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What is the challenge your project is going to address and how does it connect to your chosen theme?

There is demand from patients and staff to provide video clinics for those patients who have to travel far to UCLH. Earlier pilots of video clinics improved patient experience, even capturing patients who were otherwise lost to the system. However services struggled to sustain the remote clinic model due to the following challenges, which reflect those reported in the literature(1): duration of the pilot was not long enough to embed, inflexible model, no standard workflows were developed with IT team and no user input as existing technology was used.

With a new electronic health records system (EHRS) we are a unique position to use improvement methodology to work with staff and patients as a team to build on the pilots to design effective resources to support the spread video clinics across the trust.

(1) Greenhalgh T et al. Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study. J Med Internet Res 2018;20(4):e150

What does your project aim to achieve?

The main beneficiaries are patients and staff. We aim to give patients more choice in how they would like to interact with healthcare, improve their experience and the quality of care. The objective is to produce resources that staff can use to successfully adopt and embed video clinics. It is part of a wider improvement project to roll-out video technology for remote clinics.

PDSA cycles will reveal the success criteria for sustainable video clinics, barriers to adoption and where they can add value. Patients and staff will use the cycles to design and test support tools that can be used by services to create the conditions for sustainable video clinic services that are easy to use and complement existing resources.

Success will be measured by patient experience and staff feedback, and the approval and use of the resources.

Other have shown the value of video clinics; this work would provide tools to support sustainability and spread for the technology.

How will the project be delivered?

The project will be delivered as an added part of a wider initiative involving the roll-out of video functionality and a trust-wide policy infrastructure for video clinics.  The additional funding will be for developing and delivering user experience design and testing of the support tools/resources for implementation.

The Director of Innovation, UCLH Improvement Lead and THF Improvement Science Fellow will provide direction.

The overall initiative includes key stakeholders such as patients, clinicians, administrators, IT team, the pilot programme manager, finance manager, and information governance lead. A sub-group will work on this project.

The core project team will facilitate the work of the group between the cycles and use trustwide PMO methods. The Improvement Science Fellow is also the EHRS patient safety lead and will provide clinical risk oversight. The Director of Innovation will provide business risk oversight.

What and how is your project going to share learning throughout?

On a basic level, we are planning to share any of the outputs developed to our established networks across patient and professional groups locally and nationally.  We also believe that there is immense value of transmitting other more tacit knowledge so would plan to engage others on a face-to-face basis by participating in discussions, be openly accepting requests to connect and opening our doors for visits e.g. by hosting learning days. These will be done in combination with other sharing learning events about the wider project.

We would also seek to use a diverse range of media to share the learning.

Communication methods:

Qualitative case studies
Uploading technical material such as the video clinic roll-out toolkit
Conference presentations
Informal publications e.g. blogs and other social media.
Publications in peer-reviewed journals

Networks:

Q Community
FutureNHS
UCL Partners
Other Epic sites as a UK Epic forerunner

UK Faculty of Clinical Informatics

Global Digital Exemplar forum

How you can contribute

  • Introductions to others with experience in this area (video clinics or developing roll-out toolkits for digital health delivery)
  • Engagement from Q community so that we can glean evidence from and build on previous work
  • Critical input into our models and toolkits that are well-informed eg suggestion about looking at the Barts initiative

Plan timeline

2 Jul 2019 Wider project group planning meetings
1 Sep 2019 [wider project] Clinic model and operational process defined
1 Oct 2019 [wider project] IT and IG workflow process agreed
1 Nov 2019 Q-Exc - finalise specification and select designer
1 Dec 2019 [wider project] prepare services for first implementation
1 Feb 2020 Q Exc iterative cycles of design and test until May 2020
1 Feb 2020 Q-Exc Prototype toolkit developed
1 May 2020 Q-Exc video recording and editing finalised, launch toolkit
1 Jul 2020 Q-Exc embed finished videos in toolkit
1 Jul 2020 [wider project] stage 2 rollout
1 Oct 2020 Q-Exc + wider project - showcase dissemination event

Comments

  1. Guest

    Oliver Schafer 1 year, 12 months ago

    I have seen remote access clinics being run in a case by case consultancy model in Illinois (using Epic) to great effect. As far as I've seen Epic has great support for remote care, including video visits, telerounding and various other forms of remote consultancy and prescription services all delivered via mobile applications. This not only allows for scalable services as patient records are available now via myCare but also allows us to operate with our existing IT support services.

    I'm interested to see video services used for pre-assessments and post-operative follow ups as there could be significant cost saving by reducing the volume of patients using our transport service. There are numerous digital avenues to explore but tying this in with our existing EHRS model would probably be the best solution for UCLH.

    To provide a standard model for trusts/clinics to use will be challenging, there are videoconferencing toolkits on the market as well as open source solutions however making this secure, NHS wide and maintainable will be a difficult problem to solve.

    Undoubtedly this will be a great step towards making the NHS a more efficient healthcare provider for people with mobility issues or travel restrictions.

    Best of luck with the project,

    Oliver

     

     

     

     

  2. Yes we have a similar idea for kidney care, but using PROMs/PREMs for people to complete at home prior to having a consultation

    1. Hi Nicola - we are looking to work with areas that already have tried some remote clinics on a pilot basis; the Q proposal is to look at resources and toolkits to support sustaining and embedding the service model past the pilot phase.

  3. Hi Yogini,

    I can see similarities between our proposals. I love the idea. Do you know what QI methodologies you might employ?

    Tony

    1. HI Tony - yes there are similarities; the team have decided to focus on video clinics to build on experience and learning from earlier pilot work to explore maintenance and spread by developing support resources. Be good to see if there are areas of collaboration to maximise the outcomes.

  4. Dear Yogini,

    have you seen the work of Barts Healthcare (featured in the Topol review) on the use of remote consultations? It started with diabetes but is spreading to other areas. It is one of the Health Foundation Scaling Up teams and information can be seen on the website if you’re interested to learn more. They are a fab team!

    Another fab team is the CWTCH team from Aneurin Bevan, who are using telehealth to undertake deliberate self harm and paediatric liaison between a child and adolescent mental health service and two different hospital paediatric wards. This team are a Health Foundation Innovating for Improvement team. Both are experimenting with the use of Attend Anywhere after NHS Highland had success with this approach.

    Hope you find them as inspiring as I do!

    warm wishes and good luck.

    Anna

     

    1. Guest

      Clair Chew 2 years ago

      Thanks Yogini for sharing with me over the UCLH network. It is good to hear some success from Barts! I am definitely interested in overcoming difficulties in scaling up, we've run pilots before, so will definitely check out the Scaling Up teams resources. Would be good to hear experiences from others.

      Clair (UCLH)

    2. Thanks Anna - really helpful. I will share with our team.

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