Digital transformation in action

Making digital a core part of service transformation in Devon

Devon ICS (One Devon) encountered a series of challenges that impeded its ability to deliver efficient, high-quality care. It was over reliant on outdated analogue models and used fragmented digital platforms, which caused issues that were exacerbated by the system’s rural geography, ageing population, varied infrastructure, challenged financial position and workforce shortages. 

What the system did 

One Devon embedded digital capability within its service transformations, creating a five-year digital strategy (2022-27) in which the digital shift was the key enabler of its five strategic goals: 

• urgent and emergency care
• planned care
• diagnostics
• children, young people and maternity
• digital innovation. 

This sought to update obsolete systems and maximise usage of existing digital and technological investment. 

The system rolled out various digital platforms and systems to tackle different challenges. For example, SystmOne, an interoperable EPR, was created to enhance the logging and sharing of patient information across providers. The Devon and Cornwall Care Record (DCCR) was central to SystmOne’s success as it collated patient data from various health and social care providers. It currently includes 19,500 electronic treatment escalation patient plans and has 20,000 users.

One Devon has used digital technology to deliver care efficiently against a backdrop of scarce resources and local challenges. It has successfully scaled virtual care, enhanced virtual ward capacity and worked in partnership with DELT Shared Services, Integy and NASGP to develop ‘GP in the Cloud’ to combat longstanding GP and locum shortages. ‘GP in the Cloud’ enables GPs across the UK to deliver secure, remote, consultations. 

Similarly, GP support has been further expanded through the Kit4Care initiative, whereby domiciliary care workers can take clinical observations and access GP support when needed.

Results and benefits

The digital reforms have brought several benefits to One Devon. 

The DCCR connects over 176 organisations to enable real-time data sharing through a single platform. It is also hoped that it will soon expand to include a greater number of electronic treatment escalation plans (eTEPs). Additionally, Devon ICS is developing the One Devon Dataset, a linked dataset aimed at supporting strategic planning, proactive care, and research.

The work to change the delivery of care through digital platforms has been met with success: 97 per cent of patients felt they have been provided with excellent or good advice through the Royal Devon’s ‘Acute Hospital at Home’, and 97 per cent of patients felt that they had been treated respectfully. Overall, 93 per cent rated the entire experience as excellent or good. 

‘GP in the Cloud’ has seen the roll out of 34 pilots and delivered an additional 31,000 clinical hours, reduced agency costs by 38 per cent and saved £3 million. The blueprint has been adopted by NHS England for future national rollout.

The Kit4Care initiative has received an additional £250,000 funding, further strengthening the interface between primary and secondary care.
 

Using AI in skin cancer diagnosis in Leicester, Leicestershire and Rutland ICS

Leicester, Leicester and Rutland ICS was under pressure to adapt in the face of staffing pressures due to a national shortage in dermatologists. This was exacerbated by additional service demand as a result of an 8 per cent increase in the complexity of cancerous lesions.

What the system did

AI was used as an ‘innovative and sustainable’ mechanism to enhance capacity, better meet targets and hasten the diagnosis process. It facilitated better collaboration and insight sharing between partners, as the ICS grappled with the shortage of dermatologists. Skin Analytics (an AI powered tele-dermatology provider) was developed as part of the response to facilitate the collaborative process.

Individual skin lesions are photographed using smartphones with a special magnifying lens attachment. The technology enables the encryption of these photos for further analysis by AI DERM technology; dermatologists are then able to review them should further investigation be required. Results are communicated by post within two to three weeks, with the option of a quicker response for a face-to-face consultation if needed.

The technology is being used in the training of dermatology registrars, enabling them to recognise lesions. 

Results and benefits

During the first six months of the scheme, over one third of patients were discharged without needing to attend a hospital appointment, freeing up capacity, reducing the overall pressure on the system and ensuring appointments are given to those who need them most.

Since, a new service has been launched at Loughborough Community Hospital in March, with three further sites now up and running. 

Embedding use of the technology within the training of new dermatologists ensures a commitment to digital innovation and collaboration, contributing towards establishing a culture of knowledge sharing.
 

Providing a single digital interface across Yorkshire and Humber

The Yorkshire & Humber Care Record (‘YHCR’)  is a digital shared care record used across three ICSs (South Yorkshire Integrated Care System, Humber and North Yorkshire Health and Care Partnership and West Yorkshire Health and Care Partnership) providing health and care records across the Yorkshire and Humber region for approximately 5.8 million people. It connects the data from 160 GP practices, six acute trusts, five local authorities, six community services and two ambulance services across the region. 

What the system did

The Yorkshire & Humber Care Record was initially part of NHS England’s Local Health and Care Record Exemplars (LHCRE) programme, however it later evolved to develop Interweave – a digital platform that provides digitally enhanced and inclusive care by facilitating the real-time sharing of data to improve connectivity between regions and enabling better coordination of care. 

Interweave integrates with existing systems, creating an open-source federated model where there is no data lake. There are three main components: 

• Exchange
• Connect
• Portal. 

Exchange is at the centre of Interweave’s operation, providing the platform where providers input and share information. Operations are driven by NHS-led approaches and grounded in FHIR (fast healthcare interoperability resources) principles. Interweave uses a secure Google Cloud Platform accredited for processing sensitive patient data. Portal and Connect supplement the functionality of Exchange, by providing a blended view of patient data from multiple sources, and ensuring existing data is converted into FHIR resources respectively.

Using Interweave, the Yorkshire & Humber Care Record aims to provide a ‘single digital interface’ to present a patient’s health and care data in one place, regardless of which provider created or holds them. The shared care record empowers users – clinicians or patients – with holistic patient information, leading to more informed decisions and better management. 

Results and benefits

Through connecting different organisations, capturing and processing clinical information and automating certain tasks, Interweave has made valuable clinical time savings that have enabled professionals to focus on delivering higher-quality care. For example, in transfer of care instances between acutes and ambulances, Humber and North Yorkshire reported a mutual reduction of administrative/handover time respectively, enabling clinicians to resume duties more promptly.

Furthermore, real-time data sharing across partner regions has enabled users to better identify patient needs, reach populations and more effectively coordinate the delivery of care. The inclusion of GP connect access in the shared care record has reduced the need for acute providers to contact primary care for information and reduced the amount of admin time spent in GPs responding to these requests. 

Overall, in 2024/25, YHCR helped make £4,113,529 in efficiency savings in the Humber and North Yorkshire Health and Care Partnership, and South Yorkshire ICB projects a potential cumulative efficiency saving of £21,999,110.72 over the next five years.