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Supporting patient self-management of bronchiectasis using results messaging and chat-bots

Bronchiectasis patients provide sputum samples when unwell. Action on results can be delayed, time-consuming and patients get results after they are useful. We will streamline this with automation and chatbots.

Read comments 7
  • Shortlisted idea
  • 2022

Meet the team

Also:

  • Andrew White, Respiratory Consultant

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

When bronchiectasis patients have exacerbations, they need to submit sputum samples, start pre-prescribed rescue antibiotics before calling to enquire about their results. More proactive management of results by healthcare professionals can be very time consuming and increases dependence. We aim to improve this process using automation to retrieve sputum sample results and reporting directly to patients (via SMS initially). We will use an algorithm supported chatbot to help the patient manage their antibiotics with minimal health care professional intervention. This will eventually incorporate video links to patients and may involve an AI chatbot, to provide a more fluid experience for the patient.  The aim of this work is to improve the patients’ experience of the management of their disease, and free up clinician’s time for tackling difficult cases. The functionality could be translated into other chronic diseases.

What does your project aim to achieve?

This project aims to support patients to self-manage their condition and to ensure timely provision of results and advice where necessary. We hope to achieve this whilst reducing unnecessary health care worker interventions.   By ensuring timely communication of results and supporting this with simple advice via chatbot the quality of care should be improved whilst also freeing up clinician time for more complex cases. We want to work with patients to develop user centred tools to communicate with patients utilising devices patient already have without the need to download dedicated apps ie using SMS, SMS interactive chat and email for those that choose.

How will the project be delivered?

This project has already gone through a phase 1 implementation. We have utilised robotic process automation in a Microsoft Access 2010 database to check sputum samples daily for our bronchiectasis patients. Abnormal results are forwarded to the appropriate clinicians. We have also used the GOV.uk Notify to send patient information links and management plans to patients. As it stands, a clinician needs to connect these two processes. We are currently working with the digital team on how to automate the retrieval of lab results via the more stable protocols using APIs (application programming interface). We are also collaborating with Gloucestershire University to receive two placement computer science students starting this September. Benefit to patients will be via survey of their experience of the bronchiectasis service before and after implementation of this new system. Risk will be carefully assessed with the help of the trust’s clinical governance team.

How is your project going to share learning?

We plan to share all programming, so that others can use the code, and hence implement the digital system in other disease sites and trusts (where possible we will use open source code). We plan to showcase our work at the BTS (British Thoracic Society) conference and also Q meetings. We hope to develop interest from other Q members who could benefit and even collaborate on this work. We hope that learning on this group of patients will inform the development of similar approaches in patients with other chronic diseases to support their self-management and have had interest within our organisation from other specialties.  In the early phases of this work in Gloucestershire, this has already benefited a 2021 Q Exchange project to share learning around remote models of care and this will continue.

How you can contribute

  • We would need help from people with experience with clinical governance, digital safety and even video production.

Plan timeline

1 Jun 2022 Initial local digital approvals in place
1 Sep 2022 Computer Science placement student start
3 Oct 2022 Pilot launch
1 Dec 2022 Scaling
1 Mar 2023 Evaluation phase (qualitative and quantitative)

Comments

  1. Really like this -  the approach is exactly what we should be developing and scaling for a whole range of diagnostic tests that patients can manage themselves from home.  (building on the recent mass experience of millions of people in self-testing and reporting for COVID-19).  I've shared this example with the new NHS England diagnostics @home programme.

    1. Many thanks Nathan. Please do let us know what the NHS England team say.

      I have been thinking about other diseases that this work could be translated to…

      • Patients on DMARDs needing routine LFTs
      • DM patients monitoring their HbA1C
      •Cystic fibrosis patients with bronchiectasis and exacerbations of the latter

      • Thyroid disease patients monitoring TSH levels

      • Anticoagulated patients monitoring INR if still on warfarin.
      • CD4 count for HIV patients
      Renal patients monitoring renal function

      • Supporting remote monitoring of patients on virtual wards

  2. Mark and Charlie, I love this!!! I think this is such a clever yet simple idea which will free up, as you say, precious clinician time by allowing you to focus on the smaller number of abnormal results whilst allowing patients to have much quicker access to their results. This will improve the quality of care that you deliver. Whilst I think it will improve your workflow within the respiratory team, there will be much wider learning to share with other areas including where I work in primary care. We can spend a lot of time looking at 'normal' results and if there was an automated way to let patients quickly know their result, then it would be 'win - win'. I eagerly await your learning to share. Best of luck.

  3. Great to hear this has gone on to the next stage. Exciting stuff!

  4. Great to see this project idea shortlisted and do include the NHS AMR programme in the shared learning.

  5. Hi Charlie and Mark - on your request for Q members with experience of navigating red tape - there is lots of learning on the NHS Innovation Collaborative about this type of thing https://www.nhsx.nhs.uk/covid-19-response/technology-nhs/supporting-transformation-through-innovation-collaborative/

    This Q Exchange project from a couple of years' ago also reflected on some of the red tape hurdles to implement their tech solution https://q.health.org.uk/idea/2019/reducing-unnecessary-out-patient-appointments-in-kidney-care/

    best of luck with the idea

    Jo

  6. Hi, I'm part of the Research and Innovation team at Asthma + Lung UK and would love to have a chat about your project and whether there's anything we could do to support?

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