By Georgina Adamson
Blog 3 June 2016

I am delighted to announce enhancements to our INR self-testing service being used by 450 patients at County Durham and Darlington Foundation Trust (CDDFT). Integration with decision support software, 4S DAWN, means that anticoagulant dosing time that was initially reduced from 5 minutes to 3 minutes can now be completed in 30 seconds, saving clinicians even more time. The service has already made a saving of 21,000 clinic appointments, equivalent to a £125,000 saving in staff time alone. Scale this up to the 1.2 million warfarin users in the UK, and a saving upwards of £150 million per year could be made in the NHS.

With 4S DAWN integration, INR results taken from home by warfarin patients can now be made immediately available to the clinic team, making great strides towards a fully digital NHS by 2020. This removes the need for nurses to manually enter the patient’s test results, enabling nurses to spend more quality time caring for patients, and reducing the chance of clinical care being impacted by clerical error. This service will be offered to the hundred-plus hospitals which use 4S DAWN’s anticoagulation software, enabling a big difference to be made to the quality of life of thousands of patients, and reducing the financial strain on the NHS.

How does the service work?
The INR self-monitoring service reminds remote users to take a finger prick blood sample using a self-testing device. The patient securely sends their INR reading to the local clinic at their chosen time and via their communication of choice, such as an automated phone call or by going online. 4S DAWN anticoagulation software automatically calculates the patient’s new warfarin dose which is then checked and confirmed by a nurse.  Finally the dose is relayed back to the patient and fed directly into their medical records.

What does the future hold for digital health?
Whilst this integration is enabling great benefits for both clinicians and patients at CDDFT, I believe that this model can be applied to the wider population of warfarin patients enabling safe, efficient and cost effective care across the whole of the NHS. Streamlining the anticoagulant pathway gives patients a greater responsibility to manage their condition, whilst feeling fully supported remotely.

The broader vision for this holistic model of care is to adapt the INR pathway to long term conditions across the board, whether it be diabetes, COPD or mental health, enabling much needed widespread time and monetary saving in the NHS, all whilst enhancing patient care. Applying this approach to just 10 pathways could easily see savings in the NHS of billions of pounds per year.

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