Patient Management System - Referral System Specification

Document purpose

This document outlines the requirements for the automated patient management and referral system Optimise Healthcare Group has commissioned. It is provided for perusal by relevant third parties who require a brief on our processes. Any sensitive intellectual property related to our internal operations has been deliberately redacted.

The system will eventually need to tie in with Medicus as the internal patient record system. This document does not include styling, look & feel, page definition or the content of web pages - those follow at a later stage.

A * next to an item denotes it as mandatory user input to proceed.

Project overview

The system has been commissioned to help Optimise transition from a fragmented, spreadsheet & e-mail-based workflow to one that's fully integrated, centrally managed, and auditable. Currently, patients are onboarded using a combination of paper & email forms, with statuses collated in a spreadsheet before being added into Semble once fully onboarded.

The system centrally manages the initial assessment and onboarding of NHS patient referrals by offering patients and GPs a facility to digitally complete questionnaires using access links, and deciding on next steps based on the scores attained.

Core concepts

Patients

Before referrals can be considered, patients must be added to the system. The following information can be captured (* = mandatory):

Patient details

• First Name*
• Middle Name
• Last Name*
• Gender (dropdown: Male / Female / Non Binary)
• Pronouns (He Him / She Her / They Them)
• NHS Number
• Semble Number
• Email
• Phone number
• Date of Birth*
• Locality* (dropdown - denotes the NHS GPs available to the patient, as well as the services Optimise can offer the patient)
• Additional needs / support

Address

• Line 1, Line 2, Line 4, City, Postcode, Country

Once the basic information has been captured, onboarding moves on to confirm whether the patient has any Risk Factors. These are defined in the system settings and are subject to change.

Other elements of the patient record

Current GP - the patient can have their current GP linked to their record to streamline referral processing and allow communication with the GP if required. The GP is chosen from a dropdown list, and GP availability can dynamically change.

Diagnosis (new) - following successful assessment with Optimise, or via other clinical means, new diagnoses can be logged against the patient's record:

• Condition*
• Description
• Diagnosis Verified?* (Not Verified / Verified)
• Diagnosis evidence (none, one or many uploads): File Title + File Upload

There is also provision for Previous Diagnosis for conditions previously diagnosed via other healthcare providers; evidence can be obtained and stored as proof if required.

Notes - free text notes may be stored against the patient's record.

Patient referrals

The most basic way a referral can be categorised is which pathway it is seeking care through. This is the first core piece of information attained about a referral, as it dictates how the rest of the logic of the system should follow:

• NHS Patient Referral
• Private Patient Referral

Depending on the class chosen, certain flows become available or unavailable. NHS Patient Referrals must also be categorised into one of the following sub-classes:

• Right to Choose Adult
• Contract
• ERS

NHS patient referral types

• ADHD Medicine Review
• ASD Assessment
• ADHD Assessment

There are some edge-case conditions where an NHS Patient Referral will not be able to choose one of the above types.

Type of patient

• New Patient, No Existing Diagnosis (Category A)
• New Patient, Has Existing Diagnosis (Category B)
• Existing Patient, Shared Care Referral (Category D)
• Existing Patient, Referred for Alternate Treatment (Category F)

To ascertain the type of patient during initial onboarding, their NHS number (unique ID) is used to determine whether they're already known to Optimise.

NHS patient flows

NHS Patient Referrals go through 3 stages of processing:

1. The Initial Referral Flow
2. Processing, Verification, & Data Gathering Flow
3. Consent & Final Onboarding

These flows have elements that can change depending on the patient information provided, as well as the information provided about their GP (or if a GP is even involved).

Stage 1 - Initial referral flow

A patient must be added first before a referral can be created for them. There is currently one main pathway to submit a new NHS Patient Referral:

• Manually (Optimise filling in the referral themselves if they already have all the data - e.g. a paper/manual GP submission obtained by e-mail or phone)

Manual referral form

First, the user is prompted with a list of the patient's Risk Factors. If these are still accurate, the user confirms them; if not, they cancel and amend these first before continuing.

Once Risk Factors are confirmed, referral data input begins:

Referral type - ADHD Medicine Review / ASD Assessment / ADHD Assessment

Patient treatment pathway (sub class)* - Right to Choose Adult / GM Contract / ERS

Patient type* - conditional dropdown based on the patient's previous interactions and route to Optimise (Category A / B / D / F as above).

Referrer details - information about the referral that got the patient into Optimise. It is possible to "Continue without Referrer". If GP is selected and set on the patient's record, GP information is pulled in automatically. If any choice except "Self Referral" is made (or GP chosen but none set), the user must provide:

• First Name*, Middle Names, Last Name*
• Email, Phone
• Address Line 1, Line 2, Line 3, City, Postcode, Country (dropdown)

GP - every referral must be associated with a GP (usually the patient's current GP; referrals can be updated if a patient moves GP throughout the process). It is possible to "Continue without GP", but this blocks GP-led pathways later in the referral lifecycle.

Stage 2 - Processing, verification & data gathering

(Details redacted - sensitive company intellectual property. Summary below.)

Once a referral has been marked as "In Progress", it may progress to this flow. The flow and logic vary depending on the Patient Referral Type chosen in the initial referral.

Because email and phone are both optional fields for patients: where "Email" is specified but no address is available, send via SMS; where no phone is specified but e-mail is available, send via e-mail.

Depending on the type of referral, the user progresses through a pipeline of actions to validate patient information, get information from a GP, issue questionnaires relevant to the referral, and score these questionnaires to validate patient suitability for assessment or treatment. For example, an NHS referral for an ADHD Assessment may involve:

• Questionnaires being sent & completed
• Questionnaire responses being automatically scored to establish a basis for assessment
• If required, additional evidence being requested at any time from the GP directly

If the patient meets the criteria (via questionnaire responses or other means), they proceed to final onboarding. The referral is considered "Accepted" but not "Onboarded".

Stage 3 - Consent & final onboarding

(Details redacted - sensitive company intellectual property. Summary below.)

After a patient has had their referral accepted, they must provide certain consents and forms with supplementary information before they can be onboarded and become a full patient.

Unified questionnaire experience - the patient completes all required questionnaires and forms in one single unified experience. Required questionnaires and forms vary depending on referral type.

Once a response has been received (or the manual override used), the referral is considered fully onboarded and can be sent via the API for further processing in external systems.

Post-onboarding appointments

Once a patient has been fully onboarded, Optimise must track whether they attend a set of post-acceptance appointments. Failure to attend appointments results in discharge from Optimise's care; if a patient is discharged for non-attendance, they need to complete the onboarding process again.

The appointments can be booked, tracked and their outcomes monitored within the context of this system.