Leeds Community Dietetics AireLogic & Forms4Health Good afternoon my name is Mark Simpson, I’ve been working for the Leeds Community Dietetics service for several years now on their innovative projects along with my colleague, Clinical Lead Iona Taylor. Iona and I take the ideas our staff have and with her clinical knowledge and my design and use of the data, work to see them through Mark Simpson © Leeds Community Healthcare NHS Trust September 2017

Our project start Met Aire Logic through AHSN Innovation important to LCH and Aire Logic Uses of the forms4health tool At an AHSN event last year we presented the Oral Nutritional Supplement Passport, a self-care model for patients with long term conditions. We have since had lots of helpful input from the AHSN for it, guiding us throughout and helping us get ready for evaluation. During this time they introduced us to Aire Logic as they saw that out innovation work could be supported by then. The AHSN were working with AireLogic who were looking for a test case for an electronic tool they had developed, and the AHSN put us in contact. © Leeds Community Healthcare NHS Trust May 2018

Getting the right pilot group Which cohort to use, Passport not right IBS a better fit Thought through success criteria AireLogic wanted to trial their electronic tool Forms4Health; but we quickly realised that the Passport patient’s were not the right caseload to use this on as Passport patients are mostly elderly with long term conditions. However, our second largest patient cohort is IBS, which is generally a much younger demographic, more likely to engage with an electronic tool. We originally looked at using this new tool with the Passport, but Passport holders are largely over 65 years old and we knew this was probably not the right demographic to test an electronic innovation. So instead we discussed using their ‘Forms4Health’ tool with our IBS cohort to see if we could improve patient care and save clinical time. The IBS cohort is predominantly female, and new diagnosis in people over 50 is 25% less than under 50’s1, making this a cohort much more likely to engage in this test. © Leeds Community Healthcare NHS Trust May 2018

Functional Gut Disorder Form Nationally approved tool Standard for assessment Long for completion by hand Took most of appointment to complete A nationally approved tool, the Functional Gut Disorder form is used in our team as standard practice for assessing our IBS patients and finding out which of the varied IBS symptoms affect them most. The paper form is long, and clinicians were reporting it taking more than half a patient’s appointment in some instances, to then be added to the record later. The Function Gut Disorder (FGD) Form is used by our team as standard practice for tracking symptoms. Our team report that its use in consultations can be lengthy, sometimes taking more than half an appointment (20 mins) to complete with a patient. AireLogic used the Forms4Health tool to create an electronic version that can be sent to patients to complete before the appointment, and be on their medical record before they attend. © Leeds Community Healthcare NHS Trust May 2018

What Forms4Health did Took the form and made it look engaging: Allows better data capture: All while being straightforward and easy for the patient AireLogic used Forms4Health to create an electronic version of the FGD form that we can send out directly to patients via link. The electronic version is more intuitive to complete, captures all the data we need, and guides the patient through the process © Leeds Community Healthcare NHS Trust May 2018

The Patient Experience An IBS Patient is referred and flagged as IBS at triage A text reminder is sent before the appointment Also send the link to the form, asking the patient to fill it. Patient fills the form in and sends it back Admin add to the record With this new tool we can identify IBS patients when they are referred and send them the form to complete when we send them appointment reminders. They fill it in before the appointment, it is emailed back to us, and electronically added to their patient record for the clinician to review. An IBS Patient is referred to the team. They are flagged as IBS at triage, a flag which stays with them until their appointment is booked. When admin send reminder texts the week before the appointment they can also send the link to the form, asking the patient to fill it. Patient fills the form in and sends it back Admin can add to the record © Leeds Community Healthcare NHS Trust May 2018

The Electronic Form – Benefits Saves time & a more patient centred consultation Greater patient engagement More Responsive Patient Self-Care DNAs Patient getting to discharge quicker We are saving clinical time in the appointment, admin time afterwards, responding to the patient’s referral earlier, and giving them a full appointment dedicated to their specific symptoms. We hope that patient uptake means that they can use the form to track their own symptoms and feel more in control of their own care Saves time & a more patient centred consultation The clinician knows the patient’s specific problems before the consultation starts, and can spend more time addressing them. Greater patient engagement The form is easy to use and looks great. Patients can use any device & have a whole new way of communicating with us More Responsive We are contacting the patient and gathering information much earlier than normal, so the patient feels their care is already making progress Patient Self-Care The patient is in control of their symptom monitoring, in line with the NHS 5 Year Forward View © Leeds Community Healthcare NHS Trust May 2018

Changes to IBS Care so far

Considerations/Problems Patient Engagement IG & Systems The ‘Tech Averse’ ‘Tech Averse’ staff…. Some of the things we identified as blockers were; Patient engagement – the form would only have sufficiently high uptake if patients were confident that using it was part of their treatment plan IG – AireLogic worked with our Trust’s teams to ensure all IG needs were met And the tech averse – some people may not like using an electronic form, especially to fill in details of their bowel habits, and that is perfectly understandable, but we thing a good engagement campaign at the beginning of their care will go a long way to address that Tech-averse staff – we know some staff prefer the paper form, and we’re working with them to feel confident using a new system © Leeds Community Healthcare NHS Trust May 2018

The pilot now Within 6 months soft-launched to the staff Whole cohort engagement Comparisons and evaluations Extending to LTCs Patients described the form as “Well put together” and “Easy to use”. Working with AireLogic we made the form, processes and put everything together in just under 6 months which may be a record for an NHS innovation. Early feedback from patients using it is brilliant. Within 6 months soft-launched to the staff Whole cohort engagement campaign – our main focus is to make the form standard practice and ensure good uptake With the support of AireLogic we will continue the trial and once we have enough data will begin comparisons and evaluations Patients described the form as “Well put together” and “Easy to use”. © Leeds Community Healthcare NHS Trust May 2018

Evaluation Track how many of the forms are sent back Feedback from staff about time freed up in appointments The Dietetic service see standard IBS patients, and offer a specialist ‘FODMAP’2 service for patients it could help. We intend to track rough estimates of time saved from clinical staff The service offers a limited Low FODMAP diet, which is second stage care for IBS treatment and is a very difficult diet to follow. We will use Forms4Health and our Therapy Outcome Measures to track the difference in patient outcomes between standard IBS treatment and Low FODMAP treatment, hopefully allowing us to bid for more Low FODMAP funding. Further applications for this in Community Care Using our health records we can track how many of the forms are sent back, by whom and how frequently, and collect feedback from these users. Feedback from staff about time freed up in appointments The Dietetic service see standard IBS patients, and offer a specialist ‘FODMAP’2 service for patients it could help. We now have 2 identical forms with different names (IBS & FODMAP). This means we can; Compare IBS vs FODMAP Therapy Outcome Measure results Building evidence for business case to extend our FODMAP service 2 Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols © Leeds Community Healthcare NHS Trust May 2018

forms4health - scalability Leeds Teaching Hospitals Trust 420,000 forms per month 16, 000 users Improve Patient safety 50+ Integrations Build own forms in hours £3m savings Leeds Care Record © Leeds Community Healthcare NHS Trust May 2018

forms4health – free trial Try a form – we’ll build it for you We’ll help you implement it Get users/patients to try it Measure the benefits © Leeds Community Healthcare NHS Trust May 2018