A digital ecosystem for acute oncology

Acute oncology (AO) triage lines play a vital role in providing urgent care for patients with cancer facing complications, and are typically managed by specialist nurses. There are 3000 calls per day from patients in England alone to AO triage lines for emergency support. However lack of capacity leads to high call waiting times and lack of specialist call-handling nurses frequently leads to unnecessary admissions for patients. Indeed it has independently been estimated that £650m is wasted across the UK on unnecessary AO bed days [NHS Wales]. There is also no routine method of logging information that arises from these calls (i.e. call volumes, wait-times and patient-related data e.g. symptoms and outcome). This means that we may be missing opportunities to learn and improve services. In this 2.5 year project, we will create a digital platform to help manage these calls better, to ensure: that patients at risk of adverse clinical outcomes receive prompt medical support and those patients who can avoid admissions are able to safely do so. Specifically, our existing digital platform co-developed with the East of England Cancer Alliance which digitally connects patients with AO services, ACORN (ACute Oncology care Reporting and Navigation), will be expanded in a step-wise manner. Our expanded platform, ACORN+, will integrate with devices (e.g. wearable BP monitors) and connect with electronic health records, however, standardised methods are needed to collect and assess this data, in an anonymised, secure and legally compliant way. We will therefore co-create guidelines with patients, for the industry on reporting certain data from these technologies, relevant to AO. Moreover we will incorporate elements of AI-supported decision making into ACORN+ to improve clincial workflows both in terms of efficiency and outcome. We will also build a secure database that is compatible with wide-ranging technologies, to store this data, that prioritises protection of patient data, does not infringe privacy, but can be used safely by the entire field for research and innovation. In sum, the ACORN platforms will be able to save the NHS 100s of millions of pounds each year whilst improving clinical outcomes and patient experience. ACORN+ will be developed in line with UK regulations and the novel AI-driven features will mean the technology will reguire approval as software as a medical device. Evidence of safety and reliability of the platform will be derived within a prospective clinical study. This work will be supported by a leading digital regulatory experts – Hardian Health. This project is a collaboration with key national stakeholders including Macmillan Cancer Support, the UK Acute Oncology Society, Cambridge University Hospitals and the East of England Cancer Alliances. These partnerships will help us to co-create a platform that addresses the needs of AO services, whilst delivering on health equality. Public and patient engagement work will be led by Macmillan Cancer Support, following a co-creation model ensuring that risks such as digital exclusion, data privacy concerns are mitigated against. Outputs will be presented at national and international meetings, and published in multiple peer-reviewed papers.