National Clinical Lead for Prostate Cancer Reviews System

Using technology to face demographic change

Jonathon McFarlane is coming to see the iQudos ASIMOV system tomorrow in Royal Derby Hospital. Its now been managing patients for nearly a year and was tested on 250 patient episodes prior to use and another 200 since the start of the year. Its error rate incredibly is lower than any of the humans (consultants, registrars) that we tested it against! Not a single error to date (versus standard human error rate of 10%).

It also would cost £5m to use nationally to provide the outpatient care of patients with stable prostate cancer rather than £23m for consultants, £19m for nurses or £15m for the GP alternatives.

Jon is leading the NHS improvement workstream on stable prostate cancer from a  clinical point of view and is part of a group who have been using prostate tracker software to keep an eye on prostate cancer patients in the community. This is an interesting use of technology but the downside is of course that a doctor or nurse still has to sit in a hospital looking at all of the results to decide if the patient is safe or not. Although the costs charged to the community are cheaper the cost of providing the service is not any different and as per yesterdays post it looks like it costs in reality £112 per patient if a consultant talks to the patient versus £94 for the nurse. So the community gets a good deal and the hospital edges closer to bankruptcy! The ASIMOV system takes the patients blood tests and clinical details to produce a clinical management advice letter following national guidelines, providing safe care every time.

As in industry, the only way we are going to be able to provide safe care for the ever growing number of patients with chronic disease is to harness new technology to help less trained people to do the work of more specialised employees. We can barely afford the workforce we have, let alone the one we need with the demographic challenges of the future.

Let me know what you think!

The Hidden Cost of Community Care

Much of the NHS cost is hidden blow the waterline

We have a tendency to cheat in the NHS when calculating costs. We often like to use salaries as the costing factor. Its nice and simple, easy to understand, makes sense. But unfortunately its also a gross over simplification. Patient Level Information Costing Systems are revealing more and more of the degree of oversimplification. Take the example of prostate cancer care. We know that it is expensive, prostate cancer is a chronic disease, happily most men will not die from it. They do however still need a signifcant amount of looking after. For example men after radiotherapy ought to have a flexible sigmoidoscopy every 5 years (or rectal cancer might be missed). A prostate blood test so low that it reads as normal on a GP system might spell the disaster of recurrance for a man who has had prostate surgery, meaning a lost chance of cure.

In primary care many are concerned that the £100 per consultation costs seems very high for the care delivered. Fascinatingly PLICS reveals that in my hospital it costs £112.43 for a consultant to see the patient. This represents a loss of £12.43 for every patient seen. One would expect the hospital nurse led appointment to make more sense. However these telephone consultations a funded at approximately £25 per patient. Unfortunately it costs £94.28 to deliver the nurse led care, losing the Trust £69 for each patient episode.

Surely the current drive for community based care will save us money? Well, not if you believe the Service Delivery Office. This NHS organisation made the effort to identify whole costs of care and discovered that care provided in the community is on average 50% more expensive due to the inefficiencies of providing the care away from the very savings of scale that the whole of industry attempts to utilise by building cars in factories rather than dealerships.

Take a look at the approximate national cost of providing care for the men who have a diagnosis of prostate cancer in the UK using different models:

If all men were cared for by consultants = £23.6m
If all men were care for by nurses = £19.8m
If all men were cared for on a LES (£40) + capitation fee/standard consultation cost = £14.7m

If community care was less efficient as predicted by the SDO then those figures could have 50% added to them.

If all men in the UK were followed up using the iQudos expert system in the community by nurses trained to use the software:

Cost of iQudos + nurse = £5m

The real cost of providing care does not simply reside in the cost of salary. Much of the cost of NHS care is associated with the  other functions of running a huge organisation. Simply moving the staff or even the patient in to the community will not automatically provide cheaper care.

Does anyone disagree?

March 2007 - Can primary care reform reduce demand on hospital outpatient departments? A research summary of the evidence for four different approaches to reducing demand for specialist outpatient treatment - transfer of services, relocation of specialists to community settings, liaison between primary care and specialists, and professional behaviour change (Roland et al, 2006).

Stable Prostate Cancer System Completes Testing

After a one and half year research project, using the data of 250 real patients our prostate cancer system has completed clinical testing! Thanks to our team of dedicated clinicians.

How does the system work? Our software pulls the basic data about the patients care from various software systems. A nurse will then have a consultation with the patient, taking particular care to ask questions about any symptoms or problems the patient may be experiencing. As the system knows whether the patient had for example a radical prostatectomy, radiotherapy, is on hormonal manipulation etc. the system will instantly spot if the patients clinical situation is safe to continue in nurse led care or needs specialist advice. It immediately recognises situations such as failure of the 'ASTRO criteria', missed flexible sigmoidoscopy, suspicious rises in PSA. Twenty six different situations are taken in to account before providing a management plan. It also provides advice in common clinical problems.

The system can, if desired, produce a copy of the letter in the patients native tongue! Not many medical staff can do that in real time! It will then email the letter directly to the patients GP. No notes are needed, no typing up or letters to be posted!

It can safely provide care based on national guidance for all men with stable prostate cancer.

One of the amazing facts is that the human doctors showed an error rate of about 10% (less for consultants, more for registrars), the computer rather irritatingly had an error rate in testing of zero.

Rather than the current situation where it takes between 1-2 years to train and assess a specialist nurse as safe,  a nurse can be trained to use the software in a single day. This leaves GP's, specialist oncology nurses and consultants free to concentrate on those patients who really benefit from their care.

Visit www.iqudos.com for more or watch the youtube video on http://www.youtube.com/watch?v=OWViWN42oyc&feature=plcp

Raising Quality, Reducing Cost

Thanks for dropping by. We've set up this new blog to be able to quickly provide news regarding our services. We produce expert systems to enable nurses to run specialist follow up, without specialist training. The expert is the computer, the nurse is the health professional and carer. Our systems are tested on real patient data and then assessed in clinical use. Each system is registered with the MHRA as a medical device (as all expert systems in use should be!) This enables patients to be cared for according to national standards at costs below either hospital or GP lead care, while providing all the outcome data and clinical governance that modern NHS demands.

We are part of the NHS family and are run as a social enterprise. Our directors include a doctor, finance director of an NHS Trust, a healthcare company specialist and professor of information engineering.

We are pleased to answer questions or hear requests for new areas of research or products. Get in touch via our main site at www.iqudos.com