12. COMMUNITY
PRIMARYCARE
OPD
SPEC.
TEAMS
EMIS
System
One
SIR
SMC
Paper
SMC
G2
FRONT DOOR
UNSELECTED
PRIMARY CARE
OPD
REGION
Phone
NWAS
Patient Center
Tbc
TRIAGE
GP STREAMING
MINORS
MAJORS
RESUS
PRIMARYCARE
Manchester triage
SCM
Physical observations
ECG - tracemaster
DISCHARGE
ADMISSION
SCM
Patient flow
PAS
Phone calls
ECDS
SCM / DocMan / ECDS
Patient flow / PAS
ASSESSMENT
EAU
AAC
STU
WARD AREA
Medical
Surgical
Level 2 / 3
Specialty area
Theatre
DIAGNOSTICS / CARE / PHARMCY
Radiology
SCM
TheatreMan
Anaesthetics platform
Pagers
Paper task lists
ICNARC
CUR
Laboratory
Histopathology Spec. consults
Cardio-resp Endoscopy
SCM / CRIS / PACS
Paper / SCM / Spectra
Tracemaster / Vitalograph…..
SCM / Telepath
SCM / Paper / Phone
SCM / ???
DISCHARGE PHASE
Repatriation
Discharge home
IMC / Stepdown
Mortality
SCM
Datix
SCM
Tbc
SCM
Paper / phone
Ascribe / EMIS
Home iv / Diabetes team
CAST / Heart failure team
Specialty nurses
Hot clinics
Virtual care
District nurses
AHP
SCM
Paper
Malinko
Pharmacy SCM / Ascribe / EMIS / Robot
Intrducr
Set topics
Post question of what we are – healthcare delivery that uses IT or fundamentally an IT company that delivers healthcare? What was the last major process or organsiaitonal change that you can recall that did not have a significant digital component eitehr in the design / planning / execution / sustainability
Salford
- what define us
- QI
- engagement
- digital
- high level of digital maturity
- GDE status
- risk associated with both of these features?
Then NCA and ICO footprint
What do we want from digital – what problems are we here to solve?
What do you want?
How do we see digital improving
- standardisation
- reduction in variation
- automation
- happy staff
- reduction in ‘low level’ thinking
Where does cost feature
What about outcomes
What about long term outcomes – this links to system and service design
Talk about the value of data / the new oil. Can also be the new asbestos; what does this mean?
Media abuse of the term big data. Data science
Things only have value if there is action / output
Basic ingredients are cheap but when combined by a skilled chef their value exponentiates
Data in context becomes information
This can then expand our knowledge (mental map of the world) and support decisions
The further we get down this road, the greater value we relise from data
There are challenges
- who owns data (GDPR gives rights but not ownership)
- who is responsible for data quality. If this resource is so valueable then where is our QA investment
- are we collecting data correctly (we spend lots of time entering semi structured information into monolithic systems and then ask ourselves how to return this data – how long do EPR have left. When will we move to a position of data liqudity allowing us to surface the right information when we want it)
We are all familiar with this
But what drives this
Right infromation -> right person -> right time???
Data is both a product of healthcare delivery and a driver for it
This is limited…..
Tech can change the nature of a workforce / specific roles
AI can support but is unlikely to replace doctors
However where could roles be
- enabling
- safety netting
- basic functions e.g. chatbots
- decision support
- voice chat / mental health
What is the role for regulaion
Who wathces the watchmen
Do we understand enough about deep learning / are our fears those of the luddites
Ongoing Topol review – interim draft published late June
- how will technologies change the profession
- what does this mean for skills in the workforce and lifelong learning
Where else should we focus? Patients; generate own data; drive self management
NHS digital academy (300 intake – should support this). But what are the routes in?
What about changing nature of work? Developing new groups – clincial data scienticsts / medical software engineers
How acan we assess the value – this is not an individual trust exercise
Digital interventions e.g. Apps (NHS app library, Orcha
Plans for how to engage clinical staff with user generated data / where to store and record this
There are always concerns about data security – often this relates to system use and SOP
Is this fair
What have we done to protect Dave?
Ultimately we need to have systems that people can use and want to use
Who has a pretty EPR that no users moan about…..
What is design – not just what it looks and feels like but how it works
How do we engage our users in development
- understand the role of a system or document
- prototype
- iterate
- review
- learn
- eye track
- consider heuristis such as banner blindness
Organsiational buy in at all levels
Explaining the concept
Selling a vague value proposition
Competing projects
BYOD
Alignment of enabling systems
Not paying for what we can do
Understanding what we could but shoud not do do
Scope creep
Too much scope trimming
Coming back to the idea of a control center
- what is this
- what could or should it be
Is it a thing / a system / a process
Do we need a building
What do we want it do do
Why do we want it to do this
Highest level we want to be proactive rather than reactive
Know decision are being made based on a standard set of data
Measure responses and understand optimal
Think about 4 areas (IP OP Theatres and Region)
TO engage the market, how can we communicate to them
What is a realistic discussion
- e.g. is Reduce LOS ok?
- what about competing / conflicting drivers
Input or output based spec
Or risk based spec?
How will we map this to our process
Patient journey
System interactions…
Amazingly people get though this regularly….
This is too complex!
Control center evokes idea of screens on walls
Comes back to garbage in and garbage out
Need to think of these drivers as the detail of the higher level specification
How would you conceptualise how to id where we need to palce work / ssytem s/ efforts (project matrix)
Lots of ways to describe risk and impact
Digestable / communciable
Preference is a bow tie diagram
Other tools?
Explan chart
Repeat this multiple times to generate heirarchy of needs
This drives spec
Speaks to the fact that tech alone cannot change the whole system
Allows us to measure success
Allows us to understand component value e.g. if something ocvers 90% of use cases then ROI more likely
Look to the region
SRFT hosts
- renal
- neuro
- spines
- neurosurgery
- dermatology
All have large catchment
All mix IP and OP
All run their own processes for transfers
Risks / problems?
Daily average = 35 unique calls / day from external sites
Average time for discussion and documentation = 9 minutes
Total StR time costs to SRFT = 5.25 hours
11% of callers waited >15 minutes for initial response
>1000 referrals
Onboarding ~50 doctors per month
Critical mass reached
Increase in activty – before regional rollout 90 / month now 140
This was unmet demand
Used in all referring sites
Operational information / service change
Now not paying a StR to answer the phone – 05 wte released. Clinics / internal support
Understand:
Activity over region by site / acute bed base
Track of transfers
Types of patients
Acuity
Where to place resource
Expansion of rollout
Finalise vendor partnerships
Digital operating model….
