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Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life


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Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016

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Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life

  1. 1. Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life WELCOME #EPaCCS
  2. 2. EPaCCS: in the national context Prof Bee Wee NCD for End of Life Care 17 March 2016
  3. 3. Wider context
  4. 4. Wider context New models of care Initiatives for improving: integration choice, personalised care and control Support for improvements: organisation level System level
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  7. 7. www.england.nhs.uk18/03/2016
  8. 8. www.england.nhs.uk18/03/2016
  9. 9. www.england.nhs.uk18/03/2016
  10. 10. www.england.nhs.uk18/03/2016
  11. 11. The scale of the challenge • Individuals to be able to view their records, and to record and edit information about what matters to them – by April 2018 • Records to be interoperable, digital and real-time – by 2020 • Professionals to view and use this as a means to improve service and experience of care • Draw information and evidence/metrics from records • Ideally align records and data collection
  12. 12. www.england.nhs.uk18/03/2016
  13. 13. North West EPaCCS Stephen Burrows North West EPaCCS Lead Greater Manchester, Lancashire and South Cumbria and Cheshire & Merseyside Strategic Clinical Networks 17th March 2016
  14. 14. Potential North West issues • Patients that cross boundaries when using EoLC services (e.g. 15% -20% of EoLC patients in one acute trust not from that locality), or move
  15. 15. Patient flow from primary to secondary care
  16. 16. Potential North West issues • Patients that cross boundaries when using EoLC services (e.g. 15% -20% of EoLC patients in one acute trust not from that locality), or move • Standardising (as much as possible) the processes and flow of information to NWAS from 33 CCGs
  17. 17. Ambulance service Tertiary services Acute trusts, hospices GPs, community
  18. 18. Potential North West issues • Patients that cross boundaries when using EoLC services (e.g. 15% -20% of EoLC patients in one acute trust not from that locality), or move • Standardising (as much as possible) the processes and flow of information to NWAS from 33 CCGs • Use of other shared resources (e.g. hospices / other organisations that cross boundaries) • Providing patient access • Reporting and monitoring of outcomes (measuring ‘like for like’)
  19. 19. • Use existing systems • Avoid / reduce duplication of existing EoLC recording • Replace / reduce other non-electronic EoLC communication • Quick and easy to use, avoiding over use of text • Ensure sustainability and make ‘future-proof’ North West requirements
  20. 20. • Identification of 20 EPaCCS ‘localities’ across the North West (from 33 CCGs), and subsequent setting up of EPaCCS Task Groups to meet regularly and represent the range of stakeholders within a locality involved in End of Life Care (EoLC). • Creation of a common dataset – the North West EPaCCS dataset – a minimum implementation of which ensures ISB 1580 compliance, but which also includes other frequently used information commonly shared by end of life care services. Accepted by all localities in 2013, and continually updated to reflect changes to the standard. The North West EPaCCS – achievements so far - 1
  21. 21. • System supplier created, nationally available, EPaCCS templates based upon the NW EPaCCS dataset available and in use in local systems – EMIS Web/LV/PCS (available since 2013), INPS Vision+ (available since 2014), TPP SystmOne (now available locally), iPM Lorenzo (Morecambe Bay), Graphnet (available since Nov 2014) etc. • Training materials for the national EPaCCS templates to support local rollout of their use, and provide resource for EoLC facilitators etc involved in supporting EPaCCS use. The North West EPaCCS – achievements so far – 2
  22. 22. • A‘Why EPaCCS?’ film to encourage and promote the use of EPaCCS by clinicians in all EoLC services. • A North West template for an EPaCCS Information Sharing Agreement (ISA), shared with all localities for their adaptation and completion. • An ISB compliant End of Life View available in the MIG (Medical Interoperability Gateway) supplied by Healthcare Gateway. This is currently the only commercial solution allowing for the streaming of information recorded on GP systems to be shared with other organisations. The North West EPaCCS – achievements so far - 3
  23. 23. • Regional support and networking provided through the creation of EPaCCS Network Implementation Groups (NIG) – for Cheshire & Merseyside, Greater Manchester, and Lancashire & Cumbria – that meet quarterly, and share best practice / developments via a Yammer network. • Targeting and support for locality EPaCCS implementation set through the Eight Key Areas document, RAGB-rated on a quarterly basis, and fed back through SCNs and AHSNs to organisations. Starting in GM, this has been developed into an AHSN supported performance dashboard to be rolled out further. The North West EPaCCS – achievements so far – 4
  24. 24. • First examples of real-time EoLC information being shared through EMIS to EMIS, and via the MIG with other services including OOH etc. happening across the region. • Continuing work with NWAS and The Christie to agree a co-ordinated means of receiving real- time EoLC information either through the MIG Shared Record Viewer or Graphnet. The North West EPaCCS – achievements so far – 5
  25. 25. • EPaCCS Supplier meetings held twice yearly to pursue regional development and initiatives in terms of interoperability. • Link into Lancashire Patient Record Exchange System (LPRES) and Datawell interoperability solutions for Lancashire & Greater Manchester. • Work ongoing to promote EPaCCS implementation through Transform agenda. The North West EPaCCS – achievements so far – 6
  26. 26. Challenges in progressing EPaCCS • Leadership • Clinical engagement • IT engagement • Finance
  27. 27. Stephen Burrows NW EPaCCS Lead
  28. 28. Kate Estcourt & Annamarie Challinor
  29. 29. GP Practices 22 Eastern Cheshire 18 South Cheshire 12 Vale Royal 2 Hospitals East Cheshire NHS Trust Mid Cheshire NHS Foundation Trust 2 Hospices East Cheshire Hospice St Luke's Hospice Cheshire
  30. 30. Where did it all start? • October 2012- bid for 50K underspend monies Specialist Palliative Care -Manchester & Cheshire Cancer Network- 2 year coordination/IT support • May 2013- Attended National EPaCCS Roadshows 1. Don’t wait around for the all singing , all dancing system that does everything you need it to do- or you will still be here in 2 years 2. Don’t underestimate the level of end of life training and communication that you will need to put into this to make it a success
  31. 31. How did this influence the approach we took in Cheshire? 1. GP System to be the driver for EPACCS • 49/52 Practices using • Community Provider use with District Nurses, Matrons 2. Clinically led throughout • GP Clinical Lead • Specialist Palliative Care Teams 3. Supported by project coordination and education • End of Life Partnership host coordinator and lead education • EPaCCS steering group with IT representation North West EPaCCS Lead
  32. 32. 1. Encourage use of the template • Current users of EMIS Web • Quality incentive /contracts for GP’s • Marketing & Resources with support North West Lead • Reinforce through local training , projects and audit • Create GSF automated Register functionality 2. Influence wider access to EMIS Web • Identify key teams involved in end of life care • Support local Hospices and help sourcing funding 3. Get EPaCCS onto wider locality ICT agendas • Integrated Care e.g. Caring Together • Pinoeer Cheshire – Cheshire Care Record • Electronic Patient Records- Hospitals 4. Obtain local evidence base to demonstrate impact • Public Health Data collection- EMIS Enterprise • Develop reporting cycles as part of GP contracts/ LES 5. Purchase software to enable interoperability Project Plan 2014-Present Day
  33. 33. EMIS Template
  34. 34. The Summary View The End of Life summary view will allow you to see an overview of all the read codes entered for End of Life , including those entered by other teams e.g. Macmillan, District Nurses, Matrons, Specialist Nurses NB: Providing your practice has agreed and activated the sharing of information with these teams
  35. 35. Benefits of using one system for EPaCCS • No double entry for clinicians‘ • Dovetailing of existing local IT strategies • Allows for a clinically led approach • Ease of locality reporting - EMIS Enterprise • Consistency of education • Consistency of communication • Negotiating power at locality level with EMIS
  36. 36. EPaCCS- Phase 3 & 4- 2016 onwards: ACUTE HOSPITAL • Mid Cheshire Trust • East Cheshire Trust URGENT CARE • Out of Hours GP’s • NWAS • NHS 111 SOCIAL CARE • Crossroads Care • Social Workers VIEW ONLY ACCESS Cheshire Care Record Cheshire Care Record Cheshire Care Record
  37. 37. South & Vale Royal Local EPaCCS related GP Quality Scheme 2014-15 Eastern Cheshire - overall 0.29% (2014 was 0.23%) South Cheshire - overall 0.46% (2014 was 0.229%) – Vale Royal - overall 0.48% (2014 was 0.353%) Impact upon Palliative Care Registers
  38. 38. Numbers of GP Practices with Dementia patients on the GSF Register 13 of 22 Eastern Cheshire Practices (59%) – (2014 was 12/22 - 54%) 15 of 18 South Cheshire Practices (83%) – (2014 was 7/18 – 39%) 9 of 12 Vale Royal Practices (75%) – (2014 was 6/12 – 50%) South CCG Non –Cancer on the GSF
  39. 39. Thank you
  40. 40. How the NHS Summary Care Record supports EPaCCS Summary Care Record - Supporting Person Centred Coordinated Care
  41. 41. @NHSSCR Current status • SCRs are an electronic record of key information from the patient’s GP practice • As a minimum contain medication, allergies and adverse reactions 96% Nationwide coverage of patients have had an SCR created (55 million) 2.5m SCR utilisation SCRs accessed last year to support urgent and emergency episodes of care
  42. 42. @NHSSCR • GP practices now have capability to enrich SCRs with a set of additional information - with patient consent • Includes individual coded items and associated free text from the GP system • Automatically kept up to date over time • Reason for medication • Significant medical history (past and present) • Anticipatory care information (such as information about the management of long term conditions) • Communication preferences (as per the SCCI-1605 national dataset) • End of life care information (as per the SCCI-1580 national dataset) • Immunisations SCRs with additional information include: SCRs with additional information Supporting person centred co-ordinated care
  43. 43. @NHSSCR Dr Mark Spring, GP Sandford Surgery, Dorset and Clinical Lead for Urgent Care Services "The enhanced functionality to create enriched SCRs is simple. I can record information once and share it easily, which is fantastic! As an Out-of-Hours GP, I know the importance of making sure essential patient information can be accessed. Creating enriched SCRs empowers other people looking after my patients to be able to access accurate and detailed information – it reassures me that my patients will receive the best possible care whenever they need it.” SCRs with additional information Supporting urgent and emergency care
  44. 44. @NHSSCR • The SCR additional information includes clinical codes from the SCCI1580 standard and other related information:  Patient’s carers and their details  Communication needs (including SCCI1605)  Disability and functional status  Social context  Advance care planning and DNACPR  Other patient preferences  Items not automatically included may be manually included • The SCR can signpost to further information held elsewhere:  Flagging the existence of an advance care plan, resuscitation status, LPA etc.  Directing the user to where this is held Supporting EPaCCS…
  45. 45. @NHSSCR Supporting EPaCCS… • SCR is being used in a wide number of care settings including emergency, palliative and end of life care • Provides a cost effective solution for health communities to accelerate local record sharing and an opportunity for settings with lower digital maturity to be included • SCR is available wherever the patient is treated across the NHS in England: • beyond the footprint of the EPaCCS system • beyond the EPaCCS core user group • where the EPaCCS system is not available • … so, SCR can supplement your existing local record sharing plans… 49
  46. 46. @NHSSCR Professor Bee Wee NHS England Director for End of Life Care * The SCR provides the end of life preferences entered in the GP practice system - complementing local Electronic Palliative Care Co-ordination systems (EPaCCS) SCRs with additional information Supporting end of life care “The Summary Care Record provides a great opportunity for everyone to have their views and preferences digitally recorded by their GP practice*, and viewed when necessary, during the final stages of their life. This can bring enormous peace of mind to these individuals and those close to them, and help professionals who are trying to deliver care in accordance with the individual’s needs and wishes.”
  47. 47. Web: Email: Twitter: @NHSSCR Sign up to the SCR bulletin: For further information on SCR content, see the SCR Inclusion Set Overview:
  48. 48. EPACCS as part of an Integrated Care Record. Mohammed Abas Martin Jones
  49. 49. EPACCS is not a Care Plan! It is essential information that:  Allows care co-ordination 24 / 7  Gives & Key information at a glance – guiding an urgent / emergency response It also: 1. Is a clinical system 2. Depends on up to date registers and information 3. Requires a critical mass of usage to work
  50. 50. The Challenge in Manchester 1. Is it easier, better, simpler, quicker than what happens now? 2. Multi agency info – what do we leave out? 3. 3 Acute Trusts, 3 Hospices, 3 CCG’s, 80 care homes 100 GP practices 1 Out of Hours, 1 Local Authority, Ambulance emergency dispatch & new 111 system.
  51. 51. The Challenge in Manchester 4. Demands & pressure of clinical work – time poor – GP - QP, QoF, LES, DES. 5. Double inputting, Double consent – Evolution - when is it slick enough to roll out! 6. Pressure to deliver 2008 Strategy - Oct 2013 Target – annual funding – Incidents – Business cases!
  52. 52. The Challenge in Manchester 7. Over 2 years a lot can change - Centralised – localised – One team , Place based care Integrated Health & Social care – GM Devolution. 8. Higher threshold for Social Care impacts on health care – What system do Health & Social Care professionals need?
  53. 53. ...and some potential show stoppers • Has every one got a NHS net account or an N3 connection? • Will it work on mobile devices that may be bought in the future? • Information sharing agreements, clinical steer / leadership? • In a commercial relationship – to develop a product.
  54. 54. PATIENT CONSENT Information access Right information, any place, at right time GPs, Practice Nurses, OOH Doctors, Active Case Managers, Social Workers, District Nurses, A&E / Hospital Consultants, Safeguarding Teams, Paramedics, Community Staff , Mental Health Practitioners, Rapid Response Teams, Specialist Services….. Our solution - Manchester Care Record Live In rollout phase Manchr City Council Central Manchr FT South Manchr FT Pennine Acute HT 90 Manchr GP Practices Manchester Care Record / Portal Manchr Mental Health Trust • GP Record Summary (Investigations, Diagnoses, Medication, Allergies, etc) • Secondary Care Activity Summary (IP/OP/A&E admissions, transfers, discharges, appointments, lab results) • Social Care Activity Summary (Allocated teams & contacts, personal & relationship contacts, current & planned services, etc) • Integrated Care / Crisis / Admission Avoidance Plans • End of Life Plans / EPaCCS Register – Dec 2015 NWAS / NHS111 OOH (G2 D)
  55. 55. Manchester Care Record – Led by clinical need • Manchester GP’s views on the benefits & risks of not sharing data: Dr Paul Wright, GP, Manchester: “A shared care plan improves ownership and communication with patient and between caregivers. As well as reducing the need for repetition (tests, questions, referrals, etc,) a common IT platform gives us an opportunity to share standardise processes and reduce variability” Dr Sarah Taylor , GP, South Manchester: “The current system sometimes involves GPs faxing. This is not timely, not always accessible and the quality of information shared is variable. This system allows relevant information to be shared much earlier in the patient's care and in a more consistent manner.” • Early stage clinical co-design • Capture & share concept embedded
  56. 56. Manchester Care Record – Benefits & Outcomes • Manchester had already seen real benefits from integrated approach… Patients are involved in shaping their plan • Patient controls access to information & influences the type of care they receive • Don’t have to remember/repeat medical history • Avoid unnecessary tests • Improves outcomes and experiences. Analysis of the first 2,044 patients • Cost: Ensuring that commissioners pay appropriately for care • Overall activity and costs have reduced by 9% • Current savings to date for these patients are £360,987 • Savings in Emergency Admissions show a 15% reduction in activity and 8% in cost. Overall, the cost savings in Emergency Admissions account for 58% of the total savings so far. • The largest percentage reduction is shown in A&E activity (19% reduction). Over 6,000 patients sharing data and care plans in place. • Proactive: Using data we have identified people who would benefit from an intervention (high-risk) • Coordinated: Draws together the correct, relevant information to identify and coordinate the best interventions for that individual • Safe & Effective: Avoids harm, decisions based on correct, up to date information • Decision making: Use information to identify whether care delivery is effective and improvements required
  57. 57. Manchester Care Record – Benefits & Outcomes Use of MCR: • Member of community team ‘walked the ward’ & identified she had a care plan • Viewed care plan and shared care record on her laptop by the patient’s bed • This identified the lady had recorded end of life wishes and community team worked with the consultant to manage a discharge Outcome: • Patient remarked she was very pleased that hospital team could contact her keyworker • Patient died, at home, as she wanted Positive, but the process needed the community member of staff to identify and pass on details to the consultant – what would the impact on best practice be if those EoL wishes were flagged and immediately accessible to consultant at the point of admission? Elderly lady with lung cancer admitted to hospital
  58. 58. Benefits seen in Manchester 1. Existing Information Governance experience and frameworks 2. Existing clinical and managerial steering group arrangement with shared ownership, ethos & skills 3. “Ready” IT infrastructure & feeds/links – and organisational relationships 4. Opportunity to streamline capture of data and avoid double-entry 5. Implementation and adoption easier with existing benefits case and migrated historically captured data – forming part of a patient pathway that is instantly accessible and available 6. Opportunity to expand on existing benefits case for specific patient cohorts – maximise these for full Manchester population?
  59. 59. Randomised Coffee Trial Please find the person with the same number as you and have a coffee and a chat with them #EPaCCS
  60. 60. EPaCCS Evaluation Improving Patient Care at End of Life National Conference, 17th March 2016
  61. 61. Project brief To “examine both the impact of EPaCCS on the experience of care towards and at the end of life, for patients, carers and those who are important to them and staff and look at the body of evidence appropriate to the cost effectiveness of EPaCCS.” The Whole Systems Partnership 66
  62. 62. Analysis of EPaCCS extracted data Approach The Whole Systems Partnership 67 Survey in 2 locations (EPaCCS & Non- EPaCCS) 12 in-depth interviews (2 patients, 4 carers, 6 professionals Comparison of ONS data for place of death over 4 years Analysis of hospital costs over last year of life for those who died in hospital 5 evaluation sites (with EPaCCS since 2012) 6 ‘control’ sites (no EPaCCS reported in 2015) Back-drop of all- England figures Interviews with 8 ‘system leaders’ ?
  63. 63. What have we found? The evaluation design has sought to ‘triangulate’ findings from a range of different sources and angles – this means that we can say with confidence that:  There is a consistency of positive messages, even if on their own they fall short of being conclusive – no single deal clincher, but lots of pointers in the right direction;  We have found no counter-messages, although the presence of EPaCCS has highlighted certain challenges in delivering good quality end of life care;  The contribution that EPaCCS makes meets with resounding support from all stakeholders. The Whole Systems Partnership 68
  64. 64. Our in-depth interviews 12 people interviewed; 2 patients, 4 carers and 6 professionals; Cancer bias in patients/carers groups; 3 GPs, 2 clinical nurse specialists in nursing homes, 1 paramedic; 10 EPaCCS, 2 non-EPaCCS participants; 2 face-to-face interviews, 10 by phone; 1 research interviewer, 2 secondary listeners; NHS SI Team or clinical leads identified participants. The Whole Systems Partnership 69
  65. 65. What people told us works well The shared record speeds up care; It prevents re-telling a story and therefore builds a sense of continuity for the patient and carer; It enables patient choice e.g. PPD at home; EPaCCS facilitates conversations about advance care planning; Details matter in EoLC - personalisation affects perception of overall quality of care. The Whole Systems Partnership 70
  66. 66. Challenges – identification for EPaCCS inclusion Long-term conditions should/could be included, but identification can be challenging, for example in MS the natural history could be relapsing/remitting, so its more difficult to identify the last year of life: “It’s criteria based. We don’t consider you as being in the last year of life, so we won’t put you on the register. I’m wanting to talk about it, but it’s closed off.” [Male patient, 49, EPaCCs site] The Whole Systems Partnership 71
  67. 67. Challenges – difficult conversations Key to entry into EoLC and EPaCCS – gatekeeping; Taboo - clinicians fear raising the subject:  “Depends on how empowered the family is. If you’ve got a gentle, timid family, they often don’t fare as well as those brave enough to ask questions. If you’re able to ask a question, that goes a long way. You need to be able to ‘speak healthcare’. We need a different attitude.” [Female carer, 67, non-EPaCCS site] Conversations take time:  “It’s not the time it takes to do the data entry, it’s the correct conversations with patients, carers and families that take time.” [Female GP, 52, EPaCCS site] The Whole Systems Partnership 72
  68. 68. Responding to the challenges EPaCCS can surface these, and other challenges, in delivering person-centred and co-ordinated care at or approaching the end of life; But the challenges don’t undermine the potential benefit that EPaCCS can bring; EPaCCS needs an environment in which there is an ongoing process of building capability across the workforce and for all aspects of end of life care. The Whole Systems Partnership 73
  69. 69. Key messages Patients, carers and professionals all express enthusiastic support for the benefits that EPaCCS can bring; System leaders see EPaCCS as an important tool to improve coordination of care, and outcomes, at the end of life; ‘Success’ in terms of EPaCCS implementation needs to reflect a broad range of quantitative and qualitative measures that are routinely collected and reported locally for purposes of system improvement; The costs of EPaCCS are low relative to the costs of care and it is possible to argue that they have the potential to reduce costs for hospitals. The Whole Systems Partnership 74
  70. 70. End quotes [Patient]: “how can they say I’m not in the last year of life when I could’ve been in the last days? I can’t play the game. It’s as if they’re saying, ‘It’s our football and you’re not playing.” [Carer]: “she died where and how she wanted, like a Hollywood death.” [GP]: “there’s a changing emphasis in facilitating a good death, rather than being scared of death. They fear that letting someone die is doing something wrong or letting someone down.“ [Paramedic]: “they know an ambulance will turn up to help them. We didn’t use to know the plan but now I do. Electronic records are invaluable.” The Whole Systems Partnership 75
  71. 71. Swapping Conversations #EPaCCS
  72. 72. 77 Using the Summary Care Record for an EPaCCS implementation in East Sussex Barry Ray - Former IT Project Lead NHS Hastings & Rother CCG NHS Eastbourne, Hailsham & Seaford CCG NHS High Weald Lewes Havens CCG EAST SUSSEX
  73. 73. 78 The Project Plan  The Beginning - Why choose SCR?  The Middle - Engagement & Deployment  The End - Feedback & Re-assessment  The Future - What’s happening next…
  74. 74. 79 Why choose SCR?  Accessible across all regional & organisational boundaries within England  SCCI 1580 compliant (SCR/Additional Information)  Fully integrated with GP clinical systems  ‘Viewing’ interface with systems across N3 network  Security, confidentiality & audit mechanisms built in  Supports an established consent model  SCRs routinely viewed in healthcare settings
  75. 75. 80 N3 Network Care PlansCare PlansClinical Templates Electronic Patient Record Hospital Pharmacy Secondary Care Organizations Patient Hospital Wards Hospital A&E Ambulance Service OOH Service (IC24 - Cleo) Hospice Care-Home Nursing Home EOLC Template (SCCI 1580) A Core + Additional Data SCR C D Updates E GP Clinical System (GPSoC 2.1) B MDT Team PPC
  76. 76. 81 Engagement & Deployment  Board level approval at all 3 CCGs  Intensive SCR rollout programme  PLT workshops & Locality meetings  Staff Training: GP Surgery + Hospital Setting  Hospice Information Network  Clinical Template Design & Development
  77. 77. 82 Feedback & Assessment  Local Commission Service – EOLC  Extending LCS to all Vulnerable Patients  Re-design of Clinical template to cater for:  Admission Avoidance Scheme  Preferred Preferences for Care  Palliative Care  Viewing Figures Reporting Dashboard
  78. 78. 83 What’s happening next…  Pushing for changes to SCR  Improvements to viewing format & layout  Links to external sites (e.g. Care Plan repository)  Easier 3rd party integration (Single-click access)  Read/Write capability  Extending access to non-N3 connected organisations  Providing mobile solutions to ambulance service & hospital wards  Improving feedback from users
  79. 79. 84 Contact Details Gerry McGee Head of IM&T Tel: 01273 403626 Email: Becky Gayler IM&T Project Manager Tel: 01273 485326 Email: Barry Ray Former EPaCCS Project Lead Tel: 01273 403512 Email: NHS Eastbourne, Hailsham & Seaford CCG NHS Hastings & Rother CCG NHS High Weald Lewes Havens CCG Address: 36-38 Friars Walk Lewes East Sussex BN7 2PB
  80. 80. #EPaCCS
  81. 81. EPaCCs Susan Salt Clinical Lead Lancashire and South Cumbria Palliative and End Of Life Network
  82. 82. Collaboration across all care settings
  83. 83. Collaboration across professional boundaries
  84. 84. Patient Centred
  85. 85. Clinical and IT leadership Seeing why it is important and what it can achieve Not taking no for an answer Jargon and acronym busting
  86. 86. Openness, transparency and candour • A common culture • Common values • Clear rules • Monitoring compliance • Enforcement of compliance • Accountability • Effective handling of complaints and incidents
  87. 87. Not easy….. Willingness for all staff to have difficult and honest conversations with patients and their families and then complete the EPaCCs template – and trust each other to act upon what it says……
  88. 88. Why EPaCCS?
  89. 89. Salford EPaCCS WHAT DIFFERENCE DOES HAVING AN EPaCCS MAKE? Steve Gene Assistant Director of Nursing Palliative & End of Life Care 17.03.16
  90. 90. One of 8 original pilot sites - system live late 2011 • Multisystem – EPR, Primary Care Interface (SIR), Vision & EMIS • System user training – primarily those with skills for significant conversations • Automated data extraction (EPR) established The story so far….
  91. 91. • Secure e-mail alerts real time – DNs & GP OOH (GP via ‘Docman’) • NWAS & Hospice via • 554 patients 2014-15 (430/488 PPD = 88%) • 2015-16 = 50>60 entries/month – PPD to Feb = 441/489 = 90.2% The story so far….
  92. 92. • PPD = GM KPI & ongoing local KPI • Embedded acute & community CQUIN • Embedded ‘Salford Standard’ from April ’16 • Integrated Care Organisation & Shared Care Record (work in progress) Embedding
  93. 93. Challenges • Earlier use & the 75% rule • Expansion beyond ‘core users’ • Social Care - particularly Care Home access • Ongoing professional engagement • Data transfer (quality & viewing) • ‘Whole system’ reporting
  94. 94. • System limitations • Data quality, transfer, viewing & reporting • Ownership - maintenance & assurance • Untapped potential (e.g. No. predictable deaths for Salford) • Patient & carer engagement • Best option to capture ACP – keep going! Lessons learned
  95. 95. QUESTIONS
  96. 96. End of Life Care in NorthTyneside
  97. 97. l
  98. 98. Enhanced Summary Care Record • To improve communication with those involved in the care of patients who are approaching their end of life.To: • Enable patient to be cared for in their place of choice • Support carers to care for patient at end stage of life • Patient to die in their place of choice • Improve patient /family experience at a difficult time • Support professional decision making in a timely manner • Prevent hospital admission if not necessary • Direct services where needed
  99. 99. 2015 NorthTyneside • GP palliative care registers at 0.52 % (national average still 0.2%)* • DNACPR in place in 87% of patients on register • Deaths at home –55.4% • Nursing Homes residents dying at their home - 83% (next best rate 73%) • Specialist Palliative CareTeam now in 16/40 Residential homes Residential Home residents dying at their home -77% Rapid Response Service starting Jan - April 2016- community based using SystmOne
  100. 100. Enhanced Summary Care Record • How will we measure the impact of the project ? • Baseline and trend data : • people on end of life register ( numbers and %) of practice • people dying on end of life register (numbers and % on EoLregister) • people dying on end of life register with end of life care plan in place /preferred place of death recorded • How many DNR on register
  101. 101. Enhanced Summary Care Record Impact of the project • Deaths in usual place of residence • Deaths within 24hrs of admission to hospital • Reduction in number of avoidable admissions to hospital from care homes • Reduction in length of stay and bed days for patients on the End of Life register • Reduction in emergency hospital bed days in last 100 days of life
  102. 102. Enhanced Summary Care Record • Patient & family experience • Patient and family informed on choices /expectations • Patient expressing choice • Patient experiencing care in place of choice • Patient dying in place of choice • Family distress alleviated • Family survey 3 months post death. • Questionnaire in line with N.Tyneside Patient voices project ( partnership approach to EoL surveys) • Shared learning across agencies
  103. 103. Enhanced Summary Care Record • Professional experience • Increase accessibility • Increase viewing of information • Influencing decision making about care provided and where • Decision making quicker and easier • More empathetic/quality of care • Staff groups: survey/interview • Primary care GPS , Community Matrons, NDUC • A&E departments/Medical assessment units /Hospital pharmacists • End of life social work team • Specialist nursing service
  104. 104. Enhanced Summary Care Record Pilot • Partners: NT CCG, NT General Practices, NT Local Authority ,Northumbria Health Care FoundationTrust ,Newcastle upon Tyne Hospitals FoundationTrust, Northern Doctors Urgent Care St Oswald’s Hospice, 111, (NECS) • Support :ASHN, NECS, Regionally, Nationally
  105. 105. Challenges • Summary Care Record: Version 2.1 update- completed July 2015 • READ Codes and National Data Set: Network and NCPC • NECS: 111 and e SCR • Partner organisations • Northumbria -community uptake of SystmOne ( including NH team) July 2015, NSECH • Newcastle Hospitals- completely new IT team, had to re-engage • NDOC & NEAS- market competition-shared portals • Patient feedback survey in NorthTyneside • Financial support
  106. 106. Strengths • Fed into national and regional discussions regarding data sets and highlighted problems that had not yet been identified • Created new awareness and links into NECS • Strengthened relationships with partnership organisations and identified gaps e.g. NEAS • Connectivity with all the other end of life developments in NorthTyneside • Communication strategy • Local champion • Project management has continued despite funding circumstances
  107. 107. • 4 pilot practices on SystmOne in place ready to go live (50% of NT practices on SystmOne and all NH and the team’s RH patients are on SystmOne) • Northumbria ( nearly ) ready to look at view of eSCR for end of life patients- MIG • READ codes –those used by pilot are ok regardingVersion 2.1 except for Preferred Place of Care • Working with NECS to link their and our work into 111 • Focus group feedback to be collected for patient family and professional groups • Continue to feedback Regionally and Nationally • End of LifeWork streams continuing in NT so once eSCR in place the uptake will be immediate • Would like to pick up again with other partnership organisations to take this forward and gather impact from them accessing eSCR
  108. 108. Boxing Day Dip atWhitley Bay
  109. 109. NorthTyneside Dr Kathryn Hall
  110. 110. How NWAS is tackling electronic EPaCCS sharing with 33 CCGs Phill James Programme Management Office NWAS
  111. 111. Delivering the right care, at the right time, in the right place NWAS Touch Points Planned Care: PTS Journey (To Home / Hospice / other preferred place) 111 Call: Telephone Advice Appointments Sign Posting 999 Call: Dispatch Telephone Advice Sign Posting At Scene: See & Convey See & Treat See and advise Safeguarding & Clinical Referrals Safeguarding Referrals
  112. 112. Delivering the right care, at the right time, in the right place The Vision  NHS111 and 999 successfully identify all patients as early as possible during pathway  NHS111 and 999 possess up to the minute electronic warnings that a care plan exists for an identified patient (Telephone & Face to Face)  NHS111 and 999 have electronic access to the guaranteed current care plan for an identified patient (Telephone & Face to Face)
  113. 113. Delivering the right care, at the right time, in the right place ERISS Vital Statistics • Organisations Registered 649/656 • Users Registered 3689/3949 • End of Life Care Plans (2015) 5343/1159 • Oxygen Plans (2015) 224/26 • Community Care Pathways (2015) 2161/258 Total (2015) 7728/1443
  114. 114. Delivering the right care, at the right time, in the right place ERISS
  115. 115. Delivering the right care, at the right time, in the right place ERISS EoLC Records 2015 Live Flags By Reason 0 100 200 300 400 500 600 700 800 900 1000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec CACP PPC MCCD LCP DNACPR AND ADRT CP
  116. 116. Delivering the right care, at the right time, in the right place 111 Legacy Issues OOH Adastra 111 Adastra GP Record Discharge Notes Primary Care Secondary Care SCR *DNAR in place confirmed on phone and passed to OOH for DoD/or pass back to 999 14 Day SPN Review *E-SCR: DNAR found at bottom of 5 pages of non standard care planE-SCR
  117. 117. Delivering the right care, at the right time, in the right place 999 Legacy Issues 999 Dispatch 111 Adastra Gazetteer SCR 999 ERISS E-SCR Primary/ Secondary Care
  118. 118. Delivering the right care, at the right time, in the right place Aspired Workflow Regional ICDRs Regional ICDRs 999 Dispatch 111 Adastra 999 111/999 UCD Adastra 999 Clinical Support Hub GP Records Discharge Notes Social Care Records E-SCR Graphnet MiG ERISS CP-IS FGM Handover Records
  119. 119. Delivering the right care, at the right time, in the right place Care Planning Landscape MiG E-SCR Graphnet ERISS EMiS / TPP / INPS OpenEHR Other 3rd Party Innovators Paper
  120. 120. Delivering the right care, at the right time, in the right place Care Planning Landscape MiG / STRATA GRAPHNET DATAWELL/ GM-CONNECT/ GRAPHNET RIPPLE LPRES
  121. 121. Delivering the right care, at the right time, in the right place Care Planning Landscape CUMBRIA CARE RECORD CHESHIRE CARE RECORD MANCHESTER CARE RECORDLIVERPOOL CARE RECORD LANCASHIRE CARE RECORD
  122. 122. Delivering the right care, at the right time, in the right place Scale of the Challenge 0 5 10 15 20 25 30 35 Clinical Commissioning Group EPACCS Localities Health and Wellbeing Board 0 5 10 15 20 25 MIG Datawell Graphnet GM-Connect LPRES Ripple E-SCR ERISS MIG Datawell Graphnet GM-Connect LPRES Ripple E-SCR ERISS
  123. 123. Delivering the right care, at the right time, in the right place DSA Challenge – First 9 0 5 10 15 20 25 DSAs By Locality/CCG In Place In Progress Outstanding
  124. 124. Delivering the right care, at the right time, in the right place Current EPaCCS Challenge • Put first 9 DSAs in place • Deploy 999 CAD to MiG/Graphnet interface to auto query GP flags on addresses (Governance moves - No need for only EPaCCS compliant and integrated CCGs to use ERISS) • Provide access to MiG/Graphnet instances on 111 Adastra via planned upgrade (deploy to existing 111 clinicians/999 UCD/999 CSH)
  125. 125. Delivering the right care, at the right time, in the right place Summary • 111 • Adastra upgrade will reduce the reliance upon SPNs for EoLC information – presence of tab will signify presence of a plan • 999 • Clinical flags on addresses will always be required to alert crews to presence of a plan • Clinical flags function within ERISS remains key until 999 CAD to all GP records is achieved • 111/999 • ICDRs embedded within Adastra and coupled with iVCH is the objective
  126. 126. Delivering the right care, at the right time, in the right place Thank you
  127. 127. #EPaCCS
  128. 128. Lincolnshire EPaCCS Experience (so far) Louise Price – Professional Lead (Dr Lawrence Pike)
  129. 129. Approach • Scoping outcomes • Person centric • Clinically led • Bottom up • Opportunities • Testing • Make the links
  130. 130. Engagement & Communication • Organisationally agnostic • Translation • Champions • Bravery & honesty • Relationships • Culture & behaviour
  131. 131. Selling Your Wares • Investment of time • Person centric • Flexibility • Pitching • Tools • Be prepared
  132. 132. Tools • Person centric • Clinically lead • Save time & effort • Systematic approach • Enablers • Pick & mix
  133. 133. IT • Template (S1 & EMIS) • Reflect care delivery • GP Report • My RightCare
  134. 134. Education • Website: • Brochure: specific-resources-and-documents/ • Dying to Communicate training
  135. 135. Challenges • Integration!!! • National policy • Local procedure • Assurance • Time & scalability
  136. 136. Keeping in Touch Mobile: 07436 581 567
  137. 137. Managing an EPaCCS implementation across organisations David Slater Lancashire North CCG Programme Manager UHMB Project Manager
  138. 138. EPaCCS Strategy • Only one palliative care record per patient • The Master palliative care record will be held on their registered GP practice IT system. • To utilise the Healthcare Gateway MiG service to access a patients palliative care record on their registered GP practice IT system or EMIS-to-EMIS sharing • All GP practices use the NW EPaCCS dataset • Work closely between LNCCG, UHMB, GP OOH,Community and local Hospice • All GP Practices hold regular palliative care meetings • Developments discussed and publicised through GP Development days and LNCCG IT Group meetings
  139. 139. EPaCCS Data flows Bay Urgent Care NWAS - ERISS LNCCG 12 GP Practice systems CancerCare Social Services Mental Health St John’ s Hospice Community UHMB Lorenzo EMIS Web Community EMIS Web Community LNCCG Urgent Care dashboard contains GP practice Palliative Care registers
  140. 140. Issues • All GP Practices must use the same EPaCCS template • Some GPs add patients to their GP Practice Palliative care register prior to discussing with the patient – this is unacceptable practice with data sharing • All GP practices MUST check their palliative care registers prior to go-live
  141. 141. Lorenzo Menu Items
  142. 142. Initial View
  143. 143. Summary View
  144. 144. Medicines View
  145. 145. Supportive Care View
  146. 146. Adastra
  147. 147. The Future • The North West EPaCCS dataset is the beginning of the MiG V2 journey • LNCCG GPs have developed a new dataset called Crisis Care dataset and data collection template. • LNCCG GPs are collecting data against the new template • Healthcare Gateway, LNCCG and UHMB are working together to get this new dataset operational. • The new dataset collects data for patients who have • Cancer • COPD • Dementia • Heart Failure
  148. 148. CLOSE Thank you so much for participating. Have a safe journey. #EPaCCS