Digital system from BookWise (FOI)

​Request

With regards to the article published by Channel 103 14/10/2024

£40k saved as new digital system at Jersey's hospital reduces chemo waste - Channel 103 

stating that he hospital has saved £40,000 worth of chemotherapy so far this year due to waste reduction thanks to their new digital system from BookWise, please can you answer the following questions:

1. What date was the new digital system from BookWise brought in?

2. What does "access to patient data in real time" mean? Please can you give an example to demonstrate the difference between "the old system" and "the new system"? The article refers to pharmacy preparing treatments ahead of time but patients needing to cancel their treatment on the day - how does a computer system help this situation if the chemo has already been prepared?

3. How have the digital upgrades improved waiting times for patients?

4. How much money does the hospital expect to have saved by the end of the first year with this new system?

5. For how long was "the old system" in place?

6. How much has the hospital spent on wasted chemotherapy over the last 5, 10, 20 and 30 years?

Response

1

October 2023

2

When a change in treatment is made in Oncology, Pharmacy is immediately aware of it in real-time, instead of the delay experienced in a paper-based system.

Old system:

• The hospital previously relied on manual booking systems and paper diaries.

New system: 

• With the digital system, any changes in a patient's treatment status are updated instantly. If a treatment is started, changed, delayed or cancelled, this is updated immediately.
• Some drugs are individually pre-packaged from the manufacturer; if the treatment is cancelled and the drug did not leave the Pharmacy aseptic unit, it can be returned to the stock.

Bookwise allows the Oncology team to see the patient’s whole past and future treatment pathways and bookings. This allows a complete patient journey to be viewed in one screen. It also allows the team to see if treatment was completed, deferred or skipped. The previous paper-based system involved manually reviewing diaries to determine dates of treatment.

• When referring an individual to a tertiary centre, the patient's treatment pathway can now be printed with one button-click and this information can then be transferred with the referral.
• Any clinician (nurse, pharmacist, dietician, doctor) with approved access can now view the patient’s treatment pathway at any time.
• When cancelling and rebooking appointments;

o The paper diary system involved drawing a line through cancelled appointments in the diary and searching for an available slot to rebook into.

o Bookwise enables appointments to be deferred, skipped or cancelled, and will automatically reschedule the future appointments

If Chemotherapy is sent to the Oncology Unit and stored in the fridge;

o Previously, the Pharmacy may not have been alerted to the cancellation of treatment on the day. Chemotherapy may have remained in the Oncology Unit fridge overnight or, potentially, a couple of days before being returned to Pharmacy. Such delays result in the treatment being expired and unsuitable to be placed back into stock. 

o With Bookwise, as Pharmacy can see the treatment has been cancelled, they can coordinate the return of the treatment in a timely fashion. 

3

The digital system has streamlined operations and communication within the department, and between Oncology and Pharmacy. Patient waiting times and journeys have been improved through the booking system, which is designed to maximise efficiency, ensuring that treatments are booked appropriately with exact times (taking into account chair availability, nurse time and expertise required to administer the treatment, and pharmacy preparation), reducing delays and minimising patient waiting times.

4

As stated in the article, there has been significant financial saving through reduced wastage, which can be costed against the particular treatments.  Future cancellation and resultant waste is an unknown, and addressing this query would require speculation on future outcomes, whereas Freedom of Information is a mechanism to enable access to information held in recorded form by a Scheduled Public Authority. The requested information is not held. Therefore, Article 3 of the Freedom of Information (Jersey) Law 2011 applies.

Aside from the reduced wastage of chemotherapy drugs, the efficiency in the system releases clinical staff from manual processes, allowing more time to be spent interacting directly with the patients they are treating.  

Bookwise allows capacity and demand reporting, enabling the Oncology team to review quieter periods of time where it may be possible to utilise chair space for shorter duration treatments. It also provides accurate reporting of nurse point usage. Whilst this may not give a direct cost saving, it provides a structure for workforce planning. 

5

It is understood that the manual paper diary system has been in place for over 30 years prior to the new system implementation, but a record of the exact timeframe is not held. Therefore, Article 3 of the Freedom of Information (Jersey) Law 2011 applies.

6

Information covering the timeframes requested is not available. Therefore, Article 3 of the Freedom of Information (Jersey) Law 2011 applies.

Value of chemotherapy wastage each year, from 2021 to 2024 is available, as detailed in the table below. Data for 2024 is reported through to October 2024. 

While the figure reported shows the efforts to address chemotherapy waste, even in the NHS, specific data on the total amount spent on wasted chemotherapy is not readily available. Studies have indicated that chemotherapy waste can range from 2% to 20%. Implementation of waste reduction strategies, such as dose standardisation and real-time data systems, is crucial in mitigating financial losses associated with chemotherapy waste.

Article applied

Article 3 - Meaning of “information held by a public authority”

For the purposes of this Law, information is held by a public authority if –

(a)     it is held by the authority, otherwise than on behalf of another person; or

(b)     it is held by another person on behalf of the authority.​