comprehensive elective care digital patient communication platform

A comprehensive elective care digital patient communication platform would have multiple components to ensure 2 way communication between patient and hospital where patients trust that they are in a system and can make contact when necessary. In Nottingham we piloted a system for a single procedure - laparoscopic Cholecystectomy. We learnt a lot of lessons and would be happy to share (its part of NHSX digital playbook webinar coming up). The future vision is:

The future – My Online care

Virtual communication with individual patients (with telephone / online back up)

a.      Patient to clinician

                                                    i.     Patient Questionnaires to inform clinicians

                                                   ii.     Patient validation of past medical history and drug history to save time in clinic

                                                  iii.     Pre-op assessment questionnaires (identifying which patients need to come to a face to face pre-op assessment and which don’t).

                                                  iv.     Inform patient where they are in the process (patient tracking to ensure patients don’t get lost and have interventions in correct order with patients confirming future attendance reducing DNA rate).

b.      Clinician to patient

                                                    i.     Explanation of need for investigations ahead of clinic apt.

                                                   ii.     Information to patients eg. Information for consent

                                                  iii.     Condition specific information

Efficient single meaningful consultation with patient (plus chosen representative) F2F or virtual.

o   Informed clinician (investigations performed ahead of clinic allow decisions to be made, avoid repeat appointments)

o   Informed patient (patient informed of diagnosis and treatment options prior to clinic – makes appointment more efficient)

o   Shared decision making and informed consent (digital process, measured and recorded, efficient use of clinical time)

Virtual pre-op, informed consent and enhanced recovery after surgery (ERAS) consultations (where possible)

·        Letters to patient on portal with waiting list tracking, actions required by pt. (eg. stop smoking, pre-habilitation exercises, self isolation, ERAS  etc.).

·        Pre-op consultations performed virtually (need to get blood tests, ECG etc done in primary care). Digital consent, digital sharing of information, video consultation.

Admission for treatment eg. Surgery

·        Patient attends prepared and consented with realistic expectations of surgery

·        Patient is an active participant in ERAS pathways

·        Efficient discharge process and documentation copied to patient portal as well as post op information including who to contact if in trouble.

Discharge communication to reduce readmission

·        Clear “who to call and when” if patient running into trouble.

·        Early post op digital questionnaire to identify patients running into trouble to safety net patients. (eg. lap chole pilot)

·        Could expand into “hospital at home” concept for early discharge and shorter LOS would require wearable technology in patient’s home eg. O2 sats. probe.

Follow up

After treatment, guideline based follow up investigations (eg Polyp follow up guidelines) to reduce unnecessary investigations and patient initiated follow up (patient empowerment) using symptom questionnaires to inform need for follow up.