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Our values: clinical engagement, patient involvement, local ownership, national support
New Care Models: Pioneers and Vanguards
#futureNHS
1. New Care Models Technology Support Offer 2016/17 – Mark Golledge & Helen Arthur
2. Taking Forward Information Sharing – Indi Singh
3. Local Vision – An overview of the journey and learning to date from:• Morecambe Bay – Paul Charnley, Interim CIO I3 Service• Connected Nottinghamshire – Andy Evans, Programme Director• Islington – Mark Futerman & Stephen Latimer, ICT Development and Support• Tower Hamlets – Charles Gutteridge, CIO
4. Q&A with the Panel
Session Outline
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
New Care Models:The Context
Helen Arthur - Technology LeadVanguards Programme
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
NHS Five Year Forward View• Published in October 2014
• A shared vision across seven national bodies
• New care models programme key to delivery
• Focuses on both NHS and care services
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
National Information Board
Five Year Forward View
National Information Board (digital strategy underpinning FYFV) National Information New Care Models
Domain 1 Domain 2 Domain 3
Domain 4 Domain 5 Domain 6
Integrated care pioneers
Integrated personal
commissioningVanguards
Test beds Healthy new towns
Harnessing Technology
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Strategic Context
Clinical engagement
Patient involvement
Local ownership
National support
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Our Core Values
1 Cornwall and Isles of Scilly
2 South Devon and Torbay
3 South Somerset
4 North West London
5 Islington
6 Camden
7 Waltham Forest, East London and City
8 Greenwich
9 Kent
10 Southend
11 West Norfolk
12 Stafford
13 Cheshire
14 Worcestershire
15 Nottingham City
16 Nottingham County
17 Greater Manchester
18 Sheffield
19 Blackpool and Fylde Coast
20 Wakefield
21 Airedale, Wharfedale and Craven
22 Leeds
23 Vale of York
24 South Tyneside
25 Barnsley
1
2
3
1049
5 68 7
12
13
19
14 15
21
1117 16
18
2022
23
24
25
• The integrated care pioneers programme was launched in November 2013 and is focussed on the integration of health and social care – with arm’s length bodies signed up to support pioneer sites to develop their new integrated models of care
• The programme is supporting change and innovation at a local level, sharing learning across the pioneer network – with support from national experts
• 25 sites have been announced – some sites are also vanguards / IPC sites
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Integrated Care Pioneers
5 new models of care with a total of 50 vanguards:
Integrated primary and acute care systems
Multispecialty community providers
Enhanced health in care homes
Urgent and emergency care
Acute care collaboration
9
14
6
8
13
https://www.youtube.com/watch?v=BFJzCemX7AM&feature=youtu.be
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
50 Vanguards Developing their Visions Locally
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
50 Vanguards Developing their Visions Locally
Our values: clinical engagement, patient involvement, local ownership, national support
New Care Models:Information & Technology
Mark Golledge - Informatics Lead Local Government Association
#futureNHS
Need for close alignment of activity and communications across the New Care Models programmes, building on the work already delivered and responding to the feedback.
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Developing a Streamlined Plan
Online Learning
Environments
Information and Guidance
Co-Design and Learning Collaborative
Bespoke activity (and support where required) to pilot / test new ways of working or resolve challenges
Incr
easi
ngly
bes
poke
eng
agem
ent
Activity which is shared with the wider health and care system for wider use / deployment
Coordinated activity across the new care models to capture learning and produce common guidance / case studies / evidence
Bespoke Support /
Pilot Activity
Simplify
Standardise
Share
Digital strategy
Integrated systems
Information sharing
Digital citizens
Data for outcomes, research and commissioning
Remote assistive technology
Supplier engagement and procurement of digital services locally and at scale
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Developing a Streamlined Plan:7 Core Themes
Collaborate with others working on similar objectives to:
Ensure consistent messaging
Maximise resources and opportunities
Avoid overburdening stakeholders
Align with national strategy/policy via the NIB and harness existing expertise
Look for opportunities to standardise and replicate (principles not systems)
Facilitate networking and sharing of problems, solutions, learning
Provide focussed support tailored to local vision
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Principles of Working
• More intensive support / engagement with Vanguards and pioneers: e.g. identifying front runners and fast followers to work with around the core themes
• Activity to capture learning / case studies / evidence across the New Care Models:e.g. as with work to produce blueprint for information sharing
• Activity to share and disseminate more widely with the rest of the health and care system:e.g. as with dissemination, webinars and regional workshops on information sharing
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
What this Means in Practice
Building choice of high quality support for commissioners
Taking forward Information Sharing
Indi SinghHead of Enterprise Architecture
Building choice of high quality support for commissioners
Strategic context
Breaking down “interoperability”
What this means for professionals and citizens
Current priorities
Working in conjunction with localities and the market
End of life cure prompting key preferences
Vaccinations andimmunisations history
Visual comparison of medicationsPrescribing alertsEncounter timelines
Long term conditions(trending and recall)
Pre-populationof pre-operative assessment
The development of an open environment for information sharing supporting emerging models of care based on open interfaces and open standards.
Open APIsOpen interfaces to enable information to flow across a care pathway and to be accessed across geographies
Local Integrated Digital Care Records (IDCR) that link health and social care as main approach for delivering local information sharing needs
Tight standards for key transfers of care
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 IndexAbility to locate patient record information that can then be accessed through open APIs
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
97% Of localities using NHS Number as primary identifier when sharing information
66%Of localities sharing discharge summaries electronically
StandardsLevers Incentives Service change Technical Capability
AppointmentsManage appointments in order to
co-ordinate access to care
Access RecordAccess a patient’s care record for the
purpose of direct care
Tasks Manage tasks in order to work effectively
across care settings
eDischargeDischarges from inpatient care back to
the general practitioner
A&E eDischargeInformation sent to the general
practitioner from an A&E attendance
Ambulance
Social Care
Referrals
Emerging needs
Creating a common and open set of APIs to support information sharing across health and care
Defining the key clinical information sharing needs.
Prioritising the key APIs.
Group members e.g. CCIOs, CIOs, Vanguard, Pioneers, PMCFs, NHS England.
Outlining the accreditation approach for APIs.
Group members e.g. TechUK, CIOs, suppliers, HSCIC.
Defining the key underpinning components and policies, e.g. security and authentication.
Group members e.g. HSCIC, suppliers, CIOs, TechUK, NHS England.
Establishing and creating the required APIs based on clinical information sharing needs.
Group members e.g. suppliers, innovators, CCIOs, CIOs, NHS England, HSCIC.
Made up of the above organisations, the Project Boardis responsible for the assurance and governance process.
Links to existing communities and
signposts tools and products.
Informatics and Interoperability Supports Better Care Together
Update from the IM&T workstream for Morecambe Bay Vanguard
Morecambe Bay365,000 people1000 square miles
Supporting the service redesign work performed by the clinical workstreams
• Planned Care – working speciality by speciality • Ophthalmology
• MSK
• Rheumatology
• Respiratory (etc.)
• Out of Hospital – Cumbria – Integrated Care Communities
• Out of Hospital – Lancashire - Integrated Care Communities
• Women’s and Children’s – Apps
• In Hospital
LPRES
QlikView
Integrated Analysis – Proof of Concept
Advice and Guidance/Shared records
Real reductions in referrals• up to 60% in some cases• Direct access for imaging
Operational level • Escalation and monitoring• Tariff agreements• Integration with EPRs
What is the National Replicability Value Perspective
• Telehealth –the technology is standard but we have also developed standard operating procedures and change management checklists for other organisations to follow.
• Shared Records –with LPRES and hospital access to SCR and MIG data form GPs we are opening up new ways of working. This is underpinned with the Information Sharing Gateway portal which is also used widely outside of the Bay
• Advice and guidance – as well as the technology we can provide a contracting model, a change process and guidelines on how it could be implemented
• Dashboards and Data Warehouse – this work is probably being repeated around the country but we can contribute by developing expertise in the handling of the disparate data sets in realtime/neartime
• Community engagement – working with Millom to develop plans for the collaboration between organisations and the community
Reflections/lessons learnt to date
• The Technology is the ‘easy bit’• The technology exists and works ‘out of the box’
• Should we be?• Clinically led and react/second guess emerging requirements; or • Technology led and lead clinical and management thinking?
• There are many challenges in getting this technology implemented as follows:• Knowing what is possible • Sharing the vision between clinicians and managers and informatics people• Not knowing exactly what is required and what will work – Think Big, Test Small, Scale Fast • Dealing with multiple stakeholders and their agendas/IT plans whilst trying to work as a team • Working against the “perverse incentives” such as being measured and funded on the basis of
activity you are actually trying to reduce.
Service Objectives 2016/17
• Close 2 inpatient wards (90 day process) • Reduce consultant outpatient clinics by 25 clinics per week • Save circa £5m in year - RoI on value proposition funding• No impact on
• Trajectories • Quality of care
• Challenge on funding for IM&T investment.
Connected Nottinghamshire Programme established 2013
5 Vanguard Programmes (PACS, MCP, Care Homes, U&EC and Acute Shared*)
3 Wave 1 Prime Ministers GP Access Projects2 Better Care Fund Pioneers
1 Care Act TrailblazerPopulation circa 1.2 million
Andy Evans, Programme Director
“Integrate /join up care using technology as an enabler”The technology requirements are all the same
• Risk Stratification– We use a local tool and the Devon Algorithm
• Information sharing– IG sorted for direct care– >80% of GP records available across health system– Good Community Services sharing– Mixed Secondary Care sharing– Limited Mental Health sharing– Some Social Care
• Electronic Workflow (tasks/actions/referral/notifications)– eReferrals– TPPs1 Tasks– This is the hardest one
Workflow
Information Sharing
What are we really trying to do?
• The technical projects are easier than building the relationships
• If you don’t have good relationships you wont get where you need to
• Pretty much all new models of care need the same capabilities
• Its worth the time for the elicitation requirements work early – because it will make life easier later and it will help the business understand their issues
• Do not underestimate;– The complexity of Data Quality and Records Management issues, these will both
create friction
– The time it takes to agree an IG framework for sharing
Lessons to share/we have learnt from others?
Mark Futerman & Stephen Latimer, ICT Development and Support
Local Vision – An overview of the journey and learning to date
Up and running• NHS Adapter: Ability to receive discharge notifications from hospitals and GP
referrals directly into Liquidlogic’s LAS using TDK Messaging.
Soon to be Completed• Access to the PDS spine from LAS (our social care system)
Current• The IDCR/IPHR: The Integrated Digital Care Record (for professionals) and
Integrated Personal Health Record (for residents).
Selected Health and Social Care Integration Projects
• Allows us to receive notices of Admission, Discharge and Discharge Cancellation from a partner hospital (the Whittington, Royal Free goes live soon) via Quicksilva’s adapter service.
• A template is completed by ward staff within the hospital’s PAS system and sent via nhs.net to an email address hosted by Quicksilva.
• The adapter converts it into XML and sends onto our LAS via GCSx.
• This appears as a task in LAS and is automatically placed into the group worktray of the appropriate team (e.g. GP referrals are received by the Access team).
• We are a pioneer authority. HSCIC have confirmed that it is likely that this will be taken up nationally.
NHS Adapter
• Enables nominated LAS users to verify LAS demographic data against data held about people on the NHS Spine.
• The PDS does not hold any clinical or sensitive data items such as ethnicity or religion. The PDS is a component part of the Spine.
• The Spine is the name given to the national databases of key information about service users’ health and care.
• Users need smart keyboards and a Smart card; and to be registered with the NHS registration authority at the Whittington.
PDS (Personal Demographics Service)
• The IDCR will allow health and social care professionals in Islington to view records containing collected data from multiple data sources for individuals they help.
• The IPHR will allow individuals within the borough to view their own records and will include some elements which they will be able to modify.
• Phase 1 go-live date provisionally set for September 2016.
• Phase 1 partners include the Whittington, the Out of Hours Service, Camden and Islington Mental Health Trust, University College Hospital and the London Borough of Islington (Adults and Childrens services).
• The consent model likely to be adopted will be explicit.
The IDCR and the IPHR
Portal Services
Electronic Master Patient Index
Integration EngineBT Developed Adaptors to Clinical and Social Care Systems
Clinician
Context
Management
Patient
Summary
Charts Detailed
Care
Record
Secure
Messaging
Clinical
Document
Editor
Appointments Secure
Messaging
Charts Health
Links
Clinical Provider Portal Patient Portal
UCLH
Interface
Whittington
Health Interface
EMIS Web
GP
C&IFT
Interface
OOH/ Adastra
BT Data
Centre
Health
Platform
Audit Logs
Analytics and
Reporting Products
Clinical Data
Repository
Social Care Worker Patient / Carer
Social
Services
Spine Smartcards / Soft-Token Two Factor
Authentication
N3 and internet
Royal Free
Interface
Homerton
Interface
London
Ambulance
EOL/ CareUK NMUH
Interface
Moorfields
Interface
CNWLFT
Interface
IDCR/IPHR Logical Architecture Overview
Possible View of IPHR
Charles Gutteridge
Creating value: The Tower Hamlets Vanguard
What is an MCP – Key Characteristics
3 Core Elements for Transformation
• A people health data movement
• Empowering clinicians with point of care information and outcomes data
• Developing data for population health
Ris
k s
tratif
icat
ion
Co-
ordi
nate
d ca
re
Reduce emergencyattendances
Reduce emergencyadmissions
Improve outcomes
QAdmission® algorithm
(Consent)
(Enrol)High
Moderate
Low
Very low
Very high
East London Integrated Care Programme
Background
• Provision of careMultiple teams across local health economy
• Current metricsSUS data - not actionable in real time
• SuggestionFocussed datasets using live information, used by teams
Patient at home
Social Care
Mental Health
Primary Care
Barts Health Community Teams
Condition specific
ArCaRe (COPD)Heart FailureDiabetesPalliative CareLearning disabilities
Integrated CareTH: Care navigators
WF: IC Co-ordinators
NH: Rapid Response
DIS
CH
AR
GED
Inpatient Teams involved with discharge planning
DIS
CH
AR
GED
DIS
CH
AR
GED
D
ISC
HA
RG
ED
EmergencyDepartment
DIS
CH
AR
GED
NHS numbers of patients enrolled on IC(List supplied by CSU)
NHS numbers of subgroup: co-morbidity = x(Based on Read code for ‘x’ in GP record)
Interrogate Barts Health datawarehouse(ED attendance, IP admissions)
Deriving Actionable Datasets Using Existing Metrics
Focussed, actionable data used by clinical teams
Output: e.g. Patients with COPD
Clinical Analytics Service
• Training and learning– Data science seminars– Mentoring and 1:1
• Desktop data extraction
• Advisory service– SNOMED expertise– Data visualisation
• Data linkage