REFERENCE NUMBER

Leading the way in e Health25th May,2010

E Health Innovation

2

The current challenge? The current challenge?

3

Three key questions…

Can we ride the perfect storm?

Financial challenge..

People challenge..

Ageing population..

Where should we aim?

Point or whole system?

How innovative can we be?

Disruptive or play safe?

4

Demographic change for population aged 65+ ScotlandPotential impact on emergency bed numbers 2007-2031

0

2000

4000

6000

8000

10000

12000

14000

16000

Y/E Mar 2007 Projected2011

Projected2016

Projected2021

Projected2026

Projected2031

Year

Be

ds

9%24%

41%61%

84%

Calendar year ’07 estimate

P Knight Scottish GovernmentA major challenge for Scotland-24%

more beds by 2016, 84% by 2031

NHS Tayside+148 beds 2016+517 beds 2031

5

Compelling areas for improvement..T12

Emergency Admissions / Beds04/05 65+ 04/05 All 08/09 65+ 08/09 All Target Mar 09

PerformanceTarget for 2010/11 Direct Cost

Saving

AdmissionsNHS Scotland 191871 467392 215691 522219 172684NHS Tayside 15534 37139 17128 40105 13981Angus CHP 4260 9292 4647 10164 3834Dundee CHP 6341 16424 6338 15989 5707Perth&Kinross CHP 4960 11455 6154 13967 4464Bed DaysNHS Scotland 2811244 3956421 2904447 4106840 2530120 374327 12.9% 140,747,102£ NHS Tayside 223092 306900 232588 316855 200783 31805 13.7% 11,958,755£ Angus CHP 58816 79902 58716 80260 52934 5782 9.8% 2,173,882£ Dundee CHP 99980 138106 90097 126080 89982 115 0.1% 43,240£ Perth&Kinross CHP 64639 89248 83867 110609 58175 25692 30.6% 9,660,154£ Multiple AdmissionsNHS Scotland 37072 43618NHS Tayside 2981 3431Angus CHP 830 920Dundee CHP 1233 1300Perth&Kinross CHP 902 1209Multiple Admissions Bed DaysNHS Scotland 1302384 1474086NHS Tayside 104042 114670Angus CHP 28763 29084Dundee CHP 47772 46032Perth&Kinross CHP 26567 38968

source ISD December 2009To year end 2008/09

Compelling challenge, local variation?

Reference: ISD Online National Statistical Information Publication

December 2009.

     

6

Our approach? Our approach?

7

Steps to Better Healthcare- a whole systems approach..= Constraint

A&E

in-patient

out-patient

rehab

day case

acute services

acutereceiving

ward(Med/Surg)

MIU

SAS

OOH

OOH, urgent & emergency services (community)

NHS 24

GDP

GP

Community Pharmacists

family health services

Optom

refer to GP

sub-contractout-reach

Specialist acute care

tertiary services

routinedischarge

complexdischarge

LocalAuthorities

Partner & Vol organisations

refer on-going community care

Walk-In

RadiologyEndoscopy

GP referral

GP direct

access

GP referral

day patient

OutpatientClinic

Community Services – partnership model with LA

Home Visit

district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)

elderly care

Care in the community

Community (day) Hospitals

mental health

Day Patient

Inpatient

other

OutpatientClinic

Community Services – partnership model with LA

Home Visit

district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)

elderly care

Care in the community

Community (day) Hospitals

mental health

Day Patient

Inpatient

other

Laboratory

GP feedback

= Queue Before Activity

= Target Challenge

= Trend in Volume

= Known Issue

= Suspected Issue

Q

T

T

T

acutereceiving

ward(Med/Surg)

out-patient

Q

routinedischarge

complexdischarge

Q

T

Q

C

Q

Q

C = Constraint

A&E

in-patient

out-patient

rehab

day case

acute services

acutereceiving

ward(Med/Surg)

MIU

SAS

OOH

OOH, urgent & emergency services (community)

NHS 24

GDP

GP

Community Pharmacists

family health services

Optom

refer to GP

sub-contractout-reach

Specialist acute care

tertiary services

routinedischarge

complexdischarge

LocalAuthorities

Partner & Vol organisations

refer on-going community care

Walk-In

RadiologyEndoscopy

GP referral

GP direct

access

GP referral

day patient

OutpatientClinic

Community Services – partnership model with LA

Home Visit

district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)

elderly care

Care in the community

Community (day) Hospitals

mental health

Day Patient

Inpatient

other

OutpatientClinic

Community Services – partnership model with LA

Home Visit

district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)

elderly care

Care in the community

Community (day) Hospitals

mental health

Day Patient

Inpatient

other

Laboratory

GP feedback

= Queue Before Activity

= Target Challenge

= Trend in Volume

= Known Issue

= Suspected Issue

Q

T

T

T

acutereceiving

ward(Med/Surg)

out-patient

Q

routinedischarge

complexdischarge

Q

T

Q

C

Q

Q

C

Community Care Services

Prescribing

Patient focused mgt plan approach to reducing multiple admissions in

over 75's

Improve Capacity & Flow in Medicine and

RVH

Enhance the Ambulatory Care service offered in

Ward 15

Streaming Access A/E

Quality Discharge Communications

End to end Orthopaedic pathway hip/knees

Variation in GP referral rates

Efficiencies in General Surgery OP Clinics

Information provision and coding (e.g. The

Gap)

Develop use of Community Hospitals -

improve use/flow

Community Nursing -patient contact

time/anticipatory care

AHP activity -rebalance the activity towards community

Community Diagnostics - to support Community

Hospital model

Prescribing PracticeAnti-microbials

Patients still on medicines they no

longer needMedicines

at Admission

ElectiveUrgent & Emergency

Projects overlapping more than one stream will require cross cutting team resource

CKD - IT enabled Pathway

Pre-assessment screening

Virtual Ward Self Management

Community Care Services

Prescribing

Patient focused mgt plan approach to reducing multiple admissions in

over 75's

Improve Capacity & Flow in Medicine and

RVH

Enhance the Ambulatory Care service offered in

Ward 15

Streaming Access A/E

Quality Discharge Communications

End to end Orthopaedic pathway hip/knees

Variation in GP referral rates

Efficiencies in General Surgery OP Clinics

Information provision and coding (e.g. The

Gap)

Develop use of Community Hospitals -

improve use/flow

Community Nursing -patient contact

time/anticipatory care

AHP activity -rebalance the activity towards community

Community Diagnostics - to support Community

Hospital model

Prescribing PracticeAnti-microbials

Patients still on medicines they no

longer needMedicines

at Admission

ElectiveUrgent & Emergency

Projects overlapping more than one stream will require cross cutting team resource

CKD - IT enabled Pathway

Pre-assessment screening

Virtual Ward Self Management

Improve efficiency for all 36 Outpatient Clinics .

Elective

Medicine for the Elderly

Urgent & Emergency

Prescribing

Reducing wastes and cost in prescribing

Community Care Services

Integrated Care (Virtual Ward)Deliver proactive care management via

combined model

Business Support Unit

Mental Health

8

A whole system challenge, typical NHS board..

A&E Inpatients

Acute Wards

75,979

55,464 (73%)Discharged

10,631 (14%)IP Admission

9,877 (13%)Acute R/C Admission

38%

A&E Attends

26,077Acute Attends

16,200GP/other Refer

62%

17,730 (68%)IP Admission

7,800(30%)Discharged

Direct Access

44,242Total U&E IP Admission

15,881Direct Access

(28,361)

547(2%)Other Care

Acute Patient Non Elective~ £86M Virtual Ward savings 3% ~ £2.5m pa 5% ~ £ 4.3m pa10% ~ £8.6m paSGHD HEAT T6, T8, T10 , T12

9

Doing the right things..

HEAT 1 HEAT 2Corp

3HEAT 1 HEAT 2 HEAT 3

HEAT T6

HEAT T8

HEAT T10

Corp 1

Corp 2

HEAT T12

HEAT HEAT

There is objective evidence that the Board is

able to track progress against key targets and

perform well at a tactical level

Triple Aim

Integrated ResourceFramework

10

Who are the whole system

stakeholders?

Who are the whole system

stakeholders?

11

Desire

Adopt

Our Future

Prioritise Outcome based

response

TaysideCommunity

Today

TaysideCommunityTomorrow

What do youSee?

What do youWant?

What now?Make it real!‘Test of Change’Demonstrators

Learn

Align BenefitsRealisation

Art of the probable?

Truly needsBased!

ImpactAssessment

We are here

26/05/10

T12 Emergency Bed Days over 65’s

T6 Long Term Conditions admissions

Patient experience

Community team effective patient facing time

Medication Concurrence

VIRTUAL WARD AIMS TO DELIVER £2.0-2.5M RECURRING SAVINGS VIRTUAL WARD AIMS TO DELIVER £2.0-2.5M RECURRING SAVINGS

Triple Aim – LTC Whole Care Continuum

Acute Patient Non Elective~ £86M Virtual Ward savings 3% ~ £2.5m pa 5% ~ £ 4.3m pa10% ~ £8.6m paSGHD HEAT T6, T8, T10 , T12

12

Multi-disciplinary stakeholder engagement / outcome Patients Carers Voluntary organisations Care Home representatives Home Care representatives Community/Practice Pharmacists GP’s cross section Practice Managers Specialist Nurses District Nurses Allied Health Professionals

E Health Service Improvement Senior Management repsSocial CareTelehealth / Telecare reps

Mental Health Professionals

Secondary Care – Ward

Community Hospitals

A&E

OUTCOMESAgreed Predictive Modelling was keyE Health was a key enablerLocal stakeholder engagement keyLearn from best practice LocalNationalUK/Global wide

13

LEVEL 5HIGHLY

COMPLEXCO-MORBIDITY

Macro IntegratorNHS Tayside and Councils

816

8163 LEVEL 4

COMPLEXCO-MORBIDITY

LEVEL 3SUPPORTED SELF CARE

CO-MORBIDITY

LEVEL 2SUPPORTED SELF CARESINGLE LTC

LEVEL 1PREVENTIONWELLBEING

PREDICTED RISK PROFILE

LEVEL 4COMPLEX

CO-MORBIDITY

LEVEL 3SUPPORTED SELF CARE

CO-MORBIDITY

LEVEL 1/2SUPPORTED SELF CARESINGLE LTC

LEVEL 1PREVENTIONWELLBEING

MICRO INTEGRATORS

0

0.5%

0.5%

5.0%

5.0%

20.0%

20.0%

80.0%

80.0%

100.0%

LEVEL 3SUPPORTED SELF CARE

CO-MORBIDITY

LEVELS OF CARE

Long Term Conditions

VIRTUALWARD

ANTICIPATORYCARE PLANS

PATIENT PASSPORTS

CASEMANAGEMENT

Asthma22935

COPD8795

Diabetes15808

HBP56918

CHD19341

Triple Aim – LTC Whole Care Continuum

14

Initial LTC ReferralPEONY

Combined Model

Unplanned Referral

Elective Referral

Case Finding

e Health infrastructure

Receive & CaptureReferral

AllocateCase

Manager

Assess

ProduceAnticipatoryCare Plan

Patient Passport

Diagnostic Intervention

Generate Referrals

ServiceCase

Finding

Urgent Intervention

Integrated Care

PlannedIntervention

Integrated Care

ReviewAnd Assess

Identify Cases Initiate Case Management Care Assessment & Planning Care Delivery & Review

Typical Integrated Care Model Next Future State

Single Point of Access 7*24

Updatepatientrecord

Updatepatientrecord

Service Menu

Patient, Carer,

ProfessionalInfo request

UpdatepatientRecord with ACP/PP

SKILLS MIXPLANNING

15

Federated / Locality Model

Anticipatory Care

Case Management

Virtual Ward

Treatment

Diagnostics

Enablement

Rehabilitation

Telehealth

Telecare

Locality Budgets

Local Diagnostics

Strategic GP Lead

Integrated Prescribing

Budgets

Community Hospital

Lo

calit

y C

o-o

rdin

ato

r Ward

Co

-ord

inato

r

Perth & Kinross Virtual WardTest of Change’ demonstrator

© Crown Copyright. All rights reserved [2008]

Local Profiles

Total Population – 11,123

65+ – 2,525

Under 65 – 8,598

(GRO Scotland 2006)

16

E Health opportunity E Health opportunity

17

Integrated Care – information architecture

Glu

e

Integration Platform

Ac

ce

ss

De

vic

eU

se

r

Se

cu

rity

ServiceDirectory

Ap

pli

ca

tio

ns

Clinical Portal

Clinician Manager Administrator Patient

PMS GPCommunity

Health&Social

Vir

tual

D

atab

ase

Se

rvic

e

Sta

ff I

DR

BA

C

TELEHEALTH

TELECARE

PREDICTIVE RISK

BUSINESS ANALYTICS

VirtualWards

CaseManagement

HealthCoaching

Prevention

Collaboration

18

E Health success

E Pharmacy

E Health success

E Pharmacy

19

ePharmacy

Live nationally in June 2006 used by 800,000 patients

All pharmacies able to register patients on national database

and issue prescriptions

All reimbursement claims electronic.

Minor Ailments Service (eMAS)

Acute Medication Service (eAMS)

Chronic Medication Service (eCMS)

Progress and benefits to patients throughout Scotland

> Live nationally in July 2009 used by every person who visits a GP practice or Pharmacy> 900,000 prescriptions per week processed (95% of total)> First full end-to-end UK ETP solution> Increased efficiencies in Prescription processing> Patient Safety benefits (Emergency Care Summary) > All GP Practices, pharmacies and NSS connected

> Infrastructure live May 2009, national roll out Q1 2010> First GP and Pharmacy sites in early adopter phase – NHS Fife> Allows GPs to issue six or 12 month prescriptions> Reduction in patient visits, reduced costs > Dispensing information back to GP Practice> Medicines management savings

20

ePharmacy

Core Infrastructure

A

A

GP (1000)

Pharmacy (1200)

NSS PSD ~ Atos Origin

GP System

CP System

ePharmacyMessage

Store

InformationServicesDivision

Payment processElec msgs via N3

network

Elec msgs via N3

network

CHI

Forms sent to PSD

PatientRegistration

Service

ePay rules engine

Scanning and messageprocessing

21

ePharmacyElectronic Transfer of Prescriptions Process

RxRxRx

Barcoded prescriptionform(s) produced

BarcodesScanned

Electronic messagesent & result received

ePMSPMRPMR

Pharmacy system uses elec datato support

ePMS

Issue medicationand submit claim

Paper form

Elec Msg

RxRxRx

Prescription form(s)received at pharmacy

Electronic messagessent to ePMS

ePMS GP GP

RxRxRx

22

Key focus areas?Key focus areas?

23

Key Focus Areas?

Collaboration

Supporting the whole system

Extended health and social care networks

D2D business

Supporting people living with Long Term Conditions

Older People’s Services

Scotland’s economy

Business Analytics

Performance Management

Communication

HEAT Targets / Quality Strategy in Scotland

In England? QIPP ??

Iain Anderson07805-910568

iain.anderson@atosorigin.com

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