Tackling the backlog – how new community models of care and ‘digital diagnostics’ can help Scotland tackle record patient waiting times

Last week we were treated to the unwelcome news that patient waiting times in Scotland have reached a record high. While there is no magic solution to ease the pressure on the NHS, colleagues south of the border have embarked on a new model of care – on a massive scale – that could point to an eventual solution to the current stresses and strains facing our healthcare system confronted. system.

The introduction of Community Diagnostic Centers (CDCs) in England three years ago was part of a broad strategy to modernize and improve diagnostic capabilities, reduce waiting times and ultimately improve public health outcomes by catching health problems earlier, diagnose faster and more accurately. Establishing these new centers in community locations during a pandemic was intended to make diagnostic services more accessible and relieve pressure on acute hospital locations.

If Scotland is to adopt this model, it will be important to learn from the early challenges faced by England, as outlined by the All-Party Parliamentary Group (APPG) for Diagnostics in a report published in January. MPs questioned the location of some centers and highlighted the lack of digital tools to streamline pathways, improve efficiency and address challenges in data interoperability and care coordination between primary and secondary care. However, they were also clear that CDCs connected to new technology will play an increasingly important role in adding diagnostic capacity to a vast health care system – with 127 centers now operational.

Timely and effective diagnostic services are essential for quality care and reducing wait times for treatment and future hospital admissions. Currently, the diagnosis of chronic conditions such as heart failure, chronic obstructive pulmonary disease (COPD) and severe asthma can be fragmented across healthcare settings and between medical specialties. This can lead to inefficiencies such as repetitive testing and data sharing issues. Inappropriate referrals, staff shortages – especially for specialist nurses and trained diagnostic staff – and high ‘non-attendance’ rates exacerbate the problem.

The latest Public Health Scotland report for the quarter to March 2024 makes for grim reading. The figures show that more than 500,000 patients are waiting for a new outpatient appointment and another 63,900 are awaiting treatment in hospital or in day care. The total waiting list size for new outpatient appointments is 10 percent higher than in March 2023 and more than double the waiting list total at the end of March 2020.

There are also pain points with individual conditions. A Freedom of Information request from the British Heart Foundation in February 2024 revealed that waiting times across Scotland for echocardiogram scans, a key diagnostic test for detecting heart disease, had increased from 11,745 to 19,054 patients between June 2020 and June 2023. The UK Respiratory Diagnostics Report, released in May 2024, further highlighted that delays in diagnosing respiratory diseases are ‘widespread’ in the UK, claiming that one in four people with COPD wait more than five years for a diagnosis.

Increasing testing capacity alone will not solve these problems. We need to consider how new digital tools can support the redesign of diagnostic pathways that automate clinical workflow steps and better support the needs of both providers and patients.

A digitally enabled set of care pathways will help streamline testing in community settings, integrate patient-generated health data ahead of appointments, and improve care coordination across medical specialties and between primary and secondary care.

Automation of clinical workflow steps will also reduce clinical and administrative burdens, for example automatically generating and sending treatment plans for patients and communicating with GPs. It could also eventually support a shift to home-based diagnostic tests for appropriate conditions.

Lenus Health’s Digital Diagnostics solution is an example of this concept. As a plug-in clinical workflow automation system, it improves diagnostic pathways for various cardiorespiratory chronic conditions. By streamlining processes, diagnostic services can improve efficiency and coordination at every stage, from clinical workflows to resource targeting, localized diagnostic testing, faster diagnosis through virtual assessments instead of repeated outpatient appointments, and an improved patient experience.

The solution was applied to heart failure diagnosis in NHS Greater Glasgow & Clyde and was found to reduce waiting times by 78 percent and time to treatment by 72 percent – ​​delivering two and a half times greater efficiency compared to the previous clinic model. An independent health economics study from the University of Glasgow has further supported the adoption of digital technology in heart failure diagnostics. The ‘Opera’ study, overseen by the university’s Digital Health Validation Lab (DHVL), reported a 20 percent cost saving compared to standard care due to fewer healthcare contacts and emergency admissions through earlier treatment of patients. The full research is awaiting publication in leading scientific journals, and a summary is available on the West of Scotland Innovation Hub website.

These are undoubtedly important research findings and pave the way for the solution to be deployed at scale in Scotland – through NHS Scotland’s Accelerated National Innovation Adoption (ANIA) pathway. We see this as the logical next step in addition to setting up diagnostic centers in community settings. A number of CDCs in England are already using Lenus Health’s Digital Diagnostics solution to support diagnostic pathways, collecting rich structured data through referral, triage, testing, diagnosis and treatment planning.

This rich data set, which includes test results, observable characteristics, symptoms, and patient-reported outcomes, provides a more detailed characterization of patients. This level of patient understanding can facilitate the delivery of more targeted and effective treatments that advance the goals of precision medicine and provides the fuel, in the form of structured data, to develop AI risk prediction models.

Digitizing diagnostic pathways also paves the way for wider adoption of AI-based diagnostic devices that can accelerate clinical decision making and enable more detailed reporting of pathway performance based on agreed-upon metrics.

With wait times at an all-time high and demand set to increase, new models of care are urgently needed, supported by investments in trained staff and new digital tools to streamline pathways and tackle patient backlog. While there are still improvements to be made to the CDCs, the MPs were unequivocal in their report when they wrote that “innovating patient pathways and digitizing services has streamlined operations and improved patient experiences.”

Combining advances in digital technology with testing services closer to the point of need is clearly a sensible model for future healthcare. With a more rural population in Scotland, we would do well to learn the lessons of the CDCs in England – and apply them here.