Q Exchange
Exploring better ways to monitor blood pressure for patients
- Proposal
- 2023
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
Blood pressure is a key measure of health, yet BPs collected in different settings, including home BP readings, are not routinely added to the GP clinical record. Clinical teams spend many hours reviewing and monitoring patients’ BP readings, but this is time-consuming, and trends are not always easy to spot. This project explores new ways to review all BPs, to pick up early signs of deterioration and adjust medication or treatment accordingly, both preventing admissions and improving patient outcomes.
When clinicians review blood pressure they take into account the patient’s age, medication, underlying health conditions and their normal base line. Using process automation would increase the efficiency of this process, reducing delays in identifying health issues and accessing appropriate treatment. This technology is already being used in many health settings and allows routine clinical protocols to be automated, according to strict rules, which have been developed and tested by clinicians.
What does your project aim to achieve?
This project develops, tests and evaluates an automated process to review BP readings against set criteria for each patient. Currently this review is done manually by a clinician, taking time. By automating this process all BP readings in range can be processed quickly, allowing medication reissue, routine referrals for other conditions, and for patients to continue current treatment. Any BP readings that are out of range are flagged for further review and action.
Automation allows for BPs from different sources to be collated, giving a pattern of BPs which helps identify issues sooner , enabling timely interventions and improving patient outcomes.
BPs collected in different settings can be added and reviewed alongside those collected in General Practice, using patient data effectively and allowing for trends to be spotted more quickly. This makes good use of the wider workforce in the community and broadens how healthcare data is managed, reducing health inequalities.
How will the project be delivered?
This project will be run jointly by a GP federation providing the clinical expertise and process insight, working with an automation provider with experience of designing robust automation products suitable for a health care setting. A project scoping meeting has already set milestones, budget, timelines and completed a risk assessment.
Primary care teams in Surrey are keen to explore how automation can be used to remove routine administration tasks and free up clinical time for patient facing work, whilst mitigating any risks to patients. Kent Surrey and Sussex Academic Health Science Network (KSS AHSN) have expertise in approaches to automation and will help facilitate this project, bringing their knowledge of automation. They will ensure an evaluation is carried out to show the impact of automation on the GP practice and patients, as well as looking at cost effectiveness. The learnings will be shared across the ICS and AHSN network.
How is your project going to share learning?
This project showcases how automating a well-defined process can be achieved safely in primary care, collecting data from multiple sources and giving better quality data for clinicians to review. This allows for earlier patient intervention including improved patient communication to encourage self-management where appropriate. It also addresses health inequalities by using data from community settings.
This project develops a blueprint for others to follow. There is interest in automation in primary care but the development work is time consuming, needs good risk management and requires funding. Q members have shown interest and positive support.
The learning from this project will be shared both across the ICS through the PCN network and ICS teams, and across the SE region by KSS AHSN, using their primary care innovation panel. The evaluation of this project will be shared widely across England via KSS AHSN using their primary care network links, including NHSE teams.
How you can contribute
- What do you think of this idea?
- How do you think patients will react to hearing that their BP results are collated from different places where they've had a BP check and an overall picture of their BP is now available for a clinician to review?
- How do you think patients will react to hearing that their BP results are reviewed against clinically agreed protocols using automation software, and results out of range are flagged for follow up by a clinician?
- What benefits do you see from better monitoring of BP?
- How do you feel when you hear the words process automation in the context of patient health?
- Do you have other ideas of where process automation could be used to improve how data is collected and analysed, giving better insight into patient's health status and allowing a more proactive approach to population health management?
Plan timeline
| 16 Apr 2023 | Set up project team and agree project scope |
|---|---|
| 1 May 2023 | Appoint automation provider |
| 16 May 2023 | Workshop to scope out BP review process |
| 1 Jun 2023 | Inform patients of trial and answer any questions |
| 8 Jun 2023 | Sign off automation process to trial |
| 19 Jun 2023 | Start BP automation trial, and set up evaluation |
| 19 Jul 2023 | Month 1 review |
| 21 Aug 2023 | Month 2 review |
| 25 Sep 2023 | Month 3 review and early evaluation results |
| 10 Jan 2024 | Month 6 review and decision on next steps |
Comments
Sarah Andersen 17 Mar 2023
This is a great idea - encouraging people to monitor their own BP. I have a question - when you say automated, can people upload readings from a home machine ? These are often pretty accurate if calibrated regularly.
My usual routine now is to text people their 'target' BP when I see them, so they have a record of it, and I ask them to return if their average home readings are outside this range. Are you suggesting that they would need to come back into the surgery to have BP measured ?
Simon Vickers 21 Mar 2023
Thank you. Depending on the practice's IT system and how interconnected it is, this would be the plan. The automation would be constantly running, collecting and analysing blood pressure readings from any number of sources, as long as they integrated into your system. It could be set up to automatically invite on their 40th birthday , for example, sending an invite with target range, and the option to reply with result. The automation would identify abnormal readings and action accordingly, asking for further readings, or for the patient to attend the surgery or local pharmacy to confirm the reading.
Sarah Andersen 17 Mar 2023
This is a great idea - encouraging people to monitor their own BP. I have a question - when you say automated, can people upload readings from a home machine ? These are often pretty accurate if calibrated regularly.
My usual routine now is to text people their 'target' BP when I see them, so they have a record of it, and I ask them to return if their average home readings are outside this range. Are you suggesting that they would need to come into the surgery to have BP measured ?
Julian O'Kelly 15 Mar 2023
Excellent and timely innovation - a great example of how automation can help clinicians prioritise their valuable time
Jillian Owens 7 Mar 2023
Great idea, love the personalised approach by calibrating to the patient's 'normal/healthy range' rather than generic
Elizabeth Harrison 7 Mar 2023
Interesting idea! Would anything abnormal automatically trigger a manual review? At our practice the nurses do the monitoring, patients are encouraged to have their own machines and take a profile of rested readings over the course of a week. We also have a BP machine in the waiting area that links up to their record on SystmOne. The GP, practice pharmacist or I review any results that are out of range and adjust the medication (checking kidney function, heart rate etc). I like the idea of automation when it’s about educating and empowering patients about their health and not just driven by reducing clinical time, as that can often be a false economy. This sounds good though! Good luck with your project!
Simon Vickers 14 Mar 2023
It is precisely these ‘patient initiated readings’ that this project is designed to help with. In recent years we have noticed an increase in blood pressure readings that are entered into our clinical system from outside the practice ( eg waiting room pods, home BP reading pilots, NHS health checks done by federations or pharmacies, opportunistic readings done by Make Every Consultation Count). This automation would constantly scan the clinical system identifying these readings and actioning them in accordance with a defined protocol and practice wishes. Readings that are excessively high would be flagged immediately to the practice. Borderline readings could be identified and patients notified and educated on how to manage without the practice needing to invest time and resources. Once genuine hypertension has been identified and confirmed this will be flagged to the practice or PCN Pharmacist for actioning.
Ursula Clarke 6 Mar 2023
Great idea - anything to support a reduction in admin involved in clinicalians time deserves a second look!
Jenny Partridge 6 Mar 2023
Thanks Ursula. GPs are really keen to develop the automation process for this idea, they have created the flowchart, and now need the funds to trial this innovative idea in practice.