.

First, NHS Digital hasn’t yet developed its own workflow-driven applications to make it easy to pass referrals through the system automatically and track and report on progress.

Second, the diversity of IT systems used by GPs and hospitals has proved a barrier to integration. As a result, primary care providers have resorted to faxing and emailing referrals. For their part, hospitals have printed and scanned those requests, manually re-entering and tallying these with patient records held elsewhere on their systems. Rather than accelerating case flow-through or alleviating administrative workloads, this has often created more work and delay. It is not unusual for a trust to be manually re-entering details of 15,000 referrals per month. Some major trusts accept up to 50,000 patient referrals daily.

Joining the dots

For the NHS e-Referrals programme to have its intended impact, digital processes need to be joined up end to end. Then they can start to exploit intelligent automated workflow. That includes prompt diversions of cases to more appropriate specialists or services (inside or beyond the immediate hospital); and complete traceability and reporting – with rules-driven alerts, to ensure that no case enters an administrative cul-de-sac or slips through the cracks, and that critical performance targets are not missed.

All Acute trusts are aware that the current piecemeal situation cannot continue. As of 2020, faxed referrals will no longer be accepted, and NHS services already face the prospect that they will not be paid for referrals accepted through any channel besides the e-RS portal. So trusts and their primary care practitioners might as well ensure that the e-RS leads to perceptible benefits for staff and patients.

Fortunately, approved NHS Digital development partners SynApps Solutions and Alfresco have already put in the groundwork to deliver end-to-end electronic referrals solutions. These offer trusts all of the integration; rules-based workflow; process automation; monitoring, prompting and reporting required to fully harness the benefits of digitising patient referrals.

From electronically capturing patient requirements and connecting these to patient records; to accelerating the triage process and clinicians’ acceptance/refusal/redirection of referrals; to vigilantly monitoring, prompting and reporting on referral-to-treatment progress, our combined, modular solutions are designed to extract maximum early benefits from NHS Digital’s e-Referrals initiative for everyone concerned.

The expected benefits are substantial – including efficiency gains of 60-70 per cent compared with manually processing, checking and following up on referrals and progress to treatment.

And that’s aside from the benefits to patient safety, as cases are proactively tracked and escalated thanks to automated rules in the system. Robust compliance and performance measures, meanwhile, will help ensure that trusts are paid in full and within acceptable timeframes for the cases they have accepted.

None of this needs to be an upheaval or costly exercise for trusts, either. Our solutions can be run in the cloud as well as on premise, and there are significant grants available for trusts ready to make the full transition now. Funding is applicable especially where organisations come together on joint projects, in line with NHS England’s Sustainability and Transformation Plan. Each trust can go at its own pace too, or prioritise how it tackles its respective migration to a fully digital referrals scenario. That’s because the SynApps Solutions/Alfresco solution suite is modular, offering trusts the flexibility to concentrate on just the capabilities they seek right now.

IDCR: A great new way to help clinicians via a single view of a patient’s complete medical history

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Chris Brice catches us all up SynApps’ work to help NHS and local authorities’ better share key medical information

As many of you are aware, SynApps is one of the leading providers to the NHS of a very special and actually highly desirable solution called the Integrated Digital Care Record, the SynApps IDCR.

IDCR is a solution that encompasses everything that every NHS Trust, and an increasing number of local authorities, across the UK are trying to achieve – being able to provide a cradle to archive view of a patient, finally joining up all the different back office systems that a physician needs to access to give us a total view of that patient.

More importantly, this can be extended to include not just the information within an NHS Trust, but also a GP system in a local government/external stakeholder Shared Care Record scenario – enabling a clinician, or any approved person who has access to medical records, to see everything that relates to a person, from when they were born to an archive scenario.

An open, highly functional, approach

The IDCR is an enabler to allow access to all these different systems. Ultimately it will become your integrated digital care record for easy secure access across the NHS and beyond.

Why? Because it’s designed to allow all relevant stakeholders, including social care, local authorities, clinicians and GPs, to access your clinical record or social care record. And as it’s architected to be a simple open source, open product that allows you to log in through a portal and then have access to all of the information, it’s revolutionary – and at the moment, we believe we are the only provider who can delivery this on demand. Chief Clinical Information Officers (CCIOs) in the NHS that we’ve talked to tell us they want a single view of all information irrespective of what system if comes from or where that system is, and what make this really interesting is this includes external systems too.

Our solution, then, will allow you to have a single view from any device, anytime from anywhere, from of all of the multiple, different systems, including any case notes or paper that’s been scanned. It can also provide a tracking system to overcome some real issues organisations are having with the referral to treatment (RTT) pathway that means you the patient has to be seen within a certain period of time – something all Trusts, of course, have to monitor, report on and is mandated against with significant fines if they miss their targets.

The SynApps IDCR provides a total view of any GP notes, any x-rays, any illness or ailment you’ve ever had where you’ve had engagement with the social care system, you’ve had engagement with the GP, with an NHS Trust, all displayed in a single view, in a timeline view – which means it’s a really  secure means of providing that real time link to  a patient or citizen or somebody who’s in social care in one single view and could also track where they are in the process.

Save resource

At the moment most Trusts are running over 90% of their referral targets – which sounds like a very high percentage, but the reality is, the ones that fall out are where you see horrible negative local or national press… yeah, the terrible times somebody who should have been seen because they had a serious cancer wasn’t seen, or they got missed for some reason and actually died.

Failing to address this means there’s a huge risk that you’ll miss your NHS compliance targets… and if you miss those targets, you could potentially receive significant fines or even worse go into special measures and all that that implies.

It could also save you a lot of resource, time too; by providing integrated digital care record and a RTT pathway tracking system rather than a validation system, – going from 30 to 40 people down to maybe three or four people to track, not validate, how this works.

Got to make sense, right? If you agree – drop me a line and let’s see how we can get an IDCR to help you with some of your heavy lifting!

Chris Brice is SynApps Solutions’ Director Sales & Marketing

From FOI to Keep Fit: Why You Need a Community Engagement Platform

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SynApps has started to work with key customers on a very exciting new frontier in local government – digital outreach

Local authorities are very good at dealing with their service users on social care or benefits: they know who they are, they’ve got systems to deal with it.

But what they’re not doing so well is addressing the greater or wider community… which is a problem, as UK local government now has a much bigger remit to engage with residents.

We think we may have something to help – what we’re calling our new community engagement platform that can join up all your different departments that might want to engage with the community and provide a really, easy platform to connect all of your teams internally as well and reach out to the wider community.

The best way of explaining is this: if you or I make a FOI (Freedom of information) request to our local Town Hall, it would likely struggle to provide information back within the 21 days that’s required, because it has several separate departments, run by separate teams, all running separate software systems – and they have to go through a physical ring round, email round type of check to be able to respond to our FOI request.

Clearly, it would be much better if I make an inquiry, be it FOI or ask about where I can park my bike on my next big jaunt across the local terrain, that I get pointed to a portal or website where I can find the information I am looking for as well as check what information the council holds on me, which of course has to be available to me as part of the new GDPR compliance regulations.

Great for me – I get my biking info. But it’s also great I argue, for the authority, too. What’s happening now is that the local council has to engage with the NHS. More and more have responsibility for the local CCG too, as well as GP practices. They also have a social care system, they work with the emergency services, probably the local University level, too.

My point? Community engagement is about not just linking the council’s internal systems, but having the ability to share this information across the whole local area. A good example is a council currently working with us to build a properly linked-up, self-service solution that allows me, the citizen, to look at my council information, look at my NHS record, look at my GP system record and, if I’m in a social care environment –  look at that information, too.

And it can go further. How about allowing the local authority to advertise events and things going on in its community every time I log in.  It can also ask me questions like, what are your hobbies, what sorts of sports do you do, what are your interests? And, if I pick boxes, it will then start to feed me information on those things.

A big driver here could be the Keep Fit and Healthy regime councils are now being mandated to deliver. Just think about how great it would be to combine all of that content into one place.

We think this solution is a great way to engage with your community and deliver relevant, up to date, information, and I hope you have a minute or two to check out some more of the detail here