Paper Free at the Point of Care- Digital Maturity Assessment leading to your Digital Roadmap A clinician’s view ISD Network - November 15

Dr Colin Brown - CCIO Morecambe Bay Hospitals

• Highlighted by Declan

Burning Platforms

• Increasing demand for healthcare • Diabetes, obesity, dementia, very frail elderly • Deprivation / employment challenges in NW • Heading for annual £3b spend on H&S Care in Lancashire • Potential £800m system gap by 2020

Healthier Lancashire Strategy Digital Lancashire Strategy

• Focus on health and wellbeing

• Seamless care, shared records and partnerships • Right care, first time, every time • “Better information” (at point of care), “better decisions”,

leading to “better outcomes”

• Self-care & care closer to home • Telehealth and remote diagnostics

What do we want to achieve ?

Current State GP e-Records Systems

• Deployed in early 1990’s • Business and financial drivers • Some admin loading of information from Lloyd George Paper

Records • Early mis-trust of data • Clinical checking and validation of data - clinical provenance • Now this should be the “Master e - health record”

• Emisweb is the Lancashire and Cumbria dominant system (1

exclusion in Cumbria) • Documents, summaries, e-prescribing etc

Current state Morecambe Bay

Lorenzo EPR – June 2010 Clin Docs inc IDS / clinic letters ++ Test Requests +/- Test Results ++ Digital Terming +/- ED ++ Maternity ++ Interoperable 50 modular test results ++ Connected to GP records ++ E-whiteboards ++ Paperlite OPD ++ CDNR Project +/-

Current state Blackpool

IMS PAS Vision Clinical in ED Emisweb in community Mix of information flows , including use of MIG and Docman

Current state Preston

• Legacy EPR system • Streamlining departmentals • Exploring EPR options • Information flows via FAX,

Email and post.

Current state East Lancashire

• Portal approach on top • of departmentals • Community via Emisweb • Electronic letters to GPs • Electronic lab results to GPs • Electronic x-ray reports to GPs • Letters by Faxes and email

Current state Southport and Ormskirk

• Legacy PAS and departmental systems • E-test results –letters sent to GPs • Part e-letters (mental) rest communications with GPs via email, post and fax Committed to Meditech EPR and looking at community options

Current state Lancashire Care

• Mental Health – e-notes and e-prescribing (Ascribe) • Exploring EPR options • E-test results –letters sent to GPs • Part e-letters (mental) rest communications with GPs via email, post and fax

Connecting Care Pathways LPRES using Tiani Spirit (IHE compliant)

Progress with LPRES connecting system

Built • Preston Teaching Central Hub and Morecambe Bay Affinity Domains Next Step • Affinity Domains for East Lanc’s and Lancashire Care in next 2 weeks Not Yet Scheduled • Affinity Domain for Blackpool

Facilitators for Change

• Systems approach / Partnerships • Previous underpinning enablement NWSIS • Emergence of CCIO’s and National CCIO Network • ISD Network • Accreditation – networking, standards, sharing and improving • Development of IG Framework to support shared records and an e-Sharing System (C and Lancs IG Network) • Developing strategies aligned with Manchester, Mersey and the Healthy Cities agenda

CCG Digital Roadmaps

Separate Cumbria and Lancashire CCG Digital Roadmaps – Concern 1

Constraints – Geography • Not a neat fit for all emerging health economies • Better Care Together fits Morecambe Bay footprint • South Cumbria and Lancashire • Patients flow into Lancashire Hospitals and services

• North Cumbria “Success Programme” represents a health economy with links with the North East • Cumbria Digital Roadmap may well reflect north and south county

Constraints - Investment Sequencing • CCG declares Roadmap footprint - Oct 15 • Detailed CCG Digital Roadmap Plans and Digital Maturity

Returns – March 16 • NHS England engages with DOH / Treasury – Summer 16 • Investment expected to be delivered through Tech Fund

3+

• ?? No funding likely to flow until April 2017

Investment Sequencing – Concern 2

Tech Fund - Concern 3

• Tech Fund 2 delivery into Lancashire didn’t entirely fit with strategically needs • Late support for LPRES connecting system (£1m not £2.5m) • Support for comprehensive electronic nursing record in Morecambe Bay • Not for Source EPR systems at Blackpool or E-Prescribing system at East Lancs

• Treasury reduced Tech Fund 2 from £250m to £43m • This is not an overwhelming NHS endorsement of support for meeting the strategic goal of a paperless agenda

Vanguard - Concern 4

• Vanguard funding for Better Care Together in Morecambe Bay • Does the DOH / Treasury / Government believe ?? • Vanguard clinical leaders ready and on the “runway” • Small investment only so far – goal is “man in suit on telly ! ”

• Wait too long and a whole cohort of current doctor leaders will plan retirement • Costs and size of deficit will inexorably grow, until we implement re-designed health and social care

Are we in Lancashire doing enough ? – Concern 5

• Lancashire Digital strategy but no detailed delivery plan for wide footprint transformed care • Acute Trusts deep in the here and now, balancing finances, clinical quality, safety and finances • Not yet in place wide area detailed discussions about fundamental health and social care service design • Interested – intent – commitment • Commitment from organisations • Multi-organisational delivery plan

Are we in Lancashire doing enough ? Concern 5

• Has there been enough Acute Trust collaboration so far ?

• A current sense of increasing collaboration / converging views and principles

• Are we moving fast enough ?

• We need organisations to be brave, with collaborative,

strategic leadership to put patients first and not persist in organisation-centric thinking.

How hard can it be ?

SIMPLES !