Fredrik Vivian: Outpatient transformation and patient engagement portals
Outpatients services are particularly well placed to capitalise on transformation through innovative pathways and digital technologies. These approaches offer the possibility of improving patient care, without increasing total costs, while enhancing the experience of both staff and patients.
However, reforming outpatient care is complicated. In every hospital there are many specialties each with several clinics operating their own bespoke pathways for referrals, triage, appointment booking and follow-up. It is a similar picture in GP, where each of the 6311 surgeries in England has developed its own structure for care. But in GP, as small independent businesses, early-adopters have the freedom to innovate. This has led to forward-thinking GP practices outpacing secondary care in service model innovation and the uptake of new digital technologies, such as use of text messaging and same-day ‘total triage’ systems. Meanwhile, secondary care faces challenges due to less agile governance structures and a lack of financial incentivisation, particularly for clinicians, to drive efficiency.
That being said, some key innovations are starting to make an impact. Patient engagement portals (PEPs) are one such innovation and are recommended in NHS England’s Outpatient Recovery and Transformation Programme (1). They offer a route to improving the quality and efficiency of care, while also empowering patients to navigate the healthcare system with greater autonomy. These are digital platforms with a range of functions including digital communications (such as broadcast messaging, video appointments or digital letters), online appointment scheduling, waiting list validation and sharing of results. By enabling patient engagement through digital means, we can improve communications between hospitals and patients for both clinical and administrative functions. Results have been promising: for example, deploying DrDoctor’s PEP for radiology appointments at Royal Orthopaedic Hospital reduced ‘do not attend’ rates from 7.4% to 3%, halved average wait times and saved administrators’ time (2).
When designing these systems, it is vital to consider the effects of digital exclusion and avoid exacerbating health inequalities. However, if we are mindful of this, utilising these systems for those patients who are able will free-up administrator and clinician time to better cater for those that are not able and those who are currently disadvantaged.
PEPs offer further benefits beyond improving administration of appointments. They provide a route to more flexible and dynamic care pathways such as patient-initiated follow up and the use of patient-reported outcome measures. They could also help to link up care across the health system, reducing inefficiencies that often occur when we work in silos. For example, a patient could use a PEP to ensure their renal and diabetes appointments are staggered. This could facilitate the stretching of the follow-up time for each. In the future, we should aim to use PEPs to enable fully flexible and continuous care. With self-help advice, flexible appointment booking triggered by patient concern or concerning data, and an increased use of non-synchronous communications, we can ensure the right patient is seen by the right person at the right time.
With the increasing demands of complex patients, it is vital that we innovate outpatient services. Through digital technology, new models of care and patient empowerment, we can deliver better care more efficiently and with improved experience for all. Using clinical and patient-reported data more effectively will further the potential of PEPs. The use of data to improve how we deliver patient care will be the subject of my next blog post.
References
2. https://www.drdoctor.co.uk/reducing-dna-rates-with-royal-orthopaedic-hospital
Further resources