Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life

www.england.nhs.uk

Electronic Palliative Care Coordination

Systems (EPaCCS):

Improving Patient Care at End of Life

WELCOME

#EPaCCS

www.england.nhs.uk

EPaCCS:

in the national context

Prof Bee Wee

NCD for End of Life Care

17 March 2016

www.england.nhs.uk

Wider context

www.england.nhs.uk

Wider context

New models of care

Initiatives for improving:

integration

choice, personalised care and control

Support for improvements:

organisation level

System level

www.england.nhs.uk

www.england.nhs.uk 18/03/2016

www.england.nhs.uk

The scale of the challenge

• Individuals to be able to view their records, and to record and edit information about what matters to them – by April 2018

• Records to be interoperable, digital and real-time – by 2020

• Professionals to view and use this as a means to improve service and experience of care

• Draw information and evidence/metrics from records

• Ideally align records and data collection

www.england.nhs.uk 18/03/2016

North West EPaCCS

Stephen Burrows

North West EPaCCS Lead Greater Manchester, Lancashire and South Cumbria

and Cheshire & Merseyside Strategic Clinical Networks

17th March 2016

Potential North West issues

• Patients that cross boundaries when using EoLC

services (e.g. 15% -20% of EoLC patients in one

acute trust not from that locality), or move

Patient flow from primary to secondary care


• Patients that cross boundaries when using EoLC

services (e.g. 15% -20% of EoLC patients in one

acute trust not from that locality), or move

• Standardising (as much as possible) the

processes and flow of information to NWAS from

33 CCGs

Ambulance service

Tertiary services

Acute trusts, hospices

GPs, community


• Patients that cross boundaries when using EoLC services (e.g. 15% -20% of EoLC patients in one acute trust not from that locality), or move

• Standardising (as much as possible) the processes and flow of information to NWAS from 33 CCGs

• Use of other shared resources (e.g. hospices / other organisations that cross boundaries)

• Providing patient access

• Reporting and monitoring of outcomes (measuring ‘like for like’)

• Use existing systems

• Avoid / reduce duplication of existing EoLC

recording

• Replace / reduce other non-electronic EoLC

communication

• Quick and easy to use, avoiding over use of

text

• Ensure sustainability and make ‘future-proof’

North West requirements

• Identification of 20 EPaCCS ‘localities’ across the North West (from 33 CCGs), and subsequent setting up of EPaCCS Task Groups to meet regularly and represent the range of stakeholders within a locality involved in End of Life Care (EoLC).

• Creation of a common dataset – the North West EPaCCS dataset – a minimum implementation of which ensures ISB 1580 compliance, but which also includes other frequently used information commonly shared by end of life care services. Accepted by all localities in 2013, and continually updated to reflect changes to the standard.

The North West EPaCCS – achievements so far - 1

• System supplier created, nationally available, EPaCCS templates based upon the NW EPaCCS dataset available and in use in local systems – EMIS Web/LV/PCS (available since 2013), INPS Vision+ (available since 2014), TPP SystmOne (now available locally), iPM Lorenzo (Morecambe Bay), Graphnet (available since Nov 2014) etc.

• Training materials for the national EPaCCS templates to support local rollout of their use, and provide resource for EoLC facilitators etc involved in supporting EPaCCS use.

The North West EPaCCS – achievements so far – 2

• A‘Why EPaCCS?’ film to encourage and promote the use of EPaCCS by clinicians in all EoLC services.

• A North West template for an EPaCCS Information Sharing Agreement (ISA), shared with all localities for their adaptation and completion.

• An ISB compliant End of Life View available in the MIG (Medical Interoperability Gateway) supplied by Healthcare Gateway. This is currently the only commercial solution allowing for the streaming of information recorded on GP systems to be shared with other organisations.

The North West EPaCCS – achievements so far - 3

• Regional support and networking provided through the creation of EPaCCS Network Implementation Groups (NIG) – for Cheshire & Merseyside, Greater Manchester, and Lancashire & Cumbria – that meet quarterly, and share best practice / developments via a Yammer network.

• Targeting and support for locality EPaCCS implementation set through the Eight Key Areas document, RAGB-rated on a quarterly basis, and fed back through SCNs and AHSNs to organisations. Starting in GM, this has been developed into an AHSN supported performance dashboard to be rolled out further.


• First examples of real-time EoLC information being shared through EMIS to EMIS, and via the MIG with other services including OOH etc. happening across the region.

• Continuing work with NWAS and The Christie to agree a co-ordinated means of receiving real-time EoLC information either through the MIG Shared Record Viewer or Graphnet.


• EPaCCS Supplier meetings held twice yearly to pursue regional development and initiatives in terms of interoperability.

• Link into Lancashire Patient Record Exchange System (LPRES) and Datawell interoperability solutions for Lancashire & Greater Manchester.

• Work ongoing to promote EPaCCS implementation through Transform agenda.


Challenges in progressing EPaCCS

• Leadership

• Clinical engagement

• IT engagement

• Finance

Stephen Burrows

NW EPaCCS Lead

[email protected]

mailto:[email protected]

Kate Estcourt & Annamarie Challinor

GP Practices 22 Eastern Cheshire 18 South Cheshire 12 Vale Royal

2 Hospitals East Cheshire NHS Trust Mid Cheshire NHS Foundation Trust

2 Hospices East Cheshire Hospice St Luke's Hospice

Cheshire

Where did it all start?

• October 2012- bid for 50K underspend monies Specialist Palliative Care

-Manchester & Cheshire Cancer Network- 2 year coordination/IT support

• May 2013- Attended National EPaCCS Roadshows

1. Don’t wait around for the all singing , all dancing system that does everything you need it to do- or you will still be here in 2 years

2. Don’t underestimate the level of end of life training and communication that you will need to put into this to make it a success

How did this influence the approach we took in Cheshire?

1. GP System to be the driver for EPACCS

• 49/52 Practices using

• Community Provider use with District Nurses, Matrons

2. Clinically led throughout

• GP Clinical Lead

• Specialist Palliative Care Teams

3. Supported by project coordination and education

• End of Life Partnership host coordinator and lead education

• EPaCCS steering group with IT representation

North West EPaCCS Lead

1. Encourage use of the template • Current users of EMIS Web • Quality incentive /contracts for GP’s • Marketing & Resources with support North West Lead • Reinforce through local training , projects and audit • Create GSF automated Register functionality

2. Influence wider access to EMIS Web

• Identify key teams involved in end of life care • Support local Hospices and help sourcing funding

3. Get EPaCCS onto wider locality ICT agendas

• Integrated Care e.g. Caring Together • Pinoeer Cheshire – Cheshire Care Record • Electronic Patient Records- Hospitals

4. Obtain local evidence base to demonstrate impact

• Public Health Data collection- EMIS Enterprise • Develop reporting cycles as part of GP contracts/ LES

5. Purchase software to enable interoperability

Project Plan 2014-Present Day

EMIS Template

The Summary View

The End of Life summary view will allow you to see an overview of all the read codes entered for End of Life , including those entered by other teams e.g. Macmillan, District Nurses, Matrons, Specialist Nurses

NB: Providing your practice has agreed and activated the sharing of information with these teams

Benefits of using one system for EPaCCS

• No double entry for clinicians‘

• Dovetailing of existing local IT strategies

• Allows for a clinically led approach

• Ease of locality reporting - EMIS Enterprise

• Consistency of education

• Consistency of communication

• Negotiating power at locality level with EMIS

EPaCCS- Phase 3 & 4- 2016 onwards:

ACUTE HOSPITAL • Mid Cheshire Trust • East Cheshire Trust

URGENT CARE • Out of Hours GP’s • NWAS • NHS 111

SOCIAL CARE • Crossroads Care • Social Workers

VIEW ONLY ACCESS

Cheshire Care Record

Cheshire Care Record Cheshire Care Record

South & Vale Royal Local EPaCCS related GP Quality Scheme 2014-15

Eastern Cheshire - overall 0.29% (2014 was 0.23%) South Cheshire - overall 0.46% (2014 was 0.229%) – Vale Royal - overall 0.48% (2014 was 0.353%)

Impact upon Palliative Care Registers

Numbers of GP Practices with Dementia patients on the GSF Register 13 of 22 Eastern Cheshire Practices (59%) – (2014 was 12/22 - 54%) 15 of 18 South Cheshire Practices (83%) – (2014 was 7/18 – 39%) 9 of 12 Vale Royal Practices (75%) – (2014 was 6/12 – 50%)

South CCG Non –Cancer on the GSF

Thank you [email protected]

[email protected]



How the NHS Summary Care

Record supports EPaCCS

Summary Care Record - Supporting Person Centred Coordinated Care

www.hscic.gov.uk/scr [email protected] @NHSSCR

Current status

• SCRs are an electronic

record of key

information from the

patient’s GP practice

• As a minimum contain

medication, allergies

and adverse reactions

96%

Nationwide coverage

of patients

have had an

SCR created (55 million)

2.5m

SCR utilisation

SCRs

accessed last

year to support urgent and

emergency episodes of care


• GP practices now have

capability to enrich SCRs

with a set of additional

information - with patient

consent

• Includes individual

coded items and

associated free text from

the GP system

• Automatically kept up to

date over time

• Reason for medication

• Significant medical history (past and present)

• Anticipatory care information (such as information about the

management of long term conditions)

• Communication preferences (as per the SCCI-1605 national dataset)

• End of life care information (as per the SCCI-1580 national dataset)

• Immunisations

SCRs with additional

information include:

SCRs with additional information Supporting person centred co-ordinated care


Dr Mark Spring, GP Sandford Surgery, Dorset and

Clinical Lead for Urgent Care Services

"The enhanced functionality to create enriched SCRs is

simple. I can record information once and share it easily,

which is fantastic! As an Out-of-Hours GP, I know the

importance of making sure essential patient information

can be accessed.

Creating enriched SCRs empowers other people looking

after my patients to be able to access accurate and

detailed information – it reassures me that my patients will

receive the best possible care whenever they need it.”

SCRs with additional information Supporting urgent and emergency care


• The SCR additional information includes clinical codes from

the SCCI1580 standard and other related information:

Patient’s carers and their details

Communication needs (including SCCI1605)

Disability and functional status

Social context

Advance care planning and DNACPR

Other patient preferences

Items not automatically included may be manually included

• The SCR can signpost to further information held elsewhere:

Flagging the existence of an advance care plan,

resuscitation status, LPA etc.

Directing the user to where this is held

Supporting EPaCCS…


Supporting EPaCCS…

• SCR is being used in a wide number of care settings

including emergency, palliative and end of life care

• Provides a cost effective solution for health communities to

accelerate local record sharing and an opportunity for

settings with lower digital maturity to be included

• SCR is available wherever the patient is treated across the

NHS in England:

• beyond the footprint of the EPaCCS system

• beyond the EPaCCS core user group

• where the EPaCCS system is not available

• … so, SCR can supplement your existing local record

sharing plans…

49


Professor Bee Wee

NHS England Director for End of Life Care

* The SCR provides the end of life preferences entered in the GP practice system

- complementing local Electronic Palliative Care Co-ordination systems (EPaCCS)

SCRs with additional information Supporting end of life care

“The Summary Care Record provides a great opportunity

for everyone to have their views and preferences digitally

recorded by their GP practice*, and viewed when

necessary, during the final stages of their life. This can

bring enormous peace of mind to these individuals and

those close to them, and help professionals who are

trying to deliver care in accordance with the individual’s

needs and wishes.”

Web:

www.hscic.gov.uk/scr

Email:

[email protected]

Twitter:

@NHSSCR

Sign up to the SCR bulletin:

http://systems.hscic.gov.uk/scr/signup

For further information on SCR content, see the SCR Inclusion Set Overview:

http://systems.hscic.gov.uk/scr/additional/inclusiondataset.pdf


https://twitter.com/hscic

http://www.slideshare.net/hscic

http://www.hscic.gov.uk/

http://systems.hscic.gov.uk/scr/additional/inclusiondataset.pdf

EPACCS as part of an Integrated Care Record.

Mohammed Abas

Martin Jones

EPACCS is not a Care Plan!

It is essential information that:

Allows care co-ordination 24 / 7

Gives & Key information at a glance – guiding an urgent / emergency response

It also:

1. Is a clinical system

2. Depends on up to date registers and information

3. Requires a critical mass of usage to work

The Challenge in Manchester

1. Is it easier, better, simpler, quicker than what happens now?

2. Multi agency info – what do we leave out?

3. 3 Acute Trusts, 3 Hospices, 3 CCG’s, 80 care homes 100 GP practices 1 Out of Hours, 1 Local Authority, Ambulance emergency dispatch & new 111 system.


4. Demands & pressure of clinical work – time poor – GP - QP, QoF, LES, DES.

5. Double inputting, Double consent – Evolution - when is it slick enough to roll out!

6. Pressure to deliver 2008 Strategy - Oct 2013 Target – annual funding – Incidents – Business cases!


7. Over 2 years a lot can change - Centralised – localised – One team , Place based care Integrated Health & Social care – GM Devolution.

8. Higher threshold for Social Care impacts on health care – What system do Health & Social Care professionals need?

...and some potential show stoppers

• Has every one got a NHS net account or an N3 connection?

• Will it work on mobile devices that may be bought in the future?

• Information sharing agreements, clinical steer / leadership?

• In a commercial relationship – to develop a product.

PATIENT CONSENT

Information access Right information, any place, at right time

GPs, Practice Nurses, OOH Doctors, Active Case Managers, Social Workers, District Nurses, A&E / Hospital Consultants, Safeguarding Teams, Paramedics, Community Staff , Mental Health Practitioners, Rapid Response Teams, Specialist Services…..

Our solution - Manchester Care Record

Live

In rollout phase

Manchr City

Council

Central Manchr

FT

South Manchr

FT

Pennine Acute

HT

90 Manchr

GP Practices

Manchester Care Record

/ Portal

Manchr Mental Health Trust

• GP Record Summary (Investigations, Diagnoses, Medication, Allergies, etc)

• Secondary Care Activity Summary (IP/OP/A&E admissions, transfers, discharges, appointments, lab results)

• Social Care Activity Summary (Allocated teams & contacts, personal & relationship contacts, current & planned services, etc)

• Integrated Care / Crisis / Admission Avoidance Plans • End of Life Plans / EPaCCS Register – Dec 2015

NWAS / NHS111

OOH (G2D)

Manchester Care Record – Led by clinical need

• Manchester GP’s views on the benefits & risks of not sharing data:

Dr Paul Wright, GP, Manchester: “A shared care plan improves ownership and communication with patient and between caregivers. As well as reducing the need for repetition (tests, questions, referrals, etc,) a common IT platform gives us an opportunity to share standardise processes and reduce variability”

Dr Sarah Taylor , GP, South Manchester: “The current system sometimes involves GPs faxing. This is not timely, not always accessible and the quality of information shared is variable. This system allows relevant information to be shared much earlier in the patient's care and in a more consistent manner.”

• Early stage clinical co-design

• Capture & share concept embedded

Manchester Care Record – Benefits & Outcomes

• Manchester had already seen real benefits from integrated approach…

Patients are involved in shaping their plan

• Patient controls access to information & influences the type of care they receive

• Don’t have to remember/repeat medical history

• Avoid unnecessary tests

• Improves outcomes and experiences.

Analysis of the first 2,044 patients

• Cost: Ensuring that commissioners pay appropriately for care

• Overall activity and costs have reduced by 9%

• Current savings to date for these patients are £360,987

• Savings in Emergency Admissions show a 15% reduction in activity and 8% in cost. Overall, the cost savings in Emergency Admissions account for 58% of the total savings so far.

• The largest percentage reduction is shown in A&E activity (19% reduction).

Over 6,000 patients sharing data and care

plans in place. • Proactive: Using data we have

identified people who would benefit from an intervention (high-risk)

• Coordinated: Draws together the correct, relevant information to identify and coordinate the best interventions for that individual

• Safe & Effective: Avoids harm, decisions based on correct, up to date information

• Decision making: Use information to identify whether care delivery is effective and improvements required

Manchester Care Record – Benefits & Outcomes

Use of MCR:

• Member of community team ‘walked the ward’ & identified she had a care plan

• Viewed care plan and shared care record on her laptop

by the patient’s bed

• This identified the lady had recorded end of life wishes and community team worked with the consultant to manage a discharge

Outcome:

• Patient remarked she was very pleased that hospital team could contact her keyworker

• Patient died, at home, as she wanted

Positive, but the process needed the community member of staff to identify and pass on details to the consultant – what would the impact on best practice be if those EoL wishes were flagged and immediately accessible to consultant at the point of admission?

Elderly lady with lung cancer admitted to hospital

Benefits seen in Manchester

1. Existing Information Governance experience and frameworks

2. Existing clinical and managerial steering group arrangement with shared ownership, ethos & skills

3. “Ready” IT infrastructure & feeds/links – and organisational relationships

4. Opportunity to streamline capture of data and avoid double-entry

5. Implementation and adoption easier with existing benefits case and migrated historically captured data – forming part of a patient pathway that is instantly accessible and available

6. Opportunity to expand on existing benefits case for specific patient cohorts – maximise these for full Manchester population?

www.england.nhs.uk

Randomised Coffee Trial

Please find the person with the same

number as you and have a coffee

and a chat with them

#EPaCCS

EPaCCS Evaluation

Improving Patient Care at End of Life

National Conference, 17th March 2016

Project brief

To “examine both the impact of EPaCCS on the experience of care towards and at the end of life, for patients, carers and those who are important to them and staff and look at the

body of evidence appropriate to the cost effectiveness of EPaCCS.”

The Whole Systems Partnership 66

Analysis of EPaCCS extracted

data

Approach


Survey in 2 locations

(EPaCCS & Non-EPaCCS)

12 in-depth interviews (2 patients, 4 carers, 6

professionals

Comparison of ONS data for place of death over 4 years Analysis of

hospital costs over last year of life for those who died in hospital

5 evaluation sites (with

EPaCCS since 2012)

6 ‘control’ sites (no EPaCCS reported in

2015)

Back-drop of all-England figures

Interviews with 8 ‘system leaders’ ?

What have we found?

The evaluation design has sought to ‘triangulate’ findings from a range of different sources and angles – this means that we can say with confidence that:

There is a consistency of positive messages, even if on their own they fall short of being conclusive – no single deal clincher, but lots of pointers in the right direction;

We have found no counter-messages, although the presence of EPaCCS has highlighted certain challenges in delivering good quality end of life care;

The contribution that EPaCCS makes meets with resounding support from all stakeholders.


Our in-depth interviews 12 people interviewed;

2 patients, 4 carers and 6 professionals;

Cancer bias in patients/carers groups;

3 GPs, 2 clinical nurse specialists in nursing homes, 1 paramedic;

10 EPaCCS, 2 non-EPaCCS participants;

2 face-to-face interviews, 10 by phone;

1 research interviewer, 2 secondary listeners;

NHS SI Team or clinical leads identified participants.


What people told us works well

The shared record speeds up care;

It prevents re-telling a story and therefore builds a sense of continuity for the patient and carer;

It enables patient choice e.g. PPD at home;

EPaCCS facilitates conversations about advance care planning;

Details matter in EoLC - personalisation affects perception of overall quality of care.


Challenges – identification for EPaCCS inclusion

Long-term conditions should/could be included, but identification can be challenging, for example in MS the natural history could be relapsing/remitting, so its more difficult to identify the last year of life:

“It’s criteria based. We don’t consider you as being in the last year of life, so we won’t put you on the

register. I’m wanting to talk about it, but it’s closed off.” [Male patient, 49, EPaCCs site]


Challenges – difficult conversations

Key to entry into EoLC and EPaCCS – gatekeeping;

Taboo - clinicians fear raising the subject:

“Depends on how empowered the family is. If you’ve got a gentle, timid family, they often don’t fare as well as those brave enough to ask questions. If you’re able to ask a question, that goes a long way. You need to be able to ‘speak healthcare’. We need a different attitude.” [Female carer, 67, non-EPaCCS site]

Conversations take time:

“It’s not the time it takes to do the data entry, it’s the correct conversations with patients, carers and families that take time.” [Female GP, 52, EPaCCS site]


Responding to the challenges

EPaCCS can surface these, and other challenges, in delivering person-centred and co-ordinated care at or approaching the end of life;

But the challenges don’t undermine the potential benefit that EPaCCS can bring;

EPaCCS needs an environment in which there is an ongoing process of building capability across the workforce and for all aspects of end of life care.


Key messages Patients, carers and professionals all express enthusiastic support for the benefits that EPaCCS can bring;

System leaders see EPaCCS as an important tool to improve coordination of care, and outcomes, at the end of life;

‘Success’ in terms of EPaCCS implementation needs to reflect a broad range of quantitative and qualitative measures that are routinely collected and reported locally for purposes of system improvement;

The costs of EPaCCS are low relative to the costs of care and it is possible to argue that they have the potential to reduce costs for hospitals.


End quotes [Patient]: “how can they say I’m not in the last year of life when I

could’ve been in the last days? I can’t play the game. It’s as if they’re saying, ‘It’s our football and you’re not playing.”

[Carer]: “she died where and how she wanted, like a Hollywood death.”

[GP]: “there’s a changing emphasis in facilitating a good death, rather than being scared of death. They fear that letting someone die is

doing something wrong or letting someone down.“

[Paramedic]: “they know an ambulance will turn up to help them. We didn’t use to know the plan but now I do. Electronic records are

invaluable.”


www.england.nhs.uk

Swapping Conversations

#EPaCCS

77

Using the Summary Care Record

for an EPaCCS implementation in

East Sussex

Barry Ray - Former IT Project Lead

NHS Hastings & Rother CCG

NHS Eastbourne, Hailsham & Seaford CCG

NHS High Weald Lewes Havens CCG

EAST SUSSEX

78

The Project Plan

The Beginning - Why choose SCR?

The Middle - Engagement & Deployment

The End - Feedback & Re-assessment

The Future - What’s happening next…

79

Why choose SCR?

Accessible across all regional & organisational

boundaries within England

SCCI 1580 compliant (SCR/Additional Information)

Fully integrated with GP clinical systems

‘Viewing’ interface with systems across N3 network

Security, confidentiality & audit mechanisms built in

Supports an established consent model

SCRs routinely viewed in healthcare settings

80

N3 Network

Care

Plans Care Plans Clinical Templates

Electronic Patient Record

Hospital Pharmacy

Secondary Care Organizations

Patient

Hospital Wards

Hospital A&E

Ambulance Service

OOH Service

(IC24 - Cleo)

Hospice Care-Home

Nursing Home

EOLC Template (SCCI 1580)

A

Core + Additional Data

SCR

C

D

Updates

E

GP Clinical System

(GPSoC 2.1)

B

MDT Team

PPC

81

Engagement & Deployment

Board level approval at all 3 CCGs

Intensive SCR rollout programme

PLT workshops & Locality meetings

Staff Training: GP Surgery + Hospital Setting

Hospice Information Network

Clinical Template Design & Development

82

Feedback & Assessment

Local Commission Service – EOLC

Extending LCS to all Vulnerable Patients

Re-design of Clinical template to cater for:

Admission Avoidance Scheme

Preferred Preferences for Care

Palliative Care

Viewing Figures Reporting Dashboard

83

What’s happening next…

Pushing for changes to SCR

Improvements to viewing format & layout

Links to external sites (e.g. Care Plan repository)

Easier 3rd party integration (Single-click access)

Read/Write capability

Extending access to non-N3 connected organisations

Providing mobile solutions to ambulance service &

hospital wards

Improving feedback from users

84

Contact Details

Gerry McGee Head of IM&T

Tel: 01273 403626 Email: [email protected]

Becky Gayler IM&T Project Manager


Barry Ray Former EPaCCS Project Lead


NHS Eastbourne, Hailsham & Seaford CCG NHS Hastings & Rother CCG NHS High Weald Lewes Havens CCG

Address: 36-38 Friars Walk Lewes East Sussex BN7 2PB




www.england.nhs.uk #EPaCCS

EPaCCs

Susan Salt

Clinical Lead Lancashire and South Cumbria Palliative and

End Of Life Network

Collaboration across all care settings

Collaboration across professional boundaries

Patient Centred

Clinical and IT leadership

Seeing why it is important and what it can achieve

Not taking no for an answer

Jargon and acronym

busting

Openness, transparency and candour

• A common culture

• Common values

• Clear rules

• Monitoring compliance

• Enforcement of compliance

• Accountability

• Effective handling of complaints and incidents

Not easy…..

Willingness for all staff to have difficult and honest conversations with patients and their families and then complete the EPaCCs template – and trust each other to act upon what it says……

www.england.nhs.uk

Why EPaCCS?

https://www.dropbox.com/s/cvjvjupyglsqn67/EPaCCS Video Mobile Version.mp4?dl=0

Salford EPaCCS

WHAT DIFFERENCE DOES HAVING AN EPaCCS MAKE? Steve Gene Assistant Director of Nursing Palliative & End of Life Care 17.03.16

One of 8 original pilot sites - system live late 2011

• Multisystem – EPR, Primary Care Interface (SIR), Vision & EMIS

• System user training – primarily those with skills for significant conversations

• Automated data extraction (EPR) established

The story so far….

• Secure e-mail alerts real time – DNs & GP OOH (GP via ‘Docman’)

• NWAS & Hospice via nhs.net

• 554 patients 2014-15 (430/488 PPD = 88%)

• 2015-16 = 50>60 entries/month – PPD to Feb = 441/489 = 90.2%

The story so far….

• PPD = GM KPI & ongoing local KPI

• Embedded acute & community CQUIN

• Embedded ‘Salford Standard’ from April ’16

• Integrated Care Organisation & Shared Care Record (work in progress)

Embedding

Challenges

• Earlier use & the 75% rule

• Expansion beyond ‘core users’

• Social Care - particularly Care Home access

• Ongoing professional engagement

• Data transfer (quality & viewing)

• ‘Whole system’ reporting

• System limitations

• Data quality, transfer, viewing & reporting

• Ownership - maintenance & assurance

• Untapped potential (e.g. No. predictable deaths for Salford)

• Patient & carer engagement

• Best option to capture ACP – keep going!

Lessons learned

QUESTIONS

End of Life Care

in

North Tyneside

Enhanced Summary Care Record

• To improve communication with those involved in the care of patients who are approaching their end of life. To:

• Enable patient to be cared for in their place of choice

• Support carers to care for patient at end stage of life

• Patient to die in their place of choice

• Improve patient /family experience at a difficult time

• Support professional decision making in a timely manner

• Prevent hospital admission if not necessary

• Direct services where needed

2015 North Tyneside • GP palliative care registers at 0.52 %

(national average still 0.2%)*

• DNACPR in place in 87% of patients on register

• Deaths at home –55.4%

• Nursing Homes residents dying at their home - 83% (next best rate 73%)

• Specialist Palliative Care Team now in 16/40 Residential homes

Residential Home residents dying at their home -77%

Rapid Response Service starting Jan - April 2016-community based using SystmOne


• How will we measure the impact of the project ?

• Baseline and trend data :

• people on end of life register ( numbers and %) of practice

• people dying on end of life register (numbers and % on EoLregister)

• people dying on end of life register with end of life care plan in place /preferred place of death recorded

• How many DNR on register

Enhanced Summary Care Record Impact of the project

• Deaths in usual place of residence

• Deaths within 24hrs of admission to hospital

• Reduction in number of avoidable admissions to hospital from care homes

• Reduction in length of stay and bed days for patients on the End of Life register

• Reduction in emergency hospital bed days in last 100 days of life

Enhanced Summary Care Record • Patient & family experience

• Patient and family informed on choices /expectations

• Patient expressing choice

• Patient experiencing care in place of choice

• Patient dying in place of choice

• Family distress alleviated

• Family survey 3 months post death.

• Questionnaire in line with N.Tyneside Patient voices project ( partnership approach to EoL surveys)

• Shared learning across agencies


• Professional experience

• Increase accessibility

• Increase viewing of information

• Influencing decision making about care provided and where

• Decision making quicker and easier

• More empathetic/quality of care

• Staff groups: survey/interview

• Primary care GPS , Community Matrons, NDUC

• A&E departments/Medical assessment units /Hospital pharmacists

• End of life social work team

• Specialist nursing service

Enhanced Summary Care Record Pilot

• Partners: NT CCG, NT General Practices, NT Local Authority ,Northumbria Health Care Foundation Trust ,Newcastle upon Tyne Hospitals Foundation Trust, Northern Doctors Urgent Care St Oswald’s Hospice, 111, (NECS)

• Support :ASHN, NECS, Regionally, Nationally

Challenges

• Summary Care Record: Version 2.1 update- completed July 2015

• READ Codes and National Data Set: Network and NCPC

• NECS: 111 and e SCR

• Partner organisations • Northumbria -community uptake of SystmOne ( including NH

team) July 2015, NSECH

• Newcastle Hospitals- completely new IT team, had to re-engage

• NDOC & NEAS- market competition-shared portals

• Patient feedback survey in North Tyneside

• Financial support

Strengths

• Fed into national and regional discussions regarding data sets and highlighted problems that had not yet been identified

• Created new awareness and links into NECS

• Strengthened relationships with partnership organisations and identified gaps e.g. NEAS

• Connectivity with all the other end of life developments in North Tyneside

• Communication strategy

• Local champion

• Project management has continued despite funding circumstances

• 4 pilot practices on SystmOne in place ready to go live

(50% of NT practices on SystmOne and all NH and the team’s RH patients are on SystmOne)

• Northumbria ( nearly ) ready to look at view of eSCR for end of life patients- MIG

• READ codes –those used by pilot are ok regarding Version 2.1 except for Preferred Place of Care

• Working with NECS to link their and our work into 111

• Focus group feedback to be collected for patient family and professional groups

• Continue to feedback Regionally and Nationally

• End of Life Work streams continuing in NT so once eSCR in place the uptake will be immediate

• Would like to pick up again with other partnership organisations to take this forward and gather impact from them accessing eSCR

Boxing Day Dip at Whitley Bay

North Tyneside

Dr Kathryn Hall

How NWAS is tackling electronic EPaCCS sharing with 33 CCGs

Phill James Programme Management Office

NWAS

Delivering the right care, at the right time, in the right place

NWAS Touch Points

Planned Care:

PTS Journey (To Home / Hospice / other preferred place)

111 Call:

Telephone Advice

Appointments

Sign Posting

999 Call:

Dispatch

Telephone Advice

Sign Posting

At Scene:

See & Convey

See & Treat

See and advise

Safeguarding & Clinical Referrals

Safeguarding Referrals


The Vision NHS111 and 999 successfully identify all patients as

early as possible during pathway

NHS111 and 999 possess up to the minute electronic warnings that a care plan exists for an identified patient (Telephone & Face to Face)

NHS111 and 999 have electronic access to the guaranteed current care plan for an identified patient (Telephone & Face to Face)


ERISS Vital Statistics

• Organisations Registered 649/656

• Users Registered 3689/3949

• End of Life Care Plans (2015) 5343/1159

• Oxygen Plans (2015) 224/26

• Community Care Pathways (2015) 2161/258

Total (2015) 7728/1443


ERISS


ERISS EoLC Records 2015

Live Flags By Reason

0

100

200

300

400

500

600

700

800

900

1000

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

CACP

PPC

MCCD

LCP

DNACPR

AND

ADRT

CP


111 Legacy Issues

OOH Adastra

111 Adastra

GPRecord

DischargeNotes

Primary Care

Secondary Care

SCR

*DNAR in place

confirmed on

phone and passed

to OOH for DoD/or

pass back to 999

14 Day

SPN

Review

*E-SCR: DNAR

found at bottom of

5 pages of non

standard care plan E-SCR


999 Legacy Issues

999 Dispatch

111 Adastra

Gazetteer

SCR

999

ERISS E-SCR

Primary/Secondary

Care


Aspired Workflow

RegionalICDRs

RegionalICDRs

999 Dispatch

111 Adastra

999 111/999 UCD Adastra

999ClinicalSupport

Hub

GPRecords

DischargeNotes

SocialCare

Records

E-SCRGraphnet

MiGERISSCP-ISFGM

HandoverRecords


Care Planning Landscape

MiG E-SCR

Graphnet

ERISS

EMiS / TPP

/ INPS

OpenEHR

Other 3rd

Party

Innovators Paper



MiG /

STRATA

GRAPHNET

DATAWELL/

GM-CONNECT/

GRAPHNET

RIPPLE

LPRES



CUMBRIA

CARE

RECORD

CHESHIRE

CARE

RECORD

MANCHESTER

CARE

RECORD LIVERPOOL

CARE

RECORD

LANCASHIRE

CARE

RECORD


Scale of the Challenge

0

5

10

15

20

25

30

35

Clinical CommissioningGroup

EPACCS Localities Health and WellbeingBoard

0

5

10

15

20

25

MIG Datawell Graphnet GM-Connect LPRES Ripple E-SCR ERISS

MIG

Datawell

Graphnet

GM-Connect

LPRES

Ripple

E-SCR

ERISS


DSA Challenge – First 9

0

5

10

15

20

25

DSAs By Locality/CCG

In Place

In Progress

Outstanding


Current EPaCCS Challenge • Put first 9 DSAs in place

• Deploy 999 CAD to MiG/Graphnet interface to auto query GP flags on addresses

(Governance moves - No need for only EPaCCS compliant and integrated CCGs to use ERISS)

• Provide access to MiG/Graphnet instances on 111 Adastra via planned upgrade

(deploy to existing 111 clinicians/999 UCD/999 CSH)


Summary • 111

• Adastra upgrade will reduce the reliance upon SPNs for EoLC information – presence of tab will signify presence of a plan

• 999

• Clinical flags on addresses will always be required to alert crews to presence of a plan

• Clinical flags function within ERISS remains key until 999 CAD to all GP records is achieved

• 111/999

• ICDRs embedded within Adastra and coupled with iVCH is the objective


Thank you

www.england.nhs.uk #EPaCCS

Lincolnshire EPaCCS Experience

(so far)

Louise Price – Professional Lead

(Dr Lawrence Pike)

Approach

• Scoping outcomes

• Person centric

• Clinically led

• Bottom up

• Opportunities

• Testing

• Make the links

Engagement & Communication

• Organisationally agnostic

• Translation

• Champions

• Bravery & honesty

• Relationships

• Culture & behaviour

Selling Your Wares

• Investment of time

• Person centric

• Flexibility

• Pitching

• Tools

• Be prepared

Tools

• Person centric

• Clinically lead

• Save time & effort

• Systematic approach

• Enablers

• Pick & mix

IT

• Template (S1 & EMIS)

• Reflect care delivery

• GP Report

• My RightCare

Education

• Website: www.eolc.co.uk

• Brochure: http://www.eolc.co.uk/resources/lincolnshire-specific-resources-and-documents/

• Dying to Communicate training

http://www.eolc.co.uk/

http://www.eolc.co.uk/resources/lincolnshire-specific-resources-and-documents/









Challenges

• Integration!!!

• National policy

• Local procedure

• Assurance

• Time & scalability

Keeping in Touch

[email protected]

Mobile: 07436 581 567


Managing an EPaCCS implementation across organisations

David Slater Lancashire North CCG Programme Manager

UHMB Project Manager

EPaCCS Strategy

• Only one palliative care record per patient • The Master palliative care record will be held on their registered

GP practice IT system. • To utilise the Healthcare Gateway MiG service to access a

patients palliative care record on their registered GP practice IT system or EMIS-to-EMIS sharing

• All GP practices use the NW EPaCCS dataset • Work closely between LNCCG, UHMB, GP OOH,Community and

local Hospice • All GP Practices hold regular palliative care meetings • Developments discussed and publicised through GP

Development days and LNCCG IT Group meetings

EPaCCS Data flows

Bay Urgent Care

NWAS - ERISS

LNCCG 12 GP Practice systems

CancerCare Social Services Mental Health St John’ s Hospice Community

UHMB

Lorenzo

EMIS Web Community EMIS Web Community

LNCCG Urgent Care dashboard contains GP practice Palliative Care registers

Issues

• All GP Practices must use the same EPaCCS template

• Some GPs add patients to their GP Practice Palliative care register prior to discussing with the patient – this is unacceptable practice with data sharing

• All GP practices MUST check their palliative care registers prior to go-live

Lorenzo Menu Items

Initial View

Summary View

Medicines View

Supportive Care View

Adastra

The Future

• The North West EPaCCS dataset is the beginning of the MiG V2 journey

• LNCCG GPs have developed a new dataset called Crisis Care dataset and data collection template.

• LNCCG GPs are collecting data against the new template • Healthcare Gateway, LNCCG and UHMB are working together to

get this new dataset operational. • The new dataset collects data for patients who have

• Cancer • COPD • Dementia • Heart Failure

www.england.nhs.uk

CLOSE

Thank you so much for participating.

Have a safe journey.

#EPaCCS

Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life

Healthcare

Transcript of Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life