James Thomas, IT director of University College London Hospitals foundation trust

The Government’s 18 Week Referral to Treatment Target has presented us all with the challenge of implementing a complex management system that can handle high volumes of data, pull information from disparate systems, model patient treatment pathways, and crucially provide real-time notifications and alerts.

We began working with our incumbent managed IT service provider in June 2007 investigating the possible technology solutions. This relationship has proven extremely useful in enabling us to progress the project rapidly through to deployment of the patient tracking system in November of this year.

Patient tracking is imperative so that we can intervene and react as soon as delays, blockages or lack of progress in the patient pathway are highlighted.As a trustonly about half of our referrals are direct from GPs, so in many cases the 18 week treatment pathway has already started before they get to ULCH.In addition, pathways here are very complex because of the variety of specialties that are delivered.

As an illustration of the magnitude of the task, our cancer team currently tracks every one of its cancer patients, around 270 a year, manually through their treatment pathway from outpatient, through diagnostics and therapy. There is a target of 62 days for the treatment of cancer patients and the management of this process takes a team of six to eight people. If we extrapolate that then we are talking about the trust needing to employ an extra 800-900 people to manage the treatment of our 500,000 patients annually.

The automated patient tracking system needs real-time details about the patient in order to track progress. We decided to use a business process management system from Lombardi to accomplish this. It allows us to model patient pathways and link directly to those core IT systems which hold information about patient appointments, diagnostic tests and about treatment so that when treatment is first administered whether therapeutic or a period of advised observation, this is all noted and managed.

The real-time tracking, enables parameters to be set and creates the notifications and alerts allowing the trust to know what stage the patient is at in their pathway and how long they have been at that stage. For example, the process between a patient being seen in outpatients and receiving a diagnostic MRI scan cannot take longer than for instance four weeks. An alert will be sent if two weeks has lapsed without the MRI being booked. The trust at this stage already knows that it is going outside the pathway it has set in order to deliver 18 Week RTT for this individual and this allows it time to get back on track.

A by-product is the intelligence we get from pathway management, which will tell us where we can refine our patient process and become more efficient. It may indicate the need to increase capacity in diagnostics rather than assigning resources elsewhere on the basis of who makes the most eloquent or loudest case. Patients should experience an improvement in the way they progress from outpatient through to treatment. In time we may even see a web-based patient portal so that individual patients can engage with their treatment process, and improve its efficiency by rescheduling their appointments.