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Creating a target architecture for a learning health
- 1. Creating a Target Architecture for a learning health and care system Supporting: - Information sharing - Population health management - Innovation Phil Stradling Interoperability team of Domain D, NHS England
- 3. End of life care prompting key preferences Vaccinations and immunisations history Visual comparison of medications Prescribing alerts Encounter timelines Long term conditions (trending and recall) Pre-population of pre-operative assessment PATIENT STORIES
- 6. • Establishing local health and care learning systems • Enabling a local/regional approach to information sharing and population health management. • That sharing of information based upon the local trusted relationship between citizens and health care professionals • Data should be controlled as close as possible to source • Recognising that some information will be shared nationally for improving patient care but only with the appropriate controls in place
- 7. Overview of business capabilities for information sharing and population health
- 8. 1. STP characteristics: • Self-organising community & learning healthcare system • Accountable care models • Commissioning of new models of care – MCP, PACS etc • Establishes diameter of trust – e.g. 2 to 5 million 2. STP governed “platforms”: • Operates shared services and open APIs • Customer experiences for providers, patients, commissioners, and designers • Reflects many local digital roadmaps (LDR) 3. Use of national services by STPs: • Interoperation with PDS, SCR, eRS etc • Provision of data sets to national data platform • Adoption of standards and guidance e.g. IGA, Data Security • Re-use of GDS services: e.g. Verify Social care Hosp GP PACS MCP Providers STP Platform - for shared services • Information sharing agreement • Information exchange • Patient facing apps • Care planning • Clinical repository • Pop health analytics STP leadership & governance x44 Operates a “platform” of services that meet regional needs Interoperates with local providers and national platforms
- 9. Design guide for Target Architecture - Peer to Peer pattern 9 National ServicesPDS SCR SUS ERSMESH Risk Stratification and Clinical Analytics (some reidentification) PHR Data Stores PHR Platform API PHR Platform PHR Apps Telehealth Management Platform API PHR Platform Telehealth Apps ETL Analytic Data Set Extraction Pseudonymisation Population & commissioning analytics Analytics Data Store Research Analytics IoT Data GP Data Stores GP Systems 111 Data Stores Local 111 Systems GP Data Stores GP Systems Ambulance Data Stores Local Ambulance Systems GP Data Stores GP Systems Other STP Data Stores Other STP Systems Acute SystemAcute Data Store Local Acute System Acute Data Store GP Data Stores GP SystemsGP Data Stores Local GP Systems Acute SystemAcute Data Store Local Data Store Other Local Systems STP Area of ownership API APIAPIAPIAPI APIAPIAPIAPI EPS Data Sharing Agreement & Consent Mgt Master patient Index Patient Identity Service Templates and Terminology Authorisation & Authentication Service Record Location & Registry Common Services DRAFT 1.1 - 12.4.17
- 11. GNCR architecture for data sharing across footprint and other regions 11
- 12. Hosp A Providers STP “Platform” STP leadership & governance team Use case: • Dr Lowndes needs to assess Michael and do meds reconciliation • Technically, his EPR system needs to call APIs to get data as FHIR resources from GP, MH, Diabetes providers Process: 1. Providers A and B have signed ISA to share data and use platform services 2. Providers A and B have systems that support FHIR APIs 3. Provider B notifies RLS of reference for each patient 4. Provider A finds reference for a patient 5. Provider A presents SSO token and request for access from authorisation service 6. Provider A present access token to provider B 7. Provider B responds with requested FHIR resource Required Capabilities: 1. STP has used ISA tool to define permitted data flows, and access rules 2. Record location service in use to register references 3. Authorisation service supports OAuth standard and IG rules, e.g. RBAC 4. Provider systems support FHIR profiles and standards 5. Identity federation supports OpenID Connect to broker single sign-on Record location Info Sharing Agreement Authorisation service Identity Federation I have a text to remind me of appointment with Dr Lowndes Use case: I need to review meds from GP, Diabetes and MH teams Request access token Get Meds using access token GP EPR Mental Health EPR Diabetes team EPR Dr Lowndes, Liver disease specialist STP Get record locations
- 13. • Recommends a phased approach to digitisation • Phase I (2016 – 2019) • Target digitally mature providers • Combine local resources with national funding • Enable them to take the next steps • Phase 2 (2019 – 2023) • Target trusts that have needed longer to prepare • All trusts digitally mature by 2023 Digital Exemplar Programme STP-led investment Global Digital Exemplars 13
- 14. Global Digital Exemplars: Objectives Create a network of world class organisations which support high quality care with digital technology Demonstrate how to transform care with digital technology Improved efficiency, productivity and quality through optimising working practices Shared learning with other programmes and organisations Standard system builds, template business change/deployment approaches and common operating processes A vibrant responsive market place
Editor's Notes
- A cohort of organisations GDEs selected as they demonstrably have the capability to become world leaders in digitally enabled healthcare, providing the opportunity to showcase good practice, catalyse and support continuous improvement in digital maturity across the NHS to improve patient outcomes and enhance operational effectiveness. The exemplars will demonstrate how they can improve the processes of delivering healthcare and use information to better inform decision making.
- Programme outcomes include improved efficiency, productivity and quality through optimising working practices enabled by improved utilisation of the Electronic Patient Record, achieving interoperability with the health and care system, whilst ensuring an effective cyber security framework. GDE’s will inspire, support and share best practice with other providers. GDE’s will develop standard system builds, template business change/deployment approaches and identify common operating processes to enable accelerated adoption and reductions in the costs of systems and deployments. This will be a key element of the overarching Provider Digitisation Programme which aims to secure excellence in the use of digital technology to support transformational change in the NHS.