Interoperability and the Road to Digital Maturity

Interoperability and the Road to
Digital Maturity
Thursday 23 July
Wi-Fi Network: Engine Shed
Password: Room13art

Welcome & Introduction
Janina Cross, West of England AHSN
Shanil Mantri, BaNES CCG
Wi-Fi Network: Engine Shed
Password: Room13art

The Challenges
The Five Year Forward View identified three key
challenges for health and care:
1. The health and wellbeing gap
2. The care and quality gap
3. The funding and efficiency gap

Today’s Goals
• Helping to optimise local interoperability strategy
making the best use of technology and capabilities
• Identifying the benefits of interoperability
sharing knowledge to identify opportunity and overcoming
barriers
• Accelerating the progress of interoperability
enabling capability to increase the momentum of
interoperability programmes

Personalised Health and Care 2020
By April 2016 local health economies will deliver:
• Roadmaps highlighting how, amongst a range of digital
service capabilities, they will ensure clinicians in all care
settings will be operating without the need to find or
complete paper records by 2018;
• That by 2020 all patient and care records will be digital,
real-time and interoperable.

09:00 – 09:15 Welcome and Introduction Dr Shanil Mantri, Janina Cross
09:15 – 09:30 The Gloucestershire ‘Joining Up Your Information’
Interoperability Programme Update
Dr Paul Atkinson
09:30 – 09:55 The Wiltshire Single View of Customer
Programme Update
Dr Gareth Dawes, Kevin Marshall
09:55 – 10:10 The Bristol, North Somerset and South
Gloucestershire Connecting Care Programme
Update
Dr Andrew Appleton
10:10 – 10:25 Avon and Wiltshire Mental Health Partnership
‘Joining up the Dots’ Programme
Dr Will Hall and Caroline Gadd
10:25 – 10:40 Refreshments and Networking
10:40 – 10:55 The Bath and North East Somerset
Interoperability Programme Update
Dr Shanil Mantri
10:55 – 11:10 Update from Great Western Hospital, Swindon Dr Constantin Jabarin
11:10 – 11:30 ‘No Data About Me, Without Me’ – Informatics as
a Conversation
Nick Leggett
11:30 – 12:15 Break Out Sessions A and B
12:15 – 12:20 Morning Wrap Up
Morning Agenda

Break Out Session B
NIB WORK STREAM 1.1 & 1.2
‘Enable me to make the right health and care choices’
Providing patients and the public with digital access to health and care
information and transactions and an assessed set of health and social care apps
NIB WORK STREAM 2.1
‘Give care professionals and carers access to all the data they need’
Setting the commissioning and regulatory roadmap for implementing of digital
data standards 2018/2020
NIB WORK STREAM 4
‘Build and sustain public trust’
Deliver roadmap to consent based information sharing and assurance of
safeguards
NIB WORK STREAM 6
Support care professionals to make the best use of data and technology
NIB WORK STREAM 8
Enabling information standards to underpin all other work streams

13:30 – 13:45 The South Western Ambulance Service NHS
Foundation Trust Electronic Care System (ECS)
Francis Gillen
13:45 – 14:00 National Information Board Update Michael Bewell
14:00 – 14:20 The Lancashire Shared Care Record and Citizen
Facing Platform Approach
Declan Hadley
14:20 – 14:45 An Introduction to Patients Know Best Rhiannon Thomas
14:45 – 15:15 Break Out C – Open Discussion – delivering to the NIB framework, next steps
and AHSN support
15:15 – 15:30 Feedback from Break Out Session C
15:30 – 16:00 Wrap Up and Open Networking Forum with
coffee
Dr Paul Atkinson, Janina Cross
Afternoon Agenda

Break Out Session C
1.1 Providing
patients and
the public with
digital access
1.2 Providing
citizens with an
endorsed set of
health and
social care
apps
2.1 Give care
professionals
and carers
access to all the
data they need
2.2 Giving the
right people
access to the
health and care
data they need
3. Make the
quality of care
transparent
4. Build and
sustain public trust
5. Bring forward
life-saving
treatments and
support
innovation and
growth
6. Support care
professionals to
make the best
use of data and
technology
7. Assure the
best value for
taxpayers
8. Enabling
information
standards

WEAHSN Informatics Workstream
Thank you!
Janina Cross, janina.cross@weahsn.net
07880 646 641

The Gloucestershire ‘Joining Up
Your Information’ Interoperability
Programme Update
Dr Paul Atkinson
CCIO
Gloucestershire CCG

The Gloucestershire ‘Joining Up Your
Information’ Interoperability Programme
Update
Dr Paul Atkinson, CCIO, NHS Gloucestershire
Clinical Commissioning Group
Haider Al-Shamary MPharm GPharmC
IM&T Project Manager, South Central and West
CSCSU

Joining Up Your Information (JUYI)
• 15 minutes – including time for questions!
• 5 minutes – Paul (CCG)
• 5 minutes – Haider (CSU)
• 5 minutes for questions
• 4 minuets left …

Vision:
• “To support the delivery of safe, effective and
collaborative care, centred around the service user,
• by ensuring that any professionals and the service user
have access, and can contribute to, all relevant and up-
to-date clinical and administrative information which
relates to their care, from all sources whichever
organisation they are working for and whenever and
wherever they are working.
• This includes the service user, enabling them to
collaborate in the planning and provision of their care.”

Integration Engine
Repository (big bucket) Seeker (live fetching)

What have we been doing?
• Pilot - sharing some primary care data
• EDSM (SystmOne) sharing
• My Online Care Plans
• Information Governance group
• Agreeing consent model
• Communication programme
• Gathering requirements
• Getting funding

Key activities underway
i. Signing off Requirements specification
• Clinical and Care Professionals Reference Group has reviewed and
commented: out for sign-off by provider organisations
ii. Completing Business Case
• Review and sign-off process starts on 11th June
iii Procurement Process
• Notice of Intention published on 3rd June
iv. Communications Planning
• Draft Strategy and High Level Plan produced for review at this meeting

Next Steps …
i Business Case Sign-off
•By all relevant bodies by 4th August
ii Procurement Process
•Market-testing with suppliers then procurement documentation released mid-
August
•Appoint supplier late-October
iii. Communications
Following approval of materials and plan:
•Implement Public Information Programme; process opt-outs by January 2016
•Increase “internal” communications as per plan

Patient Consent Model
Model agreed by Comms, Consent & Access Group & local LMC is one of:
“informed implied consent” to share information (i.e. opt out)
with explicit permission to view at point of care (not required when direct
referral or patient incapable)
Risk = High opt-out rate

Contact details:
glos.sharedcarerecord@nhs.net
Paul Atkinson, CCIO
NHS Gloucestershire CCG
atkinson@nhs.net
Haider Al-Shamary
MPharm GPharmC
IM&T Project Manager, South
Central and West CSCSU
haider.al-shamary@nhs.net
07833 294 049

The Wiltshire Single View of
Customer Programme Update
Kevin Marshall, Wiltshire Council
Gareth Dawes, Wiltshire CCG

Change and Innovation
Wiltshire Council created from one County Council and four District Councils in 2009,
Wiltshire Council is now the unitary authority for most of Wiltshire
• New offices,
• Insourcing of ICT Services
• Corporate rollout of Windows 7 laptops
• New ways of working (Flexible working, Lync video conferencing )
• Direct access control across the three main hubs.
• Superfast Broadband,
• Seamless direct access,
• Wireless and Ethernet connectivity across the county,
• Partnership working with Wiltshire Police (One ICT service, shared buildings,
married networks)

Single View
• Plan more effectively for the scale and type of public services required in Wiltshire
• Provide clinical continuity and improving health and wellbeing (The BetterCare
Plan)
• Save lives and protect the vulnerable (Police Service Delivery Plan)
• Improving the customer journey by providing efficient and effective services
(Wiltshire Council Business Plan)

Key Benefits
• Providing clinical continuity
and improving health and
wellbeing
• Saving lives and protecting the
vulnerable
• Improving the customer
journey by providing efficient
and effective services

What have we achieved so far?
• Partnership Days (over 100 representatives from WC, Police,
Fire and Health Organisations
• ICO engagement
• Demonstrated an initial proof of concept
• Partnership working and Cohesion
– Programme Board
– Operations Board
– Information Governance Board
– Communications Board
– Single View programme team
– ICT Sub-Group

Work in Progress
• Working together with the Health, Police and Fire Services to produce product
cases and identify benefits
• Recruited additional technical resource for solutions development
• Development of technical solution for Wiltshire Council Portal under way
• Implementing ICT sub-group across partner organisations
• Regular updates with NHS South Central and West Commissioning Support
Unit
– Sharing information and progress both ways
• IG Board are developing workflow processes
– Data sharing agreement and Sign off processes
– Privacy Impact Assessment
– Auditing existing practises
• Establishing Communications Board roles and milestones
– Revising Initial Communications Strategy
– Draft purpose statement for Single View
– Engagement with stakeholders and reference groups

Gathering Requirements
• Currently analysing the 9 partner organisations business strategies and
priorities.
– Over 65
• Product case. – I want to feel safe at home
– Who are you
– What information do you require for better informed decision making
– Where is that information currently held
– Who can it be shared with
– What are the benefits of sharing that information

Initial Product Case
• Identify hurdles
• Data Sharing
• Communications/Marketing
• Technical challenges
• Change of working practises
• Cultural changes
• Lessons learnt for future product cases

My View
(Shop Window / Access Portal)
Single View Data Store
Wiltshire Council
System
System
System
Partner x 8
Partner Data Store x 8
System
System
System
Single View
Health Portal
Health View
Version: 0.3 – 20/07/2015 PM

Connecting Care
The Bristol, North Somerset and South Gloucestershire
Connecting Care Programme Update
Dr Andrew Appleton
Wiltshire CCG

• What is Connecting Care?
• Why have Connecting Care?
– Strategic alignment
– National drivers
• Who are the partners?
• What have we delivered so far?
– What are the benefits? Tangible results so far
• What’s coming next?
• Current governance arrangements
introduction to Connecting Care

Connecting Care is the Bristol, North Somerset and
South Gloucestershire [BNSSG] programme,
dedicated to using technology to support -
• Better information sharing between local
health and social care organisations
• Joining up information to ensure care is
focused around the individual and their needs
• Improving better, safer and more joined-up
care
• Supporting increased efficiency in the delivery
of health and social care services
• Ensuring that the people who are providing
care have the information they need, when
they need it
what is Connecting Care?
Our first focus has been the delivery of a shared ‘view only’ electronic
patient record (using the Orion Health ‘portal’)

strategic alignment
5 year forward view: “Most countries have been slow to recognise and
capitalise on the opportunities presented by the information revolution……the
NHS has oscillated between two opposite approaches to information technology
adoption.....the result has been
systems that don’t
talk to each other
and a failure to
harness the shared
benefits that come
from interoperable
systems…..In
future we intend to
take a different
approach”

strategic alignment - national drivers

project approach
• Staged approach
– First stage (pilot) started in March 2013. Key
deliverables:
• A working system (can we do it?)
• Evaluation of benefits (is it any good?)
• A business case for the second stage (is it worth
carrying on?)
– Second stage started Dec 2014 (next 5-7 years)
• Scope / theme
– Stage one themed on urgent & unplanned care
– Stage two will extend the breadth & depth (more users,
more information sharing)
• Numbers of users
– Stage one 500
– Stage two – 10,000+

• Demographics
• Laboratory
• Radiology
• Encounters
• Allergies
• Diagnosis
Clinical Data RepositoryRhapsody Integration Engine
Orders and
Results (CRIS
and Ultra) X2
GPs
RiO
Extracts X4
• Authentication
• Authorization
• Single Sign-On
• Patient Privacy & Consent
• Relationships
• Audit Logs
• Patient Search
• Patient Lists
• Patient Summary
• Timeline
• Flowcharts
• Secure Messaging
• Orion Health Applications
• Third Party Applications
Presentation
Integration
Source Systems
Security & Privacy Patient Record
• Medications
• Problems
• Procedures
• Transcribed
Documents
Portal
Connecting Care Clinical Portal
Master Patient Index
MiG
NBT
Cerner
PAS
Weston
Cerner
PAS
Adastra
End Of Life
SWIFT –
North
Somerset
UHB
Medway
PAS
Adastra
Out Of
Hours
Paris Social
Care -
Bristol
what we’ve delivered so far

So far:
• Demographics
• Practitioner Details (Registered GP,
Community nurse, social worker
etc.)
• GP record summary – showing
medications, allergies, adverse
reactions noted, diagnoses
• All referrals, scheduled
appointments (future and past),
• Home visits (past) and planned
(future)
• Progress notes (from community
health )
• Hospital inpatient / outpatient
episodes
• Emergency Attendance
• End of life wish details
Coming next: discharge letters,
radiology reports, pathology reports
existence of / details from care
management plans

The people who have used Connecting Care to provide better, more joined-up
care so far include –
• Acute trusts: pharmacists, consultants/doctors, nurses, therapists, patient flow
coordinators, admin
• Primary care: GPs, medical secretaries/support staff
Acute
care
Primary
care
Community
care
Social
care
Out of
hours
• Community care: support workers, therapists,
nurses, emergency care practitioners, admin
• Social care - social workers, occupational
therapists, Care Direct advisors, care
coordinators, admin support

what we’ve delivered so far - timeline
Signed
contracts
(Feb 2013)
Start work
(March
2013)
Go live
Stage 1
pilot (Dec
2013)
Benefits &
Business
Case (May
2014)
Approvals
from all
partners
(Sept
2014)
Stage 2
Start (Dec
2014)

The main benefits for me (as a clinician or social care professional) are:
• Confidence in my decision making is improved
• The quality of my consultation (or assessment) is improved
• I do not make unnecessary referrals or carry out duplicate assessments
• It saves me time (which can be used to provide care, or for other duties)
• I am more informed before a visit/appointment, which means I can provide more
timely/more appropriate care
• I have better relationships with colleagues
• My input into a patient/service user’s care can be seen by others, so the
recognition of my profession is increased
Connecting Care - benefits

The main benefits for my patients/service users are:
• They don’t have to keep telling their story (e.g. remembering / explaining
medications
• They receive safer, more appropriate care
• They have a better experience of the services offered, potentially with fewer
duplications or delays
• They might not have to be admitted to hospital

Out of
hours care
• Saves appointments and visits
• Saves admissions
• Safer prescribing
• Improved quality of consultation
Pharmacy • Safer prescribing – provides access to allergy and GP prescribing
information
• Saves time – Reduces the amount of time calling GP practices
• Safer communication – reduces errors
Hospitals /
A&E
• Safer care – patient background, context and medications
• Saves time – reduces time trying to find out information
• Reduces risks – where patients unable to inform clinicians about
relevant information / fax errors etc

Community
care
• Saves time in triage and assessment
• Saves time – reduces the amount of calls to GPs
• Saves unnecessary home visits
• Supporting risk management and safeguarding
Social care • Supporting referral management
• Saves time in triage and assessment
• Informs assessments & care planning
• Saves installation and equipment costs
• Supports risk management and safeguarding
General
practice
• Reduces burden on practice administrators
• Supports risk management and safeguarding
• Increased confidence in better care being provided outside of
the practice
• Immediate access to GP records (new registrations)

“Massive difference in
time spent accessing
information. On average
[I can] access the GP
record within 30 seconds
compared with 15-20
minutes taken via
telephone or via fax”
Critical Care Pharmacist
Manager UHB “3 cases identified
on Connecting
Care today that
were already
allocated to a
health practitioner
(BCH OT or IMCS
OT) so did not
require referrals to
BCC OT”.
Occupational
Therapist Bristol
City Council
“I now use Connecting Care
on almost every case I deal
with it (approx. 25 cases per
shift). It always makes a
difference and adds
value. Every shift, acute
admissions are avoided.”
Doctor (out of hours)
“Have been able to identify trends
which have then resulted in
swifter [safeguarding]
interventions…one case where
concerns would not have
increased without Connecting
Care…”
Social Worker Safeguarding team
“Connecting Care is
brilliant…I use it to
triangulate information
from service users, to
find out about other
services involved so
that I can contact them
to inform my
assessments”
Bristol social worker
“it has enabled us to
commence discharge
planning earlier in the
patients stay to help
prevent delays later
on.”
Discharge Nurse
“Unable to obtain a
medication history
or allergy status
from the
patient….accurately
confirmed through
Connecting Care …”
Pharmacist, NBT
““Information about
the patient’s
diagnoses has helped
our team decide
which type of therapy
to offer the patient”
UHB

“On Monday I managed to obtain details for
22 patients on Connecting Care, I saved a huge
amount of time as I didn’t need to phone the
GPs and wait for the faxes to arrive” Acute
Pharmacist
“I used Connecting Care to find vital
information for the diabetes nurses . The
information logged by district nurses is a
goldmine of information. We saved 20
minutes on the telephone and managed to
find the reason for patients insulin being
discontinued” Discharge Nurse
“In cases where we are dealing with a
person who is being supported by
Rapid Response and the district
nurses, Connecting Care comes in to
its own. All the notes from visits are
documented and it can save at least
30-40 minutes on duty cases of this
nature” Social Worker “The extra patient detail
is useful when deciding
to stop drugs such as
anti-platelets and it
helps to identify risk
factors” Doctor
Having access to
accurate, timely,
shared information
is no longer a
‘blocker’ to
providing high-
quality, effective,
efficient care…
“Without Connecting Care
today I couldn’t have done
my job.” Pharmacist
“Connecting Care has been really helpful tonight.
Could not do without it. Particularly in the case of an
old lady with XX who I could not reach on the phone.
Without Connecting Care this would have resulted in a
visit and probably her door being broken down. But
with CC I was able to work out that all that should of
been done, had been done.” OOH Doctor

what’s next?
• We have come a long way in a year…but there is so much more we know can be
achieved!
Connecting Care was announced of one of three ‘NATIONAL EXEMPLAR’ sites for
clinical system interoperability
Attracting national attention
We have series of projects planned to develop breadth & depth
Sir Bruce Keogh, NHS
Medical Director visiting
Frenchay Hospital in
March 2014 to view
Connecting Care

what’s next?
In 2015 our key projects are In the pipeline…
• Rollout to 2000 users this year
• Children's safeguarding project –
sharing information from our 3 local
authorities’ children’s systems
• Document sharing – clinical and
social care documents shared in
portal...and ‘sent on’ to other
recipients (GPs) – initial focus is
eDischarge
• Lots of system replacements  (2
hospital PAS, 3 community systems,
1 social care system, 2 pathology
systems)
• New infrastructure, new data centre
with UHB hosting, re-write lots of
our ‘core config’ to support
improved performance
• Rollout to 10,000 users +
• Pharmacy (sharing more – hospital
prescribing / community pharmacy)
• Supporting cancer care
• Mobile working, patient access
• Specialist systems (renal, maternity,
dental etc etc.)
• Sharing more information from
within hospitals – e.g. assessments,
care plans
• Enable sharing of richer end of life
plans
• Better support for some workflow /
pathways

A sample of some possible financial benefits:
Admissions Prevention
10,000 users could see annual saving of £1,036,288 from admissions
prevented by using information in Connecting Care
Based on a Department of Health reference cost 2012/13 of £1,436 for a unplanned
admission and only the same rate of stated admissions prevented in the pilot
Reducing duplicate assessments
10,000 users could see a annual saving of £179,520 on stopping the
duplication of assessments as a result of using information in Connecting Care
Based on cost savings if the same rate of stated admissions prevented during the pilot
continues – based on £60 for an average cost of a face to face assessment by a
community nurse - Department of Health reference cost 2012/13
what can Connecting Care potentially offer?

A sample of some possible financial benefits:
Time savings - calling other organisations
10,000 users could see a annual saving of £155,278 of ‘people time’ as
Connecting Care users spend much less time calling other organisations for
information
Based on salary cost savings if only one call per week per user is saved where the
medium salary between NHS bands 7 to 8 is used.
Reducing home visits
10,000 users could see a annual saving of £68,000 on stopping unnecessary
home visits as a result of using information in Connecting Care
Based on cost savings if the same rate of stated home visits prevented during the pilot
continues – based on £60 for an average cost of a face to face assessment by a
community nurse - Department of Health reference cost 2012/13
what can Connecting Care potentially offer?

Connecting Care governance
SYSTEM LEADERSHIP GROUP
Connecting Care
MANAGEMENT GROUP
Connecting Care
PARTNERSHIP
PROGRAMME BOARD
Connecting Care
‘USER GROUP’
(Clinical & Social Care)
PROJECT SPECIFIC
BOARD(S)
Connecting Care
PROGRAMME TEAM
Connecting Care
LOCAL PROJECT
TEAMS
Directors of
Finance Group
Strategic
level
Oversight &
assurance
level
Delivery
level
Connecting Care
SUBJECT SPECIFIC
SUB-GROUPS

• What is Connecting Care?
• Why have Connecting Care?
– Strategic alignment - UHB
– National drivers
• Who are the partners?
• What have we delivered so far?
• What are the benefits? Tangible results so far
• What’s coming next?
• Current governance situation
Thank you for your time!
summing up

AWP ‘Joining up the Dots’
Programme
Dr Will Hall, Bristol Mental Health
Caroline Gadd, Otsuka Health Solutions

Joining the Dots
Context Approach Progress Questions
Confidential - please do not disrtribute
or duplicate
21/07/2015

Assertive
Contact &
Engagement
Bristol
Sanctuary
Employment
Service
Inpatient
Services
Women's
Crisis House
Community
Rehabilitation
Service
Bristol
Wellbeing
Therapies
Service
(IAPT)
Dementia
Wellbeing
Service
Community
Access
Support
Service
Assessment &
Recovery
Service
Crisis Service
Early
Intervention in
Psychosis
Complex
Psychological
Interventions
Service
Community Mental Health Services Men's Crisis
House
System Leadership
Primary Care and GPs
Confidential - please do not
disrtribute or duplicate
21/07/2015

Delivering better care together
or duplicate
21/07/2015

Recovery focus
Mental Health is
changing in Bristol
Confidential - please do not disrtribute or
duplicate
21/07/2015

Primary Care
Drug & Alcohol
Services
CAMHS
Asylum Services
Homeless
Services
Housing Services
Criminal Justice
System
Acute Hospital
Liaison
Social Care Services
Forensic &
specialists MH
Services
Health & Wellbeing
Board
Commissioners
Public Health
Emergency
Services
Learning
Disability
Services
Assertive
Contact &
Engagement
Bristol Sanctuary
Employment
Service
Inpatient
Services
Women's Crisis
House
Community
Rehabilitation
Service
Bristol Wellbeing
Therapies
Service
(IAPT)
Dementia
Wellbeing
Service
Community
Access Support
Service
Assessment &
Recovery
Service
Crisis Service
Early
Intervention in
Psychosis
Complex
Psychological
Interventions
Service
Community Mental Health Services
Men's Crisis
House
System Leadership
Wider Connections
Confidential - please do not
disrtribute or duplicate
21/07/2015

Why is now the right time?
System working in mental health is new…
leadership of the system needs to be
dynamic & integrating
The experience for users needs to be
seamless with smooth pathways of care
Information needs to be shared across the
system easily & allow insights that add value
Mental health services need to look ahead to
future pan-sector models of care delivery
or duplicate
21/07/2015

or duplicate
21/07/2015

“I have not been
myself for months
now”
VISIT TO GP
“I don’t know
what’s going on”
A&E VISIT
CRISIS
RESOLUTION TEAM
“Am I ever
going to feel
well again?”
FAMILY SUPPORT PLUS
CHARITY SUPPORT
“I lost my job
and I have no
idea if I can
get another
one”
HOUSING LEGAL
BENEFITS
EARLY INTERVENTION TEAM
PLUS PC MONITORING
“I’ve lost my job
and my home –
there is no future”
CRISIS +
SECTION
“I am taking
it day by day”
“I have a job but still
have good and bad days”
“Actually life
is pretty good
again”
GP
SUPPORT
RECOVERY TEAM +
RECOVER NAVIGATOR
RECOVER NAVIGATOR
INTRODUCE
RECOVERY
NAVIGATOR
RISK OF RELAPSE
RECOVERY NAVIGATOR
ALERT & INTERVENTION
RECOVERY
PLAN
REVIEW
or duplicate
21/07/2015

Change
Understanding the need
for change (SUs and SPs)
Gathering ideas for
Analytics and Technology
Working with teams on
new ways of working
Testing early versions and
getting feedback
Training and
implementation
Analytics (data
insights)
Developing insight from
data
Alerts to support
proactive intervention
Design pathway
improvements, and better
use of resources
Technology
Care pathway tools
• Assessment
• Risk assessment
• Care plans
• Progress notes
Dashboards
• System level
insights
• Management level
insights about risk
etc.
How can information be better used
across BMH to improve service
users’ outcomes and experience?
or duplicate
21/07/2015

Modelling the relative
likelihood of service
users entering crisis in
a defined period of time
duplicate
21/07/2015

Success
•Cross organisational working and collaborative nature of project teams and
project groups
•Level of Service User and Provider Engagement
•Over 100 people involved in baseline service evaluation with Service Users and
Service Providers
•Iterative build enables engagement and constant input on something tangible
Challenges
•Competing priorities with teams in transition
•Dependencies with other projects
•Integration of data systems
Learns
•So far bottom up change approach feels good
•Strong concerns over data use from some user groups
•Benefits of public-private sector partnership
•Approach to service evaluation
Progress
duplicate
21/07/2015

• Opportunity to link up with regional projects
• To explore potential areas of crossover
• To learn from other projects
Thanks for Listening
Questions….
or duplicate
21/07/2015

BaNES Interop Programme
Update
Shanil Mantri
Chief Clinical Information Officer
B&NES CCG

Background
• Population 200,000
• One main acute trust
• 27 GP practices
• Coterminous with LA
• One community provider

Approach
• Provider engagement
• Focus on clinicians/service providers
• How will we work differently?
• Defined projects

Progress
• Early on journey
• Formed an interoperability board
• Commissioned an options appraisal
• Agreed on portal solution
• Full business case: Connecting Care

Issues
• Terminology
• Resource
• Technical limitations
• Organisation buy in

Update from Great Western
Hospital, Swindon
Constantin Jabarin
Chief Clinical Information Officer
The Great Western Hospital

Update from The Great
Western Hospital,Swindon
Dr Constantin Z Jabarin
Clinical Fellow in Emergency Medicine Department &
Chief Clinical Information Officer, GWH

• Background
• Private sector
• Swindon
• Emergency Department
• Where we are now
• Vision
• Interoperability

No Data about Me without Me
Nick Leggett
Patient Contributor
Informatics as Conversation

The Healing Conversation
The agents of healing:
• The healer (the
healthcare
professional)
• The patient (the
seeker of healing)
• The bystander (the
democratic citizen)
Bystander
Healer
Healing
Patient

The Cycle of Additive CoProduction
Each agent of healing
has a different part to
play, but all are equally
necessary – and equally
valuable – to the process
CoInitiate
CoDesign
CoProduceCoDistribute
CoEvaluate

Proactive Democratic Interoperability
NHS England Five Year Forward
View
Patients will have full access to … fully
interoperable electronic health
records, and be able to write into
them.
Personalised Health and Care 2020
(NIB)
It is essential that citizens have access
to all their data… and the ability to
‘write’ into it.
This framework prioritises
comprehensive access – with the
ability for individuals to add to their
own records – by 2018

• Break Out Session A
(CCIO Group inaugural meeting)
• Break Out Session B
Challenge to delivering interoperability

SWASFT Electronic Care
System
Francis Gillen
South Western Ambulance Service Trust

The Road to Digital Maturity
Francis Gillen (francis.gillen@swast.nhs.uk)
Executive Director of IM&T
South Western Ambulance Service NHS
Foundation Trust

• Mobile Device for On Scene Use by Ambulance Crews
• Access to NHS No. and Historic Patient Records
• Clinical Capture – Presenting Condition, Observations,
Vital Signs, Treatments, Medications, Safeguarding
• Decision Support – Clinical Algorithms & NICE
Guidelines
• Service Options – Access to DoS
• Handover and Referral – Hospital, Specialist Units, GP

•Executive Summary Referral Form
•NEWS Support
•ESCR Access
•E-Handover Hospital
•GP and Specialist Referral
•Record Filters
•MiDoS

Thanks for Listening
Francis Gillen (francis.gillen@swast.nhs.uk)
Executive Director of IM&T
South Western Ambulance Service NHS
Foundation Trust

National Information Board
Update
Michael Bewell
NHS England

PERSONALISED HEALTH AND CARE
2020
Using data and technology to transform outcomes for
patients and citizens
National Information Board Work Stream 2.1: Roadmap Direction
Giving care professionals access to all the data they need
Michael Bewell Interoperability Engagement lead NHS England
Personalised Health and Care 2020: A

AS A CARE PROFESSIONAL, PAPER-FREE
AT THE POINT OF CARE WILL MEAN:
Personalised Health and Care 2020: A Framework for

DIGITAL MATURITY – “PAPER-
FREE” HEALTH AND CARE

A NEW FOCUS ON PLACES WORKING
TOGETHER TO DELIVER INTEGRATED
DIGITAL CARE
create an annual digital
roadmap outlining steps
towards being paper-free
Every local area will be invited
to:
assess and encourage
progress using a new Digital
Maturity Index

DRAFT CONTENT AND USE
Self assessment
Benchmarking
Resource
prioritisation
Digital
alignment
Learning from
Others
Continuous
improvement

FEED INTO NATIONAL
DELIVERY AREAS
Personalised Health and Care 2020: A
We have engaged with a diverse group of stakeholders from across health, social
care, voluntary and community sectors to inform our priorities:
Investment
in enabling
technology
to deliver
safety,
quality and
efficiency
Accelerate
improvem
ent across
the health
and care
system
Developm
ent of
inclusive,
viable
local plans
to
prioritise
investment
and realise
benefits
Baseline
and
benchmar
king tool to
assure
progress
and
highlight
best
practice
Developm
ent of an
open
environme
nt based
on open
interfaces
and key
standards
Utilising
regulatory,
inspection,
commissio
ning and
developme
nt levers
Creation
of a
digital
maturity
index
Sustaine
d
investme
nt in
technolog
y
Developin
g digital
capability
Creation
of local
digital
roadmap
s
Aligning
levers
and
incentive
s
Efficient
system
transacti
ons
Interopera
bility
Digitising
system
transactio
ns and
“back
office”
processes

DIGITAL MATURIY - KEY CAPABILITIES
Capabilities
for Joined
Up Care
Description Illustrative examples Outcomes/Benefits
1. Records,
Assessment
s & Support
Plans
Giving health & care professionals
the capability to capture
information for subsequent use by
others, and to use information
captured by others, supporting
better clinical decisions at the
point-of-care
• Accessing details of diagnoses
• Accessing demographics/contact
details
• Developing a single multi-agency
care plan
• Accessing detailed patient history
• Patient safety
• Quality of care
• Continuity of care
• Care co-ordination
2. Transfers
of Care,
Orders &
Comms
the capability, make referrals,
process transfers, record
discharges, summarise care
episodes and place orders to /
with other professionals
• Making a referral to another
service
• Ordering radiology services
• Discharging a patient from a
service
• Summarising an A&E episode
• Patient safety
• Quality of care
3. Decision
Support
the capability to react more
appropriately and promptly to
events happening across the
system through automated rules-
based analysis, prompts and alerts
• Being alerted to deteriorating
patients
• Being alerted to an end-of-life plan
• Being alerted to hospital
admissions
• Being alerted to a discharge-ready
patient
• Patient safety
• Quality of care

DIGITAL MATURIY - KEY CAPABILITIES
Capabilities
for Joined Up
Care
Description Illustrative examples Outcomes/Benefits
4. Remote
& Assistive
Care
the capability to monitor, diagnose,
counsel or advise patients remotely
and access experts/expert advice at
the point of care
• Telemonitoring
• Teleconsultation
• Telecoaching
• Telecare
• Patient safety
• Quality of care
5. Asset &
Resource
Optimisatio
n
Providing health & care
professionals with assurance that
highest quality physical assets are
available at the point of care at
lowest cost
• Patient tracking
• Product tracking
• Geolocation
• Patient safety
• Efficiency
6. Citizen
Activation
Giving citizens the capability to
manage their own health through
access to knowledge on their
health, care and condition, access
to support mechanisms and
transactional services
• Accessing diagnostic results
• Ordering a prescription
• Recording ‘end of life’
preferences
• Contributing patient-generated
information to the care record
• Citizen activation
• Citizen experience
• Patient safety

INTEROPERABI
LITY STRATEGY:
the development of an open environment
for information sharing based on open
interfaces and open standards.
Action
Professio
nal
Through my system
I can directly access
and contribute to
summary and
detailed care
information
Transfers
of Care
NHS
Number
Key
Priorities
Procureme
nt Guide
Interopera
bility
Handbook
Tools
Open
APIsOpen interfaces to enable information
to flow across a care pathway and be
accessed across geographies
Local Integrated Digital
Care Records (IDCR) that
link health and social care
for delivering local
information sharing needs
Local
IDCRs
Tight standards
for key
transfers of
care
GP
Systems
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.
Summar
y Care
Record
Citiz
en
Using my PHR I
can access care
information about
myself and
contribute
information
PH
R

Business Justification - Build a business case for
investment in Integrated Digital Care Records
Information Governance and standard templates
- Check I am in line with Information
Governance guidance
Citizen Engagement - Allow citizens an easy way
of engaging with their care records
Clinical Engagement - Provide clinicians with
open-source components to deliver integrated
care records
Open interfaces - providing re-usable interfaces
so that systems and software can talk to each
other
Open Requirements - A de facto business case for
use to support an Integrated Digital Care Record
(IDCR)
Open Governance - endorsed templates with
supporting guidance you can use for your IDCR
initiative
Open Citizen- common information and tools to
support citizen engagement for your IDCR
initiative
Open Viewer - Web based IDCR application for
both care professionals and citizens to use
Open Integration - re-usable interfaces and
integration engine to bring systems together into
your IDCR

LOCAL DIGITAL ROADMAP:
BRADFORD

QUESTIONS
Digital Maturity Assessment
• How will an understanding of your current position – as a
provider and a health and care economy - with respect to the
key elements of digital maturity be of benefit
• What additional advice guidance and support would you
welcome to ensure you produce the most comprehensive
digital maturity assessment?
Interoperability :
• Are you undertaking an initiative to enable interoperability
across your locality? Does it align to the interoperability
strategic direction?
• What additional advice, guidance and support would you
welcome to help you take forward your local interoperability
approach?
Professio
nal
Through my system
I can directly access
and contribute to
summary and
detailed care
information
Citiz
en
Using my PHR I
can access care
information about
myself and
contribute
information
PH
R

Lancashire Shared Care Record &
Citizen Facing platform
Declan Hadley
Healthier Lancashire NHS England &
North West Coast AHSN

Record Sharing to empowering the patient
West of England
Presented by Declan Hadley & Tony Schaffel
@declan_hadley
declanhadley@nhs.net
July 2015

Patient Activation
Hayley Fraser gets 3D-printed hand

Interoperability: Strategic Alignment

Safer services – sharing data

Consent model
Application layer
Empowering citizens – Patient activation

Integrating Lifestyle data & technology
Consent model
Application layer

Recap – Now?
Clinical Systems
Organisation A
Clinical Systems
Organisation B
Clinical Systems
Organisation C
Care Systems
Organisation D
GP Practice 3rd Sector / Other
Patient / Carer / Citizen
Discharge summaries, scanned letters, path labs results, medication, care plans..

LPRES
Less systems, more integrated, rich ecosystem
Care Systems
Organisation C
Primary Care Systems
Organisation B
Secondary Care Systems
Organisation A
H&WB Platform

O
N
D i g i t a l H e a l t h E c o s y s t e m
Share Empower Enable Knowledge
Record Sharing - Patient Activation - Channel Shift - Population Health

£
Record Sharing - Patient Activation - Channel Shift - Population Health
Workforce Change- Health Literacy- Digital Inclusion - Economic Growth

An Introduction to Patient Know
Best
Rhiannon Thomas
Patient Knows Best

PATIENT-CONTROLLED RECORDS:
END-OF-LIFE CARE PLANNING
PATIENT-CONTROLLED RECORDS:
CONNECTED HEALTHCARE

Pharmacy
Pharmacies
Secondary
care/Hospital
Community teams
Employers
Relatives
GP
Charities & Patient
Advocacy Groups
Government &
Commissioning bodies
Researchers
Social services
Mobile device and
app developers
Patient
Primary care
services
Specialist services
THE PROBLEM
SHARING OF INFORMATION
• Health system is
fragmented and doesn’t
communicate with each
other = technical
problems
• Ignores the explicit
consent of the patient =
legal issues
• Disempowers patient and
no one feels in control

Hospital services
GP
Current ways to empower the patient gives them
access to lots of information in lots of places, e.g.
patient access to GP information or hospital
information on a patient portal.
Fundamentally flawed:
• The patient doesn’t own the data
• Often read-only
• Tied to an organisation or a software provider
• Multiple sites, multiple logins
• Patient can’t share information with anyone else
• They are not portable
• Creates even more data silos, this time patient
facing
TRADITIONAL PATIENT PORTALS – THE SOLUTION?
Apps and devices

Pharmaceuticals
Pharmacies
Secondary
care/hospitals
Primary care
health services
Employers
Relatives
GP
Charities & Patient
Advocacy Groups
Government &
Commissioning bodies
Researchers
Mobile device and
app developers
Community
teams
Specialist services
Social services
THE SOLUTION

HOW DOES A PATIENT-CONTROLLED
RECORD HELP EVERYBODY?

WHAT CAN YOU DO WITH A PATIENT-CONTROLLED RECORD
• Send messages, letters, appointments and reports
• Contact and message the patient or other
professionals
• Web video consultations and remote appointments or
follow-ups

• Lab results all in one place
• Track symptoms and be alerted
• See measurements from a variety of sources,
including wearables and other devices

• Care plans for self-management
• Surveys completed remotely
• Medications
• Calendar of upcoming appointments
• Images, genetics and diagnoses

SECURE AND SAFE
• All information stored on the secure NHS N3
network in the UK, no servers outside EEA
• IGSoc level 3 compliant, ISO27001
• Overcomes liability and data protection as the
patient is sharing their copy of their information
• Information encrypted in transit and storage
• Unique private key encryption, so only the people
the patient trusts can see the information
• Open APIs for full interoperability with existing IT
systems http://dev.patientsknowbest.com
• Full medico-legal audit trail

1RANKED IN WORLD FOR PATIENT ACCESS TO
MEDICAL RECORDS
RANKED IN EUROPE FOR eHEALTH 20154 CONTINENTS
THAT PKB IS
BEING USED
ACROSS
9 COUNTRIES USING PKB
…AND GROWING
15 WORKFLOW TOOLS FOR
PATIENTS AND PROFESSIONALS
18
100
DEVICES AND APPS
INTEGRATED WITH PKB
200
PAYING SITES
USING PKB IN 2015
Messaging, care planning,
surveys, web video, symptom
tracking, resource library,
appointments, home
monitoring, medications…
English, Dutch, Polish,
French, German, Arabic,
Chinese, Russian, Welsh,
Spanish, Hindi, Gujurati,
Greek, Swedish, Portugese,
Tamil, Urdu, Turkish, Bengali
LANGUAGES TRANSLATED+
+
+
400YEAR-ON-YEAR 2015 GROWTH
%500,000
BIRTHS PLANNED FOR
MATERNITY APP IN 2016
#

“
”
THANK YOU
I really like this service... Maybe its the novelty, but having a way of interacting
with clinicians that mirrors how people use online facilities is brilliant

Open networking forum
with coffee
Thank you!

Interoperability and the Road to Digital Maturity

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