from RDC through PSFU & RMS to end-of-life
As patients receive ever better care for cancer diagnoses their life expectancy improves. They can return to living normal lives. However there is always a risk that their cancer may return. Should it do so they need the earliest possible intervention. While they’re away from the hospital environment living independent lives its easy for those earlier signs to be missed.
Additionally there is an increased risk that newly referred patients whose investigations have been deferred due to capacity issues caused by Covid-19 may be ‘lost’ to the system as it gets back to normal. Delays can prove life-threatening as shown in this article.
Utilise digital technology to automate a Remote Monitoring Surveillance (RMS) that conforms to the requirements of Personalised Stratified Follow Up (PSFU), as recommended by the NHS.
Collect a range of data from patients, blood and other biomarker tests, endoscopy, histology, radiology reports, treatment details, quality of life questionnaires like HNAs, (perhaps using beetroot@). Set up patient-specific monitoring pathways that enable automatic identification of patients of concern. Monitoring pathways are similar to the monitoring profiles used in beetrootDMARD, the monitoring rules for which which are based on diagnosis and medication. In beetrootCANCER the templates’ rules are based on tumour site and treatment regime, for example urology and prostate cancer.
Also use beetroot@ to:
A cancer patient’s experience goes through stages. From diagnosis, through treatment, to follow-up, and then, if necessary through recall to further treatment. PSFU and RMS only applies post-treatment, at discharge to follow-up.
beetrootCANCER supports the collection of data at an earlier stage than follow-up – by recording diagnosis and treatment details. But still not right at the earliest interaction patients have with cancer.
The NHS in England has identified Rapid Diagnostic Centres (RDC) and the Faster Diagnostic Standard (FDS) as an important initiative in speeding up possible cancer diagnosis, and improving patient experience. beetrootCANCER is being enhanced to support the capture of clinical data at this very early stage, and contributing to reducing the administrative burden of processing early investigations by introducing a digital tracker for every patient coming through RDC.
Tracking patients through RDC does away with spreadsheets and automates the scheduling of investigations, alerting to abnormal test results, ensuring patients know which tests to go for and when, and notifying RDC staff when patients either don’t go for expected investigations, and/or are at risk of exceeding agreed thresholds towards possible diagnosis such as the 2 week wait timescale.
Even though a small number of patients that go through the RDC receive a cancer diagnosis, their clinical data has been captured at this early stage and can be seamlessly ‘passed’ to tumour site specialists in the event of a diagnosis, or re-referral at a later date. And by using the digital tracker there are significant administrative and nursing cost-savings in processing all patients in the same way.
This is why we think the addition of the beetrootRDC module makes beetrootCANCER a complete digital cancer patient record.
This image is a sneak preview of our interpretation of a digital tracker for patients referred to the RDC.
Adding digital support for RDC completes the loop for recording data for cancer patients. From GP referral to collection of investigation data, other observations, treatments details, remote follow-up right through to discharge back to primary care. One record providing a view of all the important clinical data for a patient in a simple, accessible format.
At the end of 2019 the MSE Group Cancer Directorate, initiated a tender process to procure a new open access cancer surveillance digital health service. The intention was, at that time, to provide faster and more effective remote surveillance and monitoring of cancer patients treated at any of the Trust’s three hospitals (covering a population of 1.2 million). The competitive process started just before Christmas 2019, and responses were received by early February, 2020.
And then the coronavirus pandemic gathered pace.
The selection process revealed THERAPYAUDIT to be the preferred bidder, with a proposal to offer beetrootCANCER as the digital health service of choice. beetrootCANCER is unashamedly based on beetrootDMARD, a service which has been successfully deployed to the Trust to benefit clinicians and patients who required remote Disease Modifying Rheumatic Drugs (DMARDs), such as methotrexate. While beetrootCANCER wasn’t presented as an off-the-shelf solution for cancer surveillance, it had a sound basis to work with, and the additional benefit of a two-level beetroot@ PROMS service to enable effective communication with patients.
Michael Catling, former MSE Group Director, Cancer
This beetrootCANCER deployment is at an early stage, but work has started with breast cancer units to identify patients and connect to the various data sources that will provide important patient data. The plan is to extend the service to colo-rectal and prostate cancer patients, and also introduce the web-portal version of beetroot@ over the coming months. Although the necessary use of video-consult is a vital tool in maintaining ongoing communication between THERAPYAUDIT and MSE team members, a deployment devoid of physical contact from the outset will be an interesting challenge. Human beings, after all, are exactly that, human and social, and even a single in-person kick-off meeting is worth a number of crackly video calls.
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