interoperability and the road to digital maturity

Interoperability and the Road to Digital Maturity

Thursday 23 July

Wi-Fi Network: Engine Shed Password: Room13art

Welcome & Introduction

Janina Cross, West of England AHSNShanil Mantri, BaNES CCG

Wi-Fi Network: Engine Shed Password: Room13art

The Challenges

The Five Year Forward View identified three key challenges for health and care:

1. The health and wellbeing gap2. The care and quality gap3. The funding and efficiency gap

Today’s Goals

• Helping to optimise local interoperability strategy

making the best use of technology and capabilities

• Identifying the benefits of interoperability

sharing knowledge to identify opportunity and overcoming barriers

• Accelerating the progress of interoperability

enabling capability to increase the momentum of interoperability programmes

Personalised Health and Care 2020

By April 2016 local health economies will deliver:

• Roadmaps highlighting how, amongst a range of digital service capabilities, they will ensure clinicians in all care settings will be operating without the need to find or complete paper records by 2018;

• That by 2020 all patient and care records will be digital, real-time and interoperable.

09:00 – 09:15 Welcome and Introduction Dr Shanil Mantri, Janina Cross

09:15 – 09:30 The Gloucestershire ‘Joining Up Your Information’ Interoperability Programme Update

Dr Paul Atkinson

09:30 – 09:55 The Wiltshire Single View of Customer Programme Update

Dr Gareth Dawes, Kevin Marshall

09:55 – 10:10 The Bristol, North Somerset and South Gloucestershire Connecting Care Programme Update

Dr Andrew Appleton

10:10 – 10:25 Avon and Wiltshire Mental Health Partnership ‘Joining up the Dots’ Programme

Dr Will Hall and Caroline Gadd

10:25 – 10:40 Refreshments and Networking

10:40 – 10:55 The Bath and North East Somerset Interoperability Programme Update

Dr Shanil Mantri

10:55 – 11:10 Update from Great Western Hospital, Swindon Dr Constantin Jabarin

11:10 – 11:30 ‘No Data About Me, Without Me’ – Informatics as a Conversation

Nick Leggett

11:30 – 12:15 Break Out Sessions A and B

12:15 – 12:20 Morning Wrap Up

Morning Agenda

Break Out Session B

NIB WORK STREAM 1.1 & 1.2‘Enable me to make the right health and care choices’ Providing patients and the public with digital access to health and care information and transactions and an assessed set of health and social care apps

NIB WORK STREAM 2.1‘Give care professionals and carers access to all the data they need’ Setting the commissioning and regulatory roadmap for implementing of digital data standards 2018/2020

NIB WORK STREAM 4 ‘Build and sustain public trust’ Deliver roadmap to consent based information sharing and assurance of safeguards

NIB WORK STREAM 6 Support care professionals to make the best use of data and technology

NIB WORK STREAM 8 Enabling information standards to underpin all other work streams

13:30 – 13:45 The South Western Ambulance Service NHS Foundation Trust Electronic Care System (ECS)

Francis Gillen

13:45 – 14:00 National Information Board Update Michael Bewell

14:00 – 14:20 The Lancashire Shared Care Record and Citizen Facing Platform Approach

Declan Hadley

14:20 – 14:45 An Introduction to Patients Know Best Rhiannon Thomas

14:45 – 15:15 Break Out C – Open Discussion – delivering to the NIB framework, next steps and AHSN support

15:15 – 15:30 Feedback from Break Out Session C

15:30 – 16:00 Wrap Up and Open Networking Forum with coffee

Dr Paul Atkinson, Janina Cross

Afternoon Agenda

Break Out Session C

1.1 Providing patients and

the public with digital access

1.2 Providing citizens with an endorsed set of

health and social care

apps

2.1 Give care professionals

and carers access to all the data they need

2.2 Giving the right people

access to the health and care data they need

3. Make the quality of care transparent

4. Build and sustain public

trust

5. Bring forward life-saving

treatments and support

innovation and growth

6. Support care professionals to make the best

use of data and technology

7. Assure the best value for

taxpayers

8. Enabling information standards

WEAHSN Informatics Workstream

Thank you!

Janina Cross, [email protected] 646 641

mailto:[email protected]

The Gloucestershire ‘Joining Up Your Information’ Interoperability Programme Update

Dr Paul AtkinsonCCIO Gloucestershire CCG

The Gloucestershire ‘Joining Up Your Information’ Interoperability Programme Update

Dr Paul Atkinson, CCIO, NHS Gloucestershire Clinical Commissioning Group

Haider Al-Shamary MPharm GPharmC

IM&T Project Manager, South Central and West CSCSU

Joining Up Your Information (JUYI)

• 15 minutes – including time for questions!• 5 minutes – Paul (CCG)• 5 minutes – Haider (CSU)• 5 minutes for questions

• 4 minuets left …

Vision:• “To support the delivery of safe, effective and

collaborative care, centred around the service user, • by ensuring that any professionals and the service user

have access, and can contribute to, all relevant and up-to-date clinical and administrative information which relates to their care, from all sources whichever organisation they are working for and whenever and wherever they are working.

• This includes the service user, enabling them to collaborate in the planning and provision of their care.”

Partner organisations:ERIC

Integration Engine

Repository (big bucket) Seeker (live fetching)

Integration Engine

What have we been doing?

• Pilot - sharing some primary care data• EDSM (SystmOne) sharing• My Online Care Plans• Information Governance group• Agreeing consent model• Communication programme• Gathering requirements• Getting funding

Key activities underway

i. Signing off Requirements specification• Clinical and Care Professionals Reference Group has reviewed and

commented: out for sign-off by provider organisations

ii. Completing Business Case• Review and sign-off process starts on 11th June

iii Procurement Process• Notice of Intention published on 3rd June

iv. Communications Planning• Draft Strategy and High Level Plan produced for review at this meeting

Next Steps …

i Business Case Sign-off•By all relevant bodies by 4th August

ii Procurement Process•Market-testing with suppliers then procurement documentation released mid-August•Appoint supplier late-October

iii. Communications

Following approval of materials and plan:•Implement Public Information Programme; process opt-outs by January 2016•Increase “internal” communications as per plan

Patient Consent Model

Model agreed by Comms, Consent & Access Group & local LMC is one of:

“informed implied consent” to share information (i.e. opt out)

with explicit permission to view at point of care (not required when direct referral or patient incapable)

Risk = High opt-out rate

Contact details:[email protected]

Paul Atkinson, CCIO

NHS Gloucestershire CCG

[email protected]

Haider Al-Shamary

MPharm GPharmC

IM&T Project Manager, South Central and West CSCSU

[email protected]

07833 294 049




The Wiltshire Single View of Customer Programme Update

Kevin Marshall, Wiltshire CouncilGareth Dawes, Wiltshire CCG

Single View

Change and InnovationWiltshire Council created from one County Council and four District Councils in 2009, Wiltshire Council is now the unitary authority for most of Wiltshire

• New offices, • Insourcing of ICT Services• Corporate rollout of Windows 7 laptops• New ways of working (Flexible working, Lync video conferencing )• Direct access control across the three main hubs. • Superfast Broadband, • Seamless direct access, • Wireless and Ethernet connectivity across the county, • Partnership working with Wiltshire Police (One ICT service, shared buildings,

married networks)

Single View• Plan more effectively for the scale and type of public services required in Wiltshire• Provide clinical continuity and improving health and wellbeing (The BetterCare

Plan)• Save lives and protect the vulnerable (Police Service Delivery Plan)• Improving the customer journey by providing efficient and effective services

(Wiltshire Council Business Plan)

Key Benefits

• Providing clinical continuity and improving health and wellbeing

• Saving lives and protecting the vulnerable

• Improving the customer journey by providing efficient and effective services

What have we achieved so far?• Partnership Days (over 100 representatives from WC, Police,

Fire and Health Organisations• ICO engagement• Demonstrated an initial proof of concept• Partnership working and Cohesion

– Programme Board– Operations Board– Information Governance Board– Communications Board– Single View programme team– ICT Sub-Group

Work in Progress • Working together with the Health, Police and Fire Services to produce product cases

and identify benefits • Recruited additional technical resource for solutions development• Development of technical solution for Wiltshire Council Portal under way• Implementing ICT sub-group across partner organisations• Regular updates with NHS South Central and West Commissioning Support Unit

– Sharing information and progress both ways• IG Board are developing workflow processes

– Data sharing agreement and Sign off processes– Privacy Impact Assessment– Auditing existing practises

• Establishing Communications Board roles and milestones– Revising Initial Communications Strategy– Draft purpose statement for Single View– Engagement with stakeholders and reference groups

Gathering Requirements• Currently analysing the 9 partner organisations business strategies and

priorities.– Over 65

• Product case. – I want to feel safe at home– Who are you– What information do you require for better informed decision making– Where is that information currently held– Who can it be shared with– What are the benefits of sharing that information

Initial Product Case

• Identify hurdles• Data Sharing• Communications/Marketing• Technical challenges• Change of working practises• Cultural changes• Lessons learnt for future product cases

N3 Network

My View(Shop Window / Access Portal)

Single View Data Store

Wiltshire Council

Sys

tem

Sys

tem

Sys

tem

Partner x 8

Partner Data Store x 8

Sys

tem

Sys

tem

Sys

tem

Single View

Health Portal

Health View

Version: 0.3 – 20/07/2015 PM

Questions and Feedback?

Connecting CareThe Bristol, North Somerset and South Gloucestershire Connecting Care Programme Update

Dr Andrew AppletonWiltshire CCG

• What is Connecting Care?• Why have Connecting Care?

– Strategic alignment– National drivers

• Who are the partners?• What have we delivered so far?

– What are the benefits? Tangible results so far• What’s coming next?• Current governance arrangements

introduction to Connecting Care

Connecting Care is the Bristol, North Somerset and South Gloucestershire [BNSSG] programme, dedicated to using technology to support -• Better information sharing between local

health and social care organisations• Joining up information to ensure care is

focused around the individual and their needs• Improving better, safer and more joined-up

care• Supporting increased efficiency in the delivery

of health and social care services• Ensuring that the people who are providing

care have the information they need, when they need it

what is Connecting Care?

Our first focus has been the delivery of a shared ‘view only’ electronic patient record (using the Orion Health ‘portal’)

strategic alignment

5 year forward view: “Most countries have been slow to recognise and capitalise on the opportunities presented by the information revolution……the NHS has oscillated between two opposite approaches to information technology adoption.....the result has been

systems that don’t talk to each other and a failure to harness the shared benefits that come from interoperable systems…..In future we intend to take a different approach”

strategic alignment - national drivers

Royal College of Physicians’ “We must

revolutionise the way we use information. We

must create pathways in which information

moves with patients across the system in real-

time”

Victoria Climbié (The Laming Report):

“...systems were crude and information failed to

be passed...information systems that depend on

the random passing of slips of paper have no

place in modern services”

Caldicott 2:“For the purposes of direct care,

relevant personal confidential data should be

shared among the registered and regulated health

and social care professionals who have a

legitimate relationship with the individual.”

Caldicott 2: “people also expect professionals

to share information with other members of the

care team, who need to co-operate to provide a

seamless, integrated service. …”

DoH Winterbourne View Final Report:

“All local authorities and their local safeguarding partners should

ensure they have...information-sharing processes in place across

health and social care to identify and deal with safeguarding...this

requires a multi-agency approach including all partners”

Connecting Care partnership

project approach

• Staged approach– First stage (pilot) started in March 2013. Key

deliverables:• A working system (can we do it?)• Evaluation of benefits (is it any good?)• A business case for the second stage (is it worth

carrying on?)– Second stage started Dec 2014 (next 5-7 years)

• Scope / theme– Stage one themed on urgent & unplanned care – Stage two will extend the breadth & depth (more users,

more information sharing)

• Numbers of users– Stage one 500– Stage two – 10,000+

• Demographics• Laboratory• Radiology• Encounters• Allergies• Diagnosis

Clinical Data RepositoryRhapsody Integration Engine

Orders and Results (CRIS and Ultra) X2

GPs

RiO Extracts

X4

• Authentication• Authorization• Single Sign-On• Patient Privacy & Consent• Relationships• Audit Logs

• Patient Search• Patient Lists• Patient Summary• Timeline• Flowcharts• Secure Messaging• Orion Health Applications• Third Party Applications

Presentation

Integration

Source Systems

Security & Privacy Patient Record

• Medications• Problems • Procedures• Transcribed

Documents

Portal

Connecting Care Clinical Portal

Master Patient Index

MiG

NBT Cerner

PAS

Weston Cerner

PAS

Adastra End Of

Life

SWIFT – North

Somerset

UHB Medway

PAS

Adastra Out Of Hours

Paris Social Care - Bristol

what we’ve delivered so far


So far: • Demographics• Practitioner Details (Registered GP,

Community nurse, social worker etc.)

• GP record summary – showing medications, allergies, adverse reactions noted, diagnoses

• All referrals, scheduled appointments (future and past),

• Home visits (past) and planned (future)

• Progress notes (from community health )

• Hospital inpatient / outpatient episodes

• Emergency Attendance• End of life wish details

Coming next: discharge letters, radiology reports, pathology reports existence of / details from care management plans

The people who have used Connecting Care to provide better, more joined-up care so far include –

• Acute trusts: pharmacists, consultants/doctors, nurses, therapists, patient flow coordinators, admin

• Primary care: GPs, medical secretaries/support staff


Acute care

Primary care

Community care

Social care

Out of hours

• Community care: support workers, therapists, nurses, emergency care practitioners, admin

• Social care - social workers, occupational therapists, Care Direct advisors, care coordinators, admin support

what we’ve delivered so far - timeline

Signed contracts

(Feb 2013)

Start work (March 2013)

Go live Stage 1

pilot (Dec 2013)

Benefits & Business

Case (May 2014)

Approvals from all partners

(Sept 2014)

Stage 2 Start (Dec

2014)

The main benefits for me (as a clinician or social care professional) are:

• Confidence in my decision making is improved

• The quality of my consultation (or assessment) is improved

• I do not make unnecessary referrals or carry out duplicate assessments

• It saves me time (which can be used to provide care, or for other duties)

• I am more informed before a visit/appointment, which means I can provide more timely/more appropriate care

• I have better relationships with colleagues

• My input into a patient/service user’s care can be seen by others, so the recognition of my profession is increased

Connecting Care - benefits

The main benefits for my patients/service users are:

• They don’t have to keep telling their story (e.g. remembering / explaining medications

• They receive safer, more appropriate care

• They have a better experience of the services offered, potentially with fewer duplications or delays

• They might not have to be admitted to hospital



Out of hours care

• Saves appointments and visits• Saves admissions• Safer prescribing• Improved quality of consultation

Pharmacy • Safer prescribing – provides access to allergy and GP prescribing information

• Saves time – Reduces the amount of time calling GP practices • Safer communication – reduces errors

Hospitals / A&E

• Safer care – patient background, context and medications• Saves time – reduces time trying to find out information• Reduces risks – where patients unable to inform clinicians about

relevant information / fax errors etc


Community care

• Saves time in triage and assessment • Saves time – reduces the amount of calls to GPs • Saves unnecessary home visits • Supporting risk management and safeguarding

Social care • Supporting referral management• Saves time in triage and assessment• Informs assessments & care planning • Saves installation and equipment costs• Supports risk management and safeguarding

General practice

• Reduces burden on practice administrators • Supports risk management and safeguarding• Increased confidence in better care being provided outside of

the practice• Immediate access to GP records (new registrations)


“Massive difference in time spent accessing information. On average [I can] access the GP record within 30 seconds compared with 15-20 minutes taken via telephone or via fax” Critical Care Pharmacist Manager UHB “3 cases identified

on Connecting Care today that were already allocated to a health practitioner (BCH OT or IMCS OT) so did not require referrals to BCC OT”. Occupational Therapist Bristol City Council

“I now use Connecting Care on almost every case I deal with it (approx. 25 cases per shift). It always makes a difference and adds value. Every shift, acute admissions are avoided.” Doctor (out of hours)

“Have been able to identify trends which have then resulted in swifter [safeguarding] interventions…one case where concerns would not have increased without Connecting Care…”Social Worker Safeguarding team

“Connecting Care is brilliant…I use it to triangulate information from service users, to find out about other services involved so that I can contact them to inform my assessments” Bristol social worker

“it has enabled us to commence discharge planning earlier in the patients stay to help prevent delays later on.”Discharge Nurse

“Unable to obtain a medication history or allergy status from the patient….accurately confirmed through Connecting Care …” Pharmacist, NBT

““Information about the patient’s diagnoses has helped our team decide which type of therapy to offer the patient” UHB


“On Monday I managed to obtain details for 22 patients on Connecting Care, I saved a huge amount of time as I didn’t need to phone the GPs and wait for the faxes to arrive” Acute Pharmacist

“I used Connecting Care to find vital information for the diabetes nurses . The information logged by district nurses is a goldmine of information. We saved 20 minutes on the telephone and managed to find the reason for patients insulin being discontinued” Discharge Nurse

“In cases where we are dealing with a person who is being supported by Rapid Response and the district nurses, Connecting Care comes in to its own. All the notes from visits are documented and it can save at least 30-40 minutes on duty cases of this nature” Social Worker “The extra patient detail

is useful when deciding to stop drugs such as anti-platelets and it helps to identify risk factors” Doctor

Having access to accurate, timely,

shared information is no longer a

‘blocker’ to providing high-

quality, effective, efficient care…

“Without Connecting Care today I couldn’t have done my job.” Pharmacist

“Connecting Care has been really helpful tonight. Could not do without it. Particularly in the case of an old lady with XX who I could not reach on the phone. Without Connecting Care this would have resulted in a visit and probably her door being broken down. But with CC I was able to work out that all that should of been done, had been done.” OOH Doctor

what’s next?

• We have come a long way in a year…but there is so much more we know can be achieved!

Connecting Care was announced of one of three ‘NATIONAL EXEMPLAR’ sites for clinical system interoperabilityAttracting national attentionWe have series of projects planned to develop breadth & depth

Sir Bruce Keogh, NHS Medical Director visiting Frenchay Hospital in March 2014 to view Connecting Care

what’s next?

In 2015 our key projects are In the pipeline…• Rollout to 2000 users this year• Children's safeguarding project –

sharing information from our 3 local authorities’ children’s systems

• Document sharing – clinical and social care documents shared in portal...and ‘sent on’ to other recipients (GPs) – initial focus is eDischarge

• Lots of system replacements (2 hospital PAS, 3 community systems, 1 social care system, 2 pathology systems)

• New infrastructure, new data centre with UHB hosting, re-write lots of our ‘core config’ to support improved performance

• Rollout to 10,000 users + • Pharmacy (sharing more – hospital

prescribing / community pharmacy)• Supporting cancer care• Mobile working, patient access • Specialist systems (renal, maternity,

dental etc etc.)• Sharing more information from

within hospitals – e.g. assessments, care plans

• Enable sharing of richer end of life plans

• Better support for some workflow / pathways

• And lots and lots more!!

A sample of some possible financial benefits:

Admissions Prevention

10,000 users could see annual saving of £1,036,288 from admissions prevented by using information in Connecting Care

Based on a Department of Health reference cost 2012/13 of £1,436 for a unplanned admission and only the same rate of stated admissions prevented in the pilot

Reducing duplicate assessments

10,000 users could see a annual saving of £179,520 on stopping the duplication of assessments as a result of using information in Connecting Care

Based on cost savings if the same rate of stated admissions prevented during the pilot continues – based on £60 for an average cost of a face to face assessment by a community nurse - Department of Health reference cost 2012/13

what can Connecting Care potentially offer?

A sample of some possible financial benefits:

Time savings - calling other organisations

10,000 users could see a annual saving of £155,278 of ‘people time’ as Connecting Care users spend much less time calling other organisations for information

Based on salary cost savings if only one call per week per user is saved where the medium salary between NHS bands 7 to 8 is used.

Reducing home visits

10,000 users could see a annual saving of £68,000 on stopping unnecessary home visits as a result of using information in Connecting Care

Based on cost savings if the same rate of stated home visits prevented during the pilot continues – based on £60 for an average cost of a face to face assessment by a community nurse - Department of Health reference cost 2012/13

what can Connecting Care potentially offer?

Connecting Care governance

SYSTEM LEADERSHIP GROUP

Connecting Care MANAGEMENT GROUP

Connecting Care PARTNERSHIP

PROGRAMME BOARD

Connecting Care ‘USER GROUP’

(Clinical & Social Care)

PROJECT SPECIFIC BOARD(S)

Connecting Care PROGRAMME TEAM

Connecting Care LOCAL PROJECT

TEAMS

Directors of Finance Group

Strategic level

Oversight & assurance

level

Delivery level

Connecting Care SUBJECT SPECIFIC

SUB-GROUPS

• What is Connecting Care?• Why have Connecting Care?

– Strategic alignment - UHB– National drivers

• Who are the partners?• What have we delivered so far? • What are the benefits? Tangible results so far• What’s coming next?• Current governance situation

Thank you for your time!

summing up

what does it look like?

AWP ‘Joining up the Dots’ Programme

Dr Will Hall, Bristol Mental HealthCaroline Gadd, Otsuka Health Solutions

Joining the Dots

Context Approach Progress Questions

Confidential - please do not disrtribute or duplicate

21/07/2015

Assertive Contact &

Engagement

Bristol Sanctuary

Employment Service

Inpatient Services

Women's Crisis House

Community Rehabilitation

Service

Bristol Wellbeing Therapies

Service(IAPT)

Dementia Wellbeing

Service

Community Access Support Service

Assessment & Recovery Service

Crisis Service

Early Intervention in

Psychosis

Complex Psychological Interventions

Service

Community Mental Health Services Men's Crisis House

System Leadership

Primary Care and GPs


21/07/2015

Delivering better care together


21/07/2015

New

Mod

els

Understanding

outcomes & experienceChanges in culture across

services

Co-production

Recovery focus

Psyc

holo

gica

lly In

form

edMental Health is changing in Bristol

Confidential - please do not disrtribute or duplicate21/07/2015

Primary CareDrug & Alcohol

Services

CAMHS

Asylum Services

Homeless Services

Housing Services

Criminal Justice System

Acute Hospital Liaison

Social Care Services

Forensic & specialists MH

Services

Health & Wellbeing Board

Commissioners

Public HealthEmergency

Services

Learning DisabilityServices

Assertive Contact &

Engagement

Bristol SanctuaryEmployment

Service

Inpatient Services

Women's Crisis House

Community Rehabilitation

Service

Bristol Wellbeing Therapies

Service(IAPT)

Dementia Wellbeing

Service

Community Access Support

Service

Assessment & Recovery Service

Crisis Service

Early Intervention in

Psychosis

Complex Psychological Interventions

Service

Community Mental Health Services Men's Crisis House

System Leadership

Wider Connections


21/07/2015

Why is now the right time?

System working in mental health is new…

leadership of the system needs to be dynamic & integrating

The experience for users needs to be seamless with smooth pathways of care

Information needs to be shared across the system easily & allow insights that add value

Mental health services need to look ahead to future pan-sector models of care delivery


21/07/2015

… the RIGHT INFORMATION was at the

fingertips of the RIGHT PERSON at the

RIGHT TIME to make the BEST DECISION?


21/07/2015

… our solution PROACTIVELY alerts

you when something has CHANGED?

“I have not been myself for months now”

VISIT TO GP

“I don’t know what’s going on”

A&E VISITCRISIS

RESOLUTION TEAM

“Am I ever going to feel well again?”

FAMILY SUPPORT PLUSCHARITY SUPPORT

“I lost my job and I have no idea if I can get another

one”

HOUSING LEGAL

BENEFITS

EARLY INTERVENTION TEAMPLUS PC MONITORING

“I’ve lost my job and my home –

there is no future”CRISIS +SECTION

“I am taking it day by

day”

“I have a job but still have good and bad days”

“Actually life is pretty good

again”

GP SUPPORT

RECOVERY TEAM +RECOVER NAVIGATOR

RECOVER NAVIGATOR

INTRODUCERECOVERYNAVIGATOR

RISK OF RELAPSERECOVERY NAVIGATORALERT & INTERVENTION

RECOVERYPLAN

REVIEW


21/07/2015

… the service user was at the CENTRE so

they can be involved, even own, their plans,

progress and assessments?


21/07/2015

Change

Understanding the need for change (SUs and

SPs)

Gathering ideas for Analytics and Technology

Working with teams on new ways of working

Testing early versions and getting feedback

Training and implementation

Analytics (data insights)

Developing insight from data

Alerts to support proactive intervention

Design pathway improvements, and better

use of resources

Technology

Care pathway tools• Assessment• Risk assessment• Care plans• Progress notes

Dashboards• System level

insights• Management level

insights about risk etc.

How can information be better used across BMH to improve service

users’ outcomes and experience?


21/07/2015


21/07/2015

Modelling the relative likelihood of service users entering crisis in a defined period of time


Success• Cross organisational working and collaborative nature of project teams and

project groups • Level of Service User and Provider Engagement• Over 100 people involved in baseline service evaluation with Service Users and

Service Providers• Iterative build enables engagement and constant input on something tangible

Challenges• Competing priorities with teams in transition• Dependencies with other projects• Integration of data systems

Learns• So far bottom up change approach feels good• Strong concerns over data use from some user groups• Benefits of public-private sector partnership• Approach to service evaluation

Progress


• Opportunity to link up with regional projects• To explore potential areas of crossover• To learn from other projects

Thanks for Listening

Questions….


21/07/2015

Refreshment Break

BaNES Interop Programme Update

Shanil MantriChief Clinical Information OfficerB&NES CCG

Bath and North East Somerset

Background

• Population 200,000

• One main acute trust

• 27 GP practices

• Coterminous with LA

• One community provider

Approach

• Provider engagement

• Focus on clinicians/service providers

• How will we work differently?

• Defined projects

Progress

• Early on journey

• Formed an interoperability board

• Commissioned an options appraisal

• Agreed on portal solution

• Full business case: Connecting Care

Issues

• Terminology

• Resource

• Technical limitations

• Organisation buy in

Questions?

Update from Great Western Hospital, Swindon

Constantin JabarinChief Clinical Information OfficerThe Great Western Hospital

Update from The Great Western

Hospital,SwindonDr Constantin Z Jabarin

Clinical Fellow in Emergency Medicine Department &Chief Clinical Information Officer, GWH

• Background

• Private sector

• Swindon

• Emergency Department

• Where we are now

• Vision

• Interoperability

Questions?

No Data about Me without Me

Nick LeggettPatient Contributor

Informatics as Conversation

The Healing Conversation

The agents of healing: • The healer (the

healthcare professional)

• The patient (the seeker of healing)

• The bystander (the democratic citizen)

Bystander

Healer

Healing

Patient

The Cycle of Additive CoProduction

Each agent of healing has a different part to play, but all are equally necessary – and equally valuable – to the process

CoInitiate

CoDesign

CoProduceCoDistribute

CoEvaluate

Proactive Democratic Interoperability

NHS England Five Year Forward View

Patients will have full access to … fully interoperable electronic health records, and be able to write into them.

Personalised Health and Care 2020 (NIB)

It is essential that citizens have access to all their data… and the ability to ‘write’ into it. This framework prioritises comprehensive access – with the ability for individuals to add to their own records – by 2018

• Break Out Session A (CCIO Group inaugural meeting)

• Break Out Session B Challenge to delivering

interoperability

SWASFT Electronic Care System

Francis GillenSouth Western Ambulance Service Trust

The Road to Digital Maturity

AmbulanceElectronic Care

System

Francis Gillen ([email protected]) Executive Director of IM&T

South Western Ambulance Service NHS Foundation Trust

The End User Device

Summary of Capability

• Mobile Device for On Scene Use by Ambulance Crews • Access to NHS No. and Historic Patient Records• Clinical Capture – Presenting Condition, Observations,

Vital Signs, Treatments, Medications, Safeguarding• Decision Support – Clinical Algorithms & NICE

Guidelines• Service Options – Access to DoS• Handover and Referral – Hospital, Specialist Units, GP

The Patient Record Journey

Observations

The Clinical Record

Hospital Workstation

Outputs

NEWS Support

Deployment Schedule

Developments

•Executive Summary Referral Form•NEWS Support•ESCR Access•E-Handover Hospital•GP and Specialist Referral•Record Filters•MiDoS

Thanks for Listening

Francis Gillen ([email protected]) Executive Director of IM&T

South Western Ambulance Service NHS Foundation Trust

National Information Board Update

Michael BewellNHS England

PERSONALISED HEALTH AND CARE 2020Using data and technology to transform outcomes for patients and citizensNational Information Board Work Stream 2.1: Roadmap Direction

Giving care professionals access to all the data they need

Michael Bewell Interoperability Engagement lead NHS England

Personalised Health and Care 2020: A Framework for Action

AS A CARE PROFESSIONAL, PAPER-FREE AT THE POINT OF CARE WILL MEAN:


DIGITAL MATURITY – “PAPER-FREE” HEALTH AND CARE


A NEW FOCUS ON PLACES WORKING TOGETHER TO DELIVER INTEGRATED DIGITAL CARE

create an annual digital roadmap outlining steps towards being paper-free

Every local area will be invited to:

assess and encourage progress using a new Digital Maturity Index


DRAFT CONTENT AND USE


Self assessment

Benchmarking

Resource prioritisation

Digitalalignment

Learning fromOthers

Continuous improvement

FEED INTO NATIONAL DELIVERY AREAS


We have engaged with a diverse group of stakeholders from across health, social care, voluntary and community sectors to inform our priorities:

Investment in

enabling technolog

y to deliver safety, quality

and efficiency

Accelerate

improvement across

the health

and care system

Development of

inclusive, viable local

plans to prioritise investme

nt and realise

benefits

Baseline and

benchmarking tool to assure progress

and highlight

best practice

Development of an open

environment

based on open

interfaces and key standard

s

Utilising regulator

y, inspectio

n, commissi

oning and

development levers

Creation of a

digital maturity index

Sustained

investment in

technology

Developing

digital capabili

ty

Creation of local digital

roadmaps

Aligning levers and

incentives

Efficient system transact

ions

Interoperability

Digitising system

transactions and “back office”

processes

DIGITAL MATURIY - KEY CAPABILITIES


Capabilities for Joined Up

CareDescription Illustrative examples Outcomes/Benefits

1. Records, Assessments & Support Plans

Giving health & care professionals the capability to capture information for subsequent use by others, and to use information captured by others, supporting better clinical decisions at the point-of-care

• Accessing details of diagnoses• Accessing demographics/contact

details• Developing a single multi-agency

care plan• Accessing detailed patient history

• Patient safety • Quality of care• Continuity of care• Care co-ordination

2. Transfers of Care, Orders & Comms

Giving health & care professionals the capability, make referrals, process transfers, record discharges, summarise care episodes and place orders to / with other professionals

• Making a referral to another service

• Ordering radiology services• Discharging a patient from a

service• Summarising an A&E episode


3. Decision Support

Giving health & care professionals the capability to react more appropriately and promptly to events happening across the system through automated rules-based analysis, prompts and alerts

• Being alerted to deteriorating patients

• Being alerted to an end-of-life plan• Being alerted to hospital

admissions• Being alerted to a discharge-ready

patient


DIGITAL MATURIY - KEY CAPABILITIES


Capabilities for Joined Up

CareDescription Illustrative examples Outcomes/Benefits

4. Remote & Assistive Care

Giving health & care professionals the capability to monitor, diagnose, counsel or advise patients remotely and access experts/expert advice at the point of care

• Telemonitoring• Teleconsultation• Telecoaching• Telecare


5. Asset & Resource Optimisation

Providing health & care professionals with assurance that highest quality physical assets are available at the point of care at lowest cost

• Patient tracking • Product tracking• Geolocation

• Patient safety• Efficiency

6. Citizen Activation

Giving citizens the capability to manage their own health through access to knowledge on their health, care and condition, access to support mechanisms and transactional services

• Accessing diagnostic results• Ordering a prescription• Recording ‘end of life’

preferences• Contributing patient-generated

information to the care record

• Citizen activation• Citizen experience• Patient safety • Continuity of care• Care co-ordination

INTEROPERABILITY

STRATEGY:

the development of an open environment for information sharing based on open interfaces and open standards.


Professional

Through my system I can directly access and contribute to summary and detailed care information

Transfers

of Care

NHS Number

Key Priorities

Procurement

Guide

Interoperability

Handbook

Tools

Open APIsOpen interfaces to enable

information to flow across a care pathway and be accessed across geographies

Local Integrated Digital Care Records (IDCR) that link health and social care for delivering local information sharing needs

Local IDCRs

Tight standards for key transfers of care

GP System

s

Patient Record IndexAbility to locate patient record information that can then be accessed through open APIs

Open interfaces from national systems such as SCR to simplify access.

Summary Care Record

Citizen

Using my PHR I can access care information about myself and contribute information

PHR

Business Justification - Build a business case for investment in Integrated Digital Care Records

Information Governance and standard templates - Check I am in line with Information Governance guidance

Citizen Engagement - Allow citizens an easy way of engaging with their care records

Clinical Engagement - Provide clinicians with open-source components to deliver integrated care records

Open interfaces - providing re-usable interfaces so that systems and software can talk to each other

Interoperability handbook - Understand the interoperability options you can take and how to procure using interoperability tools and standards

Open Requirements - A de facto business case for use to support an Integrated Digital Care Record (IDCR)

Open Governance - endorsed templates with supporting guidance you can use for your IDCR initiative

Open Citizen- common information and tools to support citizen engagement for your IDCR initiative

Open Viewer - Web based IDCR application for both care professionals and citizens to use

Open Integration - re-usable interfaces and integration engine to bring systems together into your IDCR

Open Architecture - Infrastructure and tools to support both structured and unstructured IDCR information

LOCAL DIGITAL ROADMAP: BRADFORD


QUESTIONS


Digital Maturity Assessment • How will an understanding of your current position – as a

provider and a health and care economy - with respect to the key elements of digital maturity be of benefit

• What additional advice guidance and support would you welcome to ensure you produce the most comprehensive digital maturity assessment?

Interoperability :• Are you undertaking an initiative to enable interoperability

across your locality? Does it align to the interoperability strategic direction?

• What additional advice, guidance and support would you welcome to help you take forward your local interoperability approach?

Professional

Through my system I can directly access and contribute to summary and detailed care information

Citizen

Using my PHR I can access care information about myself and contribute information

PHR

Lancashire Shared Care Record & Citizen Facing platform

Declan HadleyHealthier Lancashire NHS England & North West Coast AHSN

Record Sharing to empowering the patientWest of EnglandPresented by Declan Hadley & Tony Schaffel

@declan_hadley

[email protected]

July 2015

Patient Activation

Hayley Fraser gets 3D-printed hand

Consumer is king

Interoperability: Strategic Alignment

Safer services – sharing data

Consent model

Application layer

Empowering citizens – Patient activation

Integrating Lifestyle data & technology

Consent model

Application layer

Recap – Now?

Clinical SystemsOrganisation A

Clinical SystemsOrganisation B

Clinical SystemsOrganisation C

Care SystemsOrganisation D

GP Practice 3rd Sector / Other

Patient / Carer / Citizen

Discharge summaries, scanned letters, path labs results, medication, care plans..

LPRES

Less systems, more integrated, rich ecosystem

Care SystemsOrganisation C

Primary Care SystemsOrganisation B

Secondary Care SystemsOrganisation A

H&WB Platform

ON

D i g i t a l H e a l t h E c o s y s t e m

Share Empower Enable Knowledge

Record Sharing - Patient Activation - Channel Shift - Population Health

£

Record Sharing - Patient Activation - Channel Shift - Population Health

Workforce Change- Health Literacy- Digital Inclusion - Economic Growth

Thank you - questions?

An Introduction to Patient Know Best

Rhiannon ThomasPatient Knows Best

PATIENT-CONTROLLED RECORDS:

END-OF-LIFE CARE PLANNING

PATIENT-CONTROLLED RECORDS:CONNECTED HEALTHCARE

Pharmacy

Pharmacies

Secondary care/Hospital Community teams

Employers

Relatives

GP

Charities & Patient Advocacy Groups

Government & Commissioning bodies

Researchers

Social services

Mobile device and app developers

Patient

Primary care services

Specialist services

THE PROBLEM

SHARING OF INFORMATION• Health system is

fragmented and doesn’t communicate with each other = technical problems

• Ignores the explicit consent of the patient = legal issues

• Disempowers patient and no one feels in control

Hospital services

GP

Current ways to empower the patient gives them access to lots of information in lots of places, e.g. patient access to GP information or hospital information on a patient portal.

Fundamentally flawed:

• The patient doesn’t own the data

• Often read-only

• Tied to an organisation or a software provider

• Multiple sites, multiple logins

• Patient can’t share information with anyone else

• They are not portable

• Creates even more data silos, this time patient facing

TRADITIONAL PATIENT PORTALS – THE SOLUTION?

Apps and devices

Pharmaceuticals

Pharmacies

Secondary care/hospitals

Primary care health services

Employers

Relatives

GP

Charities & Patient Advocacy Groups

Government & Commissioning bodies

Researchers

Mobile device and app developers

Community teams

Specialist services

Social services

THE SOLUTION

HOW DOES A PATIENT-CONTROLLED RECORD HELP EVERYBODY?

WHAT CAN YOU DO WITH A PATIENT-CONTROLLED RECORD

• Send messages, letters, appointments and reports • Contact and message the patient or other

professionals• Web video consultations and remote appointments

or follow-ups


• Lab results all in one place• Track symptoms and be alerted• See measurements from a variety of sources,

including wearables and other devices


• Care plans for self-management• Surveys completed remotely• Medications• Calendar of upcoming appointments• Images, genetics and diagnoses

ABOUT PATIENTS KNOW BEST

SECURE AND SAFE

• All information stored on the secure NHS N3 network in the UK, no servers outside EEA

• IGSoc level 3 compliant, ISO27001

• Overcomes liability and data protection as the patient is sharing their copy of their information

• Information encrypted in transit and storage

• Unique private key encryption, so only the people the patient trusts can see the information

• Open APIs for full interoperability with existing IT systems http://dev.patientsknowbest.com

• Full medico-legal audit trail

http://dev.patientsknowbest.com/

1RANKED IN WORLD FOR PATIENT ACCESS TO MEDICAL RECORDSRANKED IN EUROPE FOR eHEALTH 20154 CONTINENTS

THAT PKB IS BEING USED ACROSS

9 COUNTRIES USING PKB…AND GROWING 1

5

WORKFLOW TOOLS FOR PATIENTS AND PROFESSIONALS

18

100

DEVICES AND APPS INTEGRATED WITH PKB

200PAYING SITES USING PKB IN 2015

Messaging, care planning, surveys, web video, symptom tracking, resource library, appointments, home monitoring, medications…

English, Dutch, Polish, French, German, Arabic, Chinese, Russian, Welsh, Spanish, Hindi, Gujurati, Greek, Swedish, Portugese, Tamil, Urdu, Turkish, Bengali

LANGUAGES TRANSLATED+

+

+

400

YEAR-ON-YEAR 2015 GROWTH

%500,000BIRTHS PLANNED FOR MATERNITY APP IN 2016

#

“”

THANK YOU

I really like this service... Maybe its the novelty, but having a way of interacting with clinicians that mirrors how people use online facilities is brilliant

Open networking forum with coffeeThank you!

interoperability and the road to digital maturity

Healthcare

care information

care records

care choices

care settings

support care professionals

technology nib work

right health

personalised health