Digital Primary Care Success Stories

Tracey GraingerHead of Digital Primary Care Strategy, NHS England

Digital Primary Care• Improving access for patients and citizens• Reducing bureaucracy across General Practice

Patient records

Practice infrastructure

Consultation access

Online appointment booking

Online repeat prescriptions

Pre-referral diagnosis

Telehealth, telecare and health living apps

Access to patient data at the point of care

Interoperability to allow data sharing between health and care professionals

Patient empowerment through the use of endorsed apps and other digital tools

92% of practices offer patients online access to their Detailed Care Record

Online Appointment Booking

98.7% of practices offering

8.4 million patients signed up

12% of all appointments are available online

Online Repeat Prescriptions

97.4% of practices offering

8.2 million patients signed up

4% of all repeat prescriptions requested online

Online Access to Records

6% of appointments could have been dealt with by practice staff other than the GP

4% of patients could have avoided contact with the practice if self-care support had been available

£29 per patient savings could have been achieved from reduction in telephone calls, appointments and administration

of 1.2 trillion Google searches are health-related

50 million visits per month to NHS Choices

49%

of adults go online for health information

Diabetes and Chronic Kidney Disease Early Identification and Prevention

How do we improve early diagnosis of

LTCs?

How can GPs support patients to improve how their

conditions are managed?

How do we know that this is having a

positive impact?

Long Term Conditions – What Problems Are We Trying to Solve?

Improve prevalence through case finding

Embed high quality primary careEducation Improvement in outcomes

for those on LTC registers

Prac

tice

Proc

esse

sEn

able

rs

Syst

emati

c ris

k st

ratifi

catio

n

Proa

ctive

pati

ent r

ecal

l

Diag

nosis

con

sulta

tions

us

ing

tem

plat

es

• Risk Stratification searches

• Templates• Resource to run searches

Syst

emati

c re

call

of

targ

et g

roup

s

Mon

itorin

g

Increasing prevalence for defined conditions to

targetTw

o st

age

cons

ulta

tion

and

plan

dev

elop

men

t

Actio

ns fr

om c

are

plan

pr

ogre

ssed

Annu

al re

view

• Searches• Care Plan Template &

Training• Resource to deliver care plan

Increasing number of care plans to target

Parti

cipa

tion

in

sem

inar

s and

pra

ctice

vi

sits

• Backfill cover

Ensu

ring

data

co

mpl

eten

ess

Mon

itorin

g of

ou

tcom

es

• All previous enablers• Data Management

Improvement in defined condition specific clinical indicators

NHS Camden Clinical Commissioning Group

WHAT ARE THE OVERALL RESULTS?

• Before LTC LCS were introduced, the % of changes were ranging from 0 – 4% across 5 LTC’s.

• After initiation of LTC LCS, within 6 months these changes rose up to 6%.• Within 18 months time they had blossomed upwards of up to 13%• Fast forward to 30 months and this growth is still sustainable. we are continuing to see

changes developing with a positive growth of up to 5% • THIS IS GREAT!


SPECIFICALLY IN CKD

4/1/2012 4/1/2013 4/1/2014 4/1/2015 4/1/20160

1000

2000

3000

4000

5000

6000

0.00

0.50

1.00

1.50

2.00

2.50

3.00

4312 44454740

5459 5464

1.701.80

1.90

2.10

2.40

CKD Register

Population Prevelance

From introduction to where we are now (30 months on) in the LTC LCS Programme, the CKD Register has gone up by approximately 25% and in turn Prevalence is up by + 0.7%


SPECIFICALLY IN CKD

4/1/2013 4/1/2014 4/1/2015 4/1/20160.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

2.99

6.22

13.17

0.09

% Change in CKD Register

Before LTC LCS was introduced

6 months after… 18 months after.. 30 months after..

Radical growth Sustainable Growth


SPECIFICALLY IN DIABETES

From introduction to where we are now (30 months on) in the LTC LCS Programme, the Diabetes Register has gone up by approximately 15% and in turn Prevalence is up by + 0.8

4/1/2012 4/1/2013 4/1/2014 4/1/2015 4/1/20167000

7500

8000

8500

9000

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

7699

8019 8055

8623

8827

3.00 3.003.30

3.30

3.80

Diabetes Mellitus Register

Population Prevelance


4/1/2013 4/1/2014 4/1/2015 4/1/20160.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

3.99

0.45

6.59

2.31

% Change in Diabetes Register

Before LTC LCS was introduced

6 months after… 18 months after..

Radical growth Sustainable Growth

SPECIFICALLY IN DIABETES


IT & SYSTEM AS “SUPPORT” ROLE-EMIS TOOLS: REPORTS

IMPROVE PREVALENCE BY CASE FINDING

ACHIEVING EARLY DIAGNOSIS, AND BETTER OUTCOMES AND VALUE FOR MONEY OF LTC MANAGEMENT

PAYMENT & ACTIVITY RELATED REPORTS

DATA QUALITY

Case finding

Various LCS’s


IT & SYSTEM AS “SUPPORT” ROLE- EMIS TOOLS: REPORTS (CASE FINDING)

Camden CCG LCS reporting suite- a snap shot

Diabetes case finding


IT & SYSTEM AS “DEVELOPER”ROLE- EMIS TOOLS: CLINICAL TEMPLATE

High risk Diabetes review template

SERVICE SPECIFICATIONS ARE TRANSLATED INTO EMIS DATA ENTRY TEMPLATES USING READ CODES

VALIDATED AND TESTED BY CLINICAL LEADS

CARE PLANNING AND DEVELOPMENT OF A CONSISTENT CASE MANAGEMENT APPROACH ACROSS CAMDEN

Diabetes YOC plan


IT & SYSTEM AS “DEVELOPER”ROLE- EMIS TOOLS: PATIENT’S ALERTS/ POPUPS

Pop-ups/alerts with in patient care records

• AUTOMATED DECISION MAKING PROCESS

• ALERT WILL BE DISPLAYED FOR PATIENTS WE ARE IN NEED OF MONITORING

• OPPORTUNISTIC SCREENING

Pop ups


IT & SYSTEM AS “DEVELOPER” ROLE- EMIS TOOLS: PATIENT’S ALERTS/ POPUPS (CKD CASE FINDER)

Pop-ups/alerts with in patient care records

Pop ups


IT & SYSTEM AS “DATA MANAGEMENT” ROLE- SCORECARD, PROGRESS MONITORING

CCG Scorecard for LTC LES


IT & SYSTEM AS “FACILITATOR” ROLE- PRACTICE VISITS & IT WORKSHOPS

Specialist advice by data quality facilitators on

• EMIS Tools

• Enhanced Services explained

• Data submissions

• Performance data

• Using NHS Systems – e.g. CQRS

• EMIS Web Training


IT & SYSTEM AS “ONE POINT SUPPORT” ROLE

GP IT Service Desk

Desktop Support

Systems Support Team

Projects Support Team

GP IT Support Team

Application Support

Email Administration

Server Support

RA Support Network Support

Data Extractions

Practice Workshop Facilitation

Data Quality Services

Desktop Refresh

Network Upgrades

Server Upgrade

The IT and Systems teams offer a multifaceted approach covering all clinical IT requirements and any add-on services, requisite to the needs of the Camden CCG Member practices and community services.

Community Systems

Support Team

Community System

Design/Install

MDT IT Facilitation

Training


SUMMARY PAGE

• Commissioners issued service specs

• IT & Systems transformed the service specs into tools such as: EMIS Searches; EMIS

Templates & EMIS Protocols.

• Engaged with practices at multiple levels: Admin / HCA / PM / Practice Nurse /GP

• Engaged with practices at locality level through IT workshops

• Measuring the progress / achievements through scorecards

• Share information with all major stakeholders

• Move towards continuous development – monitoring through working group meetings at

senior level

Innovative Business Intelligence Toolkit

Dr Neil Paul• I’m a Full time GP – Sandbach• I run a Clinical trials team• I help lead and manage 2 GP Federations through a company called

Howbeck Healthcare.• We have won >£5million in new income for our 30 practices including

a wave 2 PMCF bid.• You can contact me on [email protected]• Read my monthly column on the trials and tribulations of IT in

primary care on digitalhealth.net

mailto:[email protected]

Truly successful products deliver proven solutions to problems• They aren't technology looking

for a cause• They cross the chasm into real

value• Identifying the ROI is key• Several Great examples

• Hand writing rpt prescriptions – EMIS and others

• Dealing with paperwork – Docman + others

A lightbulb moment• The local hospital sent round yet

another email saying how busy it was and that it had seen 100 patients yesterday!

• Loads of GPs replied their practice was busy too and that had seen twice as many that morning.

• Occurred to us that there is no record of primary care activity -

• Workforce is changing• Federations• Super practices

• Lots of need to report activity• PMCF – extended hours• Pharmacists in practice scheme

When we asked - Locally GP partners & practice managers said• We don’t know if we are getting value for money from our staff?• We don’t have any tools to performance manage them with• We don’t know who does the work and who doesn’t• We don’t know what effect introducing a change has• We cant easily model changes• We are doing too much on paper and excel spreadsheets• We record almost everything we do but have no intelligence on what we have done• We need a business intelligence and management tool that provides real time data

that is useful for the running of our practices – not just commissioning tools for secondary care.

So ApeX was born• Developed by Edenbridge

Healthcare• PID at practice level• Flexible enterprise views with strong

controls on what data is shared with whom

• Multiple Dashboards able to focus in on topics with a robust query tool for advanced users

• Live data from primary care systems able to link to other data sources

Activity, Capacity and DemandDashboards to show

All User TypesExtended Hour Report

SunSatFri

ThuWed

TueMon

MorningEveningWeekend

92.25Extended Slots / Week

% Routine5.25%

Per 1000 Patients15.8

Unused16.3 (17%)

Target / Week685

# Weeks Met Target32 (80%)

4,219871Extended Minutes / Week Total extended slots

10%Booked same day

Jan 15 Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 1550556065707580859095

100Allocated

Extended§8%Routine

16%Unused

Extended14%Routine

10%3%Telephone

Extended Routine

Session Holder Extended Week Avg

%UnusedMorning Avg Age

Sex%Re-attend(Routine)

Paul, N R (Dr)

1,098 (25%) 21 178 (10%) 9% (7%) 42

Bromley, P (Dr)

100 (2%)

Evening

820 (26%)

Weekend

8%

802 (19%) 18 0 (0%) 8% (8%) 48652 (60%) 150 (9%) 11%

698 (16%) 16 568 (72%) 15% (9%) 450 (0%) 130 (8%) 16%Robertson, L (Dr)

All User TypesActivity Trends

2995Patients Seen

Unique Patients1814

Only seen in extended205 (11%)

Avg Attendance / Patient1.33

Bromley, P (Dr)

802 (19%) 18 0 (0%) 8% (8%) 48652 (60%) 150 (9%) 11%

698 (16%) 16 568 (72%) 15% (9%) 450 (0%) 130 (8%) 16%Robertson, L (Dr)

Registered92%

Usual GP33%

DNA5%

Routine (3%)

Cancer

Rheumatoid Arthritis

CVH

Heart Failure

Stroke

CHD

COPD

Asthma

Diabetes

Hypertension

0 5 10 15 20 250 - 4

5 - 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

85+

10 8 6 4 2 0 2 4 6 8 10

Age/Sex Breakdown Disease Register Breakdown

12.1 minsAverage Waiting Time

RoutineWeekend

EveningMorning

0 2 4 6 8 10 12 14 16 18

All User TypesDNA Report

3.88%DNA Percent / Week

Total2,742

Average / Week51

Session Holder Extended Week Avg

Morning Avg Age

%Re-attend(Routine)

Evening Weekend

5-Jan 5-Feb 5-Mar 5-Apr 5-May 5-Jun 5-Jul 5-Aug 5-Sep 5-Oct 5-Nov 5-Dec1.01.21.41.61.82.02.22.42.62.8

Per 1000 Patients0.12

Patients With DNAs2104 (9.35%)

Day & Time Breakdown

0.5 1 1.5 2 2.5 3 3.5 4 4.50

1

2

3

4

5

6Y-Values

Joint Session Slots137 (5.1%)

Routine3.8%

Extended6.2%

Routine vs Extended Hour

Session Holders


Session Holder DNAs Week Avg

Routine Avg Age

Paul, N R (Dr)

1,098 (25%) 21 42

Bromley, P (Dr)

100 (2%)

Extended

820 (26%)

802 (19%) 18 48652 (60%) 150 (9%)

698 (16%) 16 450 (0%) 130 (8%)Robertson, L (Dr)

Session Holders

Sex

2995DNA Patients

Unique Patients1814

Avg DNA / Patient1.33

Registered92%

Usual GP33%

Cancer


CVH

Heart Failure

Stroke

CHD

COPD

Asthma

Diabetes

Hypertension

0 5 10 15 20 250 - 4

5 - 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

85+

10 8 6 4 2 0 2 4 6 8 10


With a prior urgent attendance

Recurring DNAs

(5.4%)4+

321

0 10 20 30 40 50 60 70

390 35%


Cancer


CVH

Heart Failure

Stroke

CHD

COPD

Asthma

Diabetes

Hypertension

0 5 10 15 20 250 - 4

5 - 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

85+

10 8 6 4 2 0 2 4 6 8 10


DNAs against booked appointment date

Same Day

1 2 3 4 5 6 7 8 9 10 11 12 13 14+0

5

10

15

20

25

Days between booking date and appointment date

1 2 3 4+0

10

20

3040

50

60

Weeks between booking date and appointment date


Session Type Breakdown

Session Type DNAs Week Avg

Routine Avg Age

Antenatal 1,098 (25%) 21 42

Medication Review

100 (2%)

Extended

820 (26%)

802 (19%) 18 48652 (60%) 150 (9%)

698 (16%) 16 450 (0%) 130 (8%)GP Morning

Sex

Slot Type Breakdown

Session Type DNAs Week Avg

Routine Avg Age

Antenatal 1,098 (25%) 21 42

Medication Review

100 (2%)

Extended

820 (26%)

802 (19%) 18 48652 (60%) 150 (9%)

698 (16%) 16 450 (0%) 130 (8%)GP Morning

Sex

Patient Location

MAP

Wilsden Surgery (NP34234)

Cullingworth Medical Practice (NP34234)

Hebdon Bridge Surgery (NP34234)

Kilmenny Practice (NP34234)

Harden Surgery (NP34234)

Ridlesdon Surgery (NP34234)

Bingley (NP34234)

Baildon Smith Practice (NP34234)

Guiseley Surgery (NP34234)

0 200 400 600 800 1000 1200 1400 1600 1800

Series 1

5-Jan17-Ja

n29-Ja

n

10-Feb

22-Feb6-M

ar

18-Mar

30-Mar

11-Apr

23-Apr5-M

ay

17-May

29-May

10-Jun

22-Jun

4-Jul

16-Jul

28-Jul9-Aug

21-Aug2-Se

p

14-Sep

26-Sep8-O

ct

20-Oct1-N

ov

13-Nov

25-Nov

7-Dec

19-Dec

1,500

1,550

1,600

1,650

1,700

1,750

1,800

1,850

Appt

s/10

00 P

atien

ts

(NP3402) Bingley

So what's the point?• It should allow us to automatically report activity where needed• It is allowing PMs to plan future capacity better• It can provide information on work done and by whom for appraisals and

performance management• It can tell you who is needing/using the care and let you come up with new

models of care• It can show affects of altering the system• It can help you understand mergers/acquisitions• Ability to build dashboards to investigate data• Lots more..

Other things we are working on: or trying to get up and running• GPAsk – a Q&A forum for clinicians and admin staff in a GP Federation including – News Events Jobs

and Questions• Early adopter of EMIS remote consulting – Enterprise S&R and their new Video consultations platform.• ECG project – with Technomed• POCT - with Allere• Automatic Form creation with Niche Health• Read Coding/ Scanning project with a partner.• Out/In sourcing digital dictation with Lexacom?• Speech recognition with Nuance• GP order comms – with Sunquest• Pt Messaging project with iPlato• Looking at Medefer – referral avoidance

[email protected]

#PMGPAccess#DigitalPrimaryCare#FutureNHS

@tracey_grainger

https://www.england.nhs.uk/digitaltechnology/info-revolution/digital-primary-care/

Digital Primary Care Success Stories

Health & Medicine

Transcript of Digital Primary Care Success Stories