Summary
The Electronic Holistic Needs Assessment, Care and Support planning tool has been developed over the last four years. Working with NHS trusts, the charity has developed an effective, easy-to-use tool that provides a simple process for assessing the needs of cancer patients and providing appropriate care and support. All of this is written-up in an electronic record that can be saved and shared with patient and the wider MDT. It starts with the patient filling in a questionnaire about his or her concerns, on a touchscreen device, and the concerns are sent to his or her health or social care professionals to help inform his or her discussions.Challenge
Research tells us that a quarter of cancer patients have unmet needs a year after treatment, due to cancer or its treatment. Effective assessment and care planning to identify people’s concerns and needs can lead to early intervention, diagnosis of consequences of treatment, improved communication and better equity of care. The development of Macmillan’s electronic Holistic Needs Assessment (eHNA) began in 2011 with the aim of providing a tool to facilitate these improved outcomes for patients and to provide management data to support the work of healthcare professionals and inform commissioners. Data identifying the number of assessments carried out on paper has been difficult to measure, adding further weight to the case for an easy-to-use electronic tool.
Objectives
To develop an electronic format for holistic needs’ assessment, care and support planning, meeting strict information governance criteria and data protection regulations. To approach and engage with Trusts and community teams which wish to use the eHNA and care planning tool and ensure that feedback is used to develop the tool and any ideas are scalable. To use data from the eHNA, care and support plans to understand the needs of cancer patients and support service planning.
Solution
Planning for the eHNA began in 2011, working with four pilot sites to understand the impact an electronic assessment tool would have on the HNA and care planning process. The pilot project was conducted over one year; however, it quickly became necessary to broaden the userbase and establish a body of evidence to demonstrate the effectiveness of the eHNA. Expressions of interests were sought from teams in Trusts already providing paper assessments. Participating sites were required to have a project steering group, and for the application to be signed off by the chief executive. A key decision at the start of the pilot project was to use tablet devices to enable the patient to complete the assessment for him or herself. While Trusts have access to the full data set collected for their patients, Macmillan has access only to non-identifiable aggregate reports. Working through the many complex information governance requirements was a key task in moving the project forward – each participating team needs to be satisfied that local and national policies are being met. The eHNA team has daily and weekly reports for each site which includes number of assessments, care plans and the conversion rate from assessment to care plans. This helps the team track the progress of the eHNA development at Trust level. The aggregated data is used by Macmillan to report on the needs of cancer patients.
Results
People affected by cancer feel they have had their needs met and have experienced improved quality of life. For health professionals, using the eHNA has given them greater confidence to undertake assessment and care planning. The project made significant progress over the course of 2013-2015, with the number of sites enrolled and the number of assessments increasing substantially. Currently there are 72 sites using the eHNA. The average number of assessments (across all sites) is 1,300 and 1,150 care plans per month. The conversion rate from assessments to care plans is consistently around 90% over the last three months.
Learnings
The biggest barrier to HNA provision continues to be lack of time and space to undertake the assessment and care planning. eHNA teams looked to overcome this by process mapping their patient pathways and identifying clearly defined eligibility criteria when deciding who to offer the eHNA to. While electronic assessments and care planning take marginally longer than verbal or paper assessments our evaluation shows that the electronic format provides a more thorough process resulting in a more focused assessment.
Evaluation
As well as the independent evaluation of the eHNA by Ipsos Mori we have access to live data and collect a daily and weekly update on site activity. We can also look at individual sites or at a regional or national level. This is an aggregated view of the eHNA outcomes such as the number of assessments, care plans and conversion rate. We can also view the top concerns, information needs and intended actions to support these. The system allows us to view the concerns and needs of people living with a cancer diagnosis based on tumour type, pathway stage and age.
