Technology addresses the backlog of gastrointestinal endoscopy referrals

Working with the Academic Health Science Network for North East and North Cumbria (AHSN NENC) and UCLPartners, software developers Cievert are implementing their Casper digital platform to develop an innovative pathway management system for gastrointestinal endoscopy (GIE) in West Hertfordshire Hospitals NHS Trust.

The implementation started in January 2020 and the two Academic Health Science Networks (AHSNs) will be supporting an evaluation of the project for clinical and economic impact.

Increasing demand and impact of COVID-19

Over the last five years the demand for gastrointestinal endoscopy (GIE) has doubled to 3 million procedures per year. Coupled with COVID-19 restrictions on endoscopies, this has meant a greater need to review and prioritise referrals effectively.

Before the pandemic research showed that a number of services reported difficulty in meeting national waiting time targets with a national average of only 55% of units meeting urgent cancer wait targets.

During the COVID-19 pandemic the British Society of Gastroenterology (BSG) is recommending that all non-emergency/essential endoscopy are ceased which means there are about 4,500 procedures for every trust to review and prioritise to minimise risk to patients.

Managing this back-log will require significant resource and increased focus on additional administrative activity.

Current systems for GIE

Each referral for a GIE is manually triaged by a consultant Gastroenterologist and, for most hospitals, this process is paper-based. Some trusts do use an e-referral systems but these are not designed specifically for GIE and the digital referrals often replicate many of the problems inherent in a paper system, such as the inability of the system to check for incomplete or inappropriate referrals.

The current approach to triaging referrals faces various challenges both in terms of the value of the information collected and the time taken.

Cievert’s solution

Cievert are a well-established NHS spinout with experience at co-producing innovative digital solutions. Casper is their web-based platform that orchestrates specialist clinical pathways by capturing information intelligently and disseminating it to help make processes and workflow more efficient.

Its most established use is in radiotherapy where it already manages a quarter of NHS radiotherapy referrals and it is also being used in pathology for reporting in the North-East of England. More recently with the support of UCLPartners and the AHSN NENC it is being developed for the management of endoscopy requests through a project at West Hertfordshire Hospitals NHS Trust.

This project aims to develop a cutting-edge pathway management system for GIE that will improve efficiency, alongside reducing risk and waiting times. It will do this in a number of ways:

  • Pre-screening referrals for appropriateness by putting in checks and prompts so as to minimise the dataset with which the staff are working.  
  • Automating administration tasks against clinical protocol, for example allowing the user to skip sections that are not relevant and for the system to communicate directly with the referrer.
  • Providing real-time reporting and oversight to inform clinical decisions.

“There was a clear absence of an intelligent, comprehensive and efficient endoscopy requesting tool available. Utilising Cievert’s programme Casper, we have built a system that can request an endoscopy electronically and also allows immediate access to guidelines and instructions for referrers.”

Dr Landy and Dr Shariff, Consultant Gastroenterologists at West Hertfordshire Hospitals NHS Trust

Dr Landy and Dr Shariff continued: “The system also allows vetting of the procedures by a specialist and then direct communication between the vetter, referrer and administrative team to organise the booking. Finally, communication with the patient, using Cievert’s programme Penguin, is also facilitated allowing questionnaires to be electronically sent to patients, vitally important during the COVID-19 pandemic. The result is a highly versatile and efficient system which is a pleasure to use.”

Cievert have been working closely with West Hertfordshire Hospitals NHS Trust to co-develop the project, engaging with all staff who will be using the system. They will be starting by digitising and streamlining two of the referral pathways (colonoscopy and oesophago-gastroduodenoscopy (OGD), building this up to working across all nine GIE pathways that are currently in use within the trust.

Projected impacts and benefits

The proposed solution will build upon Cievert’s Casper technology, which has been proven to be clinically and commercially successful in radiotherapy.

Through pre-screening referrals, automating administration and providing real-time reporting it will increase effectiveness and efficiency of the clinical pathways in terms of decreasing the number of cancellations, and reducing delays. It is also expected to eliminate incomplete or inappropriate endoscopy referrals, reducing unnecessary travel for patients.

“This is a fantastic opportunity for us to co-develop a system to help alleviate the increasing pressure of the backlog of GIE referrals that has been compounded by COVID-19 pandemic.”

Chris Kennelly, CEO of Cievert

“With the support of UCLPartners and the AHSN NENC we have been able to put this real world validation in place,” he added. “This will help us to refine our approach and collect data to improve how we automate triaging and clinical decision making to help NHS staff. Already we have learnt so much from the staff at West Hertfordshire Hospitals NHS Trust, which has been invaluable in helping us to ensure that Casper provides a truly practical solution on every level.”

The solution will immediately benefit the patients most inconvenienced by COVID-19 in one of the hospitals hardest hit. Longer term it will benefit more than 16,000 patients at West Hertfordshire Hospitals and up to 3,000,000 GIE patients nationally before scaling internationally.

It will enable greater efficiency within endoscopy services and improve decision making so appointments and diagnoses can be made sooner and the time traditionally taken up with administration can be freed up for clinical work.

Russ Watkins, Commercial Director at the AHSN NENC, said: “The AHSNs play an important role as the interface between the NHS and industry and this collaboration is a fantastic showcase of what can be achieved through partnership working.

“This innovative GIE pathway management system will improve both service efficiencies within the NHS and patient care. We’re excited to be involved in the evaluation of this transformative solution alongside UCLPartners and we look forward to supporting its potential spread and adoption in other Trusts in future.”


“This partnership between Cievert and West Hertfordshire Hospitals NHS Trust will provide a much-needed transformation of the current GIE pathways, benefitting patients and NHS staff.”

Suzanne Ali-Hassan, Head of Commercial Engagement UCLPartners

She continued: “In the context of the NHS Reset campaign, it is an example of innovation addressing an existing problem that has been worsened by the COVID-19 pandemic and UCLPartners are looking forward to helping support its adoption and spread. The evaluation will not only inform how to develop this approach for GIE so it can be more widely adopted in other trusts, but more generally it will provide insight into how to sustainably implement new technology at this crucial time and ensure it continues to add value in the future.”