Some people complain to their friends, some take to Twitter, others write to their MPs. The NHS is the pride and letdown of many users and staff. However when founders Rob and Tom decided they’d had enough of personal experiences and news stories highlighting seemingly simple information flow issues causing detrimental blockages in the NHS they established Rorytech, with the aim of being fully public when rolled out. Rob and Tom were not simply empowered usergroup members though, they had significant experience in medical informatics and information governance. Tom had, for example, run the systems behind double blind medical trials and recently built a platform that handles 1000 data points a second and used these data points in real-time to power complex algorithmic calculations. Rob had been a daily user of this platform.
The issue facing them they saw as three tiered. First was patient access. From the inconvenience of booking GP appointments to then getting to see the right person they see as needlessly time-consuming, especially since people fear their health will deteriorate in that time. The second issues was on the health care professional (HCP) side. When GPs get to the appointment they often look at an incomplete care record, which is detrimental to diagnosis and referral. Information flow is the biggest theme GPs site as a barrier to care, alongside the personal issues such as working hours and salary. In England there are 4 companies that hold patient data and getting them to work with one another and to integrate that with hospital records, held across numerous sites, has been difficult. The NHS has continued to contract more and more app booking companies, and data custodians, rather than working to create an up to date system that connects these databases. The third issue was that despite GP surgeries being organised on a combined, area wide basis, via Clinical Commissioning Groups (CCGs) through which they provision for their needs, GPs act like isolated units.
Though these may not seem linked issues, Rorytech noted that they form core parts of the triage system, which sorts and allocates patients in accordance with need, so cannot be dealt with in isolation. Rorytech knew that it was not a worthwhile exercise to simply build a better app or better interface for doctors. Since data flow was at the heart of the problems they identified, any more data creation needed to be justified through being used to solve existing issues. That is why Rorytech’s offering is probably best described as a patient-friendly app which backs an incredibly powerful platform, whose aim is to deliver for healthcare professionals (HCPs).
Looking at the Rorytech platform from the ground up, which is at the heart of their greenfield product, when rolled out there will be an app, which also can be accessed via web-browser, that patients log into similar to the way they’d do so for mobile banking. On the app they can input their major symptoms and it will show them almost real-time options for care. Rorytech stress that there will always be an option, it will never tell them not to go to seek medical assistance. They aim to have these options will be CCG-wide, though the patient will always have a home mooring, their named GP practise. Load balancing of patients, but crucially not the patient’s ‘home’ surgery, would assist in reducing queues and patient transfer from secondary to primary care. Rorytech aim to begin with surgeries and work to combine competences through existing vanguard, STP or cluster models.
The availability of appointments on their system will be based on real-time data: the correlation between appointment slots and people attending appointments. With the data inputted, if a patient only wanted to get their blood pressure taken, they need not wait say 4 days to see their GP, they could get it done in 2 hours by a healthcare assistant at an alternative surgery 1 mile down the road. Rorytech’s system also gives delegated access for authorised carers to book appointments on behalf of those they look after. The point of this is that from Rorytech’s analysis patients still want face to face care and HCPs need to see a patient to accurately be able to diagnose. Competitors to Rorytech try to work via video or messaging, with often limited access to medical records. HCP after HCP has stressed how difficult it is to give an accurate diagnosis via the phone with someone they have never seen nor have much detail on their medical history. Rorytech allows, in their own words, the current system to be empowered.
Part of that empowerment is giving HCP the information they need. The information inputted into the app will go to the HCP before the appointment. This means that before the allocated ten minute slot, for example as the patient walks to the GP’s room, the GP can bring up the relevant part of the patient's health record. Rorytech say that people they meet think this means Rorytech are doing diagnostics - far from that they insist - they’re leaving the medical care to the hardworking HCPs. The HCP interface will give the GP or nurse the whole patient record. Surprisingly to many, currently NHS GPs often cannot often see a patient's full medical record, sometimes because it is held on a rival system (eg on TPP rather than EMIS) or because they have not gotten access to the electronic summary of the patient’s hospital record. In an appointment this often leaves it up to the patient, usually not a medical professional qualified in the area of their ailment, to describe their medical history to the HCP. A lot of pressure on the patient then to get it right!
Through the GP Connect APIs which NHS Digital launched recently, Rorytech will provide a full record. This would mean that everyone involved, from a social care worker to the hospital consultant would be on the same page. However they would not all be able to see all of a patient’s record, they would only be able to see the parts that they have been given authorised access to -ie using the current delegated access system is a more joined-up and intuitive matter. Rorytech stress these data controls are a key part of their system, and an area in which their development team significant industry presence in. Records going to the GP and/or to the patient themselves will only be pulled through the system in encrypted chunks. Any wannabe hacker would only be able to see “patient 1287 seeing HCP 185558 at location 291032” or just a blank screen where the medical record should be. Safety and privacy they say are just as key aspects as interoperability - none can be compromised for the sake of the other.
This data, though seemingly quite straightforward, Rorytech believe can really assist the primary care system to be where it wants to be. Ensuring that patient see the appropriate level of care, eg nurse rather than GP, more efficiently aligns supply to demand. Study after study has shown the value in such a method, highlighting that in some cases nurses are just as qualified and proven to take up to 50% of a GP’s load successfully. Targeting load balances systems, meaning that patients can be seen quicker, with behavioural studies showing the prospect of an appointment sooner than they expected, and booked 24/7, means patients are less likely to seek out of hours care or go to A&E for non-emergency issues. This also assists A&E departments in other ways. A&Es struggle with getting beds for their patients. These beds are often held by older people who are well enough to be discharged but haven't had community care lined up for them. Rorytech hopes to increase patient transfer from hospitals to primary and community care by using their system to highlight gaps/opportunities in provision.
The data can also be used for NHS research and to be able to plan ahead for future healthcare needs. It is difficult to mine GP systems, as they so disparate. Yet the information stored in them is so crucial in being able to plan for future NHS challenges. Currently this information trickles to Public Health England via late-stage surveys and charity run initiatives. Rorytech’s system is geared to help Public Health England deliver preventative care. The symptoms inputted into their app, when verified by the GP through a simple click as part of exiting the patient record, can then be fed back to the CCG or Public Health England in a short time-frame. This data accordingly can flag public health issues - such as a spike in people booking in with symptoms such as blurry vision, excessive thirst and extreme fatigue, may signal a rise in diabetes in the area. Since GPs refer patients onto a wide range of other providers they will have no idea if what the patient comes in to see them for was in fact Diabetes, rather than say chronic fatigue, or simply stress. There is a gap in this primary care window. Having such data early on would allow CCGs and/or Public Health England to better respond to health outbreaks in a targeted and cost-effective way. Another example of how their system is helpful to preventative health pathways is that if time is freed up in a ten minute appointment by a GP being able to get to the right part of the medical record before a patient arrives, then the GP can ask the crucial questions on the NICE preventative care checklist that normally get left: have you had a pap smear recently; have you had a flu jab…? These are important, though seemingly small, issues for the long term health of the nation.
Asking Rorytech about the ransomware attack that hit the NHS in May 2017, they say mitigating such an event in future requires some relatively simple changes to data handling in the NHS, going on to explain their use of decentralised servers and security patches. How does this relate to the issues their aim of a standard model? They have planned their architecture to bring cutting-edge solutions to the various areas they tackle, but they want to build a model onto which any CCG can on-board. This is a system which sits above current providers and custodians to provide for the desperately needed interoperability between them. It can definitely have add-ons and bespoke features for local programmes, which they are enthusiastic about, but they stress that what they create, though enhanced and informed by local partnerships, they want to ensure what work they do creates a standard, interoperable model, in order to deliver the changes the NHS calls out for.
Rorytech continues to believe though in partnering locally for two reasons. Firstly, they seek to leverage the best practise work the partner is undertaking, and they cite with some excitement pioneering programmes that they are currently looking at working with. They see their value proposition as an attractive prospect for the CCGs and vanguards they highlight. It allows the CCG to focus on local delivery, while giving their programmes a wider legacy. Rorytech says that though they have their architecture planned out, it is compartmentalised in such a way that ongoing work can feed into it. Meaning that Rorytech become somewhat of a facilitator, enhancing current programme functionality. Thus NHS CCG CIOs get extra assistance in delivering cutting-edge technology aims, while their passion to improve the NHS is not limited to CCG boundaries.
Doctors, nurses, social care workers, patients and other stakeholders all speak to them about needs which could be only solved by a standardised, interoperable system. This is why Rorytech continues to believe in developing a system that sits above other systems and helps the patients access care and HCPs to deliver it. A system which Rorytech say is easily doable with the new GP Connect APIs and their expertise. We can only hope that it's not long before Rorytech’s “AppApp” and systems reach a surgery close to you.