How an NHS Trust adopted 'virtual workers' to process GP referrals

© NHS
© NHS

East Suffolk and North Essex NHS Foundation Trust is employing Thoughtonomy 'virtual workers' to process the first stage of GP referrals, saving secretaries hundreds of hours of admin work a month

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East Suffolk and North Essex NHS Foundation Trust has taken the first step into Robotic Process Automation (RPA) technology within the NHS, trialling a 'virtual employee' which will automatically process thousands of GP referrals a week.

RPA is a technology solution uniquely suited to the issues the NHS is facing, namely: a reliance on paper-based processes and an overstretched staff. According to the Institute of Public Policy Research (IPPR), automation could save the NHS up to £12.5 billion a year, the equivalent of 10 percent of its annual budget.

Working with UK vendor Thoughtonomy, the initial trial is a piece of automation software which reads and routes incoming referrals from the national GP Electronic Referral Service (eRS) 24 hours a day. It has been running since July, and is the first of its kind within the NHS. 

The old process would see a human secretary manually download and print documents, and scan that into a new document.

Now, "as soon as a referral is received, the virtual worker reads the content and extracts the reason for referral. It retrieves all relevant referral data and supporting clinical information such as scan and blood test results from disparate sources, before merging everything into a single pdf document.

"The virtual worker then uploads the document into the trust's administrative systems using highly secure smart card technology and alerts the lead consultant that the referral is ready for review and grading," the vendor explained in a press release.

It has been initially deployed for staff across the neurology, cardiology, urology, nephrology and haematology units within the trust.

Darren Atkins, deputy director of ICT at East Suffolk and North Essex Foundation NHS Trust (ESNEFT) told Computerworld UK that the referral automation project took just six weeks to deliver and the key to its success was not changing the process itself.

"A robot will follow a convoluted process, so there is no change management involved, the staff member just needs to stop doing that process," he said.

"The technology is structured using intelligent automation to train the robots to manage themselves, so if they hit an error exception, like a duplicate referral comes in, the robot doesn't shut itself down but will email the details to a human to resolve. That means it is low touch for operations," he added.

Within the first three months, the trust says it saved 500 hours in medical secretaries' time and estimates it will save £220,000 in associated direct costs by July 2019.

Frontline staff at ESNEFT have apparently welcomed the new automated process. Dr Petr Pokorny, a staff grade neurologist, said as part of a statement: "It allows for a more efficient, fluent flow of work, as it's easier to deal with five new referrals every morning rather than a huge pile of 35 referrals once a week. What's more, we now have our medical secretaries fully focused on the things that make a real difference to our staff and patients."

"The recent automation of referrals has brought positive benefit to patients and staff, the whole process is more integrated into their day and is paperless, so that warmth of reception from staff has been so positive," Atkins added.

Why Thoughtonomy?

The recently merged trust now encompasses ten hospitals across Essex and Suffolk, and Atkins was charged with finding technology "to drive forward efficacy" and was made aware of RPA through the press.

"I looked at Blue Prism, UIPath and Automation Anywhere. The problem was justifying to the board the value as it was largely unproven enough to get a six-figure investment." Atkins then "stumbled upon" Thoughtonomy and found the SaaS provider had better off-the-shelf capabilities to get started with a pilot quicker and, frankly, it "had a lower cost of entry", he said.

Read next: RPA Top Four: The best Robotic Process Automation software vendors

Thoughtonomy is built on BluePrism's platform, but specialises in easy to use tools like virtual workers, chatbots, eforms and AI capabilities. "So all the tools to tackle our automation challenges," Atkins said.

What next?

Next the trust has an ambitious pipeline of up to 60 workloads it is looking to automate, including using a virtual worker to engage with patients externally, such as a pregnant woman looking to refer themselves for antenatal care, and for automating pre-assessment forms for operations, saving patients from having to come into the hospital.

So, why hasn't the rest of the NHS been busy adopting automation?

"I think initially automation hasn't been embraced in health as it is a new technology that sounds too good to be true, so there is reluctance to invest and there are other priorities," Atkins said.

That hasn't damped down his aspirations though. "My ambition is a shared automation platform for whole NHS...I want a shared automation cloud and the beauty of the platform is it allows me to share any spare capacity and can share the blueprint of processes," he added. This includes extending the capability out to GP surgeries.

With the NHS there are always budgetary concerns, but the low cost of entry with Thoughtonomy and the eventual saving should ease those worries now that the technology has been somewhat proven out. Then there are the usual band of detractors, the bane of the RPA industry, who will always view automation as a threat to jobs.

Atkins rejects this out of hand, with the current use cases all clear examples of automation that helps employees, not replacing them, which in an organisation as knowingly overstretched as the NHS should at least be explored fully.

"When you say 'robot' people imagine a physical robot. These virtual workers help staff understand that you can't see it, but it mimics what you do, it's an extension to your team as a supportive function," he said.

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