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Andrew fenton ehi 31.10 Population Health Management & Target Architecture

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Bringing Population Analytics and
Integrated Care Records together –
or ‘building up PHM capability towards a
target archi...

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Open
Platforms
An STP
example
Taking a
Target
Architecture
approach
The
technology
dependencies
for PHM
PHM in the
context...

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Triple Aim
3
Health & care has to improve & introduce new
models of care to pursue the Triple Aim - with
little extra mone...

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Andrew fenton ehi 31.10 Population Health Management & Target Architecture

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Taking a system-wide approach to developing Population Health Management, building a target architecture for Accountable Care systems

Taking a system-wide approach to developing Population Health Management, building a target architecture for Accountable Care systems

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Andrew fenton ehi 31.10 Population Health Management & Target Architecture

  1. 1. Bringing Population Analytics and Integrated Care Records together – or ‘building up PHM capability towards a target architecture’ Andrew Fenton @fentonaw
  2. 2. Open Platforms An STP example Taking a Target Architecture approach The technology dependencies for PHM PHM in the context of ‘Population Health’ and Public Health Triple Aim, Accountable Care, Pop Health Management 2
  3. 3. Triple Aim 3 Health & care has to improve & introduce new models of care to pursue the Triple Aim - with little extra money & a patchwork of existing models & supporting technology. The 5YFV puts emphasis on transforming care through integrated systems of care focused on outcomes based pathways & coordinated delivery.
  4. 4. Accountable Care & PHM 4
  5. 5. 5 STPs • Sustainability & Transformation Partnership - Established to enable health and care systems to work together ACS • Accountable Care Systems - Accountability for working within a defined set of resources to provide the best possible quality of care and specified outcomes for a defined population. ACO • Accountable Care Organisations - A progression from an ACS, where a specific organisation takes on accountability through longer term contracts for achieving the specified outcomes PHM • Population Health Management – What the ACS or ACO will seek to deliver. PHM defines a group of individuals (the population), and focusses on maintaining or improving their overall health, and managing their total cost of care, thereby minimizing financial risk and increasing sustainability.
  6. 6. Accountable Care System – the thing Population Health Management – the action PHM is what ACSs (should) do 6
  7. 7. Population Health Management 7
  8. 8. Public Health, Population Health, PHM • “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” • Protection, Prevention, Promotion Public Health • "the health outcomes of a group of individuals, including the distribution of such outcomes within the group“ • Focus is on primary and secondary prevention and reducing health inequalities Population Health • “the technical field of endeavour which utilizes a variety of individual, organizational and cultural interventions to help improve the morbidity patterns (i.e., the illness and injury burden) and the health care use behaviour of defined populations". • Focus is on clinical cohort management, quality and cost outcomes. Population Health Management 8
  9. 9. 9 Public Health Population Health PHM STPs / ACSs have to consider the technology enablers across this whole space
  10. 10. Many elements of PHM already visible – but not yet high impact Right Care – unwarranted variation at system level Programme Budgeting Better Value in Healthcare GIRFT – Getting it Right First Time (acute focus) Risk stratification & predictive modeling Case management Clinical decision support tools 10
  11. 11. PHM technology dependencies “PHM cannot be undertaken without a solid, integrated and robust technology platform. This platform needs to address interoperability, messaging, cross-continuum care management, protocols and transitions, data analytics for operations and quality, financial and risk-sharing systems that support the new payment model and incentives.” 11 http://www.himss.org/new-world-population-health-how-get-good-and-then-beyond-great Population health data, intelligence and analytics • Insight driven system strategy • Information governance • Acquiring data • Data quality • Data aggregation • Advanced benchmarking • Risk stratification of population • Cohort identification • Costed care analysis • Predictive analysis Information Technology Digitisation & Infrastructure • Technology roadmap / architecture • Interoperability / shared records • IT infrastructure • Cyber security • Remote and assistive technology • Primary care IT strategy • Knowledge management • Infrastructure support
  12. 12. Current / historic models of data use; largely separate between analytics & clinical applications (and research) Analytics Data warehousing Retrospective data-sets (eg SUS and SLAM). Risk stratification using monthly or quarterly data updates. BI interface distinct from clinical interface. Main uses: strategic & op’l planning, performance, contract man’mt, case- finding. Clinical Software Electronic patient record; diagnosis, treatment, referral.. Disease management / QOF Some risk scoring (eg TPP Qrisk) Some built-in clinical decision support. Organisational Web-based BI & RS tools Batched Data flows 12
  13. 13. Taking a Target Architecture approach 13
  14. 14. what do we mean by a Target Architecture In the context of emerging Accountable Care Systems (adopting methods of Population Health Management) a ‘target architecture’ refers to the conscious development of digital capability across a geographical footprint that creates a coherent landscape of technology components, data flows and interfaces that directly support and enable the goals of the ACS. A target architecture - •Is system-wide across an area, encompassing the full scope of providers and stakeholders within a health and care system (eg including social care, care homes as well as NHS providers and independent contractors). •Provides a platform that supports multiple purposes, reducing duplication and silo’d processes and data infrastructure such as data extraction, data linkage / IG processes and multiple service contracts across sub- geographies for the same purpose. •Can evolve and develop as components are commissioned / enhanced / decommissioned, and enables flexibility in terms of open APIs and connectivity into new system capability. •Is not arrived at by accident, eg through the outcome of a procurement where the resultant impact on architecture patterns has not been a consideration. 14
  15. 15. A STP example: Bedfordshire, Luton and Milton Keynes To develop a Target Architecture to make maximum use of health and care information which is at presently stored in discreet silos. This will include the design blueprints and principles that will allow BLMK to assemble, or acquire a product, or products, or service which will support the use of BLMK Health and Care Information for the following purposes: Information to be acquired from provider systems and shared across the STP in a Shared Health and Care Record in support of Direct Care, including effective shared care planning. Information to be acquired from provider systems and shared across the STP in support of Direct Care, via identifying individuals within the population at greater risk, to design personalised interventions. Information to be acquired from provider systems and shared across the STP in a Shared Health and Care Record in support of Self-care and patient activation via a citizen facing view of this record. Information to be acquired from provider systems, effectively psuedonymised in near real-time, to support the tactical commissioning, service management, and economic functioningof the Health and Care system; supporting the integration of providers into a more response effective system. 15
  16. 16. Options to explore across a system of care Best of breed in a multi-vendor environment, with API connectivity between key applications (eg risk modeling into clinical applications). Mega-suite vendor provision, building up and out from a GDE programme. Dual model – Integrated Digital Care Record (providing shared care record linked to EPRs) + a Population Analytics service. Developing an Open Platform architecture to underpin provision of multiple requirements. 16
  17. 17. Features & benefits of an Open Architecture platform Features • Structured and unstructured data stored in an adaptable, vendor/ technology- neutral Clinical Data Repository (CDR). • Applies common clinical information models. • Open interface standards • Enterprise Service Bus linking the components together. • Platform services eg Terminology, Consent, Identity management. • Application adaptability Benefits • Avoids vendor lock-in of access / utilisation of health and care data. • Enables multiple third party applications to be run, giving long term adaptability and scaleability – supports a ‘best-of- breed’ approach to application choice. • Federatable, ie can link with similarly configured open platforms (if information models are consistent) • Can evolve and adapt over time, not linked to contract cycles. 17
  18. 18. Example open architecture platform 18 Source: woodcote-consulting.com (modified) Source systems ICDR PHR PA ILS • CC – ‘Control Centre’, real-time capacity and demand. • ICDR – Integrated Digital Care Record • PHR – Personalised Health Record • PA – Population Analytics • ILS – Integrated Lifestyle digital Services CC
  19. 19. Open platform deployments (egs) 19 Leeds residents will soon be able to better manage their health online following the development of an open platform-based Person Held Record. The £1.8 million Leeds PHR programme will kick off next year, developed in 12-month blocks, as part of an initial three-year pilot led by Leeds City Council in partnership with NHS organisations across the city. The technology will be built on an open-source platform for the health and care sector, developed in Leeds by the Ripple Foundation. It is hoped to build up to 1400 users during the three-year project. 17 NHS trusts to use OpenEHR for 100,000 Genomes Project A growing group of leading NHS trusts in and around London have begun making use of OpenEHR to capture and manage genomics data as part of the high-profile 100,000 Genomes Project. International: • Moscow • Norway • Sweden • Australia http://www.openehr.org/who_is_using_openehr /healthcare_providers_and_authorities
  20. 20. Back to ‘bringing population analytics and integrated care records together’ Historically there have been separate programmes for Shared Care Records, population analytics (or ‘whole system intelligence’), Personalised Health Records, Healthy Lifestyle digital services etc. Even in areas of stronger digital maturity, this model maintains duplication, silo’d systems and processes, conflicting data sources and sub-optimal support for PHM. Better direct interoperability between systems through FHIR interfaces will improve many work- flows and enable particular use- cases, but won’t be sufficient to support full scope of PHM requirements, eg care-coordination, personalised health records. A target architecture approach is needed, designed and developed to build and evolve from existing local landscapes and potentially towards an Open Platform architecture. 20
  21. 21. • “The accelerating expansion of the universe is the observation that the universe appears to be expanding at an increasing rate, so that the velocity at which a distant galaxy is receding from the observer is continuously increasing with time.” • This is also the natural tendency of digital ecosystems across the UK – without conscious attention at system-wide level, organisationally driven developments are likely to lead to more divergence not convergence. 21

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