There is a blog that gives some background to Spiritum Duo here.


Spiritum Duo has been designed to simply, improve and speed up clinical pathways. There are many repetitive, mundane, error prone and slow tasks that clinicians, admin staff and patients are required to undertake to get a patient through their clinical pathway. Each task adds time to the whole pathway. By making incremental savings in time, but improving each step of the pathway, patients can receive faster care.

For those of you that are not familiar with the clinical pathways, what is being discussed is essentially the patient journey for a new disease that they have unfortunately acquired. For example, a patient finds that they are drinking more fluids and peeing more, they see their GP, they suspect diabetes, they undertake a blood test which confirms this, they start treatment, they find that the diabetes is difficult to treat and so they refer to secondary care. The secondary care clinician triages the referral, may organise further tests and then sees the pateint in clinic and then optimise their treatment. The patient may then attend the hospital every 4-12 months for review of their diabetes and complications associated with this disease.

Another example is a patient that finds that they have been more tired over the last 12 months. They see their GP, who finds that the patient has put on more weight, snores, and that their bedroom-partner has noticed that the patient stops breathing in their sleep. The GP refers the patient to the sleep service in secondary care. A secondary care clinician triages the patient, decides that the patient needs a sleep study, which is undertaken, reported, and the patient found to have obstructive sleep apnoea syndrome. The patient is seen in clinic, informed of their diagnosis and started on treatment. The patient is then followed up every 1-3 years.

As you can see from the two above examples, a typical clinical pathway consists of:

  • Patient has symptoms
  • Patient sees a clinician about these symptoms
  • Patient is referred
  • Triage
  • Investigations
  • Clinic appointments
  • Treatment
  • Follow up

When you start to look at different disease pathways through this generic “clinical pathway template” you can then look for what is different and what is the same between pathways. Where things are the same, improving these individual steps in one pathway can then improve the same steps in other pathways. So you speed up the retrieval of a referral from the national referral system eRS and triage, you speed this up for other pathways as well. You speed up the requesting of CT scans for lung cancer, you speed up CT requesting for surgery.

Where things are different between diseases, trusts or even individual clinicians, then you need some way to define this. This is where the pathway configuration file (PCF) is used. Where a pathway is different, for example on the types of investigations or treatments that are availble for a disease, then these are defined in the PCF. The exact contents and language used in the PCF is an ongoing project. Once defined and standardised, the PCF would be a universal way to define clinical pathways, and allow best practice and sharing of this knowledge.

The changes that need to be made to the individual steps do not necessarily need to be “smart” AI, automation or even digital. The changes are not “digital transformation”, they are “transformation with the aid of digital where appropriate”. Digital in itself is not the answer to the problem. It is the logical and detailed breakdown of the individual steps, assessing how they are undertaken, if they are required in a new optimised clinical pathway and how they can be improved upon. If automation and/or digital is able to help in improving these steps, then all the better.

So what could be automated and / or digitised. Well there is a list of potential improvement in any clinical pathway:

  • Put all functionality into one system, or at least only use systems that work harmoniously together.
  • Put all data into a single trust wide database. This creates your single source of truth.
  • Utilise the eRS (electronic referral system) APIs (application programming interface) and automatically upload to the trust digital systems instead of manually downloading from eRS and uploading to trust systems.
  • Put all of the end-user functionality into one user interface.
  • Digitise the triage step.
  • Automatically book patients into clinics and send out invites to patients. Currently this is done manually in many places.
  • Provide all of the necessary information that is needed at the triage step in one window, with no superflous information.
  • Put all of the possible referrals and investigations that can be ordered for a patient in a single window.
  • Send patient information videos to patients when they have an investigation requested that they know little about. This can help alleviate anxieties.
  • For protocol driven and low risk diseases, consider a patient video instead of clinics.
  • Allow patients to complete disease questionnaires in their own time on a dedicated platform.
  • For systems that provide read outs of usage, for example CPAP in obstructive sleep apnoea syndrome, connect the readout data to the single system that is managing their disease.
  • For national audit, or for DVLA and other external bodies, automate the transfer of data. Much of this is still very manual.

At the end of the day, we want to create a system that is holistic, looks at the patients pathway from A to B, from first symptom to treatment and follow up, rather than individual steps on the pathway that different clinicians, investigations or treatments may play in themselves. By appreciating that the patient’s pathway is a whole, you can then improve each step of the pathway to improve the patient’s experience, the clinicians workloads and workflows.