Transcript Presentation - Peter Jenkinson

18 Week Pathway
Discussion about potential
IM&T issues
18 Week Pathway
• Delivering this 18 week patient pathway is
one of the most significant reforms in the
history of the NHS.
• “By 2008 no one will wait longer than 18
weeks from GP referral to hospital
treatment”, NHS Improvement Plan (June
2004)
By December 2008 staff will need to have access
to IT solutions that enable them to see where
every patient is in relation to their 18 week
pathway – this is a huge challenge
IM&T Challenges
• 18 Weeks will be the most challenging
target that the NHS has faced in terms of
planning, delivery and performance
measurement
• However, prior to Lorenzo the transition
from referral (via Choose and Book?) to
treatment will need to be recorded on
multiple ‘stand-alone’ IT systems
IM&T Challenges
• The 18 Week target will have a significant
impact on information systems
• Referral-to-treatment (RTT) performance
measurements commenced in January 2007?
• From CDS v6? central returns will need to
include 18 Weeks tracking information
• How will this achieved if information is held on
multiple IT systems that do not use a common
episode reference?
Unique pathway identifier
To monitor a patient journey, it will be
important to be able to link patient activity
together creating a unique pathway
identifier
A pathway status field that will also be
needed to identify the clock start / stop. For
example;
– Admission as day case or inpatient
– Start of outpatient treatment
– No need for treatment in secondary care
Unique pathway identifier
• Will the unique pathway identifier be:
– The Choose and Book unique booking reference?
– A locally generated value – eg. Concatenate hospital
patient identifier with the referral request received
date?
– Will it have to be a combination of both (when will
CaB book be fully rolled-out)?
– What happens if a patient is allocated more than one
care pathway?
Potential issues
• There are many ways in which the 18 week
pathway can be started and these will be difficult
to record / keep a track of, eg:
– Referrals to secondary care from General Dental
Practitioners and Optometrists
– Decision to Admit through A&E
– Where a national screening programme identifies the
need for further diagnostics or treatment the clock
starts at the point of the result being known
– etc
Potential issues
• The same issue applies to the clock stop,
and it will be a challenge to record this
accurately given the varied scenarios eg:
– Where treatment starts in parallel with
diagnostic testing the clock does not stop
– If a patient does not attend twice the clock will
be stopped and the patient returned to their
GP
– etc
Potential issues
• Access to diagnostics is recognised as a
major potential bottleneck
• How will tertiary referrals be handled?
Data quality / availability
• Patient tracking will require a lot of
additional computer data inputting
• This will require major upgrades to existing
IT systems and/or the development of new
interim solutions
• The capture of the additional data required
will be a major undertaking in terms of
training / change management
Impact on legacy systems
• Upgrading legacy systems to capture 18 Weeks
information will be complex and expensive
– eg. PAS systems don’t always assign the same
episode number in each of stage of a patient’s care
pathway (referral, waiting list, appointment etc)
• A significant amount of complex systems
integration may be needed to link each stage of
the pathway and enable patients to be tracked
effectively
• All of these developments will be difficult and
costly to achieve in the timescales given
CATS
• PCTs - Are you thinking of delivering this
as a provider?
• Are you looking to do this in partnership?
• You will be part of the 18 week pathway,
although you have just 4 weeks from
assessment to outcome, including
diagnostics
Questions?