NEW CARE MODEL
Acute Care Collaboration
Project partners: EMRAD covers over six million patients and eight trusts: Nottingham University Hospitals NHS Trust, Kettering General Hospital NHS Foundation Trust, Chesterfield Royal Hospital NHS Foundation Trust, Northampton General Hospital NHS Trust, University Hospitals of Leicester NHS Trust, United Lincolnshire Hospitals NHS Trust, Sherwood Forest Hospitals NHS Foundation Trust and Burton Hospitals NHS Foundation Trust.
The East Midlands Radiology Consortium (EMRAD) aims to deliver timely and expert radiology services to patients across the East Midlands, regardless of where they are being treated. Radiology services include imaging tests like x-rays and scans.
The UK has one of the lowest numbers of radiologists in Europe, and the East Midlands has the lowest number of radiologists per 100,000 people out
of all the regions in the UK. While the number of consultant radiologists grew by 5% between 2012 and 2015, in the same period the number of CT scans rose by nearly 30%. The shortage of radiologists has negative consequences for both patients and the NHS: patients aren’t getting scan results as quickly as they could, leading to delays in diagnosis, while NHS trusts are paying large amounts to outsource radiology reporting to private companies. In 2015 outsourcing costs were over £88m. The EMRAD vanguard has harnessed technology to develop creative solutions to these problems.
HOW ARE THEY HARNESSING TECHNOLOGY?
EMRAD have worked with the healthcare technology supplier GE Healthcare to create a radiology IT system capable of handling of millions of patient events. This cloud-based, shared system allows clinicians to access the complete radiology imaging record for all patients across the East Midlands, including scans, reports and clinical opinions, regardless of where they are based.
The first EMRAD pilot involved six neuro-radiologists at Nottingham University Hospitals. The neuro- radiologists volunteered to have workstations, consisting of a vanguard-funded laptop and large monitor, set up in their own homes for three months, allowing them to look at images while working from home in non-core hours. They could view images at these workstations by downloading them from the server via a secure VPN connection to the NHS network. After signing contracts (confirming adherence to policies and procedures) they were able to work on single and multi-area CT, single and multi- area MRI and x-ray images.
The radiologists reported their activity to the EMRAD support team who worked out how many images had been read and the NHS tariff. Throughout the pilot, outputs from the radiologists were continually analysed. The team took performance metrics based on productivity before and during the pilot during core hours, which reassured them that the reward working wasn’t impacting adversely on the day job. The radiologists were subsequently paid through normal payroll methods.
Based on the success of the first pilot, the system was piloted at Northampton General Hospital and Sherwood Forest Hospitals. Both pilots were in the plain time x-ray specialism, and demonstrated that the successful adoption of the technology is not unique to one particular specialty. Pilots with radiographers are also underway. Nottingham University Hospitals and Sherwood Forest Hospital have now implemented the IT system as a sustained live service (business as usual), proving there is the appetite, and capability, to make use of the technology across large teaching hospitals and smaller general hospitals.
The new system has brought about greater flexibility in the use of the radiologist workforce, resulting in additional capacity. For example, one member of staff (whole time equivalent) was generated by six staff working in this way. Over the first pilot the six neuro-radiologists looked through 1,160 images and helped 939 patients, and were able to significantly reduce the backlog of radiology images in a few weeks.
Initial evidence suggests that the reporting done for EMRAD is being done at a more efficient rate than the Royal College of Radiologists benchmark rates. By working together on the joint procurement of a new shared radiology record, the trusts have saved £3m each year, and expect to save £30m over the lifetime of the 10-year contract. Savings have also been made thanks to NHS staff undertaking work that would previously have been carried out outside the NHS. Trust income from commissioners during the pilot period was £23,753 compared to outsourcing costs estimated to be £33,504 for the same volume of work. The radiologists involved in the pilot have reported benefits too. They have valued the flexibility that being able to assess images from home has afforded them.
WHAT HAVE THEY LEARNED?
As with most major IT deployments the vanguard team have experienced teething problems, particularly with the stability and robustness of the system when rolled out to a live production environment.
Another big challenge was getting agreement on an NHS tariff rate for the new diagnostic model as there was not one already in place. The private
outsourcing companies currently charge NHS trusts different tariffs. Standardising tariffs, and ensuring that the tariffs for insourcing are attractive to both the trusts and the radiologists, is a key part of the EMRAD vision.
The consortium has been able to overcome these challenges thanks in large part to the strong, collaborative relationships between the trusts involved. The management boards are attended by senior responsible officers from each trust, and the consortium partners recognise that each
subsequent roll-out of the new system has become easier as lessons are learned and problems are solved collectively. EMRAD also has a very strong information governance lead who has attended all meetings and advised on all information governance issues relating to clinical safety, patient safety and data sharing.
The project team have also put in considerable effort to engage colleagues in the move to the new way of working. As part of their communications and stakeholder engagement plan radiologists are communicated with at least once a week via email and a patient champion has been involved in the project to ensure that any issues around patient engagement are addressed.
The IT system will be rolled out to Chesterfield Royal Hospital in the near future. The team are also running a cross-trust reporting pilot, with images from paediatrics being shared between Nottingham University Hospitals and United Lincoln Hospitals, which has already proved the robustness and resilience of the system when sharing images both between and within trusts.
The team are also nearing completion of work in partnership with GE Healthcare to develop a brokerage system. Once all seven trusts are live they will be able to take part in this system, which will manage demand across the consortium by identifying where there is capacity across the seven trusts and allocate work accordingly, making use of a radiologist eligibility dashboard and a financial dashboard.
Ultimately, EMRAD hope to create a technology tool and new care model in radiology diagnostic services that can that can be implemented across the wider NHS. They have also received considerable interest from healthcare teams around the world, suggesting that the potential application is even wider.
For further information, please visit www.emrad.org
Follow @emradNHS on Twitter