Applying technology to the challenge of community healthcare

Julia Clarke

CEO, Bristol Community Health

10 June 2015Health Insights

Who we are

• Provider of NHS adult community health services in Bristol and Offender Health in Bristol & S Glos prisons

• Social Enterprise ‘spin out’ October 2011

• Staff owned community interest company

• £45 million turnover, 1000 staff (wte)

• 30,000 patient contacts, 7000 referrals per month

Challenges of Community Health

• Rising demand and rising expectations– Ageing population with multiple long term conditions and frailty– Admission avoidance and supported discharge– Pressure on primary care & hospitals performance

• Legacy issues: under-funding, under-investment, poor infrastructure (IT, estates, systems)

• Lack of research, metrics and evidence base• Financial & commercial framework – block contract,

competition, business transfer ‘at cost’• Dispersed workforce, home and community settings• Multiple interfaces internally and externally

Our technology projects

• Mobile working (Totalmobile)

• Electronic patient record (replacement of RIO with EMIS web)

• Self-Care / telemedicine (collaboration with Phillips Healthcare)

• Connecting Care (SC and SW CSU)

• Business intelligence (Inphase & new data warehouse)

• HR systems (Perform, e-pay)

• Communications (websites & e-comms)

• Patient feedback (Meridian)

• Clinical incidents and risk (Ulysses)

Mobile workingcollaboration with Totalmobile

• An intuitive app run on android tablets

• Screens and forms designed around the clinician–patient interaction by clinicians

• Added value summary views, graphics, annotated photos and loads of potential for more

• Links (push & pull) to one or to multiple systems via API

• Rich and granular data capture

• Works off line

• Secure and IG compliant

Mobile workingcurrent status

• Around 400 users, 700 planned• Rollout suspended while we switch EPR• Demonstrable benefits

– More satisfied staff, reduced frustration– Productivity up to one hour / clinical day– Better data quality – timely and complete– Patient engagement– Added value eg. photos, functionality of tablets– Catalyst for change in working practices,

documentation, service design

Supported Self-Carecollaboration with Phillips

• Population health activation and self-management system

• Clinical / technical self-care hub – linked to patients and to clinical teams

• Health navigators / coaches / coordinators• Range of technical platforms for risk stratified population:

– Telemedicine with remote monitoring, education materials and comms

– Tailored text and voice interactions– Self care apps – lifestyle, activation

Supported Self-carecurrent status

• Detailed development of concept• Risk stratification and segmentation of population• Small scale demonstration & learning project with one

practice• Patients recruited from all segments• Support from WoE AHSN, potential test-bed• Interest from local stakeholders including Bristol Health

Partners, Bristol University, Bristol City Council

Our balanced scorecard

Theme Perspective

Making their day Patient, customer, commissioner, partners, stakeholders

Managing our money Financial, commercial, business

Time to Care Operational, systems & processes

Being the best Organisational, workforce

Technologya strategic response

Theme Contribution of technology

Making their day Clinical quality through analytics, patient feedback, data quality & availability, shared patient view, apps & smart functionality – eg photo capability, incidents reporting and analysis

Managing our money Business intelligence for contracting & management, efficiency through mobile working,

Time to Care Productivity – mobile working, apps,

Being the best Cultural change, consistent performance management, efficient systems

Cultural benefits

• Disruptive technology• Performance and quality aware• Greater discipline / rigour• Fuelled innovation• Created internal demand and faster change• Prepared for RIO-EMIS switch• Opportunity / necessity for documentation review

and service redesign• Organisational learning

What’s next?

• E-rostering linked to safe staffing

• Appointment scheduling

• More quality-analytics

• Document management

• The Cloud

http://vimeo.com/107259203