Learnings from the Implementation of an NHS 111 Integrated Digital App in the West Midlands Rachael Ellis, Chief Officer Integrated Urgent Care West Midlands Region Sandwell and West Birmingham CCG Dr. Ivana Schnur, MD/PhD Chief Medical Officer & Co-Founder Sensely Dr. Alex Yeates Medical Director & Caldicott Guardian Advanced 1
The Vision Integrated Urgent Care 2 NHS Sandwell and West Birmingham CCG acting on behalf of 16 CCGs across the West Midlands launched the Integrated Urgent Care Service in November. The service is the first of its kind in the country. It combines NHS 111 access and out of hours (OOH) GP services to improve outcomes and the experience for patients whilst also alleviating pressures on the NHS. Its clinical hub gives patients direct access to the most appropriate clinician, including GPs, for specialist advice and rapid access to the health care service they need. Other specialists working in the hub include pharmacists, advanced nurse practitioners, mental health nurses and dental nurses. The Commissioners want to make it as easy as possible for patients to obtain medical advice in the way that best suits them. For some, using the app would be most convenient. Patient safety and quality are, of course, our top priorities, but offering patients choice is also important and we believe NHS Digital helps us do that. Our mission is to give patients access to the NHS through a single digital interface. Trying to ensure simple, efficient and appropriate access to care. Ask NHS is a product and has a local digital roadmap specifically for the NHS Primary and Urgent Care needs in the West Midlands. The Commissioners continue to strive to ensure the IUC service provision supports integration and interoperation with the online digital offering.
Integrated Urgent Care Integrated Urgent Care % Reduced duplication Consistent processes Shared data Shared KPIs Opportunity to extend to ED Improved patient outcomes Seamless patient experience Alliance working in Shared staff Opportunity to extend to 999 Interoperability practice Use of premises Introduction of direct booking Shared learnings Mutual aid and resilience Service innovation Opportunity to extend to community providers 3
West Midlands Ask NHS' Deployment April 2017 Go LIVE 643 GP Practices 25,000+ Total Downloads 3,000+ Weekly Symptom Checker Usage 4000 3500 Weekly Ask NHS Usage 3000 2500 2000 1500 1000 500 0 4 Introduction of 111 In queue message saw download rates increase from single figures to over 500 p/w - indicates shift in patient demand
The Journey This was launched first within one CCG, available to 2 GP practices, 40k patients Launching per GP practice is labour intensive, and yields limited gain with only around a 5% download rate. With adhoc communications plans, requirement for GP surgery resource this was difficult to roll out at a speed we would see any benefit Single GP Surgery roll out was swapped for regional wide roll out, allowing integration with the WMIUC Clinical Hub. Followed a CCG wide roll out, with advertising on the 111 in queue message 5
The Results September 2017: 4.5 Million Addressable Patients Service Finder 11% Usage % Symptom Checker Outcomes Schedule GP Appt 12% GP Appt Booking 20% Usage Symptom Checker 30% Usage 77% Symptom Checker Completion Rate Self-care Avice 111 Hub- Priority 3-111 Hub- Priority 2-111 Hub- Priority 1-999 8% 7% 15% 14% 44% 37% Of Symptom Checker Cases are Recommend ed to contact the 111 Hub 0% 10% 20% 30% 40% 50% Self Care 39% Usage 6 v
The Clinical Hub Results September 2017: 4.5 Million Addressable Patients 30.00% 25.00% 25.00% NHS 111 Clinical Hub Referrals of DigitalCases 22.92% 20.00% 18.75% 16.67% 3% 15.00% 10.00% 8.33% Accept 5.00% 2.08% 2.08% 2.08% 2.08% 2.08% Impact on the Hub = Clinical 0.00% 70 cases p/w Hub Call Back 3% of all symptom checker activity go through to accept a call back from IUC Clinical Hub 7 v
NHS Digital West Midlands NHS Sandwell & West Birmingham CCG Regional Integrated Urgent Care Team linked with NHS Dudley CCG Collaboration, Governance, Safety, Promotion - Care UK - Primary care Requirements, deployment plan, project management, evaluation and impact assessment New digital front end option for NHS 111 Deployed in 5 months 8 NHS Dudley Clinical Commissioning Group NHS Sandwell and West Birmingham Clinical Commissioning Group
Symptom Checker Safety Safety Standards Uses the Odyssey Clinical Engine NICE accredited CDSS. Bayesian clinical assessment model not an algorithmic decision tree. Odyssey has been used for over 18 years Uses NHS Choices self-help information for self help advice. Links into the Adastra urgent care solution Integrates with Professional Odyssey Teleassess application Ongoing validation to ensure correct outcome is being reached 9
Lay use Professional use Out of hours service Mobile App Portal Kiosk GP Reception Nursing / care homes Paramedics Ambulance control room Teletriage Face to face 10
The Current Challenges We Are Overcoming Only available to adults Not everyone has access to smartphones Limited / no access to some services i.e. Takes time for data sharing agreements Community Services 11
User Satisfaction 89% of users surveyed found the app easy or extremely easy to download and register. 87% of users surveyed found the symptom checker easy or extremely easy to use. 80% of users rated the GP appointment booking/cancelling to be extremely easy. Great, reassuring voice, pleasing to the eye on how Olivia looked Brilliant presentation - very real and warming. Very responsive, its good to have a face to talk to rather than just voice The app will help to reduce number of visits to GP's or A&E 12
Measuring Success Key Performance Indicators Lower cost per transaction Improve user satisfaction Increase digital take up Increase completion rates In the West Midlands, Care UK has seen no sudden upsurge in demand 13
Measuring Success April 1 st through September 3 rd 2017 Avg. interactions per hour: 5 Avg. interactions per day: 322 Total interactions (Symptom Checker, Appointment Booking, Self-Care and DoS) = 50,025 Interactions, on average, happen once every 12 minutes 14
Learnings Setup for Success Always involve the patient (users) Keep the messaging simple Local clinician buy in (deployment support at practice level is needed) Integration with workflow Feedback, Feedback, Feedback Data sharing agreements in place to monitor clinical safety 15 Don t be afraid of the avatar
Let s meet Olivia Triage Assessment Demo 16 v
Q & A We welcome any questions Dr. Ivana Schnur, MD/PhD Chief Medical Officer & Co-Founder Rachael Ellis, Chief Officer Integrated Urgent Care West Midlands Region Sandwell and West Birmingham CCG Dr. Alex Yeates Medical Director & Caldicott Gardian Visit Stand #141 to learn more 17