Automation for better patient outcomes

The impact of COVID-19 on the healthcare sector has been profound, leading to levels of transformation and change that many would have never believed possible. This article, written for Agilisys by Marc Hardwick, Research Director at TechMarketView, explores why adoption of one of this year’s most talked about technologies – robotic process automation (RPA) – […]

The impact of COVID-19 on the healthcare sector has been profound, leading to levels of transformation and change that many would have never believed possible.

This article, written for Agilisys by Marc Hardwick, Research Director at TechMarketView, explores why adoption of one of this year’s most talked about technologies – robotic process automation (RPA) – continues to accelerate and how organisations can successfully automate processes to achieve better patient outcomes.

2020 has proved to be a year like no other, as healthcare providers have seen their already stretched resources pushed to breaking point by the response to COVID-19. Healthcare has faced, and continues to face, enormous challenges dealing with the crisis. To date, technology has played a key role in offering solutions and we have seen new digital services introduced to the NHS at a speed that would have been unthinkable previously. Barriers have been knocked down overnight and we have heard repeatedly of digital progress being made in days that would otherwise have taken months, or even years. All this has impacted the adoption of Robotic Process Automation (RPA), in particular. Indeed, pressure on the NHS has caused many organisations to accelerate the adoption of automation solutions like never before.

RPA sales and deployment have been growing significantly over recent years and have become an important component of the wider UK enterprise software market in their own right. We estimate that the broader UK market for RPA software and associated services was already worth over £350m per year in revenue prior to the pandemic.

The strong focus on digital transformation in the NHS Long Term Plan and associated policies, as well as the ongoing requirement to improve effectiveness and efficiency, has helped make RPA a key growth area in healthcare. However, it remains in the main an embryonic and immature technology and whilst it has been delivering pockets of tactical value within specific teams or use cases, it remains a long way from being a strategic asset underpinning genuine wider digital transformation.

The rush to develop automation solutions, particularly in response to COVID-19, has added to already complex digital estates where ‘point’ solutions remain disjointed and often chaotic. Healthcare organisations are going to need support and guidance to ensure they leverage the investment made to date and get strategic value from automation as an integrated part of any wider digital strategy.

Accelerating RPA adoption within the NHS

RPA has proved its value in organisations that deploy lots of legacy systems and applications and where that environment has created lots of inefficiencies. There are approximately 50 standard business processes where RPA is proven to work well, typically within the back office of large-scale organisations. These include: payroll processing; tax filing; employee onboarding and offboarding; data aggregation and migration; and pricing.

Different parts of the NHS and the organisations within it, remain at very different stages of maturity on their automation journeys. There remains a mixed understanding of RPA and the benefits that it can deliver. This has resulted in some clients underestimating the cost and time associated with upfront and ongoing work that can sometimes manifest in delays following proof of concepts and pilots.

Breaking down the barriers to adoption: getting the culture right

Accelerating adoption of automation requires a number of key barriers to be overcome. Fortunately, there is much to be learnt from NHS ‘RPA Pioneers’ keen on sharing and collaborating.

One of the most important barriers regardless of sector is organisational culture. The move from more tactical productivity enhancements and efficiency gains towards improving patient outcomes is moving the measurement of success away from FTE (Full time equivalent role) reduction towards outcomes, such as ‘time saved’ or patient experience improvements. Today’s focus is more on doing things better, and less on doing things cheaper.

Pioneers such as East Suffolk and North Essex NHS Foundation Trust started by setting firm expectations around what automation meant in reality, conscious that they did not want robot technology to appear threatening. The mantra selected for automation was “making time matter” – the emphasis being on demonstrating how RPA would help clinical and corporate staff free-up valuable time that would then be better spent on patients. Whilst there were some secondary benefits, for example increased clinical utilisation and a reduction in outpatients, the primary goal, and measurement of success, was time saved. Decisions were also made to be very open and honest about the technology and not hide the robots away. Robots were given their own identity on all the Trust’s different systems and are now fully engaged with the security and information governance teams, ensuring that there is full control and compliance over the work undertaken.

Engagement aids adoption

Engaging early throughout an organisation, showcasing the robots and pushing a ‘time matters’ agenda will help drive adoption. Successful Trusts have run programmes of engagement workshops where staff are asked to nominate processes that were either unpopular or inefficient, and that might benefit from automation. Governance is critical – in East Suffolk and North Essex all automation opportunities are governed by an ‘e-Health Group’ which is managed by clinicians,  and which evaluates all the opportunities and prioritises processes based on a number of factors – including how much time would be saved; the clinical risk; and impact on the speed of the patient journey. The governance has been introduced to ensure that the processes that are automated are not necessarily the easiest but are aligned with the organisation’s strategic objectives.

Saving time and improving the patient experience

Another RPA pioneer, the University Hospitals of Morecambe Bay, focused its initial efforts on two key areas – firstly using RPA to improve the patient experience, and secondly looking to save healthcare professionals time in their day jobs, so that they could spend more time using the specialist skills they had trained long and hard for. The Trust was also keen to make best use of the work done elsewhere and saw the NHS Digital Exchange and Blue Prism Cloud as great sources of use cases and evidence base for what was possible.

In the patient experience space, Morecambe Bay built an automation process to communicate with large volumes of patients at short notice. This saw digital workers employed to help patients’ book, prepare for and follow up appointments, ensuring everyone received tailored communications, confirming each step of their treatment. With 600,000 hospital appointments booked a year, there was no way staff could have proactively managed that level of personalised communication manually.

When it came to saving time for specialist skilled professionals, they initially focused on midwives, where information was constantly having to be transferred from one system to another. Midwives are specialists and it made little sense for them to spend their valuable time focused on data entry. For example, midwives were taking blood samples from new mums-to-be, then sending the samples off to a lab in Newcastle with results coming back via the labs own system. Results were then having to be manually downloaded and entered back into the Morecambe Bay patient record systems. This was taking a specialist Midwife up to two hours per day. They have now automated some 90% of this and will eventually automate the entire process so it uploads automatically directly into the Electronic Patient Record (EPR) system. The midwife then just receives a summary report across all the different patients being able to quickly identify which results have come back.

East Suffolk and North Essex has also been championing the use of robot technology on processes that directly impact patient care and believe they are one of only a handful of Trusts doing this, having created a clinically safe environment with all the appropriate safety checks and governance layered around it. The Trust has gone live with a project involving multi-disciplinary teams for cancer services, where a team of experts around the country can review a patient’s diagnostics, imaging and CAT scans, and decide on a course of action. Taking the clinical output and updating the patient record and contacting the GP will now be done by a robot saving a considerable amount of admin time.

Adoption via collaboration: cloud-based RPA

Progress made by both East Suffolk & North Essex and Morecambe Bay was underpinned by a spirit of collaboration making sure the wider NHS was benefiting from early automations, treating the NHS as a single organisation, and going on to help create a marketplace for sharing work across Trusts. This has now morphed into the NHS Digital Exchange, an “automation library” owned by the NHS and hosted by RPA software provider Blue Prism, making much of the automation work done to date freely available to any other healthcare organisations in the country currently utilising Blue Prism Cloud. This is now providing access to 40-plus pre-automated processes that can be downloaded and adapted to other Trusts, all designed to save time and money and avoid “wheels being reinvented”.

Some 20 or so NHS Trusts have now joined this community of healthcare organisations sharing tried and tested automations to help accelerate and scale activity. The library of pre-built automation assets covers a broad range of processes from tackling enhanced access to services, and patient communication from admissions through to outpatient support. Automations enabling key back office support for things like recruitment, HR onboarding, and finance processing are also available. As each Trust contributes new assets into the growing library of automations, the benefit of RPA grows accordingly, helping speed things up and in turn deliver better value for money for the taxpayer.

The ROI of cloud is now proven – it is no longer an early stage technology or something that requires early adoption of customers. Cloud offerings have matured, and they have the reference ability and scale required. Many organisations now have a preference or mandate to choose a SaaS product over building out an architecture for themselves. Even for some existing on-premise customers, the advantages of scalability via SaaS or access to additional features of a cloud platform, can challenge a business to consider whether they should migrate from a full on-premise architecture to a SaaS model, or take a further step forward and join a hybrid environment.

The other advantage of the SaaS based product is that it has the potential to bring the benefits of enterprise automation to a market of smaller organisations. SaaS can definitely help smaller organisations get the benefit of automation, with programmes easier to start, test and evaluate, and all with a better ROI. This offers better value for an organisation that may not be able to set up an automation Centre of Excellence and invest in dedicated servers to run RPA and has a low cost of entry. As a consequence, we have seen almost all the major RPA vendors invest heavily in developing and marketing cloud native options for their software.

Moving from ‘Digital Chaos’ and task automation to genuine strategic value of Intelligent Automation

TechMarketView’s theme for 2020 is ‘Digital Chaos’ – highly applicable to the state of the automation market within the NHS – one of unruly digital development and a proliferation of automation point solutions. Much of the focus has been on RPA and where, despite lots of Proof of Concepts (PoCs) and multiple use cases, implementations often have not scaled. Despite a number of very public outliers who have led the charge in both the uptake and visibility of RPA technology, RPA rollouts have typically been led by individuals within their Trusts who have continued to push forward new use cases and champion its utilisation. Risk aversion is certainly an issue, pulling the focus towards task automation and a limited roll out.

However, the end goal was always meant to be genuine process automation, enabling clients to run processes flexibly and in a manner conducive to withstanding digital change. Intelligent automation underpinned by AI will eventually replace today’s rules-based software. We expect to see RPA and AI and ML getting much closer together, dramatically increasing the flexibility and intelligence of automation software. Robots will get to a position where they can identify suitable processes for automation and then set about making it happen.

Automation as a strategic asset is a potential game changer for healthcare but organisations are going to need a lot of support and guidance if they are to align automation with the wider corporate strategies in a fashion that will drive transformational change. Specifically, healthcare needs support around change management, training and governance and to move the focus away from the technology and towards patient outcomes if automation is to be adopted in a more strategic way that supports wider digital transformation programmes.