Kingston Hospital NHS Foundation Trust –

New COVID Virtual Clinics, PAS Clinic Build & Correspondence

OVERVIEW

During the peak phase of the COVID-19 pandemic, the majority of face-to-face appointments across the trust were cancelled due to priority treatment for coronavirus cases. It was urgently necessary to move future outpatient appointments over to virtual telephone and video consultations. The existing trust EPR system (Oracle Cerner) was not configured to support this transition.

CHALLENGE

The extreme pressure on NHS trusts due to the pandemic meant that there was limited availability from trust staff to engage on this project. The e-Health PAS build team were required to deliver with minimal service interruption. Successful delivery involved collating, documenting and configuring clinic build requirements across all main outpatient services. Extensive out-of-hours support was needed to complete the project within the agreed deadline.

OBJECTIVES

  • Enable outpatient appointments to be scheduled for face-to-face, telephone and video

  • Enable rescheduling of existing and future appointments

  • No impact on current live service, and the ability to revert back to original BAU processes post-pandemic

  • Ensure billing and tariff information is pulled through in reporting as expected

ANALYSIS APPROACH

Working with project stakeholders on the key project milestones:
Current State Review:

  • Analysis of existing clinic build design and review
  • Requirements gathering, documentation and GAP analysis

Future State Review:

  • New virtual clinics design and mapping
  • Rollout plan, impact assessment and trust sign off
  • Proof of concept build in non-live environment

Deployment in LIVE system

“IMPROVED DNA RATES”

“BETTER CAPACITY
MANAGEMENT”

PROBLEM IDENTITY

The e-Health team identified and analysed the scope of clinic and appointment types to be configured within the new virtual setup, as well as those to be excluded.

Key elements of the current state review were understanding trust-specific process & design, and defining and reviewing additional configuration requirements, such as orders to schedule workflow.

As part of this project rollout, we identified approximately 2,000 (face-to-face, telephone and video) appointments for configuration. To ensure that appointments could be billed correctly, a critical dependency was pulled through reporting.

A pivotal part of the project specification was that appointment letters must display the correct content, along with instructions for patients to attend the virtual appointment.

St Marys hospital
BENEFITS & OUTCOME
  • New functionality to enable admin staff to book face to face, telephone or video appointments into the same clinic
  • Improved DNA rates and outpatient appointment attendances post implementation
  • New appointment letters containing all the relevant information for patients to connect successfully and on-time for their virtual appointment
  • Better capacity management due to a more flexible appointment booking process
  • Correct billing of face-to-face and virtual appointments due to custom solutions implemented in the outcome of attendence process
  • Capability for existing appointments bookeds to be rebooked as virtual
  • Clean up of old redundant configuration to improve end-user experience and ease of back-office maintenance
  • Mitigation of user errors and data quality issues due to new security solutions adopted

SOLUTION

A full implementation plan and change control process were identified and documented. To mitigate the trust-wide operational impact, go-live was agreed upon at a specific time.

Clinics and appointment types were reconfigured to support the COVID-19 virtual appointments project. System audits identified approximately 1,200 new orders to be built to support the ‘orders to scheduling’ workflow.

New custom fields were implemented within the ‘Outcome of attendance‘ workflow to support reporting and operational requirements.

Custom PAS build audits were executed in the live system to identify redundant clinics and appointment types for removal.

Rules logic was incorporated into letter templates. This would ensure appropriate (treatment-specific) information and instructions for patients, in readiness for their virtual outpatient appointment.

Full domain extract of new configuration as part of trust handover and back-office maintenance moving forward.