Following our Long Term Conditions Innovation Exchange in 2017, Nottingham University Hospitals put forward a proposal to trial a digital outpatient follow up project to reduce unnecessary appointments for patients and help improve patient experience.

Following a successful roll out in three clinical specialties, the project has been shortlisted for a HSJ Award in the Digitising Patient Services category. Here Clinical Lead for the project, Dr M. Ananth Sivanandan, talks about the project and the benefits so far, as well as the importance of digital innovation in healthcare.

 What is the digital outpatient follow up project?

The ‘My Online Care’ project is examining the use of carefully designed and/or selected digital questionnaires that patients can complete remotely on a smartphone, tablet or computer. These are then used by the medical team to help decide whether a patient actually needs to attend a face-to-face outpatient appointment. By using this system to remotely monitor patients’ symptoms, we are aiming to reduce the need for our patients to attend hospital. We are piloting in three specialities: oncology, breast surgery and musculoskeletal.

What is your role in the project?

I have been the clinical lead for this project at NUH. My role has involved working with and supporting the pilot specialties to develop the questionnaires needed for this project and how these are integrated into our outpatients’ care. I have been leading the work in oncology specifically and have been involved in selecting the oncology follow-up pathways to pilot our digital solution, as well as developing and validating the clinical questionnaires needed. My work as clinical lead for ‘My Online Care’ has also involved presenting at a variety of regional, national and international events to share the work we have been doing.

What did Nottingham University Hospitals NHS Trust do to put the project in place?

Although the premise of the project seems simple, a lot of behind of the scenes work had to be put in before we could start testing with patients. This is a multi-faceted project and we therefore made sure to have a multi-professional project team made up of clinicians, IT professionals, healthcare improvement specialists, admin staff, as well as colleagues from our project’s technology partner DrDoctor, to coordinate and lead on the various workstreams. Critical steps for this project included selecting the appropriate clinical questionnaires and clinicians designing their own if none were available, achieving clinical safety and information governance sign-offs, seeking patient and public involvement into both the questionnaires and the project aims, and mapping current follow-up pathways and how our technological solution could fit in..

What are some of the benefits of the project?

The project seeks to improve our patient’s experience by reducing burdens on their time and expenses by not needing to attend hospital as much as compared to the traditional outpatient follow-up pathway. By reducing face-to-face appointments, it can also free up clinicians’ time to spend with patients that need it. In oncology specifically, this project can reduce the risk to immunocompromised patients by eliminating unnecessary hospital appointments. From an operational perspective, we also intend to reduce the number of patients that do not attend appointments and the overall costs of outpatient activity.

What are the results of the project?

In oncology, we have successfully tested and validated questionnaires in 10 different oncology follow-up pathways and have shown a potential opportunity for follow-up reduction of almost 30% as a whole across the pathways tested. We have then gone on to perform a remote monitoring pilot in two oncology pathways with over 90% of digital appointments to date going on to save the need for a face-to-face appointment. We are now spreading to further oncology follow-up pathways to build on this success.

Patients have been overwhelmingly positive about the questionnaire content, the usability of the digital interface and the use of the digital questionnaires to supplement their care. All patients that have opted to take part in the project have remained on the digital follow-up pathway, which reflects positively on the benefits of this project to patient experience.  

What would winning the HSJ Award for Digitising Patient Services mean to the team?

If we were to win a HSJ award, in a category full of worthy nominees with a judging panel made up of well-respected healthcare professionals, it would be a fantastic achievement for the whole project team and testament to the work we have been doing to improve the experience for our patients and staff. There have been some difficult points in the last year to get this project up and running and by winning this award, it would show that the persistence of the team to overcome those challenges has led to something of genuine worth.

The EMAHSN have been critical in the success of the project. They funded our first year of work with our external technology supplier and supported the development of the project by forming part of our monthly project board meetings. They have been keen to support the spread of our work and have linked us in to a number of meetings where we have had the opportunity to present to a wider audience. These events have helped affirm to us a project team that the work we are doing is really innovative and motivated us to build on our positive outcomes to date.

Finally, why do you think digital innovation is important for the healthcare system?

As someone working on the front-line, it is clear that the increasing workload demands on the health-service cannot continue to be met by our current traditional healthcare model, to do so would lead to disservice to our patients and staff. Digital innovations provide the opportunity to redesign services to the benefit of patients and staff. Our project has shown the willingness from both patients and staff to embrace the benefits that digital technology can bring.

To find out more about the digital outpatient follow up project, visit

Our webpage https://healthinnovation-em.org.uk/our-work/innovations/digital-outpatient-appointment-management 

Or Nottingham University Hospital’s website https://www.nuh.nhs.uk/my-online-care