Maximising technology in London’s Community Diagnostic Centres

Imagine a future where a patient with breathlessness, referred by their GP, can go to a ‘one stop’ diagnostic centre to have all their scans and blood tests on the same day, in the same place. The patient can book their appointments online at a convenient time. This is soon to be reality with 40 Community Diagnostic Centres (CDCs) set to open by March 2022.

During the pandemic, patients requiring diagnostic tests were placed on long waiting lists, with the severe backlog now a significant challenge for the NHS’ recovery. In October 2021, nationally 22.7% of patients requiring an MRI had waited more than six weeks. The transformation of diagnostic services is urgently required to reduce waiting times and diagnostic backlogs for elective care. Part of this transformation is the establishment of the CDCs which aim to create more clinical capacity and earlier and faster diagnosis, whilst reducing demand upon acute care. CDCs are located out of hospital settings in accessible places such as shopping centres and high streets.

The three AHSNs in London (UCLPartners, Health Innovation Network, and Imperial College Health Partners) are working with the NHS London CDC Programme and their clinical pathway group in the design and development of the CDCs. Specifically, identifying how the CDCs could maximise the opportunities that cutting edge technology offers to improve patient outcomes and address the diagnostic backlog in the cardiology pathway.

We worked with the cardiac clinical network to understand their priorities, challenges and ‘bottlenecks’ in cardiology diagnostic pathways and matched them with a range of innovative solutions that could support the establishment of 20 CDCs in London over the next five years. The priority areas included:

• Better utilisation of workforce through automation of tasks
• Referral efficiency and support tools e.g. booking systems
• Patient engagement and communication ​tools between clinicians
• Emerging cardiac diagnostics.

Cardiology Innovation Exchange Event

On 1 December 2021 we held an AHSN Innovation Exchange event where a panel of clinical cardiac stakeholders selected solutions they wanted to hear more about. This provided an opportunity to introduce participants to the potential of solutions that could address the challenges facing cardiac diagnostics. 

As the automation of tasks has huge potential for CDCs, we invited Darren Atkins, Chief Technology Officer at Royal Free London NHS Foundation Trust’s Centre of Excellence for Robotic Process Automation to present their work.

Darren outlined how robotic process automation uses software to automate business processes by human workers. Robots are deployed to emulate the way people use business systems (through a keyboard or a mouse), the decision they make and the processes they follow in order to augment, replace and digitalise manual work processes. Processes like taking an appointment cancellation text message by a patient and re-allocating that appointment to another patient.

At the Royal Free, they have automated the management of referrals using robotics, replicating some of the human tasks in processing an electronic referral. The robot will undertake tasks such as downloading, checking attachments, and uploading documentation onto the electronic patient record. This has resulted in the robots saving the team approximately 300 hours per week in their management of the 8600 referrals they receive.

In the true spirit of NHS innovation, they share their automation solutions with other NHS organisations including their blueprints, coding, templates, and processes through their Intelligent Automation Digital Exchange. They also provide automation consultancy support for other NHS trusts with their mantra ‘By the NHS for the NHS’.

As part of providing a taster of the digital technologies that could benefit cardiology pathways in CDCs, we invited a number of innovators to present their solutions. They ranged from a virtual consultant-delivered triaging service to platforms that help patients manage appointments or provide education on their diagnosis / treatment and a safe digital solution for clinician-to-clinician discussion and sharing clinical-grade images. The benefits include:

• Reduction in patients not turning up for their appointments
• Increased clinical staff capacity and optimised use of clinic equipment including diagnostics
• Virtual patient follow-up or providing instant access to results.

The cardiologists wanted to learn more about cardiac innovations that are ready for adoption, to enable easier and faster diagnostic of cardiac conditions. We heard about a NICE-recommended ambulatory ECG monitoring patch that detects cardiac arrhythmias. In Liverpool Heart and Chest Hospital, the introduction of the ECG patch has reduced the 24 / 48 hour Holter waiting list from eight weeks to a few days.

Another innovation will streamline blood tests in CDCs. This portable blood analyser delivers real-time, lab-quality diagnostic test results, including blood tests required prior to patients having other diagnostics such as CT scans. 

The event was closed by Dr Rajan Sharma, Head of Cardiology Clinical Services at St George’s NHS Foundation Trust and NHS England Lead for Community Diagnostic Centres who discussed the 3-5 year vision for cardiology pathways in CDCs. They aim to take a phased approach, moving from a focus on increasing capacity over the short term, to developing coherent cardiology pathways that intersect with CDCs at the appropriate time.

Rajan summarised the coherent and blended model outlining which tests will remain in primary and secondary care alongside the tests that will be undertaken in CDCs. The CDCs will deliver a mixed model of GP Direct Access to test and Secondary Care Access to test. An overall increase in primary care access is part of the recommended model supported by protocols, order communications, onward referrals and access to specialist advice.

The development of CDCs represents a huge opportunity to improve patient care by enhancing equity of access to NHS services, more rapid diagnosis of important cardiac diseases, and streamlined pathways to improve patient outcome and experience. Primary and secondary care innovations provide an opportunity to really put the patient at the heart of care delivery.

Dr Rajan Sharma, Head of Cardiology Clinical Services at St George’s NHS Foundation Trust and NHS England Lead for Community Diagnostic Centres

Watch back and next steps

Access the presentations and the recording of the event.

Please note, the innovations referred to at the event are not preferred suppliers and there are other solutions that can support the challenges identified. This event was intended to inspire people as to how innovations can support health system problems, rather than endorse any specific solutions.

The horizon scanning and Innovation Exchange event is the start of the journey for the AHSNs to support the London healthcare system with the establishment of CDCs. We look forward to sharing our expertise and knowledge of cutting-edge technology to help CDCs provide a seamless and high-quality service for our patients across London.