GREATER MANCHESTER EXPERIENCE

Transcription

1 Greater Manchester Cancer Vanguard Innovation Remote Monitoring / Stratified Pathways GREATER MANCHESTER EXPERIENCE NADEEM AHMED - INFORMATICS ENTERPRISE ARCHITECT, DIGITAL The Christie Previously - Greater Manchester Cancer Vanguard JANE BROWN - MACMILLAN RECOVERY PACKAGE IMPLEMENTATION LEAD (Wythenshawe, Trafford, Withington, Altincham)

2 Greater Manchester Cancer Vanguard Innovation InfoFlex Cancer Information System Solutions implemented at MFT (Wythenshawe & Withington sites) INFOFLEX COLORECTAL Remote Monitoring Risk Stratified Pathway - Multiple Tests Review & Scheduling Solution INFOFLEX BREAST Risk Stratified Pathways - Annual Breast Mammogram Recall Solution

3 Greater Manchester Cancer Vanguard Innovation InfoFlex Cancer Information System Solutions implemented at MFT (Wythenshawe & Withington sites) Single integrated solution covering all cancer requirements - can implement all or parts of it as required Interfaces (HL7 standards) with local Trust systems - Patient Administration System (PAS) Demographics and Referrals, Pathology and Radiology Incorporates daily extracts / feeds from Somerset Cancer Registry, Endoscopy (Colorectal) Updated for new requirements - e.g. Treatment Summaries stored on the Allscripts EPR system In the future - ability for real-time exchange of data between connected healthcare organisations (Hospitals, Hospices, Social Services )

4 Greater Manchester Cancer Vanguard Innovation InfoFlex Cancer Information System Solutions implemented at MFT (Wythenshawe & Withington sites) New aftercare pathway designs (process maps and associated clinical protocols such as End of Treatment Summary Templates and patient letters) clinically led design of processes. Project teams included:- - CIMS - MFT Clinicians and Administrators for the Breast and Colorectal Services - Trust IM&T Interface and Business Intelligence teams - Project management by the GM Cancer Vanguard PMO office.

5 Greater Manchester Cancer Manchester University Foundation NHS Trust (Wythenshawe site) Breast Aftercare Pathway CIMS Project Schedule Draft Milestones Vanguard Innovation Oct 17 Nov 17 Dec 17 Jan 18 Feb Pre-Project Engagement Key Stakeholders, resources, Info gathering/sharing /signoff. Design Workshop 1 InfoFlex design, IT infrastructure & network Clinical users Review existing breast pathway flow CIMS - InfoFlex Clinical work flow development IM&T & CIMS Review technical spec. Design Workshop 2 Agree clinical change review. IM&T & CIMS agree/review technical spec & interface requirements Build Design 2 Testing Design 2 Design Workshop 3 Clinical workflow sign-off IM&T & CIMS Tech Spec sign off UAT testing Design 3 Pre live testing Clinical training Testing e2e Design 3. Go Live.

6 The Colorectal Aftercare Pathway To Be business process - designed as part of the recovery package and used on the InfoFlex system Greater Manchester Cancer Vanguard Innovation

7 Greater Manchester Cancer PID BENEFITS REALISATION - InfoFlex System & Colorectal Pathway Vanguard Innovation Benefit No Benefit Description 1 People affected by cancer - prepared and equipped for supported self-management by time of the conclusion of planned cancer treatments. 2 Patients equipped with lifestyle so that their risk of long term conditions and subsequent new cancer is reduced. 3 People affected by cancer with a subsequent worry or new problem can easily and promptly access professional help (rapid re-access to specialists) 4 Improved patient experience people affected by cancer are confident about what they need to do, what to look for, and can easily access advice and help as and when needed. They no longer feel lost or abandoned on completion of treatment pathway 5 The recovery package elements are key to successful risk stratified supported self-management. 6 Regular PROM data collection reliable feedback on patient experience and the prevalence of problems including late toxicities following treatment 7 Capacity released from outpatient follow up clinics in acute trust supported by robust end of treatment consultations and facility to re-access. 8 Potential benefit from healthy lifestyle adoption by cancer survivors to enhance their recovery, reduce comorbidities and later new cancers

8 Macmillan Cancer Colorectal Cancer Survivorship Project TRADITIONAL TO RISK STRATIFIED FOLLOW-UP Traditionally Consultant-led Risk stratification - protocol - Initially - nurse-led - Now includes - supported self-management Frustrations Database risks / governance - Trust Risk Register patients lost to fup Patient and clinician experience COLORECTAL CANCER SERVICES

9 Protocol Macmillan Cancer Colorectal Cancer Survivorship Project INTRODUCING RISK STRATIFIED FUP THE ESSENTIAL ELEMENTS Recovery package elements COLORECTAL CANCER SERVICES - HNA / Care Plans - Treatment summaries - HWBE Wide team support clinical, directorate managers IT Macmillan project funding Follow-Up Co-ordinator

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11 Macmillan Cancer Colorectal Cancer Survivorship Project Excel Spreadsheet.. To INFOFLEX

12 INTERFACES with Trust PAS (demographics, Pathology, Radiology, Endoscopy & Somerset (referral)

13 Blood CEA (via interface between InfoFlex and Trust Pathology)

14 TRACKING Test due Result available / overdue Outcome Schedule next tests Generate letter to patient

15 TREATMENT SUMMARY Pre-populated standard templates Copy saved on EPR

16 Overview of all activity

17 Macmillan Cancer Colorectal Cancer Survivorship Project SOME KEY POINTS NEW PATIENTS (eg:- MDT, new referrals) timely inputting COLORECTAL CANCER SERVICES HISTORIC CASELOAD (excel spreadsheet) gradual transfer (eg: most recent diagnosis, fup appt, clinical need) VIRTUAL CLINICS for risk stratified supported self-management; scheduling surveillance tests (tariff) TELEPHONE SUPPORT recorded; outcome (tariff) NURSE-LED CLINIC EMERGENCY APPT SLOT supporting rapid reaccess END OF TREATMENT SUMMARY timely generation; shared clinician and nurse (InfoFlex standard templates) FOLLOW-UP CO-ORDINATOR workforce development; first point of team contact OTHER USERS Research Nurses And THE FUTURE Patient Portal, Primary Care

18 PATIENTS RISK STRATIFIED TO SSM Fup Nov 2017 March 2018 TOTAL NUMBER OF PATIENTS - New Colorectal Cancer diagnoses in patients - Receiving Curative Surgery in patients AGE RANGE CANCER GROUPINGS F1 Dukes A and good Dukes B F2 bad Dukes B, Dukes C to 87 years F1 11 F2-6 END OF TREATMENT SUMMARY - completed 17 (100%) HEALTH & WELL-BEING CLINIC - attended - Offered 15 - Attended 10 } 73% - Invited, declined 1} - DNA 3 - Waiting List 1 - N/A* - 2 DATE OF DIAGNOSIS range May 2014 August 2017 AVERAGE TIME FROM DIAGNOSIS TO SSM FUp range 8months 3years 2months *Service not provided when appropriate to invite or other clinical reason

19 Macmillan Cancer Colorectal Cancer Survivorship Project Service Redesign SERVICE USER FEEDBACK

20 Macmillan Cancer Colorectal Cancer Survivorship Project Service Redesign OUR LEARNING 6 MONTHS ON SUPPORTED SELF MANAGEMENT - No-one lost to follow-up - All surveillance tests timely, according to agreed management plan - Demand management PROCESSES - Mulitple excel spreadsheets - stopped - Wrong blood test invite letter sent pre-ct Scan cea rather than U&Es - Letter inviting to attend cea not requested on system Co-ordinator fully briefed; Standard Operating Procedure VIRTUAL CLINICS - Dedicated Clinician Time and Space Part of workplan; reduce interruptions

21 Greater Manchester Cancer Vanguard Innovation Nadeem Ahmed Enterprise Architect & Informatics Lead Jane Brown Macmillan Recovery Package Implementation Lead