A new Patient Care Messaging system from iPLATO is having a significant impact on absenteeism, according to early results from the Islington Primary Care Trust, this was announced at a recent eHealth event in London.

The Clinical information Systems and Electronic Records and eHealth 2004 conference and exhibition was attended by electronic records and IT managers, GPs and practice managers, clinicians and health managers with a particular interest in IT. In a presentation made by Simon Jones, Islington PCT’s Primary Care ICT Manager and Steve Colman, Practice Manager at the City Road Medical Centre the audience heard early results from the pilot indicating that Patient Care Messaging has the potential to reduce the ‘did not attend’ (DNA) rate to zero.

iPLATO’s Patient Care Messaging system is being piloted at three Islington PCT sites - City Road, Goodinge and Clerkenwell and is also being trialled by the North East London Mental Health Trust. The three Islington sites will truly test the effectiveness of iPLATO’s Patient Care Messaging system as they are spread geographically across the borough and all have differing list sizes and patient demographics.

City Road Medial Centre is an inner city practice with five doctors and two nurses in a relatively deprived area. Although it had not undertaken specific steps to tackle patient DNAs, its efforts to improve patient access had reduced the number of missed appointments prior to the pilot. Therefore its DNA rate of 20 per week was relatively low in comparison to the national average (of 50 per week); however, on the basis of £18 per appointment this still adds up to about £21,000 per annum.

The City Road Medical Centre pilot was launched at the end of August and since then there has been an unquestionable improvement in the number of DNAs. In June, July and August the average equalled 12 ‘no shows’ per week, however after introducing Patient Care Messaging and by the third week in September DNAs at the practice gradually fell to zero.

The City Road Medical Centre pilot was launched at the end of August and since then there has been an unquestionable improvement in the number of DNAs. In June, July and August the average equalled 12 ‘no shows’ per week, however after introducing Patient Care Messaging and by the third week in September DNAs at the practice gradually fell to zero.

Islington PCT does not expect Patient Care Messaging to be a miracle cure for missed appointments, as Simon Jones, Primary Care ICT Manager for the PCT explains: “It’s unavoidable that some patients will still fail to inform the surgeries that they can’t make their appointment and some patients do not own a mobile phone. However the surgery has publicised the pilot in the local press and through leaflets and waiting room posters. Patients are also asked for their mobile numbers at reception so that they can be included on the reminder system - they can of course opt out if they wish.”

Commenting on the relevance of SMS reminders and the PCM pilot at City Road Medical Centre, Practice Manager Stephen Colman said: “There has been an increasing trend for patients to give us a mobile number, and for many mobiles are the preferred point of contact. Although it is still early days, the fall in the number of DNAs speaks for itself.

The PCM system is accessed with a web browser on a secure website within NHSNet and the automatic appointment reminders work by extracting the relevant information from EMIS, the surgery’s clinical system, to create an SMS message which is sent from the secure server to the SMS gateway operated by Orange. Messages are sent out in batches twice a day, 24 hours in advance of the patients’ appointments, for example patients with morning appointments are sent a reminder at 8am the preceding day and reminders for afternoon appointments are sent at 12am the day before.

The patient can then choose to respond to the reminder by confirming, rescheduling or cancelling the appointment by either calling the healthcare site or replying with an SMS message. If an SMS message is sent in reply, it is converted by iPLATO’s system into an email and delivered to the healthcare site’s administration.

Stephen continues: “All the staff operating the PCM system received comprehensive onsite training from iPLATO so they are all aware of its capabilities beyond the automatic appointment reminders.”

Commenting on the viability of PCM and the possibilities for commercial use after the pilot, Simon Jones said: “The system could also be used to remind new patients about their registration appointments; high-risk patients to come in for flu jabs; new mothers about post-natal clinics; and interaction with people that are hard to reach - the so-called ‘excluded’ and ‘disengaged’ patient groups.”

Arjen Soetekouw of iPLATO commented: “Improving access to healthcare and reducing absenteeism in the UK is a very pertinent issue and Patient Care Messaging offers GP practices and hospitals a very effective tool in the kit bag. It is a guaranteed way of reaching patients without wasting healthcare resources as it requires no intervention from healthcare staff.

“It is not just a ‘quick win’ solution but an easily maintainable system that guarantees results. It is also a service that can be used in conjunction with other IT systems, as and when they are introduced according to the NPfIT schedule, to improve the efficiency and quality of healthcare in the UK.”

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iPLATO, specialist developers in mobile and wireless technology applications, has launched the next generation of Patient Care Messaging (PCM), a new system that integrates with existing healthcare administrative and clinical systems to send automated appointment reminders to patients.

The new patient service was launched at a celebratory occasion in London on August 26th, attended by a multitude of public and private healthcare organisations. iPLATO presented the new version of Patient Care Messaging to an interested crowd and formally launched the service by sending a text message to all people present.

Over the past few years absenteeism has been highlighted as a serious issue and the Doctor Patient Partnership has, since 1999, been running a campaign to highlight missed GP and practice nurse appointments. Its independent research* revealed that UK patients miss 13 million GP and practice nurse appointments per year, the reason most frequently cited being simply: ‘I forgot’.

With each GP appointment estimated to cost at least £18 it is estimated that, missed doctors appointments cost the NHS a staggering £162 million a year.

“With the public announcement of the National Programme for IT (NPfIT) two years ago NHS Trusts are now obliged to take certain steps to introduce new IT systems and services to benefit both NHS staff and patients,” explains Arjen Soetekouw of iPLATO. “Appointment reminders have not been included as a requirement of the NPfIT but one of its major aims is the provision of an electronic booking (Choose and Book) service that will allow patients to book their appointments, at a time convenient to them.

“iPLATO’s PCM system is designed to complement the Choose and Book service. With a national roll out of PCM it would easily be a valuable extension to the national IT infrastructure, as both initiatives have similar goals and require similar patient data.”

Patient Care Messaging aims to proactively reduce absenteeism and improve the quality of care. It is based on iPLATO’s SMS (short message service) technology and runs over Orange’s gateway services which control the message delivery to thousands of patients. A server system managed by iPLATO is hosted within NHSnet, the NHS’ existing secure administration network. It collates data from the clinical systems and transfers these into text messages to be sent to the patient’s mobile phones at a set interval prior to their appointment.

The patient can then subsequently choose to respond to the reminder by confirming, rescheduling or cancelling the appointment by either calling the healthcare site or replying with an SMS message. If an SMS message is sent in reply, it is converted by iPLATO’s system into an email and delivered to the healthcare site’s administration.

iPLATO has several pilot projects running with NHS Trusts across London, including the Islington Primary Care Trust and the North East London Mental Health Trust, which so far are receiving very positive feedback indicating that the Patient Care Messaging is having a positive impact on absenteeism.

Arjen Soetekouw of iPLATO commented: “Healthcare managers have by now tried a number of different ways to reduce absenteeism, for example, telephone calls and letters to remind patients but these methods are usually relatively ineffective or disproportionately time consuming. With our Patient Care Messaging system, appointment reminders are automatically sent, without the need for intervention from healthcare staff, to patients’ mobile phones, which are inherently personal devices and thus always carried by the user. A guaranteed way of reaching patients without wasting healthcare resources.

“With the ongoing National Programme and the emphasis on improving healthcare services the issue of absenteeism is becoming increasingly pertinent and a problem that if tackled appropriately could help eliminate wasted resources.

“Patient Care Messaging is a means for healthcare organisations to effectively reduce the number of ‘did not attend’ patients. It is not just a ‘quick win’ solution but a maintainable system that guarantees results. It is also a system that can be used in conjunction with other IT solutions, as and when they are introduced according to the NPfIT schedule, to improve the efficiency of quality of healthcare in the UK.”

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Notes for Editors:

*The Doctor Patient Partnership (DPP) and Institute of Healthcare Management survey (August 2004), conducted for the DPP’s ‘Keep it or Cancel it’ campaign, revealed:

•  9 million missed GP appointments per year
•  Just under 4 million missed practice nurse appointments per year
•  Missed GP appointments cost around £162 million per year (estimating that a GP appointment costs £18)
•  37% of GP practices believe that reminding patients about their appointments could reduce these    figures
•  67% of practices think that patients ‘forget’ their appointments.

The survey was conducted with 707 GP surgeries throughout the UK.