TCC-CASEMIX™ – the first national exemplar for the surgical pathway, enabling major new insights for embodied carbon as well as surgical productivity, and patient safety.
TCC-CASEMIX Limited commenced trading in January 2020 with a significant social purpose, but also generating equally significant commercial value. Our purpose is transformational (an often over-used term) for surgical services delivery. Read on and you will understand very clearly why we make this claim. Our strategy was to deliver a digital exemplar for the surgical pathway in acute care services, and this is what we have achieved. By this we mean that at every stage of the patient journey, a digital data flow supports the pathway, from the pre-operative stage, through peri-operative and post-operative stages.
Why is this important?
- Because the health system is highly fragmented, largely because of the incompatible systems that support the myriad of digital subsets of patient data. The fragmentation can lead to significant patient safety issues, where incomplete patient data leads to mis-diagnosis, directly impacting patient health and well-being, and in some cases, leading to the death of the patient. No where is this more acute than in the surgical pathway.
- It is important also because without the digital dataflow, this leads to surgical service providers unable to manage their theatre resources efficiently, and this leads to a sub-optimal process with poor productivity. Specifically, providers have a paucity of data to inform surgical list planning. This has been specifically highlighted in the ‘Getting It Right First Time’ [GIRFT] initiatives.
TCC-CASEMIX™ technologies addresses all these needs, and more, because we acquire unique surgical pathway datasets never previously achieved. For example, real-time data capture in the operating theatre, means that our algorithms are able to make the direct correlation between patient complexity and the impact on surgical procedure duration. Rather than the vague estimates of procedure duration that charcterises the existing process, we produce statistically reliable forecasts of list completions. It is this capability that delivers substantial productivity improvement of between 20%-40% – directly benefitting patients.
Nowhere is as important for patient safety as the use of implantable medical devices used in surgery, where TCC-CASEMIX™ technologies provide full traceability. Other initiatives have attempted to do this, but simply lead to yet another piecemeal dataset, offering limited value. However, TCC-CASEMIX™ also conjoins medical device performance into the dataset of patient diagnostics and demographics. The value of this unique capability is that it enables medical device performance to be understood in the patient context – proverbial ‘gold-dust’ for manufacturers, surgeons, and patients alike.
To avoid the possibility of ‘yet another silo of data’, TCC-CASEMIX has developed a pioneering infrastructure known as an ‘Open Registry Infrastructure’ (ORI). We have created a means to harvest medical device data for the whole surgical pathway from across Europe, where our technologies are being deployed through this major new health technology. It is through the ORI where the digital pathway delivers major benefits because data harvested on the surgical pathway is accessed through a Data Access Portal ‘, shining a laser like focus into medical device performance from every major stakeholder perspective.
The Open Registry Infrastructure fulfils our social purpose to democratise data, and for the patient it delivers insights akin to a Trustpilot™ of medical devices, offering open transparency and quality assured data.
A Net Zero perspective
With the publishing of the NHS Net Zero ambitions, and more specifically the SBRI NetZero competition to decarbonise the surgical pathway, it will not be difficult to appreciate how TCC-CASEMIX can offer significant value to identify how and where carbon is acquired all along that pathway. With the total digital pathway now joined as a data flow, and with full traceability of all resources deployed in surgery, we have the framework to assimilate embodied carbon at every stage of the pathway. This is PredictOR, our award winning SBRI research.
Working with medical device, and surgical instrument manufacturers we support them in a full life-cycle carbon analysis. By mapping use of devices, instruments, and surgical procedure packs to every type of surgical procedure, the carbon footprint of each procedure is reliably forecast. It is here where the ORI delivers huge value, because it assimilates not only the physical performance of medical devices, but their environmental performance too.
Imagine this supreme potential – to have a medical device information system, that not only reports on safety and performance, but embodied carbon performance as well. Imagine that the carbon footprint choices are now available to the patient, along with the choice of surgical intervention and the choice of medical device, not suited to their needs. This is the ambition of TCC-CASEMIX with its pioneering PredictOR vision.
A tangible reality – PredictOR in practice
The vision for PredictOR is being trialled under the direction of Professor Richie Gill and his TOKA research programme. TOKA and PredictOR are offering a compelling value proposition. It is one where informed patient consent is being transformed through a new innovation in treating knee disease. It is a programme also being supported by our Working Group on Patient Public Involvement, led by Helen Hughes, Chief Executive of Patient Safety Learning, and the Cumberlege Committee Patient Reference Group
Conventional knee disease is often treated with what is known as a Total Knee Arthroplasty [TKA], where an implanted artificial knee is used in attempt to cure the diseased joint. A TKA can be unreliable and cause the patient significant pain and discomfort. There are a variety of alternative approaches to management of degenerative knee disease, these range from conservative (non-surgical) management to less invasive procedures such as high tibial osteotomy (HTO). In the TOKA research program we are investigating the patient impact alongside the carbon impact of the TOKA approach to HTO and the conventional TKA. The procedure enables the patient’s knee to remain intact, and instead the procedure makes the corrections required to the knee with a much smaller medical device.
What has this to do with carbon reduction? Firstly, it requires a much smaller implanted device that provides a brace to the knee, and this device can be formed using a new manufacturing process known as additive printing. The method of manufacture is quite different to the conventional foundry casting and milling processes used for TKA’s, and as such it is expected to result in significantly reduced carbon impacts.
The research is being carried out in the UK and Hungary, and directly comparable procedures are being undertaken using devices manufactured conventionally as well as under the new manufacturing process. TCC-CASEMIX technologies are being used to capture the necessary data in surgery (both patient knee metrics as well as procedure duration times). We expect to see faster procedure duration, leading to much improved productivity in knee surgery.
The research is also evaluating measurable patient outcomes factors, such as post-operative pain and mobility. In other words, it is a procedure that potentially offers, a low carbon solution, much improved measurable patient outcomes measures and at lower cost. It will demonstrate that not all carbon reduction initiatives necessarily involve greater costs to the NHS.