Stable Prostate Cancer Expert System
Executive Summary
Our proven and award winning software system allows patients with stable prostate cancer to be cared for according to national guidance with huge efficiency savings over any other model of care. It can be used in a number of ways,
• Any nurse of band 5 or above in primary or secondary care
• Automated AI follow up directly by patients over a smart phone/computer
It uses built in expertise and hard wired clinical governance to ensure high quality outcomes. It can be used in hospital to free up clinical nurse specialist or consultant time or in the community by practice nurses without adding to the work load of GP’s. It can be used directly by patients via smart phone or email with automated follow up, testing and history taking every 6 months. It is easy to set up, registered at the MHRA and provides outcome data in real time. If patients are discharged it enables secondary care doctors to set the criteria for re-referral whilst ensuring that patients have gold standard care after discharge.
Stable Prostate Cancer Follow Up
Happily, most men with prostate cancer do extremely well with treatment. Whilst the majority will remain well, some men will relapse with the disease. It is for this reason that men are followed up long term. The changes in blood bio-chemistry or clinical findings can be extremely subtle, yet these need to be picked up early on in order to ensure men have the chance of further effective treatment.
The current guidelines for prostate cancer suggest that if appropriate, patients follow up should be in the community. In many ways this stands to reason. The difficulty however, is setting up systems to ensure that follow up is not missed and neither are the subtle changes that might be the warning signs of a need for further treatment.
Our prostate cancer service monitors men with stable prostate cancer who have undergone any of the usual treatments for the disease (including watchful waiting).
Flexible Implementation Clinician Led
This service is provided via a nurse using our innovative expert system soft-ware (typically in a telephone clinic) to monitor a man’s progress and to ensure that he stays well. The software is designed to identify changes in symptoms and blood tests, looking out for things such as bone pain, erectile dysfunction, deteriorating kidney function, triggering of rules such as the ASTRO or Phoenix criteria (which may not be known to all GP’s). The system can automatically produce letters for GPs, output can also be produced directly for the patient. The system has an integral patient administration system (which can interface with hospital systems) with in-built recall and texting abilities. It can also auto-generate follow up reminders and blood test request forms.
This system can be used in a number of ways; within the hospital or in the community.
Within hospitals there is huge pressure on CNS and consultant time. The system has been used to allow new nurses to fill stable prostate cancer monitoring roles, allowing them to have their own case load from day one. This can be used to rapidly flex staff, for example in response to rising demand, cover for mater-nity leave etc. Unlike the difficulties of getting funding for and appointing a band 6 or 7 CNS, temporary sessions from a band 5 nurse are usually simpler to justify and organise, while freeing up CNS or consultant time for core roles such as counselling, improving RTT times etc.
A second way that the system can be used is to seamlessly drive discharge of stable patients to the community. The commonest models of discharge have to date have been direct discharge with instructions to the GP or more formally organised locally enhanced services. While these are often started with enthusiasm, experience has shown that men are sometimes not followed up to the let-ter and that some find their way back to the hospital later than would have been hoped for. This shatters confidence of both GPs and consultants in terms of discharge. By using the iQudos system patients can be safely discharged back to a community based service. Consultants can set the rules very simply for when patients should be re-referred. Analysis of each patient’s symptoms and tests occur at each clinic visit and in-built expertise produces advice on problem management for the GP as necessary. The optimal way for this to be run is that patients are enrolled into the iQudos system at the Trust and can be transferred into a community clinic, usually provided at a couple of locations within a CCG or GP Federation. iQudos will provide the necessary IT integration, training and support to staff. Care can then provided from local GP surgeries. The service is designed to be entirely transparent. It is the GPs service.
The other advantage of this system is that real time outcome reporting is possi-ble. We know what is happening to patients automatically without having to compile reports from notes. These reports can be used for commissioners, GPs and local consultants. It also means that patients who have had new or research treatments can still be assessed even if they are being monitored in the com-munity. The expert system is fully configurable. New rules can be added as new tests become available and as the understanding of prostate cancer improves, these new criteria can even be applied to our patient records, instantly finding patients who might benefit from a new approach.
Flexible Implementation Patient Led
Using the same proven expert system engine patients can benefit from auto-mated follow up. Men are contacted by text or email once every six months via our automated system. They are then asked to complete a short symptom questionnaire and prompted to have a blood test. This can be done by smart phone or computer. In the background our system collates these results and compares them with previous test results and their known pathway. The software sends reminders for non compliers and notifies patients if all well or staff if there are issues with tests/questionnaire or compliance.
GP benefits
iQudos provides an incredibly easy way for GP’s to set new services up for their CCG, with support right from the start in the production of a case for change and business case. The services are designed to bridge the gap between primary and secondary care whilst maintaining the existing links. Savings can be pro-duced whilst knowing that the patients are being treated according to national standards of care. If a patient does need referral all of the information regard-ing the patients specialist management in the clinic is automatically summarised. Unlike most discharge schemes which load more work onto GPs this care, de-spite its potentially complex nature, can safely be delivered by a community based nurse team. The system contains a full patient administration system.
Secondary Care Benefits
- More appropriate use of hospital resources
- Increases the time available for consultants to concentrate on sub-specialist care
- For surgeons it can free up time for joint operating
- Help to meet cancer and 18 week wait targets
- Offset any reductions in specialist nurse hours and European working time directive effects on junior staff
- Allows specialist nurses to use their skills where they really count
- Ability for local consultants to set expert system criteria
- Patient data still available for easy audit and research
- Ability to receive regular reports or even copy letters if required
- iQudos is determined to build bridges between consultants and GP commissioners when designing local pathways
Specific Case Studies
- Follow up co-located with secondary care
Southern Derbyshire have run the service since 2012. There are 1200 consulta-tions per year. Nurse time and software is funded by the CCG but the nurse is based with the broader MDT team in case of questions. The service has allowed expansion of the case load and flexibility of usage of staff. The Trusts calcula-tions via PLICS suggest a saving of roughly £60,000 per year by moving patients from consultant clinics.
Study period Sept 2012 – Sept 2019
Set up; nurse led team, telephone based, pathway aware, cloud based expert system which generated follow up, letters, test requests etc. Interpreting 27 rules to ensure patient safety.
Number of consultations 7,700 over 7 years.
Staff savings £270,000
Admin savings £115,000
Total savings £385,000
Additional income from CCG (access and quality improvement) £130,000
Freed equivalent of 3,850 new patient consultant appointments during the same period.
- Follow up in lead practices
Hull runs the stable prostate cancer service in the community within lead prac-tices. 5 practices cover the city population of circa 300,000 patients. Training was provided by iQudos but is now cascaded by administrators and users. The service is in year 6. There are 1341 enrolled patients.
- Follow up at individual practices
East riding run the service at 37 practices across their CCG. Each practice has established a lead clinician, most commonly a practice nurse to care for the pa-tients. The service is largely self run and is in year 6. There are currently 806 enrolled patients.
- Expert system supported patient self care
This new product uses the same engine tested in circa 14,000 patient consulta-tions. Patients receive a text or message instead of an appointment. The mes-sage contains a short question with configurable questions and a reminder to have a PSA performed (along with reminders). The system collates the result of blood tests, symptoms, previous results and pathway to ensure the patient is safe. If they are they are texted/emailed a message, if not or in case of non compliance the relevant clinical person is notified.
Appendix
iQudos
iQudos was set up with help from an NHS foundation Trust, clinicians, the East Midlands Development Agency and NHS Innovations. It is part of the NHS family, working as a social enterprise. Its role is to make it easy for commissioners to bring secondary care patient management into a primary care setting or for GP Networks to rapidly and easily set up new services. Bringing the expertise to the patient whilst still producing savings for the health economy. At the core of iQudos services are computer based decision support systems based on nation-al and international guidance. These systems push the boundaries of technolo-gy to produce management advice which could be called telemedicine 2.0. Not just reporting abnormalities but ensuring the quality of medical management and enabling hard-wired instant outcome measurements. iQudos have been winners and finalist in a number of national awards.
Contact:
Mike Henley
Medical Director
mike.henley@iqudos.com
07769 737 838
Twitter @iqudos