InfoFlex is providing a reliable system for remotely monitoring cancer patients at low risk of recurrence once they have reached end of treatment and are back at home.
- Enables supported self-management
- Reduces unnecessary hospital appointments
- Ensures security of follow-up
- System can be easily adjusted to meet local clinical requirements
- Secure system to manage patients on remote pathway with potential improvement of health outcomes
- Reporting/analysis functions always available
- Reduction of outpatient visits
- Improvement of patient management by eliminating use of clumsy, fault-prone spreadsheets
- System can be easily adjusted to meet local administrative processes
- Reduction of risk to patients on remote follow-up
- Flexible, cost-effective system to deliver national and local stratified follow-up strategies
Across the health service there is pressure on clinic space as the number of patients diagnosed with cancer increases. Face-to-face follow up clinics for low risk patients post treatment can overload clinic space, hence the push for stratified follow-up and remote monitoring. In line with the national targets, the local commissioners for UCLH have stated that by 2020 they want to see 70% of breast cancer patients, 40% of colorectal cancer patients and 40% of prostate cancer patients on stratified follow-up. The NHS planning guidance 2018-2019 has recently been updated and clearly states the ambition for all breast cancer patients to move to a stratified follow-up pathway by 2020/2021. In addition, the document also stipulates an agreed system for remote monitoring to be in place by March 2019.
Evidence has also suggested that routine outpatient appointments, such as 6 monthly or annual follow-ups, may not be in the patients’ best interests in terms of health outcomes. For example, recurrent symptoms or psychological issues might happen between appointments but patients have a tendency to wait to highlight the problem until the next appointment, rather than contacting their clinical team. Removing routine follow-up appointments but providing education and support to low risk patients makes them more likely to take ownership of their own health, learn how to identify signs of recurrence and understand when it is timely to contact their cancer team.
As different tumour sites require different levels of follow-up, it was necessary to implement a remote monitoring system that could be easily adapted to meet varying requirements.
For example, the Lymphoma team were keen to put patients on stratified follow-up (although they had not been selected as a target by UCLH commissioners). After a year of routine appointments no tests are needed but the clinical team has to rely on patients to contact them and respond to quality of life questionnaires. The previous system relied on administrators checking a spreadsheet to ascertain whether a patient had responded, which was both less safe and less easily manageable than an electronic remote monitoring system, especially as numbers have risen to over 150.
Design and Implementation
“InfoFlex just makes the process so much easier. InfoFlex will highlight to the user that a patient is on stratified follow-up or that they are now doing a quality of life questionnaire or that this patient has not responded to a quality of life questionnaire. It makes it so much safer and easier to manage than a spreadsheet.”
Alia Nizam, Cancer Stratified Follow-Up Project Lead
Alia has been responsible for overseeing the design and implementation of remote monitoring processes for breast, lymphoma, prostate and colorectal cancer. The first two systems are already in live use. Her role begins at the point at which an end of treatment meeting takes place between CNS and patient and the latter is informed that they, being at low risk of recurrence, will be remotely monitored. The Living With and Beyond Cancer strategy to facilitate supported self- management includes a Holistic Needs Assessment so that patients can expect to be provided with the necessary information to cope after end of treatment, without further face-to-face contact in outpatients.
A generic stratified follow-up email is sent to the administration team by the CNS after the end of treatment so that the patient can be entered onto the relevant InfoFlex Remote Monitoring system. The system is designed to highlight when a particular event needs to happen, such as a mammogram, PSA test or a response to a questionnaire, as well as alerting when such an event has been missed. Clinical staff are informed and can take action accordingly. When results come through they are manually entered into the system, the CNS is informed and will review them. A pre-populated letter can then be sent out by the administration team, informing the patient of the result and the date for the next routine test or appointment if necessary.
Alia found support from the InfoFlex team invaluable during the design and implementation process. She had to make sure the most important information was on InfoFlex and then customise the UCLH remote monitoring designs to meet local needs. She said she found this relatively easy with the support of a knowledgeable and experienced InfoFlex Care Pathway Designer. For example, a generic prostate design from another hospital was chosen as the template but lacked end of treatment clinic dates. Alia said: “It was very easy to put that in and customise it; it was nice to bounce ideas off her [the designer]. Her experience was really useful.”
The flexibility of InfoFlex was also noted. For example, pre-populated letters regarding PSA results were built into InfoFlex but also allowed for further patient specific information to be added by the CNS as an option. “So she [the designer] allowed that flexibility whereby we can edit and put additional information in if we need it.”
Because there is quite a high turnover of administrative staff, Alia has to make sure that very structured guideline manuals are available for the team to follow, and again has found help from the InfoFlex designer invaluable.