Tracey GraingerHead of Digital Primary Care Strategy, NHS England
Digital Primary Care• Improving access for patients and citizens• Reducing bureaucracy across General Practice
Patient records
Practice infrastructure
Consultation access
Online appointment booking
Online repeat prescriptions
Pre-referral diagnosis
Telehealth, telecare and health living apps
Access to patient data at the point of care
Interoperability to allow data sharing between health and care professionals
Patient empowerment through the use of endorsed apps and other digital tools
92% of practices offer patients online access to their Detailed Care Record
Online Appointment Booking
98.7% of practices offering
8.4 million patients signed up
12% of all appointments are available online
Online Repeat Prescriptions
97.4% of practices offering
8.2 million patients signed up
4% of all repeat prescriptions requested online
Online Access to Records
6% of appointments could have been dealt with by practice staff other than the GP
4% of patients could have avoided contact with the practice if self-care support had been available
£29 per patient savings could have been achieved from reduction in telephone calls, appointments and administration
of 1.2 trillion Google searches are health-related
50 million visits per month to NHS Choices
49%
of adults go online for health information
Diabetes and Chronic Kidney Disease Early Identification and Prevention
How do we improve early diagnosis of
LTCs?
How can GPs support patients to improve how their
conditions are managed?
How do we know that this is having a
positive impact?
Long Term Conditions – What Problems Are We Trying to Solve?
Improve prevalence through case finding
Embed high quality primary careEducation Improvement in outcomes
for those on LTC registers
Prac
tice
Proc
esse
sEn
able
rs
Syst
emati
c ris
k st
ratifi
catio
n
Proa
ctive
pati
ent r
ecal
l
Diag
nosis
con
sulta
tions
us
ing
tem
plat
es
• Risk Stratification searches
• Templates• Resource to run searches
Syst
emati
c re
call
of
targ
et g
roup
s
Mon
itorin
g
Increasing prevalence for defined conditions to
targetTw
o st
age
cons
ulta
tion
and
plan
dev
elop
men
t
Actio
ns fr
om c
are
plan
pr
ogre
ssed
Annu
al re
view
• Searches• Care Plan Template &
Training• Resource to deliver care plan
Increasing number of care plans to target
Parti
cipa
tion
in
sem
inar
s and
pra
ctice
vi
sits
• Backfill cover
Ensu
ring
data
co
mpl
eten
ess
Mon
itorin
g of
ou
tcom
es
• All previous enablers• Data Management
Improvement in defined condition specific clinical indicators
Page 10
NHS Camden Clinical Commissioning Group
WHAT ARE THE OVERALL RESULTS?
• Before LTC LCS were introduced, the % of changes were ranging from 0 – 4% across 5 LTC’s.
• After initiation of LTC LCS, within 6 months these changes rose up to 6%.• Within 18 months time they had blossomed upwards of up to 13%• Fast forward to 30 months and this growth is still sustainable. we are continuing to see
changes developing with a positive growth of up to 5% • THIS IS GREAT!
Page 11
NHS Camden Clinical Commissioning Group
SPECIFICALLY IN CKD
4/1/2012 4/1/2013 4/1/2014 4/1/2015 4/1/20160
1000
2000
3000
4000
5000
6000
0.00
0.50
1.00
1.50
2.00
2.50
3.00
4312 44454740
5459 5464
1.701.80
1.90
2.10
2.40
CKD Register
Population Prevelance
From introduction to where we are now (30 months on) in the LTC LCS Programme, the CKD Register has gone up by approximately 25% and in turn Prevalence is up by + 0.7%
Page 12
NHS Camden Clinical Commissioning Group
SPECIFICALLY IN CKD
4/1/2013 4/1/2014 4/1/2015 4/1/20160.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
2.99
6.22
13.17
0.09
% Change in CKD Register
Before LTC LCS was introduced
6 months after… 18 months after.. 30 months after..
Radical growth Sustainable Growth
Page 13
NHS Camden Clinical Commissioning Group
SPECIFICALLY IN DIABETES
From introduction to where we are now (30 months on) in the LTC LCS Programme, the Diabetes Register has gone up by approximately 15% and in turn Prevalence is up by + 0.8
4/1/2012 4/1/2013 4/1/2014 4/1/2015 4/1/20167000
7500
8000
8500
9000
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
7699
8019 8055
8623
8827
3.00 3.003.30
3.30
3.80
Diabetes Mellitus Register
Population Prevelance
Page 14
NHS Camden Clinical Commissioning Group
4/1/2013 4/1/2014 4/1/2015 4/1/20160.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
3.99
0.45
6.59
2.31
% Change in Diabetes Register
Before LTC LCS was introduced
6 months after… 18 months after..
Radical growth Sustainable Growth
SPECIFICALLY IN DIABETES
Page 15
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “SUPPORT” ROLE-EMIS TOOLS: REPORTS
IMPROVE PREVALENCE BY CASE FINDING
ACHIEVING EARLY DIAGNOSIS, AND BETTER OUTCOMES AND VALUE FOR MONEY OF LTC MANAGEMENT
PAYMENT & ACTIVITY RELATED REPORTS
DATA QUALITY
Case finding
Various LCS’s
Page 16
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “SUPPORT” ROLE- EMIS TOOLS: REPORTS (CASE FINDING)
Camden CCG LCS reporting suite- a snap shot
Diabetes case finding
Page 17
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “DEVELOPER”ROLE- EMIS TOOLS: CLINICAL TEMPLATE
High risk Diabetes review template
SERVICE SPECIFICATIONS ARE TRANSLATED INTO EMIS DATA ENTRY TEMPLATES USING READ CODES
VALIDATED AND TESTED BY CLINICAL LEADS
CARE PLANNING AND DEVELOPMENT OF A CONSISTENT CASE MANAGEMENT APPROACH ACROSS CAMDEN
Diabetes YOC plan
Page 18
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “DEVELOPER”ROLE- EMIS TOOLS: PATIENT’S ALERTS/ POPUPS
Pop-ups/alerts with in patient care records
• AUTOMATED DECISION MAKING PROCESS
• ALERT WILL BE DISPLAYED FOR PATIENTS WE ARE IN NEED OF MONITORING
• OPPORTUNISTIC SCREENING
Pop ups
Page 19
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “DEVELOPER” ROLE- EMIS TOOLS: PATIENT’S ALERTS/ POPUPS (CKD CASE FINDER)
Pop-ups/alerts with in patient care records
Pop ups
Page 20
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “DATA MANAGEMENT” ROLE- SCORECARD, PROGRESS MONITORING
CCG Scorecard for LTC LES
Page 21
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “DATA MANAGEMENT” ROLE- SCORECARD, PROGRESS MONITORING
CCG Scorecard for LTC LES
Page 22
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “DATA MANAGEMENT” ROLE- SCORECARD, PROGRESS MONITORING
CCG Scorecard for LTC LES
Page 23
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “FACILITATOR” ROLE- PRACTICE VISITS & IT WORKSHOPS
Specialist advice by data quality facilitators on
• EMIS Tools
• Enhanced Services explained
• Data submissions
• Performance data
• Using NHS Systems – e.g. CQRS
• EMIS Web Training
Page 24
NHS Camden Clinical Commissioning Group
IT & SYSTEM AS “ONE POINT SUPPORT” ROLE
GP IT Service Desk
Desktop Support
Systems Support Team
Projects Support Team
GP IT Support Team
Application Support
Email Administration
Server Support
RA Support Network Support
Data Extractions
Practice Workshop Facilitation
Data Quality Services
Desktop Refresh
Network Upgrades
Server Upgrade
The IT and Systems teams offer a multifaceted approach covering all clinical IT requirements and any add-on services, requisite to the needs of the Camden CCG Member practices and community services.
Community Systems
Support Team
Community System
Design/Install
MDT IT Facilitation
Training
Page 25
NHS Camden Clinical Commissioning Group
SUMMARY PAGE
• Commissioners issued service specs
• IT & Systems transformed the service specs into tools such as: EMIS Searches; EMIS
Templates & EMIS Protocols.
• Engaged with practices at multiple levels: Admin / HCA / PM / Practice Nurse /GP
• Engaged with practices at locality level through IT workshops
• Measuring the progress / achievements through scorecards
• Share information with all major stakeholders
• Move towards continuous development – monitoring through working group meetings at
senior level
Innovative Business Intelligence Toolkit
Dr Neil Paul• I’m a Full time GP – Sandbach• I run a Clinical trials team• I help lead and manage 2 GP Federations through a company called
Howbeck Healthcare.• We have won >£5million in new income for our 30 practices including
a wave 2 PMCF bid.• You can contact me on [email protected]• Read my monthly column on the trials and tribulations of IT in
primary care on digitalhealth.net
Truly successful products deliver proven solutions to problems• They aren't technology looking
for a cause• They cross the chasm into real
value• Identifying the ROI is key• Several Great examples
• Hand writing rpt prescriptions – EMIS and others
• Dealing with paperwork – Docman + others
A lightbulb moment• The local hospital sent round yet
another email saying how busy it was and that it had seen 100 patients yesterday!
• Loads of GPs replied their practice was busy too and that had seen twice as many that morning.
• Occurred to us that there is no record of primary care activity -
• Workforce is changing• Federations• Super practices
• Lots of need to report activity• PMCF – extended hours• Pharmacists in practice scheme
When we asked - Locally GP partners & practice managers said• We don’t know if we are getting value for money from our staff?• We don’t have any tools to performance manage them with• We don’t know who does the work and who doesn’t• We don’t know what effect introducing a change has• We cant easily model changes• We are doing too much on paper and excel spreadsheets• We record almost everything we do but have no intelligence on what we have done• We need a business intelligence and management tool that provides real time data
that is useful for the running of our practices – not just commissioning tools for secondary care.
So ApeX was born• Developed by Edenbridge
Healthcare• PID at practice level• Flexible enterprise views with strong
controls on what data is shared with whom
• Multiple Dashboards able to focus in on topics with a robust query tool for advanced users
• Live data from primary care systems able to link to other data sources
Activity, Capacity and DemandDashboards to show
All User TypesExtended Hour Report
SunSatFri
ThuWed
TueMon
MorningEveningWeekend
92.25Extended Slots / Week
% Routine5.25%
Per 1000 Patients15.8
Unused16.3 (17%)
Target / Week685
# Weeks Met Target32 (80%)
4,219871Extended Minutes / Week Total extended slots
10%Booked same day
Jan 15 Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 1550556065707580859095
100Allocated
Extended§8%Routine
16%Unused
Extended14%Routine
10%3%Telephone
Extended Routine
Session Holder Extended Week Avg
%UnusedMorning Avg Age
Sex%Re-attend(Routine)
Paul, N R (Dr)
1,098 (25%) 21 178 (10%) 9% (7%) 42
Bromley, P (Dr)
100 (2%)
Evening
820 (26%)
Weekend
8%
802 (19%) 18 0 (0%) 8% (8%) 48652 (60%) 150 (9%) 11%
698 (16%) 16 568 (72%) 15% (9%) 450 (0%) 130 (8%) 16%Robertson, L (Dr)
All User TypesActivity Trends
2995Patients Seen
Unique Patients1814
Only seen in extended205 (11%)
Avg Attendance / Patient1.33
Bromley, P (Dr)
802 (19%) 18 0 (0%) 8% (8%) 48652 (60%) 150 (9%) 11%
698 (16%) 16 568 (72%) 15% (9%) 450 (0%) 130 (8%) 16%Robertson, L (Dr)
Registered92%
Usual GP33%
DNA5%
Routine (3%)
Cancer
Rheumatoid Arthritis
CVH
Heart Failure
Stroke
CHD
COPD
Asthma
Diabetes
Hypertension
0 5 10 15 20 250 - 4
5 - 16
17 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
75 - 84
85+
10 8 6 4 2 0 2 4 6 8 10
Age/Sex Breakdown Disease Register Breakdown
12.1 minsAverage Waiting Time
RoutineWeekend
EveningMorning
0 2 4 6 8 10 12 14 16 18
All User TypesDNA Report
3.88%DNA Percent / Week
Total2,742
Average / Week51
Session Holder Extended Week Avg
Morning Avg Age
%Re-attend(Routine)
Evening Weekend
5-Jan 5-Feb 5-Mar 5-Apr 5-May 5-Jun 5-Jul 5-Aug 5-Sep 5-Oct 5-Nov 5-Dec1.01.21.41.61.82.02.22.42.62.8
Per 1000 Patients0.12
Patients With DNAs2104 (9.35%)
Day & Time Breakdown
0.5 1 1.5 2 2.5 3 3.5 4 4.50
1
2
3
4
5
6Y-Values
Joint Session Slots137 (5.1%)
Routine3.8%
Extended6.2%
Routine vs Extended Hour
Session Holders
All User TypesDNA Report
Session Holder DNAs Week Avg
Routine Avg Age
Paul, N R (Dr)
1,098 (25%) 21 42
Bromley, P (Dr)
100 (2%)
Extended
820 (26%)
802 (19%) 18 48652 (60%) 150 (9%)
698 (16%) 16 450 (0%) 130 (8%)Robertson, L (Dr)
Session Holders
Sex
2995DNA Patients
Unique Patients1814
Avg DNA / Patient1.33
Registered92%
Usual GP33%
Cancer
Rheumatoid Arthritis
CVH
Heart Failure
Stroke
CHD
COPD
Asthma
Diabetes
Hypertension
0 5 10 15 20 250 - 4
5 - 16
17 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
75 - 84
85+
10 8 6 4 2 0 2 4 6 8 10
Age/Sex Breakdown Disease Register Breakdown
With a prior urgent attendance
Recurring DNAs
(5.4%)4+
321
0 10 20 30 40 50 60 70
390 35%
All User TypesDNA Report
Cancer
Rheumatoid Arthritis
CVH
Heart Failure
Stroke
CHD
COPD
Asthma
Diabetes
Hypertension
0 5 10 15 20 250 - 4
5 - 16
17 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
75 - 84
85+
10 8 6 4 2 0 2 4 6 8 10
Age/Sex Breakdown Disease Register Breakdown
DNAs against booked appointment date
Same Day
1 2 3 4 5 6 7 8 9 10 11 12 13 14+0
5
10
15
20
25
Days between booking date and appointment date
1 2 3 4+0
10
20
3040
50
60
Weeks between booking date and appointment date
All User TypesDNA Report
Session Type Breakdown
Session Type DNAs Week Avg
Routine Avg Age
Antenatal 1,098 (25%) 21 42
Medication Review
100 (2%)
Extended
820 (26%)
802 (19%) 18 48652 (60%) 150 (9%)
698 (16%) 16 450 (0%) 130 (8%)GP Morning
Sex
Slot Type Breakdown
Session Type DNAs Week Avg
Routine Avg Age
Antenatal 1,098 (25%) 21 42
Medication Review
100 (2%)
Extended
820 (26%)
802 (19%) 18 48652 (60%) 150 (9%)
698 (16%) 16 450 (0%) 130 (8%)GP Morning
Sex
Patient Location
MAP
Wilsden Surgery (NP34234)
Cullingworth Medical Practice (NP34234)
Hebdon Bridge Surgery (NP34234)
Kilmenny Practice (NP34234)
Harden Surgery (NP34234)
Ridlesdon Surgery (NP34234)
Bingley (NP34234)
Baildon Smith Practice (NP34234)
Guiseley Surgery (NP34234)
0 200 400 600 800 1000 1200 1400 1600 1800
Series 1
5-Jan17-Ja
n29-Ja
n
10-Feb
22-Feb6-M
ar
18-Mar
30-Mar
11-Apr
23-Apr5-M
ay
17-May
29-May
10-Jun
22-Jun
4-Jul
16-Jul
28-Jul9-Aug
21-Aug2-Se
p
14-Sep
26-Sep8-O
ct
20-Oct1-N
ov
13-Nov
25-Nov
7-Dec
19-Dec
1,500
1,550
1,600
1,650
1,700
1,750
1,800
1,850
Appt
s/10
00 P
atien
ts
(NP3402) Bingley
So what's the point?• It should allow us to automatically report activity where needed• It is allowing PMs to plan future capacity better• It can provide information on work done and by whom for appraisals and
performance management• It can tell you who is needing/using the care and let you come up with new
models of care• It can show affects of altering the system• It can help you understand mergers/acquisitions• Ability to build dashboards to investigate data• Lots more..
Other things we are working on: or trying to get up and running• GPAsk – a Q&A forum for clinicians and admin staff in a GP Federation including – News Events Jobs
and Questions• Early adopter of EMIS remote consulting – Enterprise S&R and their new Video consultations platform.• ECG project – with Technomed• POCT - with Allere• Automatic Form creation with Niche Health• Read Coding/ Scanning project with a partner.• Out/In sourcing digital dictation with Lexacom?• Speech recognition with Nuance• GP order comms – with Sunquest• Pt Messaging project with iPlato• Looking at Medefer – referral avoidance
#PMGPAccess#DigitalPrimaryCare#FutureNHS
@tracey_grainger
https://www.england.nhs.uk/digitaltechnology/info-revolution/digital-primary-care/