PowerPoint Presentation · 2019-01-30 · 400 Departments E-Triaging referrals faster, safer and...

Northern Ireland Electronic Care RecordInformation for better care

E-Triage

The Journey To PaperlessMost Flexible Digital System of the Year

Wilbert Allen – IS Programme Manager

Northern Health & Social Care Trust (NI)


Outline

Background

Aim/Objectives

Project/Change Management

Results/Evaluation

Future Plans


Background Process

Day 1

Day 1/Day 2

Day 2/Day 3• Porter delivers referral to Specialty Office

Day 3/Day 6

Day 5/Day 7

Day 6/Day 8

• Referral date stamped (Booking Office)

• Each referral sorted by Specialty

• Booking Office register on PAS

• Referral placed in folder for collection

• GP sends paper referral

• Consultants Triage – note outcome on referral

• Porter returns referral to Booking Office

• Booking Office update PAS

• Booking Office arrange appointment


Background Systems

Clinical Northern Ireland

Communication Electronic

Gateway Care Record

Merlok

EMIS Web

INPS

Regional Integrated

Digital Care Record

(Orion Healthcare)


Aim of Development



Gateway Care Record

Regional Integrated

Digital Care Record

(Orion Healthcare)

Merlok

EMIS Web

INPS


Objectives of Development

GP makes referral using

CCG Referral presented to Consultant for E-Triage using NIECR and auto registered on PAS (in-

built DQ alert)

E-Triage outcome presented to

Booking Office via NIECR

PAS updated, referral archived

and fully auditable in

NIECR

NIECR updates CCG with referral

status

CaPPS updated if Red Flag referral


Project Management - People

PRINCE2

System Suppliers

HSCB/GPs

HSC eHealth

CliniciansAdmin Staff

Technical Staff

DQ & Information

Staff


Project Management - People

Testing

Pilot

Rollout


Change Management - People

⚫ Cultural Shift – GPs, Admin,

Clinicians

⚫ Service Users involvement

⚫ Training and Support


Change Management - Process

Day 1

Day 1/Day 2

Day 2/Day 3• Porter delivers referral to Specialty

Day 3/Day 6

Day 5/Day 7

Day 6/Day 8

• GP sends E-Referral via CCG

• Automatically registers on PAS and immediately available for Triage on NIECR

• Consultant Triages on NIECR

• Automatically returned to Booking Office in NIECR

• Automatically updates CCG



Before After

• Referral date stamped (Booking Office)

• Each referral sorted by Specialty

• Booking Office register on PAS

• Referral placed in folder for collection

• GP sends paper referral

• Consultants Triage – note outcome on referral

• Porter returns referral to Booking Office




Results

⚫ Bi-directional link with CCG and NIECR

⚫ Automated registration of referral on patient

administration system

⚫ E-Triage tool established within NIECR

⚫ Write-back function from NIECR to CCG

⚫ Inbuilt data quality alert facility


BENEFITS

- GP

- Trust

- Patient

Quicker Triage Process/Patient Appointment –

Red Flag Referrals

Improved Data Quality –

Primary/Secondary Care IT

Systems

Full Referral Traceability

Flexibility for Consultant

Full Patient History available

on NIECR for Consultant

Triage

Improved Communication

Faster Onward Referral To

Other E-Triage

Specialties

Reduced from

7 days -> 2 days

Audit Trail across

CCG, NIECR, PAS

systems

Trust Patient Demographics

updated

Improved decision making / patient

outcome

Reduced from

1 day -> 0 days

Automated write-back facility to GPs

Evaluation

Triage from any PC or mobile device


100+ Consultants E-Triaging referrals faster, safer and paperless

1 in 3 referrals electronically triaged on day of receipt

“Robustness of referral process is secure. Paper referrals very occasionally did get

lost/not get actioned. We have not seen this at all since changing to e-referral triage.”

Clinical Lead, E-Triage development

Results/Evaluation - NHSCT

Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18

4946 4510 5005 5021 5003 5165


400 Departments E-Triaging referrals faster, safer and paperless

Target : 250,000 referrals 2018/19

“The benefits to clinician, secretary, diabetes network and booking staff are

objective and palpable. … Booking Office staff rapidly want to roll it out.”

Dr Neil Black, Western Health and Social Care Trust

Results/Evaluation – NI Region

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6000

Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18

Belfast

Southern

South Eastern

Western

Northern


Further Developments



Gateway Care Record

DERMATOLOGY - PHOTO TRIAGE


SEHSCT

SHSCT

E

N

H

A

N

C

E

M

E

N

T

S

Future Paperless Plans

• Community/ Mental Health referrals

• Internal referrals

• Advice requests

• Discharge referrals with advice (EDT)

NHSCT


Electronic Document Transfer (EDT)

Primary Care

60,000 referrals

CCG

Secondary Care

1 million EDT documents

PAS

LCID

Symphony

NIECR


Questions?

Efficiency Savings Project of the Year 2018

Is it possible to be 100% digital by May 2019?

Welcome and introduction

Our organisation

• An Arm’s Length Body of the Department of Health and

Social Care.

• Created in 2006 by bringing together a number of

previously separate NHS organisations.

• Provide a range of critical central services to NHS

organisations, NHS contractors, patients and the public.

• Still deliver the core range of services we started with and

have taken on additional services as our stakeholders’

needs have evolved.

Snapshot

Our key areas of work

Our strategy

The money flowing through the NHSBSA

Our performance

2017/18

+29

The Award…

NHS Dental Services • Supporting the Dental Contract Reform

programme

• 100% of payments processed on time and

accurately

• 43.5 million dental activity claim forms were

processed - over 96% submitted electronically

• 9,200 dental providers submit FP17s every month

• Over £2 billion per annum is paid to dental

providers

• £874 million patient charges are recovered

Before 2014….

• Print and dispatch 30,000– pay statements

– schedules

– superannuation statements

…. using 6 million sheets of paper per

annum!

• Paper-based pension process:

– annual reconciliation process

….30,000 sheets of paper each year!

Drivers behind the campaign

• SoS vision of achieving a paperless

NHS by 2018.

• Pensions was a kick-start to

achieving our vision to deliver all

services to dentists online.

• Engagement, engagement and

engagement.

Digitising Pay Statements

• In 2014 we switched from printed to online

– monthly pay statements

– schedules

– superannuation statements

• Engagement

– British Dental Association

– Clients – NHS England, Dept. of Health and Social Care, Welsh Govt.

– Effective communication campaign with dentists

– Footnotes on final paper versions

… and a bit of bottle!

Improving service delivery

• Transition to paperless statements improved service delivery

– Information with customers three days earlier.

– We’ve all had experience where digital is not universally better for us as a customer.

– We made this transition without a single complaint from our customers.

Dental patient form processing (FP17)

• 43.5m claims made by dentists submitted to the NHSBSA per annum

• Information used to calculate dentists’ contractual performance, pension contributions and payments.

• Previously all submitted on paper

– requirement to be scanned

• Working for years to encourage dentists to submit online

– over 96% now submit online

• The National Health Service (Primary Dental Services and General Ophthalmic Services) (Amendment)

Regulations 2017

• Relevant section comes into force on 1 May 2019

Compass

• Introduced in February 2016

• Online portal helping us to build on the success of the FP17 initiative

• Dentists now submit processing enquiries online:

– saving dentists’ time

– saving paper

– increases response times

• A solid platform to enable further service developments and improvements

• FP17s to be completely paperless by April 2019

Benefits

• As a result of the initiatives above, almost all of our dental services are 100% digitally delivered

• 96% of dental claims are now made online

• Savings of £140,000 per annum on postage

• Savings of £70,000 on printing and processing

• Faster, easier access to information

• More detail available as standard

• Greater information security

• Greater transparency

• Improved audit trail

• Reduction in the need to make enquiries on telephone or by email

• Reduction in query resolution time

The future

• Creation of an online FP17

• Compass platform developed to enable every dental service to be delivered online

• Improving flexibility

– direct impact on patient care through data improvements and improved NHS commissioning

Chris Dawson

Operational Lead – Dental

NHS Dental Services

Tel: 0191 244 6803

[email protected]

www.nhsbsa.nhs.uk/DentalServices.aspx

mailto:[email protected]

http://www.nhsbsa.nhs.uk/DentalServices.aspx

Digital Waste Permits

Best Small Scale Digital Project

Paul Bayley

Head of Customer Services

Powering the Paperless Environment - 6th November 2018

HOUSEHOLD WASTE PERMITS SCHEME

CONTEXT - DIGITAL CUSTOMER SERVICES

• A clear case for change – digital society, customer expectations, financial

challenge

• Digital design principles

- Service design based on customer need

- End-to-end digital service

- Continuous improvement

- Consistent and familiar user experience

- Available to all

• Established digital solution architecture – simple, re-usable and evolving

PROJECT HEADLINES

• Before - 10,000 applications a year / 66% online / 60,000 paper permits

printed and posted.

• Objectives – reduce administration, printing, paper and postage costs; provide

a more responsive customer service.

• Project – in house development, re-using and extending existing technology

solutions, plus development of a new mobile app for HWRC staff.

• Time / Cost – 6 weeks / £5,000 external spend

• Launch - November 2017

CASE STUDY: DIGITAL WASTE PERMITS

Before – 10,000 waste permit applications a year; 60,000

individual waste permits printed and posted each year.

After – 96% digital permits; £36,000 cost savings; more

responsive customer service.

PROJECT OUTCOMES

• 90% online applications

• 96% digital permits

• 36% less calls

• £36,000 annual saving

• 12 trees worth of paper!

• Re-usable digital solutions

KEY SUCCESS FACTORS

• Challenging conversations

with the business

• Coordinated

communications to nudge

customers online

• A clear digital ambition, but

start small and simple, and

build confidence

• Trust in our digital skills,

capability and architecture

KEY ARCHITECTURAL PRINCIPLES

• Understand end user context

• Minimal upfront design and prototype

• Build once, re-use

• Extend through an incremental and iterative approach

• Build to change instead of building to last

• But, standardised processes and data architecture are key

WASTE PERMITS SOLUTION STACK

• Case management

• Notifications

• Core Integrations

• Intelligent Forms

• Integrated mobile

application

BLUE BADGE SOLUTION STACK

• Case management

• Notifications

• Service calendar

• SharePoint for document

management

• Core Integrations

• Integration to Northgate

BBIS


• Payments

• Appointment booking

• Document asset upload


application

COUNCIL TAX SOLUTION STACK

• Case management

• Service calendar

• SharePoint for document

management

• Core Integrations including

Northgate RABS API

• Integration to Northgate

BBIS

• Notifications framework

replaces CRM email


• Online account and Portal

• Payments

• Appointment booking

• Document asset upload


application

•Online account common

functions and features

WHAT HAPPENED NEXT?

• More collaboration with business colleagues and with digital partners to

deliver further digitalisation of services

– Keeping up with customer expectations

– Persistent communication nudging customers to digital

– More financial and non-financial benefits

– Rapid response to changes in policy or business priorities

– Continued evolution of our digital solution stack

SuRe: Delivering Mobile

Care and Support

Tony Phythian

Business Systems Manager, NCHA

SuRe: Delivering Mobile

Care and SupportTony Phythian

Business Systems Manager, NCHA

Nottingham Community

Housing Association

• Locally based registered provider of quality

social housing for rent, shared ownership and

social care services in the East Midlands

• Working across Nottinghamshire, Derbyshire,

Leicestershire, Lincolnshire, Rutland and

Northamptonshire


Housing Association

• A Community Benefit Society with charitable

rules, founded in 1973

• Annual turnover > £75m

• Property asset value > £450m


Housing Association

• We develop accommodation, providing on

average 200-250 new homes each year

since 1973

• 9,000 social housing properties, providing

general needs housing at submarket rents to

over 17,000 people


Housing Association

• For people with housing and support / care

needs: 1,100 bed spaces in > 750 properties,

and around 400 units of floating support

• Care and support provided in our own

accommodation, in properties rented by other

landlords and in customer’s own homes

The challenge: Delivering care and

support in a digital world

We use our support planning IT system – “SuRe”

• to create and monitor support plans and delivery of support

• for a diverse range of service users, including people:

• with learning disabilities

• with mental health issues

• fleeing domestic violence

• and the elderly frail

• Numerous iterations, from MS Access in 2002 to a browser / SQL

system in 2012



Problems:

• No access to the system in the field

• Community colleagues…

• visit office, print support plans and history

• travel to customer and deliver support

• travel back to office, wait for a computer, update the system



Problems:

• Waste of time and money

• Increased environmental impact

• Increased data security risk – paper records

• Reduced face-to-face support time

• Lose immediacy of information added, reducing quality



Drivers for change:

• More support delivered in the community

• Reduced resources

• Wide geographical area

• Limited office space

• Limited access to ICT

• Huge amount of travel time and associated costs

Our aim

• Maintain quality but reduce costs

• Deliver more with less

• Reduce quantity and risk of paper records

Our objectives

• Maintain or improve our support record keeping

• Allow colleagues to work more independently

• Reduce travel time / need to return to the office

• Use less paper

Stage 1 trial

• A web-based version of SuRe

• Made available externally to our systems

• Using 4G / 3G network

• Delivered via budget tablets

• Tested across Derbyshire

Trial area

Mobile coverage in

Derbyshire

Indoor and outdoor

Outdoor

No coverage

www.idmobile.co.uk

Findings

• Poor and unreliable mobile signal in selected area

• Budget tablets were budget tablets

• Additional services, eg corporate email and sat nav,

were well received

We needed a

new approach

Our solution

• We needed to be able to work off-line to be

unrestricted by mobile signal

We needed

an app!

Our solution

• Worked with the developers of our existing SuRe

system, Breeze IT

• Designed Android app, slim version of SuRe

• Procured better quality devices

• Established security and device control tools

• Following testing, built and deployed 260+ devices

over a few weeks throughout the East Midlands

: SuRe app and tablets

Our solution: SuRe app and tablets

We provided 260+ colleagues in the field a tablet which…

• is managed by mobile device management software

• provides on and off-line access to our key SuRe system

• gives access to their corporate email accounts in the field

• provides access to corporate intranet and HR systems

• gives access to a controlled set of other apps provided access to a telephone

Advantages and cost savings

Colleagues can now:

• read and write support records of the people they

are supporting while they are supporting them

• communicate better with each other

• keep up to date with corporate information

• access other tools, eg benefits websites for use in

support

• find where they are going with satnav

…without the need to

go into an office


NCHA benefitted by:

• an annual reduction of £50k in mileage costs

• £200k+ travel time saved over a year

• better communication with colleagues in the field

• providing a better servcie to our customers

• saving some paper


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Updates by time of day


We asked users what

they thought….

…this is what

they said…

The bottom line

Annual costs: £85k

• assuming all devices are replaced every three years (they won’t be)

Annual benefits: £288k

• opportunity savings as more work done for less money

Annual savings: £200k+

The bottom line

£-

£50,000

£100,000

£150,000

£200,000

£250,000

£300,000

100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

%age of assumed savings

Proportion of assumed savings (£/year)

Total Benefits (£/Year)

Costs (£/Year)

Lessons learned

• Nothing will work if you rely on a mobile signal

• Cheap tablets will fail and cost more in the long run

• Try to use the same type of tablet to ease support

• It’s important to have mobile device software / controls

• Use developers that know you and know the system

Any questions?

A paper free organisationA realistic strategy

Tuesday 6th November 2018

Alastair GalbraithStrategic Accounts Director, Restore Digital

Report on printer

usage – to

encourage heavy

printers to think

before they print.

Digital workflows

for Accounts

Payable and

Receivable

reduces paper

and automates

processes.

HR typically is

heavy with paper

and archives can

be digitised and

future processes

automated.

Robotics and AI

are helping

remove

administrative

burdens and

automate

processes.

Remove any

‘dark boxes’ of

unknown data.

Email: Collate

and automate

incoming mail

through a digital

mailroom.

Telephone:

Collate and

automate

incoming mail

through a digital

mailroom.Physical mail:

Collate and

automate

incoming mail

through a digital

mailroom.

Try and stop

taking paper

notes and use

tablets and

laptops instead.

Digitalising

data and records

can help make

SAR requests

and complying to

audit trails easier.

JIT scanning of

files you need

regularly or

imminently.

Any questions?

Alastair Galbraith

Strategic Accounts Director

Restore Digital

Get in touch:

[email protected]

Scan4Safety: Innovation through standardisation

Mark Songhurst

Work-stream Lead Scan4Safety

The Leeds Teaching Hospitals NHS Trust

© GS1 2018

Tech Transformation is coming

98

“In all my experience, the small part is finding or inventing the technology. The big part is embedding the culture of always looking for the best possible technology and embracing it. I want to drive that culture change… But from today let this be clear: tech transformation is coming”

Matt HancockSecretary of State for Health and Social Care

© GS1 2018

Nursing Time

99

• “Nurses waste ‘an hour a shift’ finding equipment”

(Source: S Ford, Nursing Times vol. 105, 10 February 2009)

• In a Trust the size of Leeds, that equates to 20 hours per month per

nurse, or 212 working hours per year

• Of the 3,794 registered nurses at Leeds that equals 1,241,026 hours per

year

• In total, a loss of 411 Nurses to looking for equipment

© GS1 2018

A hospital of needs and wants

101

Patient Location

Bed Side Notes

Plans for care

Observations

Medicines

To provide the best levels of care in the best surroundings

Patient Location

Bed Side Notes

Plans for care

Availability

Referrals

Support patient recovery

Innovate

Patient Location

Accurate Outcomes

Financial Control

To be the best for specialist and integrated care

Patient Location

Test Results

Sufficient Stock

Availability of Resources

Medicines

Research

Innovate

Explore Outcomes

To receive the best care available in a timely manner

Communication

Bed Side Care

Plans for care

Resources

© GS1 2018 102

The standards we need

Patient

Global Service Relationship

Number (GSRN)

Place

Global Location Number (GLN)

Product

Global Trade Item Number

(GTIN)

© GS1 2018 107

Combining Standards for success

GSRN + GLN = Patient Tracking

LTHT is able to label down to bed space level and start unlocking the potential

Associates patient, to place, to product, to process.

Automatically updates the e-whiteboard

Mobile ppm+ app will allow access to e-forms within the patient EPR at the bedside

© GS1 2018 109


GTIN + GLN = Stocks and Stores

Organisation

Physical Location

Function

Interventional Radiology Stores SJUH

© GS1 2018 111

Can this be done at Scale?

120 Specialist Services

175 Buildings

114 Wards

135 Departments and Clinical Areas

69 Operating Theatres

232 Materials Management Areas

28 Inventory Managed locations

£18m Inventory

• Over 17,000 staff

• Turnover of £1.17 billon

• Over 2,000 beds

© GS1 2018 112

What have we done at Leeds

Global Location Numbering

22,303 22,303 2,000+

Plus Over 1,400 function GLNs for Stores

© GS1 2018 113


Patients – All patients receiving medication or intervention have a GS1 Compliant Wristband

114,000 inpatients

242,000 Emergency Department attendees

9,969 babies born

72,532 Day Cases

© GS1 2018 114


Catalogue Management Our work with GHX and two other

demonstrator sites(Plymouth and Salisbury)

has given us access

to over 130,000 GTINs

790,000 Order lines

630,000 Invoices

300 Systems and Applications

PEPPOL Enabled

© GS1 2018

116


Order Management

PEPPOL

Purchase Orders

Order Response• Order

Acknowledgement• Order

Acceptance/RejectInvoice/Credit Notes

Advanced Shipping Notice(ASN)

© GS1 2018 117


Inventory Management

32 of 69 Theatres fully scanning at Point of Care (awaiting a development in PPM+ before further roles out due December 2018)

Reviewing usage information to reduce Inventory further

© GS1 2018 119


Product Recall

2 months work checking we had no cases

17,000+ patients / 22,000implanted items checked in

under 30 minutes

Bin collection reminder service

The problems –

1. High number of missed bins due to the wrong bin being put out.

2. High number of missed bins due to contaminated bins

Subscribers:

8,077

Engagement rate (90 days up to 25/10/2018):

87%

48%Reduction in the number of

“wrong bin out” calls

27%Reduction in bins not being emptied

due to contaminated waste.

17/10/2016

Subscribers: 5,493

No preferences: 67%

17/10/2016

Subscribers: 5,493

No preferences: 67%

25/10/2018

Subscribers: 8,077

No preferences: 20%

“I like the updates, I have mental health problems, this causes me to be forgetful, with updates I can be reminded of bin collection to ensure I can get the bin out in time and which bin I need to put out.”

“In my opinion it's perfect”

“I think my updates are useful and clear”

“Gritter topic is useful”

“I just enjoy the variety and, of course, the bin reminder. All the Council matters in a handy place - good idea.”

“Think it’s great well done”

“I'm very grateful for your reminders”

“All very good”

“Excellent email service! The bin day reminder is great!”

“Bin collection email works and is very useful.” “Your information is excellent”

“A good service, well done”

“Perfect as it is!”

“I like the reminder of which bin is to be collected the following day - works well. Thank you”

Thank you / Diolch

PowerPoint Presentation · 2019-01-30 · 400 Departments E-Triaging referrals faster, safer and...

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