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?

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

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?