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Inderjit Singh - ECO 15: Digital connectivity in healthcare


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Presentation by Inderjit Singh, Head of Architecture and Cyber Security, NHS England at ECO 15, Haydock Park Racecourse

Published in: Health & Medicine
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Inderjit Singh - ECO 15: Digital connectivity in healthcare

  1. 1. LOCAL HEALTH AND CARE RECORDS Indi Singh – Head of Architecture and Cyber Security, NHS England 1 Feb ‘18
  2. 2. 2 What are Local Health and Care Records? • They are not new • There are currently over 60 instances in operation today • Formed by local organisations working together to establish local longitudinal records • However they vary in terms of the scope of data, and the range of their uses
  3. 3. What three sets of information do you access most in eLPR? (tick up to 3) GPs Barts Health, Homerton, ELFT Consolidated Lab results 19% 8% 13% Patient history 1% 15% 5% Radiology images, X-rays, scans 19% 4% 14% Histopathology results 3% 2% 3% Outpatient Clinic Letters 13% 13% 15% Previous attendances 7% 4% 5% Upcoming Appointments 18% 2% 11% Discharge summary 10% 12% 12% Patient medication information 2% 20% 11% Complications / known allergies 1% 7% 2% Chronic conditions 2% 11% 6% Clinical procedures 5% 2% 3% 3 Uses of local shared care record - East London
  4. 4. Why is this needed? 4 • Fragmented sharing of information • Organic development of local shared care records (circa 60 initiatives) and benefits • 9% reduction in decision to admit to hospital (Hampshire), 50% increase in same day, 24/48 hour discharges (Cheshire). • Localities to access to data for their local health and care system to inform local planning decisions • Data used for operational management often not based directly on care record, and with time-lag
  5. 5. Informed by Citizen Juries, successful information sharing initiatives are based on the following: • Public and Professional Trust • Majority of patient flows • Transparency – being clear on the purpose and use upfront and ongoing • Local leadership and delivery • Ability for data to be shared so pertinent to that local population e.g. wider determinants of health • Agility in being able to introduce new services and understand the impact • Sustainability in investment • Circa 2-5m size populations Basis of Approach 5
  6. 6. 6 A Local Government Perspective • In 2016 the LGA and partners set out its ambition for closer integration across health and care. • In practice this is about services that are delivered to get the right outcomes for citizens of all ages and communities with an emphasis on improving citizen’s wellbeing. • One of the ten enablers for successful integration we identified was the need for common information and technology – at an individual and population level – shared both between relevant agencies and individuals.
  7. 7. The journey has started 7 But only in pockets, not coherent or consistent or scaled
  8. 8. 8 Aims of the Local Health and Care Record programme • Build on local pull and learning from academic research and citizen’s juries • Focus on improving delivery of integrated care • Many local examples across the country from Hampshire to Northumberland via Bristol, Manchester and Leeds • A locally-led ‘exemplar' approach • This is not a national top-down programme • Striking a balance between national leadership and co-ordination and local ownership • “Raising the bar” in terms of ambition
  9. 9. Where looking to get to? 9 • Comprehensive normalised longitudinal care record across venues of care – acute, social care, primary care, community. • As a professional – enabling me to have access to the pertinent information when needed – test results, future appointments, reports, history • As a patient – ability for patient facing services to access and use comprehensive care record view • Ability to use data from the care record (in de-personalised form) to support local planning • e.g. targeted interventions for different cohorts such as frailty,, diabetes local service planning. • Coherence and consistency - these longitudinal records being interoperable through use of common standards, common information governance framework, common capabilities
  10. 10. Our ambitions for localities • Authorised health and care professionals involved in a person’s care have access in real- time to a comprehensive care record comprising the pertinent individual level information they need to inform their care decisions, when and where they need it; • Combining and analysing the underlying data in the record enables more precise interventions and supporting the development of population health management; • Empowering citizens and carers to manage their own care by giving them access to their own healthcare records, and • Working alongside research and academic institutions in providing a rich information base of de-personalised and anonymous information to support research into conditions and the development of new treatments and pathways for care. Draft 2
  11. 11. Data Services Platform (DSP) Local Health and Care Record Exemplars Provider infrastructure – Point of Care systems Local Health and Care Record Exemplars Local Health and Care Record Exemplars Local Health and Care Record Exemplars Modular data (national flows) Modular data (national flows) Open APIs Open APIsOpen APIs Open APIs Extraction Extraction National Commissioning Data Repository (NCDR) Digital Interoperability Platform (DIP) 11 “Big Picture Summary”
  12. 12. 12 Information Architecture – types of data and controls
  13. 13. So what are we doing? - Smarter, Standardised, Scaled 13 • Selecting 5 mature* exemplar communities to create normalised longitudinal care records at scaled and sustainable level. circa 2-5m level populations • Maturity – public, professional engagement, local transformation plan alignment • Co-design with them and blueprint and template what works • Common design authority, IG network, professional reference group • Set of upfront expectations of them being “exemplars” • Baking in published interoperability specs e.g. Care Connect specs - meds, obvs, • Use of National Record Locator so can link across exemplars • Adhere to the IG framework on the controls that are needed to be in place across all uses of data. Define and implement the cyber standards for shared care records. • Use the common “black-box” de-identification component delivered by DSP for use of data for subsequent purposes. This ensures consistency in approach and removes duplication of investment • Use the common data architecture assets e.g. data dictionary, meta-data so there is consistency whether these are local or national flows
  14. 14. Individual Care Use Secondary Use LHCRPlatform NationalInfrastructure De-Id/Re-Id Key Management Master Patient Index Reference Data National Data Landing Data Quality Local Data Landing Local Event Management Metadata Catalogue National Standards Open APIs Terminology and Code Sets IG and ISAs Data Integration Caseload Management Shared Care Record Local Data Flows De-ID/Re-ID Implementation Population Health BI Commissioning Intelligence Data Linkage Normalisation – local and national Analytical Capability Data Marts and Data Quality National Products Audit Business Uses Operational Dashboards Pathway Management Patient Activation Decision Support Analytics DSP Data Marts Analytical Services Population Health Management Dashboard Analytical Data Catalogue NCDR Event Management National Record Locator Federation Broker Authorisation and Authentication DIP Risk Stratification 14 Reference Architecture
  15. 15. Infrastructure Information Exchange and Local Care Record ICT infrastructure support and strategic ICT services, including Primary Care IT support Data Management and Information Governance support Population Health Analytics and Digital support Insight Impact and Intervention Informatics, analytics and digital tools to support system planning, assurance and evaluation • Actuarial analysis and intervention modelling • Supporting system financial management, quality and clinical outcome measurement • Planning and evaluation, needs assessment, opportunity analysis Informatics, analytics and digital tools to support care coordination and management, risk and impactability models • Risk stratification and impactability modelling for early intervention and preventive care • Supporting systems for the development of individual care coordination and management • Services to support clinicians to make faster and better interventions at the point of care with a patient Transformation and change support • Pathway optimisation and care model design • Specialist advice on organisational design, governance and payment and contract reform • Workforce and leadership development support Patient empowerment and activation • Support for implementing shared decision-making • Support for implementing Self-care programmes (including social prescribing and innovative digital and remote technologies) • Support for implementing Personal Health Budgets and Integrated Personalised Commissioning Primary Care transformation and support for GP Forward View • Change management support • Support for improving access and managing demand System Optimisation Demand management and capacity planning support • Services to support smooth transition of care into, out of and between organisations • Command centres Medicines optimisation support System assurance support • Provider relationship management and supply chain support • Continuous improvement and performance incentives • Financial and quality measurement and assurance 12 1110 9 87 6 5 4 3 Digitising care & operational services, including EPR (access for GDE fast followers) Advisory and implementation support Vendor systems and Hardware Strategy / implementation support Infrastructure 1A 1B 2A 2B 15 Commercial Framework