Patient Online Programme
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A presentation by Alan McDermott, Regional Director for Patients and Information at NHS England.
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Patient Online Programme
- 1. www.ehilive.co.uk | 3-4 November 2015 | #ehilive PATIENT ONLINE PROGRAM ME Alan McDermott Regional Director Patients and Information NHS England
- 2. 1. Ambition for Patient Online 2. 2014/15 Commitments and achievements 3. 2015/16 GMS contract commitments and guidance 4. Clinical systems update 5. Progress to date 6. Benefits and evidence of success 7. Ambition beyond 2016/17 www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 3. www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 4. www.ehilive.co.uk | 3-4 November 2015 | #ehilive Patients and Public Will be able to: a) more effectively share in the responsibility for their health and welfare b) have more convenient access to NHS Services Clinicians/Practices Will be able to devote more of their time to supporting the clinical needs of patients rather than dealing with administrative and support tasks that patients can carry out for themselves NHS Will benefit from improved health outcomes for patients, increased patient satisfaction and reduced administrative costs
- 5. www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 6. 2014/15 Business Plan Commitment: Patients are able to order repeat prescriptions online, book appointments online and have online access to the summary information in their GP records in 95% of GP practices from March 2015. Progress towards meeting the 2014/15 Commitment: www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 7. www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 8. www.ehilive.co.uk | 3-4 November 2015 | #ehilive ā(2A) A contractor must promote and offer to its registered patients, in circumstances where the medical records of its registered patients are held on the contractorās computerised clinical systems, the facility for any such patient to access online all information from the patientās medical record which is held in coded form unless ā (a) in the reasonable opinion of the contractor, access to such information would not be in the patientās best interests because it is likely to cause serious harm to ā (i) the patientās physical or mental health, or (ii) the physical or mental health of any other person; (b) the information includes a reference to any third party who has not consented to its disclosure; or (c) the information in the patientās medical record contains a free text entry and it is not possible under the contractorās computerised clinical systems to separate that free text entry from other information in that medical record which is held in coded form.ā;
- 9. 2015/2016 Requirements Building on the contractual requirements from 2014/2015, the following are now new contractual requirements for 2015/2016: Patient access to their GP record ā¢ From 1 April 2015, it is a contractual requirement49 to offer online access to all detailed information, i.e. information that is held in a coded form within the patientās electronic medical record. There is no contractual requirement to provide online access to any free text that may be included within the patient record. Where free text is currently embedded within coded information, technical amendments will be made to GP software, through the GPSoC contract, to allow coded information to be separated from free text to allow GPs to withhold free text whilst still meeting the contractual obligation to provide coded information. This means coded information in a recognised NHS-supported coding scheme such as Read Codes, CTV3, SNOMED and supplier coding systems. GP software will be configured to offer all coded data by default but GPs will have the option and configuration tools to withhold coded information where they judge it to be in the patientās interests or where there is reference to a third party. There are circumstances where a GP may believe that is not in the best interest of the patient to share all the information in the record. In particular there may be circumstances where it is likely to cause serious harm to the physical or mental health, or condition, of the patient or any other person, in which case a GP should withhold that information. There may also be circumstances where information relates to, or is provided by, a third person who can be identified from the information and has not consented to the disclosure. The GP should consider whether it is reasonable to disclose the Information without that third partyās consent. Further guidance is available from the Department of Health50. Practices may make available any other items of information agreed between the patient and practice. These changes are agreed with the understanding that the GP Systems of Choice (GPSoC) programme will be the process by which the nationally approved and funded systems necessary to satisfy these requirements will be made available to practices by NHS England. All contractors are expected to have access to this necessary system during 2015/16 to enable implementation by 31 March 2016 ā where such systems are not currently available during 2015/16 contractors are required to publish a plan by 30 September 2015 on how they intend to achieve the requirement by the end of the financial year. In any event, practices are required to provide summary information, as a minimum, in line with the 2014/2015 contractual requirements, where the nationally approved and funded systems have been provided by NHS England. Further guidance is available from the Royal College of General Practitioners (RCGP)51 and NHS Engalnd.52 49 In meeting this new requirements colleagues are reminded of key relevant legislation, the Data Protections Act, s. 7-s. 10, and the Data Protection (Subject Access Modifcation) (Health) Order 2000 ā see http://www.legislation.gov.uk/uksi/200/413/made www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 10. www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 11. www.ehilive.co.uk | 3-4 November 2015 | #ehilive EMIS ā¢ Detailed coded record functionality available in current release ā version 5.5, available to all practices since end of August 2015 ā¢ Currently being assessed by HSCIC ā¢ Future releases ā enhancements to patient facing services TPP ā¢ Detailed coded record functionality available in release due to be switched on for practices November 2015 ā¢ Currently being assessed by HSCIC INPS ā¢ Detailed coded record functionality planned for early 2016 Microtest ā¢ Detailed coded record functionality planned for early 2016
- 12. www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 13. ā¢ Each appointment booked online could reduce costs for practices by Ā£0.29* ā¢ 33m appointments available per month ā¢ ~1m appointments booked online ā equivalent to Ā£290,000 saving ā¢ 8.5m patients are enabled for online booking services ā¢ Substantial opportunity for further savings by practices actively offering and promoting the online service *HSCIC research What is being done: ā¢ Rapid development of evidence base and best practice from high performing practices ā¢ Develop model for practices showing how efficiencies can be obtained and how to promote with patients ā¢ Develop collateral for use by practices ā advice about websites, promotion to patients, staff training, etc. Number of Appointments Available Mar-Aug 2015 312.2 73.8 18.9 1.3 1932 1932 1932 1932 1ST QUARTILE 2ND QUARTILE 3RD QUARTILE 4TH QUARTILE Average No. Appointments Booked online per practice April-August 2015 Wide variation in practices using online appointment booking (1,146 practices have no online bookings) 25 14 30 31 32 34 3 2 4 4 4 4 5 10 15 20 25 30 35 40 Millions All Appointments Available Appointments Available Online
- 14. What is being done: ā¢ Rapid development of evidence base and best practice from high performing practices ā¢ Develop model for practices showing how efficiencies can be obtained and how to promote with patients ā including link to EPS ā¢ Develop collateral for use by practices ā advice about websites, promotion to patients, staff training, etc. Wide variation in practices using online prescription ordering (960 practices have no prescriptions ordered online) 459 131.8 30.6 1.7 1932 1932 1932 1932 1ST QUARTILE 2ND QUARTILE 3RD QUARTILE 4TH QUARTILE Average No. Prescriptions ordered online per practice April-August 2015 ā¢ Each prescription ordered online could reduce costs for practices by Ā£0.50* ā¢ 35m repeat prescriptions fulfilled per month ā¢ ~1.2 m prescriptions ordered onlineā equivalent to Ā£600,000 saving ā¢ 8.3m patients are enabled for online prescription booking ā¢ Substantial opportunity for further savings by practices actively offering and promoting the online service *HSCIC research
- 16. www.ehilive.co.uk | 3-4 November 2015 | #ehilive Record views by category Category Patients Registered Times Viewed % Total Views Medical Record 79,453 274,022 45% Summary 2,567,109 231,091 38% Test Results 325,535 59,323 10% Letters 83,512 50,135 8% Total 3,055,609 614,571 100% 286.7 25.2 3.3 0.0 1950 1950 1950 1950 1st quartile 2nd quartile 3rd quartile 4th quartile Average no. online record views per practice Q4 2014/15 ā¢ Practices need to meet their GMS contract requirements for 2015/16 ā¢ Foundation for patients taking more responsibility for their health and care
- 17. www.ehilive.co.uk | 3-4 November 2015 | #ehilive 325,535 354,642373,958 408,964 446,788 403,925 - 100,000 200,000 300,000 400,000 500,000 600,000 700,000 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Actual Linear (Actual)
- 18. www.ehilive.co.uk | 3-4 November 2015 | #ehilive 87,713 93,922 103,798 111,875 143,480 - 50,000 100,000 150,000 200,000 250,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Actual Linear (Actual)
- 19. www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 20. www.ehilive.co.uk | 3-4 November 2015 | #ehilive Improve safety Look up medical jargon Improve health control Improve knowledge and health literacy Improve access and convenience Reduce errors and duplications Less pressure on staff Increase use of SMS Save phone calls Increase patient satisfaction Improve communication with patients Administrative time saving Source: http://goo.gl/49oD49 Saving time and resources
- 21. www.ehilive.co.uk | 3-4 November 2015 | #ehilive Offer high percentage of appointments online Clear campaign Staff training Encourage patients during consultation Offer to new patients Limit taking prescriptions over the phone
- 22. www.ehilive.co.uk | 3-4 November 2015 | #ehilive āBig thing for us is that it is a whole team effort - if you don't do it as a team it becomes responsibility of receptionistā āThere's nothing to be afraid of. The whole set up process is simple. Just do it!ā āStart really promoting early - the sooner you do it the better it isā āGet the PPG on sideā āWe've seen phone calls reduce significantlyā
- 23. www.ehilive.co.uk | 3-4 November 2015 | #ehilive Gradually open up detailed record access Clear campaign Strong leadership Staff champion Patient champion Offer basic access automatically Clear process and procedures
- 24. www.ehilive.co.uk | 3-4 November 2015 | #ehilive āIt takes around 10 minutes to look through a request online ā on paper it is very time consumingā āDecide what your protocol is, keep it simpleā āMakes for richer consultation and discussionā āTook a planned approached to online services ā done in manageable chunksā āIf this wasnāt switched on we couldnāt manage and would need at least another member of staff!ā āOffering records access is more time consuming but only initiallyā
- 25. www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 26. www.ehilive.co.uk | 3-4 November 2015 | #ehilive 2015/16 ā¢ Patients have access to the detailed coded information in their GP records 2016/17 ā¢ Greater range of apps available to patients 2018 ā¢ Patients have access to the detailed information in all their health records (primary care, secondary, community, mental) ā¢ Patients can write into their records ā¢ 15% of patients using smartphones for access to NHS Online services 2020 ā¢ Patients have access to the information in their health and social care records ā¢ NHS will be operating āpaper free at the point of careā
- 27. www.ehilive.co.uk | 3-4 November 2015 | #ehilive
- 28. 33 www.ehilive.co.uk | 3-4 November 2015 | #ehilive
Editor's Notes
- ***Please donāt change the layout and format of this slide ā developed by AM to describe detail. Note ā known issue with April data which affects the figures. Average No. of Appointments online per practice April-August 2015 This graph is based on POMI data from April to August (DRAFT_POL_Monthly_TrendAnalysis_August_2015). The ranking is calculated using the average number of appointments booked online from April to August. The practice with the most appointments booked online on average was ranked 1 and so on.
- ***Please donāt change the layout and format of this slide ā developed by AM to describe detail. Scale of opportunity 1st bullet point has just been left wasnāt sure if needed to be updated 2nd bullet point was taken from HSCIC portal PHF10 for Q1 to Q4 2014/2015 3rd - bullet point is taken from high level stats - month on month from POMI data (0.Chart in Microsoft PowerPoint 26Oct at 31Aug15) 4th & 5th bullet points from high level stats from POMI data (0.Chart in Microsoft PowerPoint 26Oct at 31Aug15)
- This information and figures are as at 31 March 2015. More up to date info is not available.
- We are looking into the reasons why there was a drop in August. One of the possible causes are changes in system configuration. This should be resolved when new releases for detailed coded records access are implemented.
- Patients Improve safety: Look at your test results and doctorsā comments. Patients will soon be able to see doctorsā comments on the results. Through their comments on the results, clinicians can reassure patients about minor abnormalities of no clinical importance. They can remind people of when they need to be reviewed. This is key way of improving safety and an efficient use of resources. Look up medical jargon: Share your record with family, particularly if you canāt read English, or look at the information buttons, if your record access system has them. They will give you more information about complicated terms and test results so that you can understand more about what you read. Improve health control: patients seeing their test results, their letters and the free text of their consultations enables them to make more decisions for themselves, moving demand away from the practice. Improve knowledge & health literacy: Supports self-care and shared decision-making, improves compliance with medication and increases patient confidence and understanding Improve access and convenience: e.g. LTC patients they are the most likely to gain benefit. They have repeated investigations and referrals in the NHS and social care. Without record access, they have to contact the practice for every result, for the contents of letters, to check appointments and whether letters of referral have been sent. Record access means that they can do much of this without the practice, saving calls and appointments. Reduce errors and duplications: it is a good way of vetting for inaccuracies and data cleansing (e.g. patients who look at the records and find errors, can ask for things to be re-coded) Practices Less pressure on staff Increase use of SMS Save phone calls Increase patient satisfaction Improve communication with patients Administrative time saving
- High percentage of appointments online: open a high percentage of appointments and a range of appointment types/make all appointments available via the telephone or face to face available online Encourage patients during consultation: GPs encouraging patients to opt-in for the GP online services during consultations Offer to new patients: Include as part of registration process when registering new patients i.e. issue login details at point of registration with patient having to opt out if they donāt want it Limit taking prescriptions over the phone: The removal of the facility to take prescription requests (with a few exceptions e.g. for vulnerable patients) over the telephone appears to have been a major success factor in increasing the numbers of patients ordering repeat medications online. Although this is not a mandatory requirement, and will require cultural change for both practices and patients, it is undoubtedly a safer and quicker process for both. Staff training: Be prepared and get your processes sorted out and staff trained before you do anything Clear campaign: Clear campaign to promote transactional services (e.g. facebook, twitter, TV screens at reception, T-Shirts, answering machines)
- Slowly open up detailed record access: Majority of practices have built slowly in opening the detailed record. Although there are some that have only started from end of the financial year. It isnāt the number but the clinical decision with the patient. Staff champion/patient champion: Staff champion. (A common denominator for many high performing practices) - Have a patient who champions the practice and is happy to help gain the confidence of new patients. Offer basic access automatically: The staff automatically offers the basic access and then review if full access is appropriate. Then offer directly. Clear processes and procedures: Maximise use of templates ā structured data, simple, quick and more efficient to use once set up Strong leadership: A less tangible aspect but most definitely noticeable in the discussions with the practices is the impression of strong clinical leadership and strong management to deliver online services. This has been to ensure: A better service and transparency for patients. The pursuit of identifying ways to achieve efficiency in the system and the organisation. Clear campaign: e.g. Website has a pop up for online access as soon as you go to the landing page
- Patient experience of in-hours GP services varies between different demographic groups and geographical areas. National results can mask this variance. Much of the variation can be explained by patient-level characteristics, in particular a personās age or working status. Patients who book appointments online are more likely to be female or aged 35 to 74, while patients who order repeat prescriptions online are more likely to be female or aged 55 to 74. Patients who access medical records online are likely to be male or aged 55 or over. More than half (53%) of all patients donāt know whether online services are provided by their practice and the majority of patients (86%) donāt use online services. The strongest association between awareness and use of online services relates to ordering repeat prescriptions. Patients who use online services tend to report a more positive experience of access to their surgery. However, this should be considered in context with other factors such as a patientās age, gender or work status.