Which is why when a use case comes along that highlights an innovative use of technology - in this case robotic process automation - that frees up hours for medical providers, and saves cash, it’s important to take note.
East Suffolk and North Essex NHS Trust (ESNEFT), one of the largest Trusts in the UK, has begun deploying Thoughtonomy, an intelligent automation engine, to help aid GP referrals, freeing up over 100 hours a week for staff and ensuring referrals are actioned 24/7.
We spoke to Darren Atkins, Deputy Director of ICT at ESNEFT, who explained that the project will also save £220,000 in associated direct costs by July 2019.
Atkins said that he stumbled across Thoughtonomy doing a Google search, whilst looking for an automation tool that was subscription based and didn’t have the high entry costs of on-premise technology, which would unlikely get board approval.
Upon deciding to focus on GP referrals, Atkins explained:
I wanted something that was very visible across the entire organization, almost like an automation that would show there's benefits to our end customers. And the reason I chose GP referrals was that it is high in volume. It's a very segmented process in terms of the different systems that our medical secretaries and consultants need to access. And as you know, consultant time is very precious, as is medical secretaries’. We don't want to waste time logging into different systems.
Also the referral process for us internally, it was very paper based. NHS England put out that all organizations have to be doing electronic referrals from GPs by October this year. So we've done that.
But then it would switch to a paper dominant process internally.
Traditionally, the medical secretaries would log into the referral system and a patient could have up to 30 different attachments. The medical secretaries would then download all those attachments, print them to paper, and then pass them to the consultants to grade. At the same time they would then scan all those documents to upload them to the Trust’s own electronic patient record system.
And so, to me, it just really seemed like an ideal opportunity to release time, but also to eliminate the big pile of paper.
But also potentially to speed up and streamline the process of referral triage. And I think one of the things that I've really tried to focused on, is rather than trying to automate the full end to end process, because the GP referral processes is huge and it's very complicated, is to instead use automation to start chipping away at those areas of inefficiency. By doing that you deliver automation very quickly. We did that first project in just six weeks.
Using Thoughtonomy’s virtual agents, as soon as a referral is received, the virtual worker reads the content and extracts the reason for referral. It retrieves all relevant referral data and supporting clinical information, such as scan and blood test results from disparate sources, before merging everything into a single pdf document. The virtual worker then uploads the document into the Trust’s administrative systems using highly secure smart card technology and alerts the lead consultant that the referral is ready for review and grading.
Atkins also claims that because the process for the virtual agents was designed clearly from day one, the Trust is experiencing 100% accuracy rates. However, Atkins added, traditional automation systems, if they ran into a problem, would just stop the process there and then and give up. How Thoughtonomy works, is that you build exceptions into the process. He explains.
For example, if the robot downloads a referral, tries to upload it to our own internal system and finds there is a duplicate, rather than just throwing its hands up and giving up, it will say - “okay, I've got an exception”.
It will email a member of the clinical team to say, “just to let you know we've got a duplicate, what do you want me to do about it?”
So there's probably about 15 steps through the whole process where the robot is self checking and validating yourself.
Atkins said that when he started thinking about automation across the Trust, he wanted to focus on time saved, rather than just cash. And because this is benefiting staff directly, there has been huge demand for more virtual workers to be deployed. He said:
When you start thinking about automation, the mind just boggles. We've really embraced automation using the philosophy of time matters. So we're measuring the benefit of our robots by the amount of staff hours released. So whilst things like cost saving and cash released are a secondary sideline, we’re focusing on releasing time.
So we've got staff from all areas of the business coming to us now saying can we have a virtual worker to help us? And what that's done is it really has opened up the supportive communication culture.
Atkins said that now the Trust has an ambitious plan to implement three new processes a month. For example, the Trust is creating a patient portal to allow patients to engage directly with the organisation, but is using virtual workers to help with some of that. So, for maternity self referral, an expectant parent can submit a secure online form, a virtual worker will pick it up, register the patient, book the appointment and straight away let the patient know when they have to appear at the hospital.
Share and share alike
Atkins was also keen to highlight that he is willing, and hoping, to share the work him and his team have done on the Thoughtonomy platform with other NHS organisations. He said:
We’ve built it on a platform that we’re willing to share with other NHS organisations. I’m talking to a number of organisations to see if they want to join us. There’s no reason why in the future, I couldn’t share my virtual worker staff with other organisations.
The beauty of that is that the NHS is spending less money, it means the cost of entry into automation and the health cloud is cheaper. They could be up and running very, very quickly.
And if the response from medical staff at ESNEFT is anything to go by, there could well be appetite for use of the technology elsewhere.
In terms of our medical secretaries, they were saying to me, “I've now got time to spend with patients on the phone”. A lot of time they were under so much pressure to get their referral work done, didn’t even have time to answer the phone.
So they're now talking to patients directly, you know, giving them help and advice.
Atkins added that because the virtual workers are taking the mundane and manual out of the staff’s day jobs, it’s also been the easiest change management programme he’s been involved in. He said:
Automation isn't about changing processes, it’s about taking bad processes and allowing the robots to do them. They're happy to do that 24 hours a day. Also the importance around automating certain processes is that it's very low touch in terms of change management.
So, the only change management I had to say to our medical secretaries is - “just stop doing the work”
That is the easiest change for anybody to accept. That's why it's been so successful.