Telehealth: PHMR Development Review

www.connectingforhealth.nhs.uk/qipp

Telehealth: PHMR Development Review

Richard Trusson

NHS Technology Office DH Informatics Directorate

www.connectingforhealth.nhs.uk/qipp2

Agenda• Why do we need Interoperability?• Previous work: Whole System Demonstrator (WSD) and the 9

use cases• Recent work: PHMR Specification Development• Lessons learned• What’s next?

– Draft specifications for others– PHMR early adopters


Cholesterol Monitor

Blood Pressure Cuff

Glucose Meter

Pedometer

Sensor Networks

Lights, Doors, Windows, Motion, etc.

Records•NHS•Housing•Social Care•Personal Health

Elderly Living Independently

Home Hub

Care Professio

nals

Out of Hours

Carer response servi

ce

Tele-carer

Emergencyservices

Friends and Family

Limited Offerings

No integrationIncreased Offerings

Integration requiredIncreasing Integration Complexity

Service Hub

Why Do We Need Interoperability?


Value of Information Integration

Business / Service Requirement

Information Requirement

Cross and Multi-Service Working

Effective Sharing of Information

High Quality Supporting Information

Ease of AccessEase of

Consumption and Use

Previous work: WSD and the 9 use cases• DH wanted investigation into the shared information needs for

supporting patient care under telehealth


• Working with clinicians, GPs, Nurses, etc., patients and the industry we investigated what they needed. This lead to 9 use cases.

Previous work: WSD and the 9 use cases

Use Case

Name Description

UC001 Refer Patient for Assessment The capability to allow clinicians to electronically refer patients to care managers for telehealth assessment

UC002 Assess Patient for Telehealth Monitoring

The capability to allow clinicians to share telehealth assessment results with other members of the care team

UC003 Enrol patient on the Telehealth programme

The capability to notify care team members that the patient is receiving a live telehealth monitoring service.

NOTE: this functionality is thought to be covered in UC009 in which patient status updates are sent to care team members.

UC004 Install & Commission Telehealth Equipment

The capability for a clinician to electronically submit an order for the appropriate telehealth equipment from suppliers (pending installation in the patients home)

UC005 Create/Update Telehealth Care Plan

The capability to allow clinicians to share details of a patient’s care plan with care team members

UC006 Create Telehealth Patient Record The capability to auto-populate patient telehealth records by drawing on existing sources, for example, PDS.

UC007 Monitor Readings Against Telehealth Care Plan

The capability to allow care team members to routinely view a summary of patients’ telehealth data in their local systems.

UC008 Provide Care The capability to allow those clinical users whose primary system is a non-telehealth system, to update the telehealth system with details of any patient intervention carried out by them. These updates will then be made available to the other members of the care team either directly through accessing the Telehealth system or through regular updates within the PHMR.

UC009 Send Notification The capability to update care team members as to the status of the patient


• We also identified user concerns and issues


Right

info

rmat

ion,

right

qua

lity E

asy to

consume

& use

Easily accessed

Volume of data

PrioritisationData overlap

Clinician agreementClarity of

purpose

Ownership of patient record

Clinical autonomy

Medication record

Speed of access

Action acceptance

Speed of comprehension

Clarity of addressee

Linked to relevant clinician

Linked to right patient

Messaging Assurance

Import effort

Update frequency

Professionalliability

KeyRed – most importantBlue - important

Audit trail of changes/ messages


• From– Understanding the business needs– Defining the use cases– Identifying the user concerns

…the PHMR technical demonstrator message specification was prioritised

• This sent vital signs information from the telehealth system (Philips Motiva) to the GP system (EMIS Web) and addressed many of the identified user concerns,– right information, known quality, controlled amounts, easily

accessed, easy to use.



• In early 2012 we ran a workshop at Intellect to revisit and verify the use cases.

• We identified an additional case – click through• Set message priorities. Top three were:

– Personal Health Monitoring Report– Clinician Response Message– Referral Message

• Initiated a program of work to develop the PHMR – as a result of the technical demonstrator this was the most advanced.

Recent work: PHMR Specification Development


The PHMR sends vital signs information from a telehealth service provider to a system with a legitimate interest – i.e. a GP system. The frequency of updates and range of vital signs reported on can be defined by the receiver.

•Working with the ITK team a series of WebEx meetings were run to review, verify and update the requirements.•A draft message specification was released for comment.•In August 2012 this was re-released, with updates, as a Release Candidate message ready for early adopters to start developing against.

All work for this is posted on the ITK NHS Networks site.http://www.networks.nhs.uk/nhs-networks/interoperability-toolkit-itk

Recent work: PHMR


• The engagement and development model, overall, worked.– Using WebEx– Using NHS Networks website– Gathering feedback– Reaching agreements

• Challenges:– Gathering feedback was harder than expected at times– Compressed time lines– Personal emails were better than generic ones

• Would we do anything differently next time?– Have longer timelines– Publish dates for all meetings at the start, if possible– Look to ‘public’ events for mid term discussion, if possible– Shared development environment

Lessons Learned


• PHMR: Continue to work with NHS and Industry early adopters to support implementation of the PHMR (vital signs) message. To date there are seven organisations, 2 GP system providers and the rest telehealth service providers, signed up.

• Clinician Response Message and Referral Message: use outputs from the Workshops this afternoon to inform message development and drive towards early adoption in first half of 2013.

• Work with the NHS, Industry, 3millionlives, dallas and others to support the adoption of telehealth and the implementation of interoperability standards across the board.

What’s Next?


QUESTIONS?

[email protected]

Telehealth: PHMR Development Review

Documents

Transcript of Telehealth: PHMR Development Review