Northern Ireland NHS Confederation

We’re Passionate About

Dr Graham EvansChief Information and Technology Officer

North Tees and Hartlepool NHS Foundation Trust

South Tees Hospitals NHS Foundation Trust

Putting patients first Quality, safety and patient experience

Transforming services to meet the health needs of future generations

Implementing Digital Change – A Clinical Perspective Intersystems (includes lunch) Glen 1-2 1.30 – 2.15

Implementing Digital Change – A Clinical Perspective In this session Dr Graham Evans, North Tees and Hartlepool NHS Foundation Trust will tell the story of how their Trust embarked on an eHealth/Digital programme as part of a wider health and care system Digital strategy. The programme set out to replace multiple legacy systems to bring information together in to one unified enterprise-wide solution. This is a story of clinical leadership, investment, partnership, greater safety and efficiency - but - it was not without its ups and downs along the way. Following a short presentation, Graham will join Dr Michael Quinn, Electronic Health and Care Record Clinical Director to discuss lessons for what we want to do in Northern Ireland. This session is supported by InterSystems.

Dr Graham Evans Chief Information and Technology Officer North Tees and Hartlepool NHS Foundation Trust & South Tees Hospitals NHS Foundation Trust Michael Quinn, EHCR Clinical Director

North Tees and Hartlepool NHS Foundation Trusts perspective

The Health and Care System today…..

The Health and Care System today…..The general perception from the public isthat the NHS is a single entity, with wellconnected systems and services that enablepatients and service users to moveseamlessly between point of care.

The reality is, the NHS and broader Healthand Care System, is a complexamalgamation of different organisations,operating in a dynamic and fast movingenvironment. Often working in “isolation”, butstarting to move towards “integration”.

From “Isolation………………. to Integration”

The Health and Care System today…..Advances in digital technologies have meantthings that were once thought impossible orperhaps ‘the work of science fiction’, are nowcommon place.

Who would have thought that we could everfunction without physically transacting with“hard cash”, yet, we are now able to transferfunds electronically directly into and out ofour bank accounts, we can manage thoseaccounts from home or ‘on the move’ fromour PC’s, tablets and secure smartphonesand think nothing of it.

We regularly browse and virtually “shop”from the comfort of our armchairs, we haveour weekly groceries and other goodsdelivered to our doorsteps without the needto go to stand in queues or even stack ashopping trolley.

Our customers, (Patients) and staff are alsoexpecting different service offerings and aconsequence of digital evolution……………

The Health and Care System, is laggingbehind to an extent.

Demographic and technological evolution

The Health and Care System today…..We book holidays, check-in on-line and evencomplete our tax returns all without paper,we can even control our domesticappliances, lighting and heating from mobileapplications (apps), on our phones.

We can communicate with friends andrelatives who may be thousands of milesaway, using voice and video enabledtechnologies and almost feel as if we are inthe same room, but despite all of this, we stillstruggle to digitally enable health and careservices and be able to truly transform theway in which we provide high quality, safecare for our patients.

We need to be cognisant of the emerging Cyber threat and we

develop digital systems and services!

• Your medical information is worth 10 times morethan your credit card number on the black market.

• Recently, the FBI warned healthcare providers toguard against cyber attacks after one of the largestU.S. hospital operators, Community Health SystemsInc, said Chinese hackers had broken into itscomputer network and stolen the personalinformation of 4.5 million patients.

• Security experts say cyber criminals areincreasingly targeting the $3 trillion U.S. healthcareindustry, which has many companies still reliant onaging computer systems that do not use the latestsecurity features.

Technology News | Wed Sep 24, 2014

The Health and Care System today…a target

A strategic approach is required

Information, sharing empowering, enabling

Information, sharing, empowering…enabling!In order to truly transform the health andcare system, like other markets who havesuccessfully embraced digital services, weneed to understand the needs and demandsof the people we serve….”the Patients”.

The current, and no doubt future pressuresbeing placed on the health and care system,mean we need to think and behavedifferently in order to maintain and improvehealth and care services. Digitaltechnologies can help, but thistransformation requires; People, Processand Technology being aligned, andtherefore, “not do the same thing better”, but“doing better things”.

The paradigm shift will occur, when, likeother digitally transformed industries, we shiftto a more ‘connected’ and user ‘self-managing’ model of delivery.

But we need to start somewhere!

Real-time exchange

LA and other Public Service

Systems

Primary Care Systems

Secondary Care Systems

AQP Systems

Care Systems

AD

AD

AD

AD

AD

Regional Accessible

SharedCare

Record

Medical Interoperability Gateway = MIG

Interoperability - tools

Interoperability – One step

One small step on our journey….

An evaluation of MIG use in the Rushcliffe area of Nottinghamshire found that:• All clinicians felt the MIG had improved safety and avoided

potential incidents.

• 92% felt the MIG had enabled them to improve their overallcare for patients.

• 67% thought they could now clinically assess patients morequickly.

• 75% felt the MIG had helped with prescribing or referraldecisions.

• Nearly all respondents found the MIG user-friendly, withminimal training needed.

Source: Nottinghamshire Health Informatics Service.

ED&

IUEC

People, Process Technology – “Aligning for change”

Technology

People Process

• Engagement• Awareness• Commitment• Clinical Leadership (i.e. CCIO)• Adoption• Utilisation• Security (Data and Cyber)

• Infrastructure• Hardware• Software• Devices• Systems• Security (Data and Cyber)

• Current state• Future state• Operate• Optimise• Transformation• Security (Data and Cyber)

Align

Area of weakness generally, process design to be digitally enabled…

Clinical Leadership• IT enabled projects often fail as they focus on “Technology” not the business;

National Programme for IT (NPfIT). We must learn from the past to shape the future.

• Our business is Health and Care so our approach needs to be; Business (and/or Clinically) owned and driven, but IT (Digitally Enabled).

• Clinicians (and clinical leaders, including Nursing) need to articulate and help shape the future; Technologists translate the requirement into appropriate solutions. Visionary clinicians will drive the change and commitment needed, we just need to know who they are

(and clone them). The role of Chief Clinical Informatics Officer (CCIO), is both symbolic and essential to creating the

environment and commitment for change. The CCIO, CIO (CITO) and CEO all need to be driving the agenda, supported by other key

stakeholders; i.e. Medical Directors, CNO, CFO. The vision and method needs to be underpinned by a “compact” with supporting governance.

Critical Mass……..

WWW. Work With the Willing.

North Tees and Hartlepool NHS Foundation Trust

Digital Strategy

Corporate Strategy – 2016 - 2021

An integral and enabling element of the Corporate strategic direction

Research

I & TS

Estates

People

Quality

Supporting Strategies – Re-draft & Re-design

Digital StrategyWe will focus on addressing the key healthand care objectives from a local and regionalperspective, as described in the BetterHealth Programme (BHP) and the emergentSustainability and Transformation Plan(STP).

We support the creation of a collaborativehealth and care system, key elements ofwhich are articulated within the publishedClinical Commissioning Group (CCG) LocalDigital Roadmaps (LDRs).

Our aim is to enable secure and legitimateinformation and knowledge sharing,supporting user (Patient and Clinician)access and “self-sufficiency”.

We will develop digital services that will shifthealth and care from “isolation tointegration”.

Fundamental to our health and care systemtransformation, will be the delivery of highquality, cost effective Information andTechnology Services (I&TS), such servicesare increasingly being known “DigitalServices”.

Our vision is to have a;“Secure, resilient, accurate and timelyinformation at the point of patient care; thiswill be delivered through an integratedapplication suite, combining clinical and lineof business applications, underpinned by arobust and cost effective informationinfrastructure”.

Digital StrategyOur key focus areas will be:

• Integration with the North East and North Cumbria digital health & care programmes, including the Great North Care Record. (GNCR) and population health initiatives.

• Unlocking and the power of information to improve decision making at the point of care.

• Exploiting digital technologies to deliver patient centred solutions in neighbourhoods and communities.

• Keeping patient and service user’s information safe, secure and up to date, and only used with appropriate governance and controls.

• Improving organisational digital maturity, and user digital literacy to maximise the benefits of digital technologies.

• Delivering digital services which will be paper free at the point-of-care by 2020.

Digital Strategy

Key Areas:• National Direction• Regional needs• Local enablement

Opportunities• Global Digital

Exemplar (GDE)• Fast Follower

Programme

Global Digital Exemplars: Objectives

Create a network of world class organisations which support high quality care with digital technology

Demonstrate how to transform care with digital technology Improved efficiency, productivity

and quality through optimising working practices

Shared learning with other programmes and organisations

Standard system builds, template business change/deployment approaches and common operating processes

Global Digital Exemplar Programme – GDE

Consequences• Data breaches• Sticking letters etc.• Lost in transit• No audit trail

Where are we heading?

X XX

2020

20162018

X X X Consequences• Data breaches• Sticking letters etc.• Lost in transit• No audit trail

PaperHeavy

Paper-Light Paperless

Where are we heading?

Increasing digital dependency (and increasing cyber risk to an extent)

Scan for Safety

Scan for Safety (S4S) – its all about the standards

One part of the bigger picture

The Digital Hospital

Communications

CollaborationSelf Service

Infrastructure

Safety andStandardisation

The Hospital of Things

Patient Centric

EPR• Phase 1 - Complete• Phase 2 – WIP• Phase 3 – Planning

S4S• Phase 1 – Complete• Phase 2 – Complete• Proof of Concept

development.• Phase 3 & 4, PoC

Care scanning

BHP/STP• Record Exchange

(MIG)• Telehealth/Telecare• Great North Care

Record

The Patient at the centre

All of these initiatives have been a function of a “clinically led vision” and Trust investment

programme during challenging times!

Electronic Patient Records = TrakCare - Delivery

TrakCare – Phase twoPurposeThe aim of this programme is to provide an Electronic Patient Record (EPR) system that will enable and support patient care to be provided within a paper-free environment. Patient information will be recorded electronically allowing for this to be shared securely and seamlessly across all departments and healthcare settings at the point of need, enabling multidisciplinary teams to work collaboratively to better support the care of our patients.

TrakCare – Phase two, timeline

2017Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec

MiG into ED&

IUEC

Governance

Information and Technology Services - Governance

The Trust has a robust and vertically alignedGovernance structure.

I&TS are fully integrated from an internal andexternal perspective, with oversight of alldigital and associated programmes.

Chaired by the Trust Medical

Director

Chaired by the Trust CCIO

Sustainability and Transformation Plan (STP) - Governance

As part of the overarching Better HealthProgramme (BHP) and Sustainability andTransformation Plan (STP) a formalgovernance arrangement has beenestablished.

Key programme enablers are integrated intothe governance structure, this includes theDigital Transformation Workstream (DTW).

Collaboration is the key

Local Digital Roadmaps (LDRs)Local Digital Roadmaps (LDRs)A key building block of the DigitalTransformation Workstream (DTW) is thedelivery of the digital solutions asdescribed within the various CCG LocalDigital Roadmaps (LDRs).

Across each of the CCG LDR’s, there aremany complementary systems andservice developments. Therefore, wherenecessary and appropriate, it will makesense to align these activities and createan overarching approach.

A range of digital services have beendefined and described that form the“foundations” of the DTW, the intent is toexploit the progress and solutions alreadyin progress and scale-up across the STPfootprint as necessary.

The aims of the BHP/STP digital transformation workstream are to digitally enable our health and care system, and move from‘isolation to integration’, this will be achieved by:

Digital thought leadership: Working as a collaborative health and care economy, with integrated governance, digital collaborative working,underpinned by strong and sustained clinical leadership.

Digital maturity transformation of all health and care providers: Increased digital maturity of all providers’ adoption and use of digitaltechnologies and standardised records at the point of care.

Unified health and care infrastructure: Joining together of our infrastructure (and digital services), where it makes sense to do so, to enablestaff to work across multiple sites and patients to interact with services seamlessly, this includes back office collaboration.

Electronic Patient Record and interoperability programme: Joining up of key clinical (including EPR) and line of business systems in useacross the health and care economy to support achievement of the information sharing and collaborative health and care service provision.

Information Sharing Gateway: Implementation, at pace and scale, of a single information sharing framework and agreement to all health andcare practitioners.

Digital shop windows: Signposted entry points by which citizens and patients can access, navigate and interact digitally in real time with theirhealth and care services.

Telehealth/Telecare: Delivery of digital solutions primarily used in “out of hospital” settings (i.e. people’s homes, care and residential homesetc.) to improve self-care and enable people to stay well outside of hospital.

Advanced Analytics Alliance: A joint approach with health, care and academia to maximise the potential benefits of big data, research andpredictive analytics.

BHP/STP – Digital Transformation Objectives

In Hospital • Linked to Digital Maturity.• Clinically led transformation

programme to improve patient care,

• Increase organisational efficiency and effectiveness.

• A digital hospital providing 21st

century services connected to a Health and Care “system”.

Neighbourhoods and Communities

(aka not in hospital)

• Provision of digital tools and services to support self care

• Supporting critical care pathways to transform the heath and care offer

• Minimise unnecessary admissions• Enable patients to leave hospital

and return quickly and safely to an appropriate care setting.

DigitalTransformation

Workstream

Digital Collaboration(Back Office)

• Opportunities to work collaboratively between Heath and care organisations

• Share scarce technical skills and resources

• Leverage expertise• Gain economies of scale • Reduce cost/add value• Improve customer experience• Reinvest in frontline services

DTW - Workstreams

The big picture

The Great North Care Record

Great North Care RecordA key ambition of the BHP is to deliver anintegrated health and care system enabled bydigital services and solutions. Previously theMedical Interoperability Gateway (MIG) washighlighted as “one step[ on the journey”, butthere is still far to travel.

The MIG offers a credible short to medium termsolution for information sharing between pointsof care, however, the MIG in its current form,does not provide the functional “richness”necessary to enable other secondary services,such as; operational planning and a rich sourceof population health data for research andpopulation health improvement purposes.

A technical blueprint that will form the basis ofthe Great North Care Record (GNCR), iscurrently being developed this will concludeduring Q1-2017, beyond this solution will beassessed

PatientCentred

• Personalised & coordinated• Convenient & quality focussed• Affordable & available• Wellness & prevention• Governed and managed

Great North Care Record – Enabling Patient Centred Care

Not in hospital – Neighbourhoods and Communities

Not in hospital – Neighbourhoods and CommunitiesNot in HospitalA key challenge in the transformation of thehealth and care system will be the transitionfrom the traditional model of “in hospital” careinto a safe and appropriate “not in hospital” orNeighbourhood and Community (N&C)settings.

A number of initiatives are currently in flightwithin the Trust as well as other parts of theregion, for example Darlington Healthy NewTowns (HNT).

In order to identify and exploit the appropriatedigital tools and technologies, key health andcare leaders will be required to lead andarticulate the specific scenarios and ‘usecases’ requiring digital solutions, in order toensure digital enablement is ‘designed in’, not‘added-on’.

Hospital at HomeSome significant developments are takingplace with the Trust to develop health careservices outside of the traditional hospitalenvironment. This programme of work isclinically driven and is being embraced by thepatient groups benefitting from thistransformational approach.

The model of care has being focussing onpeople and process with some initialtechnology services being considered, thisprimarily involves real-time access to thepatient record. However, it is anticipated thatthere are a vast array of possibilities on offerwith some excellent work already developedwithin the region, it is therefore suggested thatthe Trust considered adopting areas of bestpractice where possible and practical tominimise effort and maximise benefit.

Not in hospital – Neighbourhoods and CommunitiesOne of the key technologies that has beenrequested as part of the BHP has beenthe ability to provide a real-time “virtual”clinical consolation solution, supported byan appropriate Video Conferencing “style”service.

Whilst many tools already exist (such asSkype for Business, WebEx and otherproprietary services), it is expected that anindustrial scale platform and service will benecessary .

One such service, “AttendAnywhere”, isan “zero footprint” technology agnosticsolution, in other words, irrespective of thedevice the end user (Patient, Clinician,other) has available, this platform enablessecure point to point connectivity, with theability to share real-time video, audio anddigital content.

The AttendAnywhere platform is current being deliveredas part of a large scale service in Scotland delivered viathe Scottish Centre for Telehealth and Telecare.

Some parts of the STP footprint using AiredaleTelehealth services already….may not be one size fitsall!

Digital Maturity AssessmentThe Digital Maturity Assessment (DMA) measures theextent to which healthcare services in England aresupported by the effective use of digital technology..

The DMA, will help identify key strengths and gaps inhealthcare providers’ provision of digital services at thepoint of care and offer an initial view of the current ‘baseline’position across the country. The DMA supports the NationalInformation Board’s commitment to achieving a fullyinteroperable health and care system by 2020 that is paper-free at the point of care.

The Digital Maturity programme worked with a number ofpartners including Academic Health Science Networks(AHSNs) and healthcare providers and CCGs to examineeffective use of technology, with particular focus oncapabilities such as digital care records, transfers of careand medicines management.

The DMA is a framework that can be used across acute,mental health, community, ambulance and social caresettings. The DMA builds on existing evidence about howinvesting and effectively using IT can achieve better patientoutcomes, reduce bureaucracy, improve patient safety anddeliver efficiencies.

Digital Hospitals

Digital Maturity

Digital Maturity is highly dependent on appropriate “Digital Investments”

Digitally connected services

Hospital site F

Hospital site C

Hospital site E

Hospital site B

Hospital site A

Patient Flow

Hospital site D

For Illustration only

Digitally connected services

Hospital site F

Hospital site C

Hospital site E

Hospital site B

Hospital site A

Patient Flow

• Shared I&T Services “High quality safe Care is what we provide, this should not depend on where you go”….

Hospital site D

For Illustration only

• Same Patients• Same Staff• Same Systems• Same Information

Trust A Trust B Trust C

Collaborative and unifiedInformation and Technology

Services

“To Be” ….Longer term

• Increased ‘value-add’• Shared skills and resources• Knowledge transfer and retention• Minimises talent drift• Reassign ££ to frontline care

Summary

Strategy on a page

National D

riversB

HP/STP O

bjectives

Processes & Capability People & Culture

“The aims of the BHP/STP digital transformation workstream are to

digitally enable our health and care system, and move from

‘isolation to integration’.

2016 2017 2018 2019

• Paperless NHS• Person centred care• Information at the point of care• Transparency• On-line access to EPR

Paradigm shift• Not in Hospital, Neighbourhoods

and Communities• Self care• Knowledge/Education• Prevention

• Back office collaboration• Increase organisational digital maturity• GDE FF• Security (inc. Cyber) services• Knowledge and resource sharing• Analytics/Big Data• Personal digital capability

• Whole system approach• Vision• Thought leadership• Governance• Commitment

LDR digital delivery

Quick windigital solutions

Now

Thank you&

Questions?