Building choice of high quality support for commissioners

Health Insights - Taking forward Personalised Health and Care 2020 – Interoperability Strategy

Indi Singh

July ‘15

1

Strategic context

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 file Capture information electronically for use

by me and others, at the point of care

Population health & care management Analyse data effectively for the benefit of

the wider population

Decision Support Receive automatic alerts and notifications

to help me make the right decisions

Remote & assistive care Use technology to provide care remotely

Transfer of care Seamlessly transfer information

between and within care settings,

to follow my patient

Asset & resource optimisation Use 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 Digital Maturity Index

Create a digital roadmap outlining steps

towards becoming paper-free

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

Open APIs

Open 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 Priorities Tight 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 Index Ability 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

Driving adoption & use of 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

2017

Onwards

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 Organisations

10,000 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 Visits

10,000 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 Prevention

10,000 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 Assessments

10,000 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 Dive

View

Unsuccessful

View

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 health Primary Secondary Community Integrated Neighbourhood teams

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The vision: having an digital identity that enables me to have active participation along my care pathway and access and contribution to my care records

.

Utility Principles

Need to protect security and privacy and balance with utility. Need to not introduce new burden unnecessarily.

Approach: • Verify identity once for access to services

across NHS and social care • Provide choice of where and how verification

is performed • Re-use existing digital footprint of individuals –

reduce burden to end user

Privacy Principles

Need to address lack of confidence on the wrong people accessing my identity information and my identity information being lost.

Approach: • Use robust standards for identity verification &

authentication options • Ensure strict controls over the use of identity data • No centralisation of identity data or use of ID cards • Follow industry standards

Oversight by Privacy and Consumer Advisory Group Includes Privacy International, Which?, ICO, No2ID, LSE

Identity Verification - Vision

Approach to Identity Verification

Select who verifies you

National components

NHS.UK

I have a trusted identity and I choose

to use this to access health and care

services .

I will be able to

seamlessly access

national and local

services and information

Username

Password

Local Services National Services

Access to Patient Data

One Time Pin

GP Services

Online Care Plans

Diabetes Information

Select NHS Referrals slot

Order EHIC card

Matching to NHS Number

Mapping of NHS No <-> ID

26

Test Results

GP Practice

27

Healthfabric

Patient Access

Local apps

National apps

eReferrals GP

Hub

Matching service (links to NHS No)

1. Health

EHIC

Three options for verification being tested:

3. Local Gov

Council

2. “Verify”

Experian

Patient chooses identity provider

Target app requests authentication of user

Identity Platform

Mapping Table NHS No <-> ID

Hub

One overall identity approach with different options for verification and authentication but using consistent standards

Blood/Transplant

Verified eID returned to hub

Hub looks up NHS no using eID, sends NHS no to app

Apps/Services:

National components

e.g. students

e.g. long term condition patients

e.g. home owners

1 2

3 4

Identity approach – “separation of concerns”