One of the key priorities within the 5-year plan of Healthier Lancashire and South Cumbria (UK) incentives is to work with communities to improve the wellbeing, resilience and mental health of people in the region and give the children and young adolescents the best start in life. When local people require more support, they should be able to access an effective range of age-appropriate health services.
At present, there is variation in access, provision, and clinical outcomes. In addition, people with mental health problems have, too often in the past, experienced unfair discrimination and poor treatment. In some cases, support from the NHS is only available when problems get severe. Apart from that, it is not consistently available across the country, and young people can sometimes wait too long to receive that support or referral. The Lancashire and South Cumbria Health and Care Partnership has set out specific proposals that represent a fundamental shift in how they will support all children and young people with a wide range of health conditions and associated issues.
Aim: building new digital MDT capability in the Lancashire and South Cumbria region
Lancashire and South Cumbria Health and Care Partnership contracted Parsek to provide new capability within the WelLPRES platform, which will allow for:
- documentation and coordination of care for a patient beyond the boundaries of primary and secondary care in the East Lancashire region;
- treat a wide range of children and adolescents with various health difficulties, including emotional and behavioural problems;
- a range of multidisciplinary therapeutic support, including different therapies and medication where appropriate;
- understand and support the needs of individual referred children and families by working together as a team of involved stakeholders with multiple types of expertise, namely:
- East Lancashire Hospitals NHS Trust – General paediatrics
- East Lancashire Hospitals NHS Trust – health services for children and young people aged up to 19th birthday who have a range of health difficulties or/and mental disorders.
- Child and adolescent mental health service – a multidisciplinary team of professionals trained to support children experiencing emotional and behavioural problems, and their families
- Health Visiting
- Safeguarding
- School Nursing
Customer objectives: Improving governance of Paediatric MDTs through streamlined administration, better efficiency and faster decision-making
Within the WelLPRES platform portfolio in Lancashire and South Cumbria, digitally supported Paediatric Multidisciplinary Team Meetings (MDTs) are being introduced to improve the existing governance of Paediatric MDTs. This model of care is planned to roll out the digital solution to all 13 Primary Care Networks (PCNs), starting with Rossendale East and Rossendale West.
- Short-term incentives: Set up and validate a system that will digitally support the existing multidisciplinary MDT (1 PCN) for a better administrative overview, work efficiency and faster decision making.
- Mid-term incentives: Scaling a standardised and consolidated service on 3 PCNs.
- Long-term incentives:
- A standardised and consolidated service for 13 PCNs.
- A national model to support MDT for children with autism spectrum disorders (ASD), where:
- is a place where the work of the MDT Board can be aligned to existing and emerging evidence and best value practice (and vice versa);
- provides a mechanism for co-production and clinical engagement;
- has the capacity and capability support to workstreams;
- operates as a transparent and professional forum that ensures a focus on clinical excellence.
The solution: supporting the children and adolescents towards more equal outcomes
To improve the existing processes of MDTs, Vitaly Multidisciplinary Team Meetings solution is being implemented to enable multidisciplinary professionals for:
- streamlined coordination between primary care providers, community services and involved care specialists by assuring a reliable, secure and simplified administration;
- improved work effectiveness through access to all relevant patient documentation from a single, unified source of information;
- improved patient satisfaction with the quality of care by considering patients’ own health needs and their preference to manage their health conditions and other relevant aspects,
- evidence-based approach allows to continuously improve, standardise and equally develop high-quality care based on NHS long-term plan.
This way, children and young adults aged up to 19 with various health and social difficulties and who need multidisciplinary decision support will be managed holistically and efficiently.
How it works
The MDT workflow consists of five guided consecutive stages, and it most commonly includes the following multidisciplinary team members:
• Lead Paediatrician
• Community Paediatricians
• Health Visitor (employed by Virgin Care)
• School Nurse (who access EMIS Community)
• Mental Health Representative/Child and adolescent mental health services (CAMHS)
• Lead General Practitioner
• Safeguarding Representative
Some members are relevant only for a short duration of the meetings. Sometimes, these members may not attend due to travel/time constraints, work priorities, etc. Any member of the MDT may bring a case they wish to discuss with the core members or experts/specialists.
Step 0 – Introducing a patient
After seeing the child or receiving the patient materials (sometimes including video, graphics or other media documents) uploaded via Medical Image Acquisition Application (MIA)), the GP, Paediatrician or a community representative starts with the assessment procedure and refers the child to be seen by the local MDT (multidisciplinary team of professionals) to initiate the decision-making process used to determine what service the patient should receive.
Step 1 – Registering the patient and preparing the case
The requester logs in to the Vitaly solution and selects the patient. Afterwards, a form with relevant information and a question to discuss in the MDT is filled in by the requester. Patients can be registered and found via integration with the regional Master Patient Index (MPI) using NHS number or other attributes.
After successfully registering the patient, the user uploads and/or links relevant documents to the Vitaly solution.
Step 2 – Scheduling a patient case
In this step, a selection of the appropriate date for the patient case review is performed by the scheduler.
Step 3 – Preparation for the MDT meeting
The multidisciplinary team of professionals (MDT members) can easily access the list of cases that need to be discussed. As all data is already available, the participants may review the data in advance of the conference, take part in the discussion, or add additional relevant data before the meeting.
Figure 2: An illustrative example of an MDT member’s interface in the Preparation phase: agenda overview
Step 4 – Holding the MDT meeting
All participants can log into dedicated, role-specific views of the Vitaly solution during the meeting. The view of the presenting doctor allows switching between the moderator’s view and the documents to be presented. The scribe takes notes and writes the decision regarding the treatment options, which is sent to the MDT chair.
If a required participant cannot participate face-to-face, they can attend the meeting remotely through their video collaboration tool.
Step 5 – Finalisation
After the review, the protocol reaches the final stage. The chair prepares and finalises the decision note taken during the review, uploads additional data (if needed) and asks the other members if they agree with the proposal.
If the final recommendation does not need additional confirmation from the participant members, the chair concludes the case, and the final report is sent to the initiating doctor/ requester.
Standards and integrations
The complete process is designed as a web-based application for the end-user with the goal of keeping every step of the process efficient considering standards within the necessary Healthcare IT domain. The solution consists of the following IHE profiles and integrations:
- Patient Demographics Query (PDQ)
- Patient Identifier Cross-Referencing (PIX)
- Cross-Enterprise Workflow (XDW) and
- Cross-Enterprise Document Sharing (XDS) integrations with regional HIS for efficient and comprehensive information access & exchange
- Access to Microsoft Teams to stimulate remote presence.
Estimated benefits and impact
For care professionals
Multidisciplinary Team Meetings (MDTs) were found to influence clinical decision-making positively, induce better team performance after case discussion, induce more accurate diagnoses and faster collaborative decisions during their meeting, which avoids delays in treatment. It is estimated that the professional users involved will benefit from:
- faster time to result and more optimised access, care planning and effectiveness through clear and structured MDT workflows;
- less time consumption for administration due to integration with the regional hospital information system;
- elimination of geographical barriers, less travelling costs due to remote presence;
- standardised and equal high-quality care within the region due to facilitated access to multidisciplinary teams of specialists for MDT recommendations;
- improved health standards by stimulating a holistic approach to MDT recommendations;
- greater patient satisfaction due to improved decision-making process, cross-disciplinary knowledge sharing and greater inclusion of patients’ health needs and personal preferences.
For patients and their families
Furthermore, due to improved provisioning of health services in the community, the patients are expected to gain:
- Better care options within the region and increased trust in the decisions about patient’s further care;
- Improved patient outcomes due to holistic and efficient management of children and young adults aged up to 19 with a range of health and social difficulties and require multidisciplinary decision support.
A word from our customer
“We wanted to build something that was future-proofed and could have traction across Lancashire and South Cumbria. By using a digital platform in this way, we can be confident that we are only sharing information that is relevant and that we are doing it with the consent of families.
It makes setting up and conducting an MDT meeting much more straightforward. It also means the discussion is recorded and any decisions are dropped back into WelLPRES, so they can be seen by anyone who needs to review them, including people who were not in the meeting.”
Dr Chris Gardner, Consultant Paediatrician and Deputy Medical Director at East Lancashire Hospitals NHS Trust