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Virtual consultations and the NHS

To kick off the summer months, we’re going to be sharing a story every week for the 12 weeks of summer, showing you how healthcare organisations are using technology to transform patient outcomes and increase productivity. For the first blog in the series, Michael Nelson, Healthcare Technology Lead in the south of the UK, will be sharing an example of how virtual consultations are helping healthcare organisations deliver the quadruple aim by transforming patient care. 

In 2017, my wife rang me from the back of an ambulance. She’d been to the gym in the morning and had snapped her Achilles’ tendon. I headed to the hospital where emergency care had been given to pick her up. After some back and forth we were referred to a local hospital’s orthopaedic outpatients service. So started my experience with outpatient appointments, where technology could completely change care through the introduction of virtual consultations.

Between January and March 2019 there were 462,000 missed outpatient appointments[1]. Almost half a million people failing to attend an appointment that costs around £100 each[2]. And in some respects, I get it.

Graphic showing the quadruple aim in healthcareWe went through the process of driving to the hospital, parking a 10-minute walk away from the fracture clinic, and waiting almost an hour for our delayed appointment. We then had a three-minute assessment of my wife’s injury and were sent away to repeat the process six weeks later. It made me wonder whether I should go back. It also fails to address the quadruple aim of healthcare:

  1. Improving the patient experience
  2. Improving the clinician experience
  3. Improving population health
  4. Reducing the per capita cost of care[3]

Managing change in healthcare

Leadership teams at the NHS have also noticed this. In July 2018, Matt Hancock started as Health and Social Care Secretary.

In the following months, policy leads at NHS England got busy creating a strategy to transform how services are delivered and to improve patient experiences. The long-term plan was the result of this work.

It identified that technology plays a fundamental role in changing services and dedicated a chapter to digital. One of the foundational aims of that chapter was:

Over the next five years, every patient will be able to access a GP digitally, and where appropriate, opt for a ‘virtual’ outpatient appointment. [4]

Leveraging technology to overcome challenges in the healthcare sector

Man in scrubs Skyping in lab.It’s both pleasing and exciting that some are ahead of the game. Modality, a Microsoft partner have been working with a large mental health and community trust to change outpatient experiences and keep people in remote care using consumer technologies. The technology, OneConsultation, is a fully managed virtual consultation service that leverages modern technologies to deliver services in a secure and easy to use manner.

Together, they have addressed three challenges: waiting rooms, anonymity, and GDPR.

Transforming the outpatient experience with virtual consultations

Clinicians join secure virtual consultation waiting rooms using Microsoft Teams or Skype, and the service user joins the consultation via any web browser. You can use a phone, laptop, or tablet to have your remote service. No plug-ins, downloads, or apps have to be installed.

The service doesn’t store any confidential information, clinical anonymity is maintained, and all notes are captured on the EPR. The whole service is hosted in Microsoft Azure; creating a strong foundation for compliance and security.

The benefits for the organisation are that they can increase access to services and allow people to stay in their homes.

DNAs are driven down by offering options for attendance. The cost of physically attending an appointment is reduced, there’s no parking or petrol to pay. Those who have access or accessibility challenges can chose to stay at home. Clinicians get to spend time with patients that really need their help. Waiting times are reduced and because of this the patient experience improves drastically too.

And so far it seems to be successful. The mental health and community trust have had 15 percent of patients who were offered virtual consultations take up the offer.

If the rest of the NHS could save 15 percent of DNAs that would mean a £7m saving per quarter.

However, similar to many things in healthcare, finances need to transform too. At the moment, there is no central tariff for a virtual consultation, so providers don’t have a uniform way of getting paid for the delivery of the service.

Reducing the cost of care and improving population health

Virtual consultations are just one way that technology can address the quadruple aim. Patient experience is improved, clinician experience is improved, and the cost of care reduces. If more appointments are attended in this way too then population health will also improve.

At Microsoft everything we do is driven by our aim: To empower every person and every organisation on the planet to achieve more.

Virtual consultations not only save money but create an accessible means of healthcare. We all want to spend as much time at home as possible, and that’s even more important for the disadvantaged in society – technology has the power to allow this.

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About the author

Headshot of Michael Nelson smiling at the cameraMichael is the Healthcare Technology Lead in the south of the UK. He owns the overall relationship between healthcare customers and Microsoft and has over 10 years of experience working with the Public Sector. With a young son and elderly parents Michael is passionate about the opportunities for transforming healthcare.

[1] https://www.england.nhs.uk/statistics/statistical-work-areas/hospital-activity/quarterly-hospital-activity/qar-data/

[2] https://www.chelwest.nhs.uk/about-us/news/news-archive/2014/what-is-the-real-cost-of-missing-your-appointment

[3] http://www.annfammed.org/content/12/6/573.full

[4] https://www.longtermplan.nhs.uk/online-version/chapter-5-digitally-enabled-care-will-go-mainstream-across-the-nhs/3-supporting-clinical-care/