Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services, reflects on our recent sandbox work developing what good looks like in the use of digital triage.
The way health and social care is being delivered is constantly evolving, and over the last few years we have seen a significant growth in the innovative use of technology to support or deliver people’s care.
As services develop, I’m passionate that quality of care and patient safety remain central to how they deliver innovations. To enable this, and to ensure that as a regulator we have a clear view on what good innovation looks like, we’ve been working collaboratively. We worked alongside the people who use online health services, those who provide them, and our regulatory partners to encourage improvement, stay abreast of technological developments, and refine our regulatory approach — and we will continue to do so.
One area of innovation we’ve been looking at recently is the use of digital triage tools. Healthcare services can use an online tool that asks people questions about their symptoms; then, based on their answers, the tool uses an algorithm to make a decision on what service to direct them to, or it could be a tool that supports non-clinical staff to make triage decisions.
This is a really important area of innovation: effective triage helps ensure that people receive the right care at the right time, and that the resources of health and social care providers are used appropriately. We also know that if triage is not delivered well it can be a significant barrier for people trying to access services, and can cause a person’s health to deteriorate.
We needed to develop a clear view of what good looks like when using digital triage services. We’ve therefore just completed our first regulatory sandbox looking at this type of innovation.
A regulatory sandbox is a collaborative approach that brings providers, tech developers, people who use services and other regulators together to develop ideas in a common, open and safe space.
We’ve used this work to explore in detail what a good use of digital triage tools looks like, and to develop CQC’s regulatory approach where services are using them, building on our previous work to identify some questions to ask when assessing these services. The sandbox also enabled us to highlight issues that other stakeholders (like NHSX or MHRA) can address to help make sure digital triage is used safely.
Working in the sandbox, we built a consensus on what the characteristics of a good digital triage service looks like, based on CQC’s five key questions:
It‘s important that the use of digital triage tools includes the ability to identify and manage risk appropriately, and deliver a reliable, clinically-appropriate, robust and transparent service. We also think it’s important that their use forms part of a learning culture that identifies and manages risk, and learns from when things go wrong.
Suppliers of digital triage tools and the providers who use them should ensure they deliver outcomes based on the best available evidence, from sources both within their organisations and across health & social care. Tools need to draw on relevant clinical information, including from the patient record, and triage people appropriately to their level of clinical risk and need. To deliver the best outcome and promote a good quality of life, it’s also key that these tools recognise the different needs and circumstances of the people who use them.
Providers should think about how to engage with the people who use their services around using these tools, making sure they are easy to access and reflect individual needs. They need to help people to understand how the tools make decisions in a way that builds trust in the advice given.
It’s important that people who are unable or unwilling to use digital triage tools have alternative options to access services, and that the tools respect people’s preferences, reflect their diverse access needs and adapt to feedback. They also need to fast-track patients who are seriously unwell.
Innovations like digital triage should be used as a complementary part of a wider organisational vision of quality, supported by the right processes, people and external relationships to deliver high-quality care and continuous improvement.
You can find out more about what good looks like and other findings/recommendations by reading the full report , find out more about driving improvement through technology, and also check out our podcast on innovation and regulation everywhere you get your podcasts.