Clock watching: measuring and monitoring 18 week waits with Ardentia’s Pathway Manager

The NHS must deliver a tough new waiting time target by the end of next year. But the information needed to measure the 18 week “total” waiting time target can be difficult to extract from existing IT systems and hard to analyse.

Healthcare business intelligence expert Ardentia has developed Pathway Manager to help trusts collect, analyse and report on the information they need to meet 18 weeks. This is already in use at a number of trusts, including Dudley Group of Hospitals trust in the Black Country.

 In 2005, the government set a tough new waiting time target for the NHS. By the end of 2008, no patient should have to wait more than 18 weeks from GP referral to the start of hospital treatment.

The “total” waiting time target is unlike any of the waiting time targets set before it. Where these focused on how long people had to wait for a first outpatient appointment or inpatient treatment, it covers the whole patient journey.

“You need to be able to say: this is one patient, on one pathway, who has reached this point. But many IT systems can’t pull that information together and join it up.”As a result, a lot of work has gone into defining “patient pathways” (the stages of investigation and treatment that patients should follow after visiting their GP with specified symptoms) and into deciding what should count as 18 week “clock starts” and “clock stops.”

Effort has also been put into generating information on previously “hidden waits” (for example for diagnostic tests) that may stop patients being dealt with inside 18 weeks, and into helping trusts to change the way they work to eliminate waste and delay.

IT challenges

Yet, in spite of this, a number of fundamental IT challenges have still to be resolved. NHS Connecting for Health, the agency in charge of “digitising” the NHS is still talking to the suppliers of patient administration (PAS) systems about how these can be used to capture 18 weeks data.

And although a “strategic solution” for recording and monitoring 18 week waits has been promised through the new Secondary Uses Service (SUS), it has yet to be developed.

“In principle, measuring 18 weeks is simple,” says David Beeson, marketing manager for healthcare business intelligence expert Ardentia. “You start the clock when a GP refers for treatment and you stop it when treatment starts - or another decision, like ‘watchful waiting,’ is taken.

“In between, there are other key events, such as a referral to outpatients or being sent for tests. And what is difficult is that the information about these different events is held in many different systems.

“You need to be able to say: this is one patient, on one pathway, who has reached this point. But many IT systems can’t pull that information together and join it up.”

Ardentia’s Pathway Manager

Ardentia has created an 18 week wait management solution to do this, which uses a number of Microsoft technologies.

Information is held in a data-warehouse built on Microsoft SQL Server. Ardentia has created tools to search the information, build up patient pathways, create unique identifiers for patients when data is available to assign them to pathways, and identify “orphans” whose pathway is not clear.“We are getting a historical view of what is happening that lets us manage the returns we need to make, and we can build in check points to pick up possible breaches.”

It has also created reporting tools that can be used to generate internal reports, the Referral to Treatment Time (RTT) returns that have to be made to strategic health authorities and the Department of Health and to monitor the progress of individual patients.

“For example, a user can say that in order to hit the 18 week target overall, a first outpatient appointment must take place by week 10, and check that is going to happen,” says Mr Beeson. “The system will tell you if a patient is in danger of breaching an intermediate step.”

The solution is also ready for use with Microsoft SharePoint, which supports even more specific reporting. “For example, the chief executive could ask to see headline status on 18 weeks on their dashboard,” says Mr Beeson. 

Dudley Group of Hospitals trust

Ardentia worked with a number of NHS trusts to develop Pathway Manager. One of these was Dudley Group of Hospitals trust, which had already procured a data-warehouse from the company.

Deputy director of information John Uttley says: “This is one of the best projects I have been involved in. Ardentia had the technical know-how, but we contributed our NHS knowledge.

“Initially, they [Ardentia] were talking about developing a reporting tool, but the hospitals involved said they needed something operational - something that would help them hit the target.

“The result of the work was the [new solution], which we are exceptionally pleased with. It does both RTT reporting and operational tracking. We are getting a historical view of what is happening that lets us manage the returns we need to make, and we can build in check points to pick up possible breaches.”

Mr Uttley says the new information is already raising important issues at his trust. Some of these relate to data quality, which the organisation is addressing. Others relate to why things are done as they are done - and whether they could be done faster and more effectively. “18 weeks is a huge project. The only way we could imagine delivering it was by having good information.”

“We can start engaging with clinicians and asking some tough questions,” he says. “For example, if the wait to see four clinicians working in the same specialty is very different, we can start to ask why and to set standards that will bring our [overall] average wait down.”

Getting ahead of the game

When Ardentia unveiled its solution, there were more than 500 days to run before commissioners and trusts had to meet the 18 week target. However, Mr Beeson says 18 weeks is already a key focus for NHS organisations.

“Nobody knows when the strategic solution that will be delivered through the Secondary Uses Service (SUS) will be available,” he says. “But trusts are starting to think in terms of pathways and how to generate them from their existing data streams now.”

Mr Uttley agrees. “In terms of our business, we saw this as a way of reducing the risk of incurring financial penalties for breaching 18 weeks,” he says. “And there is no doubt it will improve patient care. 18 weeks is a huge project. The only way we could imagine delivering it was by having good information, so we simply could not wait for SUS.

“Some big trusts are doing their own work; but we don’t have the IT resources they have. And it often involves a lot of data input. We did not want to go down that route; being able to do this electronically is essential.”

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About Ardentia: Ardentia is a supplier of world-class business intelligence solutions. It has almost 20 years’ experience of providing web-based technology for enterprise BI solutions to the NHS, public sector and commercial companies.
Ardentia works at every level of the NHS, from national organisations to strategic health authorities, commissioners and trusts. It is responsible for delivering the common user interface for accessing and reporting information held within the NHS Care Records Service, which will hold records for every NHS patient in England.
More information, including more details about Pathway Manager, is available on its website at: www.ardentia.co.uk

About Dudley Group of Hospitals trust: Dudley Group of Hospitals trust is the main provider of acute hospital services to the residents of Dudley, which covers a geographical area of approximately 70 square miles and has a population of 305,155. Its main hospital, Russells Hall, has 722 beds.
The trust prides itself on its use of IT, and claims that its three sites are some of the most technologically advanced in the country. The trust’s website is: www.dgoh.nhs.uk