Strategic context for commissioners

Key clinical priorities

Working with local organisation on progressing

Key priorities for commissioners

Examples of what’s been achieved at a local level

Electronic record/case fileCapture information electronically for use by me and others, at the point of care

Population health & care managementAnalyse data effectively for the benefit of the wider population

Decision SupportReceive automatic alerts and notifications to help me make the right decisions

Remote & assistive careUse technology to provide care remotely

Transfer of careSeamlessly transfer information between and within care settings, to follow my patient

Asset & resource optimisationUse technology to understand what is happening and where, at all times

Urgent & Emergency Care

End of life care Complex long-term conditions

Mental Health

Every local area will:

assess and encourage progress using a new Digital Maturity Index

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

the development of an open environment for information sharing supporting emerging models of care based on open interfaces and open standards.

Open APIsOpen interfaces to enable information to flow across a care pathway and to be accessed across geographies

Procurement Guide

Interoperability Handbook

Tools

Transfers of Care

NHS Number

Key PrioritiesTight standards for key transfers of care

GP Systems

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

Expansion of SCR for access by additional care settings and additional critical information.

Summary Care Record

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

Local IDCRs 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

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

• “Interoperability” wide and expansive term and overly technical

• Breaking down “interoperability” into meaningful parts• Key priorities e.g. use of NHS Number, Transfers of Care• Key blockers e.g. information governance guidance• Future direction – new ways of information sharing

• Scope across health and care

• Co-creation of products to assist local organisations, developed in

conjunction with local organisations such as Integration pioneers

• Facilitating communities on information sharing • showing local best practice and direction of travel

Wave 2

Wave 1

Driving priority standards for information sharing

Collective guidance on breaking down “myths”

Understanding common and priority needs

Articulating direction of travel

Focus on NHS Number – driving up adoption and use of the NHS Number across health and care settings

• National baseline across health organisations in use of NHS Number

• Guidance to local organisation for access to the NHS Number

• Working with local pioneers on best practice and case for usage

http://systems.hscic.gov.uk/nhsnumber/staff/factsheet.pdf

NHS Standard Contract 15/16 - new requirements: 1) Sent by provider of Acute services, by an NHS Trust or an NHS Foundation Trust to a GP, NHS Trust or NHS Foundation Trust –

must be by secure email or direct electronic transmission from 1 October 2015

2) All providers must be able to send and receive Discharge Summaries or Post-Event Messages using all applicable Delivery Methods

Option until end of 2015

Option until end of 2016

2017Onwards

Unstructured Free Text

Locally Approved Template

Structured Headings (including free text)

Coded Elements

Currently

May Release

June/July Release

Paper Email - PDF Kettering - XML Structured Message (CDA)

The larger the cross, the higher levels of variation of content and structure

• 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

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

is the Bristol, North Somerset and South Gloucestershire programme, dedicated to using technology to support:

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 times – reduces time trying to find out information• Reduces risks – where patients unable to inform clinicians about relevant

information/fax errors etc.

“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 was logged by district nurses is a goldmine of information. We saved 20 minutes on the telephone and managed to find the reason for patient’s insulin being discontinued.”Discharge

Nurse

“The extra patient detail is useful when deciding to stop drugs such as anti-platelets and it helps to identify risk factors.”

Doctor

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

Pharmacist

“In cases where we are dealing with a person who is being supported by Rapid Response and the district nurses, Connecting Care comes into 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

“Connecting Care has been really helpful tonight. Could not do it 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. With CC I was able to work out that all that should have been done, had

been done.”

OOH Doctor

Having access to accurate, timely, shared information is no longer a ‘blocker’ to providing high-quality, effective, efficient care

A sample of some possible financial benefits:Time Savings – Calling Other Organisations10,000 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 Visits10,000 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

Admissions Prevention10,000 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 Assessments10,000 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

A sample of some possible financial benefits:

Line of business systems that ‘share’ • You cannot share paper data easily• Good electronic ‘line of business; systems that share data are critical

Integration Partner • Integration is tricky, find a software partner who ‘gets it’

Money – locally owned money • Invest locally – seek national money too, but make your local organisations put skin in the game

People – local talented people • Hire really talented project people – we did

SPIRIT• Overrides everything else• Stamp on ‘organisationally centric’ thinking at every single opportunity• Command the moral high ground that the patients/citizens best

interest occupies

Evidence from episodes of unscheduled care at Southampton and Portsmouth hospitals

Unsuccessful View – An attempt was made to access the HHR record for the patient, but not data was available, because: • GP practice not sharing• GP using TPP SystmOne (not currently able to share data)• Patient from Prison or Armed forces)

No Attempt View - No attempt was made to access patient’s record on HHR

Deep Dive View – Patient’s HHR record was accessed during the course of the episode and data available in the record

Discharge Destination

HHR View Status

Deep DiveView

UnsuccessfulView

Admission 2,286 282

Discharged – no follow up 250 10

Percentage patients admitted 72%* 81%*

Avg Pathology Tests/Pt

Deep Dive View

Unsuccessful View

Significance

Biochemistry 50.3 60.27 0.01*

Cell Path 0.05 0.04 0.14

Haematology 59.1 66.9 0.01*

Medical Imaging 1.05 0.56 0.01*

Microbiology 3.32 3.45 0.37

All Tests 113.9 131.2 0.01*

* Statistical significance <0.01

Excellent Start but we want more…..

Hospital and GP data 100/107 GP practices live 1500+ users

Access being rolled out across:

Mental healthPrimary Secondary Community Integrated Neighbourhood teams