Background

Oldham Council, Oldham Cares, and Oldham Hospital sought to digitalise a critical, paper-based process in the absence of an Acute Electronic Patient Record (EPR). The goal was to enhance collaboration across the health and care sector, reduce inefficiencies, and improve patient care. A key challenge was the Discharge to Assess (D2A) process, which relied heavily on manual paperwork, leading to delays, inconsistencies, and duplication of effort.

To address these challenges, the project aimed to create a customisable, interoperable digital solution that could be shared regionally and integrated into existing technical infrastructures, while ensuring a seamless user experience for multi-disciplinary teams (MDTs).

‍Challenge

The existing paper-based D2A process was inefficient, time-consuming, and lacked integration between multiple organisations. Key challenges included:

• Fragmented workflows between hospital and community care teams.
• Delays in processing patient discharges, increasing hospital re-admissions.
• Manual data entry, leading to errors, duplication, and inefficiencies.
• Lack of real-time information sharing among care professionals.
• Limited technical integration across Oldham’s health and care ecosystem.

The need was clear: a fully digital, interoperable platform that enabled care teams to work together seamlessly, ensuring a safe, structured, and efficient patient discharge process.

Solution

Aire Innovate provided a customisable digital platform to streamline the D2A process, leveraging Azure infrastructure and existing technical capabilities from Unity Partnership. 

The solution was designed to be highly adaptable, addressing the specific needs of Oldham’s health and care sector while allowing for future scalability. 

Key features included:

• Secure Digital Form: Hosted by Unity Partnership, replacing paper-based documentation.
• Azure Active Directory Integration: Allowing secure single sign-on for NHS staff.
• Seamless API Integration: Linking Oldham’s Azure environment to the Northern Care Alliance’s Patient Administration System (PAS), enabling real-time patient searches by hospital number and DOB.
• Multi-Device Accessibility: Designed for use on any device, including smartphones (iPhone 5 and above).
• Intuitive User Interface: Features like navigation panes, structured logic, and automated validation ensure ease of use.
• Role-Based Access Control: Enabling MDT professionals to view, edit, and submit referrals collaboratively.
• Custom Fields for Enhanced Patient Care: Temporary address, frailty score, and COVID-19 vaccination status were added to enrich the patient discharge dataset.

This first-of-its-kind implementation in Oldham successfully integrated new technology across multiple organisations, paving the way for a more collaborative and data-driven approach to patient care.

Results

The impact of Aire Innovate’s customisable and interoperable platform was significant:

• 99% of D2A referrals are now submitted digitally, ensuring the most accurate, up-to-date patient information is available.
• Eliminated paper-based inefficiencies, reducing administrative burden and errors.
• Faster, safer discharges, improving patient outcomes and reducing re-admissions.
• Enhanced MDT collaboration, allowing professionals from different organisations to work on the same referral seamlessly.
• Scalable digital capability, designed to be reused regionally and extended to support additional healthcare workflows.

The feedback from care teams has been overwhelmingly positive, with recognition of the platform’s usability, efficiency, and adaptability. This project has not only transformed the discharge process but has also established a blueprint for future digital healthcare initiatives across Oldham and beyond.