Transcript Connecting Care Board Update
Connecting Care
Our story so far…
Andy Kinnear June 2015
introduction to Connecting Care
• • • • • • • • What is Connecting Care?
Connecting Care – Why?
– Local drivers – National drivers Who the partners are What we have delivered so far – What are the benefits? What can Connecting Care offer & what’s coming next How our Governance framework works How Connecting Care fits with the national strategy Kinnear’s 5 key messages!!
what is Connecting Care?
• • • • • Connecting Care is the Bristol, North Somerset and South Gloucestershire [BNSSG] programme, dedicated to using technology to support 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 care better, safer and more joined-up 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 focus has been the delivery of a shared ‘view only’ electronic patient record (a ‘portal’ sharing our IDCR)
local need
“Adequate and timely information must be shared between services whenever there is a transfer of care between individuals or services.” “There needs to be better communication between ‘in-hours’ and out of hours services.”
NOT having access to accurate, timely, shared information is a ‘blocker’ to providing high-
“The information I have is limited and frequently is missing important elements…”
“Services in all settings including health and social care need to improve their communication and handover ”
“I don’t have access to some important
quality, effective, efficient care…
“If I had better information then it would help me evaluate risks when deciding whether to admit a patient…”
“There are delays in getting hold of information that I need…and I spend a lot of time chasing it up…” information electronically…”
“Better information would support better safeguarding”
*
Summarised from feedback from local clinicians & practitioners during workshop events
national drivers
strategic alignment
5 year forward view:
“Most countries have been
slow to recognise and capitalise
on the opportunities presented by the
information revolution
……the NHS has
oscillated
between two opposite approaches to information technology adoption.....the result has been
systems that don’t talk to each other
and a
failure to harness
the shared benefits that come from
interoperable systems
…..
In future we intend to take a different approach”
Connecting Care partnership
project approach
• • • 2011 Vision 2012 Procurement 2013 Staged approach – First stage (pilot) started in March 2013. Key deliverables: • A working system for 500 users • Evaluation of benefits • Stage one themed on urgent & unplanned care • • 2014 A business case for the second stage .Second stage started Dec 2014 (next 5-7 years)
FYFV PUBLISHED
2015 = GROWTH Stage two will extend the breadth & depth (10,000 more users, more information sharing)
what we’ve delivered so far
Integration Presentation Security & Privacy • • • • • • Authentication Authorization Single Sign-On Patient Privacy & Consent Relationships Audit Logs
Connecting Care Clinical Portal
Patient Record • • • • • • Demographics Laboratory Radiology Encounters Allergies Diagnosis • • • • Medications Problems Procedures Transcribed Documents • • • • • • • • Portal Patient Search Patient Lists Patient Summary Timeline Flowcharts Secure Messaging Orion Health Applications Third Party Applications MiG Rhapsody Integration Engine Clinical Data Repository
Source Systems
Master Patient Index
GPs
NBT Cerner PAS Weston Cerner PAS UHB Medway PAS RiO Extracts X4 Adastra End Of Life Adastra Out Of Hours Orders and Results (CRIS and Ultra) X2 Paris Social Care Bristol SWIFT – North Somerset
Analyse and reflect The backdrop the scope & theme of the pilot Capture and review The hypothesis & a framework for assessing benefits A detailed methodology and plan
benefits approach
• • The backdrop: scope and theme of the pilot Theme of ‘urgent and unplanned care’ 500 licences, shared across all partner organisations teams • • The hypothesis and framework used ‘Better sharing of information and better integrated information should have a positive effect on the quality, efficiency and cost of providing care’ Framework based on MSP • • A detailed methodology and plan Benefits realisation plan Based on Quality, Innovation, Productivity and Prevention (QUIPP) themes
Connecting Care - benefits
• • • • • • •
The main benefits for me (as a clinician or social care professional) are:
Confidence in my decision making is improved The quality of my consultation (or assessment) is improved I do not make unnecessary referrals or carry out duplicate assessments It saves me time (which can be used to provide care, or for other duties) I am more informed before a visit/appointment, which means I can provide more timely/more appropriate care I have better relationships with colleagues My input into a patient/service user’s care can be seen by others, so the recognition of my profession is increased
Connecting Care - benefits
• • • •
The main benefits for my patients/service users are:
They don’t have to keep telling their story (e.g. remembering / explaining medications They receive safer, more appropriate care They have a better experience of the services offered, potentially with fewer duplications or delays They might not have to be admitted to hospital
Connecting Care - benefits 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 time – reduces time trying to find out information Reduces risks – where patients unable to inform clinicians about relevant information / fax errors etc
Connecting Care - benefits Community care
• • • • Saves time in triage and assessment Saves time – reduces the amount of calls to GPs Saves unnecessary home visits Supporting risk management and safeguarding
Social care
• • • • • Supporting referral management Saves time in triage and assessment Informs assessments & care planning Saves installation and equipment costs Supports risk management and safeguarding
General practice
• • • • Reduces burden on practice administrators Supports risk management and safeguarding Increased confidence in better care being provided outside of the practice Immediate access to GP records (new registrations)
Connecting Care - benefits
“Unable to obtain a medication history or allergy status from the patient….accurately confirmed through Connecting Care …”
Pharmacist, NBT
“I now use Connecting Care on almost every case I deal with it (approx. 25 cases per shift). It always makes a difference and adds value. Every shift, acute admissions are avoided .”
Doctor (out of hours)
“Have been able to identify trends which have then resulted in swifter [ Care…” safeguarding] interventions… one case where concerns would not have increased without Connecting
Social Worker Safeguarding team
““Information about the patient’s diagnoses has helped our team decide which type of therapy to offer the patient”
UHB
“ Massive difference in time spent accessing information. On average [I can] access the GP record within 30 seconds compared with 15-20 minutes taken via telephone or via fax”
Critical Care Pharmacist Manager UHB
“Connecting Care is brilliant …I use it to triangulate information from service users, to find out about other services involved so that I can contact them to inform my assessments ”
Bristol social worker
“it has enabled us to commence discharge planning earlier in the patients stay to help prevent delays later on.”
Discharge Nurse
“3 cases identified on Connecting Care today that were already allocated to a health practitioner (BCH OT or IMCS OT) so did not require referrals to BCC OT”.
Occupational Therapist Bristol City Council
Connecting Care - benefits
“
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
“In cases where we are dealing with a
person who is being supported by Rapid Response and the district nurses, Connecting Care comes in to its own. All the notes from visits are documented and it can save at least 30-40 minutes on duty cases of this
“Without Connecting Care today I couldn’t have done my job.”
Pharmacist
“I used Connecting Care to
find vital information for the diabetes nurses minutes on the telephone and . The information logged by district nurses is a goldmine of information. We saved 20 managed to find the reason for patients insulin being discontinued ”
Discharge Nurse
nature
” Social Worker “Connecting Care has been really helpful tonight.
Could not do 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.
been done, had been done.” OOH Doctor
But with CC I was able to work out that all that should of
Having access to accurate, timely, shared information is no longer a ‘blocker’ to providing high quality, effective, efficient care…
“The extra patient detail
is useful when deciding to stop drugs such as anti-platelets and it helps to identify risk factors
”
Doctor
what can Connecting Care potentially offer?
A sample of some possible financial benefits:
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
what can Connecting Care potentially offer?
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
what’s next?
• • • • •
In 2015 our key projects are
Rollout to 2000 users this year Children's safeguarding project – sharing information from our 3 local authorities’ children’s systems Document sharing – clinical and social care documents shared in portal...and ‘sent on’ to other recipients (GPs) – initial focus is eDischarge Lots of system replacements systems) hospital PAS, 3 community systems, 1 social care system, 2 pathology (2 New infrastructure, new data centre with UHB hosting, re-write lots of our ‘core config’ to support improved performance • • • • • • • • •
In the pipeline…
Rollout to 10,000 users + Pharmacy (sharing more – hospital prescribing / community pharmacy) Supporting cancer care Mobile working, patient access Specialist systems (renal, maternity, dental etc etc.) Sharing more information from within hospitals – e.g. assessments, care plans Enable sharing of richer end of life plans Better support for some workflow / pathways
And lots and lots more!!
Connecting Care governance
SYSTEM LEADERSHIP GROUP
Directors of Finance Group
PROJECT SPECIFIC BOARD(S)
Connecting Care PARTNERSHIP PROGRAMME BOARD Connecting Care ‘USER GROUP’ (Clinical & Social Care) Connecting Care PROGRAMME TEAM Connecting Care MANAGEMENT GROUP
Connecting Care SUBJECT SPECIFIC SUB-GROUPS Connecting Care LOCAL PROJECT TEAMS
Strategic level Oversight & assurance level Delivery level
Connecting Care governance
Orion Health Supplier contract
Main contract & set of schedules
Bristol CCG Specific contract / SLA** Contract for services ** Internal Contract / Cooperation Agreement Connecting Care partner / supplier Connecting Care partner Connecting Care partner Connecting Care partner Connecting Care partner **
For example hosting of the system or programme delivery or other support services
Connecting Care
How does it fit with national strategy?
strategic alignment
5 year forward view:
“Most countries have been
slow to recognise and capitalise
on the opportunities presented by the
information revolution
……the NHS has
oscillated
between two opposite approaches to information technology adoption.....the result has been
systems that don’t talk to each other
and a
failure to harness
the shared benefits that come from
interoperable systems
…..
In future we intend to take a different approach”
National Approach - Bringing together cohorts on information sharing
Pioneers Wave 1
e.g. Barnsley
Technology Fund Applicants
e.g. Royal Marsden
Pioneers Wave 2
e.g. Wakefield
“Pioneering organisations”
l e.g. Hampshire, Bristo
Driving priority standards for information sharing Collective guidance on breaking down “myths” Understanding common and priority needs Articulating direction of travel 2 4
What’s the underpinning architecture?
Creation of local integrated digital care records to support clinical access to detailed care record and speciality information. Referrals/ Discharges i.e. transfers of care (clinical workflow) GP Systems GP Systems GP Systems GP Systems GP systems remain main point of curation of record Meds, allergies, adverse reactions Use SCR APIs to bring SCR content into IDCRs Expose access to IDCRs through APIs Specific key documents provided up to SCR for national access IDCR Integration Platform (e.g. Britol) IDCR Integration Platform (e.g. Hampshire) Summary Care Record GP record ectract Flags (e.g. CPIS) Discharge meds MPI Demographics IDCR Integration Platform (e.g. Leeds) Open APIs between IDCRs enable sharing across these Index Index to IDCRs Use of national assets for key flags and key documents where national access needed Clinical access and contribution to integrated digital care records and summary care record through their native clinical system. Patient access to summary information (SCR) with ability to drill down into integrated digital care records. Access through NHS Choices and PHRs PHR integration platforms will enable apps/PHRs access to other APIs for – i) transactions e.g. use NHS referrals API to book appointments and 2) use APIs to access information from wearables etc Patients also to be able to contribute to PHRs 2 5
KINNEAR’S - 5 reasons we have been successful…..
1. Line of business systems that ‘share’
• • You cannot share paper data easily Good electronic ‘line of business’ systems that share data are critical
2. Integration Partner
• Integration is tricky. Find a software partner who ‘gets it’
3. Money…locally owned money!
4. People….local talented people
•
5. SPIRIT
• • • Invest locally….seek national money too, but make your local organisations put skin in the game Hire really talented project people….we did, we do, we always will • Overrides everything else Stamp on ‘organisationally centric’ thinking at every single opportunity.
Command the morale high ground that the patients/citizens best interest occupies
• • • • • • • What is Connecting Care?
Why have Connecting Care?
– Strategic alignment - UHB – National drivers Who are the partners?
What have we delivered so far? What are the benefits? Tangible results so far What can Connecting Care offer & what’s coming next?
Governance Framework
Thank you for your time!