Modelling an Alternative Future Economic …

1 1 Modelling an Alternative Future - Economic evaluation of a Digital NHS in London Healthy London Partnership 04 July 2017 2 Table of Contents 1 Introduction .. 5 2 Summary Impact 6 Financial View - 5 to 10 years .. 6 Financial Impact .. 7 Workforce Impact .. 9 Estates Impact .. 10 Overall Workflow and Workforce Effects .. 11 As-Is and Can-Be Scenarios .. 11 Workflow .. 12 Workforce .. 13 Impact on Primary Care .. 14 Impact on Secondary Care .. 15 Admitted Patient Care.

2 15 Outpatient Care .. 16 Urgent Care .. 18 Interconnections and Principal Initiatives .. 19 3 NHS Priorities .. 21 NHS Five Year Forward View .. 21 Next Steps on the NHS Five Year Forward 21 Wachter Review .. 21 NHS Big Data .. 22 Genomics .. 22 4 Population and Demand Pressures on London .. 22 5 Technological Challenges for London .. 23 6 Route to Change .. 23 7 Channel Shift .. 24 Outside Healthcare .. 24 Within 25 8 Imminent Programmes Facilitating Digital Initiatives in London .. 26 Gateway.

3 26 NHS Digital Apps Library .. 26 London Health and Care Information Exchange (LHCIE) .. 27 Methodology Polulation Health Management .. 29 Commissioning Opportunity (COP)/Diagnosis Stratification (DST) .. 30 3 9 Unwarranted Variation .. 32 10 Key Digital Opportunities for London .. 33 The 48 Initiatives in Seven Themes .. 34 Triage .. 34 Primary Care: Artificial Intelligence Triage - Initiative 2 .. 34 A&E Reduction through AI triage Initiative 24 .. 36 Image based Triage for Dermatology Initiative 3.

4 37 Virtual General Practice Initiative 6 .. 38 Health Information Exchange (HIE) supported Electronic Patient Records (EPRs) .. 41 Access to Patients records during NHS 111 calls - Initiative 1 .. 41 Transfers between Hospitals in - Initiative 20 .. 42 Transfers due to Patient - Initiative 21 .. 43 Calls related to patient enquiries in Trust Initiative 15 .. 44 Calls to seek Missing Discharge Letters and confirm OP Appointments - Initiative 16 .. 45 Calls due to Missing or Illegible Test Results - Initiative 17.

5 46 Patient Records Retrieval due to change of Address - Initiative 39 .. 46 Reduction in paper handling time fax - Initiative 14 .. 47 Time Saving in A&E due to Electronic Patient Record (EPR) Access Initiative 25 .. 48 eOBS Digital Task Observation and Handover System - Initiative 42 .. 49 Supported Self - Management .. 50 Diabetes Self Management and Self Coaching Initiative 32 .. 50 Arts on Prescription Initiative 46 .. 51 Exercise on Prescription Initiative 47 .. 52 Expert Patient Programme Initiative 48.

6 53 Guided Rehabilitation Initiative 38 .. 54 Digital Self-Care and Care Planning in Care Homes Initiative 4 .. 55 Channel 56 Mobile enabled Community Nursing Initiative 44 .. 56 e-Prescribing Initiative 5 .. 57 Referral Support Services Initiative 10 .. 58 Pre-and Post-Surgical OP Attendance for Assessment .. 59 Outpatients Pre-operative - Initiative 33 .. 60 Outpatients Post-operative Investigation - Initiative 34 .. 61 Postage Savings by e-Referral (eRS) and emails - Initiatives 13 & 29.

7 62 Discharge to Assess - Initiative 35 .. 63 Virtual OP Clinics - Remote Follow-up Initiative 43 .. 64 e-Referral from hospital to community pharmacy Initiative 41 .. 65 4 Care Plans and End of Life (EoL) .. 66 Savings by Avoiding Re-Entry of Care Plans Initiative 22 .. 69 Implement care plan sharing in care homes Initiative 27 .. 71 Digitally Shared Care Plans Initiative 28 .. 72 Digitally shared Care Plans for patients with LTCs North Lothian Initiative 26 .. 75 Diagnostics.

8 77 Remote Communication of test results in Primary - Initiative 8 .. 77 Pathology Improvement Programme - Initiative 12 .. 77 Pathology Tests Duplication Avoidance - Initiative 18 .. 78 Radiology Tests Duplication Avoidance - Initiative 18 .. 81 Alerts .. 84 Asthma - Inhaler Sensor Initiative 84 Non-Invasive Heart Failure Monitoring Primary Care Initiative 9 .. 85 Non-Invasive Heart Failure Monitoring - Secondary Care Initiative 30 .. 86 Remote monitoring of Drug - Initiative 19.

9 86 DNA Reduction in Primary Care - Initiative 7 .. 89 DNA Reduction in Secondary - Initiative 40 .. 90 Mood Monitoring Initiative 45 .. 91 Clinical Decision Support Systems (CDSS) .. 92 CDSS GP on-line support from Secondary Care consultants Initiative 11 .. 92 CDSS and Adverse Events Initiative 37 .. 93 CDSS for Case Finding - Initiative 23 .. 94 CDSS for Photographic Image Analysis Initiative 36 .. 96 Once for London 97 Opportunities as aligned to steps in the Patient Journey.

10 98 Appendix 1 Link to Tables .. 99 Appendix 2 Link to Dashboards .. 100 Appendix 3 Social Prescribing .. 102 References .. 102 5 1 Introduction The London Digital Programme, which is part of The Healthy London Partnership (HLP), commissioned the analysts i5 Health to produce an Economic Modelling tool to support implementation of digitally enabled new models of care. The result is a package of 48 evidence based technology solutions which are explored in detail in this document in terms of releasing efficiencies.