Digital Primary Care Success Stories
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Digital tools are being used to improve access to care and reduce bureaucracy in the NHS. This includes providing online access to patient records, appointment booking and repeat prescriptions for over 90% of practices. Digital tools also aim to identify health conditions earlier through risk stratification searches, templates and remote monitoring. Data is showing improvements in identifying long term conditions like diabetes and chronic kidney disease through increased register sizes and prevalence rates. Information technology systems play an important role in implementing digital primary care strategies through tools that support case finding, care planning, data quality monitoring and sharing information across stakeholders.
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Digital Primary Care Success Stories
- 1. Tracey Grainger Head of Digital Primary Care Strategy, NHS England
- 2. Digital Primary Care • Improving access for patients and citizens • Reducing bureaucracy across General Practice
- 3. Patient records Practice infrastructure Consultation access Online appointment booking Online repeat prescriptions Pre-referral diagnosis Telehealth, telecare and health living apps
- 4. Access to patient data at the point of care Interoperability to allow data sharing between health and care professionals Patient empowerment through the use of endorsed apps and other digital tools
- 5. 92% of practices offer patients online access to their Detailed Care Record Online Appointment Booking 98.7% of practices offering 8.4 million patients signed up 12% of all appointments are available online Online Repeat Prescriptions 97.4% of practices offering 8.2 million patients signed up 4% of all repeat prescriptions requested online Online Access to Records
- 6. 6% of appointments could have been dealt with by practice staff other than the GP 4% of patients could have avoided contact with the practice if self-care support had been available £29 per patient savings could have been achieved from reduction in telephone calls, appointments and administration
- 7. of 1.2 trillion Google searches are health- related 50 million visits per month to NHS Choices 49% of adults go online for health information
- 8. Diabetes and Chronic Kidney Disease Early Identification and Prevention
- 9. How do we improve early diagnosis of LTCs? How can GPs support patients to improve how their conditions are managed? How do we know that this is having a positive impact? Long Term Conditions – What Problems Are We Trying to Solve? Improve prevalence through case finding Embed high quality primary care Education Improvement in outcomes for those on LTC registers PracticeProcessesEnablers Systematicrisk stratification Proactivepatientrecall Diagnosisconsultations usingtemplates • Risk Stratification searches • Templates • Resource to run searches Systematicrecallof targetgroups Monitoring Increasing prevalence for defined conditions to target Twostageconsultation andplandevelopment Actionsfromcareplan progressed Annualreview • Searches • Care Plan Template & Training • Resource to deliver care plan Increasing number of care plans to target Participationin seminarsandpractice visits • Backfill cover Ensuringdata completeness Monitoringof outcomes • All previous enablers • Data Management Improvement in defined condition specific clinical indicators
- 10. Page 10 NHS Camden Clinical Commissioning Group WHAT ARE THE OVERALL RESULTS? • Before LTC LCS were introduced, the % of changes were ranging from 0 – 4% across 5 LTC’s. • After initiation of LTC LCS, within 6 months these changes rose up to 6%. • Within 18 months time they had blossomed upwards of up to 13% • Fast forward to 30 months and this growth is still sustainable. we are continuing to see changes developing with a positive growth of up to 5% • THIS IS GREAT!
- 11. Page 11 NHS Camden Clinical Commissioning Group SPECIFICALLY IN CKD 4312 4445 4740 5459 5464 1.70 1.80 1.90 2.10 2.40 0.00 0.50 1.00 1.50 2.00 2.50 3.00 0 1000 2000 3000 4000 5000 6000 4/1/2012 4/1/2013 4/1/2014 4/1/2015 4/1/2016 CKD Register Population Prevelance From introduction to where we are now (30 months on) in the LTC LCS Programme, the CKD Register has gone up by approximately 25% and in turn Prevalence is up by + 0.7%
- 12. Page 12 NHS Camden Clinical Commissioning Group SPECIFICALLY IN CKD 2.99 6.22 13.17 0.09 0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 4/1/2013 4/1/2014 4/1/2015 4/1/2016 % Change in CKD Register Before LTC LCS was introduced 6 months after… 18 months after.. 30 months after.. Radical growth Sustainable Growth
- 13. Page 13 NHS Camden Clinical Commissioning Group SPECIFICALLY IN DIABETES From introduction to where we are now (30 months on) in the LTC LCS Programme, the Diabetes Register has gone up by approximately 15% and in turn Prevalence is up by + 0.8 7699 8019 8055 8623 8827 3.00 3.00 3.30 3.30 3.80 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 7000 7500 8000 8500 9000 4/1/2012 4/1/2013 4/1/2014 4/1/2015 4/1/2016 Diabetes Mellitus Register Population Prevelance
- 14. Page 14 NHS Camden Clinical Commissioning Group 3.99 0.45 6.59 2.31 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 4/1/2013 4/1/2014 4/1/2015 4/1/2016 % Change in Diabetes Register Before LTC LCS was introduced 6 months after… 18 months after.. Radical growth Sustainable Growth SPECIFICALLY IN DIABETES
- 15. Page 15 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “SUPPORT” ROLE-EMIS TOOLS: REPORTS IMPROVE PREVALENCE BY CASE FINDING ACHIEVING EARLY DIAGNOSIS, AND BETTER OUTCOMES AND VALUE FOR MONEY OF LTC MANAGEMENT PAYMENT & ACTIVITY RELATED REPORTS DATA QUALITY Case finding Various LCS’s
- 16. Page 16 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “SUPPORT” ROLE- EMIS TOOLS: REPORTS (CASE FINDING) Camden CCG LCS reporting suite- a snap shot Diabetes case finding
- 17. Page 17 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “DEVELOPER”ROLE- EMIS TOOLS: CLINICAL TEMPLATE High risk Diabetes review template SERVICE SPECIFICATIONS ARE TRANSLATED INTO EMIS DATA ENTRY TEMPLATES USING READ CODES VALIDATED AND TESTED BY CLINICAL LEADS CARE PLANNING AND DEVELOPMENT OF A CONSISTENT CASE MANAGEMENT APPROACH ACROSS CAMDEN Diabetes YOC plan
- 18. Page 18 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “DEVELOPER”ROLE- EMIS TOOLS: PATIENT’S ALERTS/ POPUPS Pop-ups/alerts with in patient care records • AUTOMATED DECISION MAKING PROCESS • ALERT WILL BE DISPLAYED FOR PATIENTS WE ARE IN NEED OF MONITORING • OPPORTUNISTIC SCREENING Pop ups
- 19. Page 19 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “DEVELOPER” ROLE- EMIS TOOLS: PATIENT’S ALERTS/ POPUPS (CKD CASE FINDER) Pop-ups/alerts with in patient care records Pop ups
- 20. Page 20 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “DATA MANAGEMENT” ROLE- SCORECARD, PROGRESS MONITORING CCG Scorecard for LTC LES
- 21. Page 21 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “DATA MANAGEMENT” ROLE- SCORECARD, PROGRESS MONITORING CCG Scorecard for LTC LES
- 22. Page 22 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “DATA MANAGEMENT” ROLE- SCORECARD, PROGRESS MONITORING CCG Scorecard for LTC LES
- 23. Page 23 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “FACILITATOR” ROLE- PRACTICE VISITS & IT WORKSHOPS Specialist advice by data quality facilitators on • EMIS Tools • Enhanced Services explained • Data submissions • Performance data • Using NHS Systems – e.g. CQRS • EMIS Web Training
- 24. Page 24 NHS Camden Clinical Commissioning Group IT & SYSTEM AS “ONE POINT SUPPORT” ROLE GP IT Service Desk Desktop Support Systems Support Team Projects Support Team GP IT Support Team Application Support Email Administration Server Support RA Support Network Support Data Extractions Practice Workshop Facilitation Data Quality Services Desktop Refresh Network Upgrades Server Upgrade The IT and Systems teams offer a multifaceted approach covering all clinical IT requirements and any add-on services, requisite to the needs of the Camden CCG Member practices and community services. Community Systems Support Team Community System Design/Install MDT IT Facilitation Training
- 25. Page 25 NHS Camden Clinical Commissioning Group SUMMARY PAGE • Commissioners issued service specs • IT & Systems transformed the service specs into tools such as: EMIS Searches; EMIS Templates & EMIS Protocols. • Engaged with practices at multiple levels: Admin / HCA / PM / Practice Nurse /GP • Engaged with practices at locality level through IT workshops • Measuring the progress / achievements through scorecards • Share information with all major stakeholders • Move towards continuous development – monitoring through working group meetings at senior level
- 26. Innovative Business Intelligence Toolkit
- 27. Dr Neil Paul • I’m a Full time GP – Sandbach • I run a Clinical trials team • I help lead and manage 2 GP Federations through a company called Howbeck Healthcare. • We have won >£5million in new income for our 30 practices including a wave 2 PMCF bid. • You can contact me on neil.paul@nhs.net • Read my monthly column on the trials and tribulations of IT in primary care on digitalhealth.net
- 28. Truly successful products deliver proven solutions to problems • They aren't technology looking for a cause • They cross the chasm into real value • Identifying the ROI is key • Several Great examples • Hand writing rpt prescriptions – EMIS and others • Dealing with paperwork – Docman + others
- 29. A lightbulb moment • The local hospital sent round yet another email saying how busy it was and that it had seen 100 patients yesterday! • Loads of GPs replied their practice was busy too and that had seen twice as many that morning. • Occurred to us that there is no record of primary care activity - • Workforce is changing • Federations • Super practices • Lots of need to report activity • PMCF – extended hours • Pharmacists in practice scheme
- 30. When we asked - Locally GP partners & practice managers said • We don’t know if we are getting value for money from our staff? • We don’t have any tools to performance manage them with • We don’t know who does the work and who doesn’t • We don’t know what effect introducing a change has • We cant easily model changes • We are doing too much on paper and excel spreadsheets • We record almost everything we do but have no intelligence on what we have done • We need a business intelligence and management tool that provides real time data that is useful for the running of our practices – not just commissioning tools for secondary care.
- 31. So ApeX was born • Developed by Edenbridge Healthcare • PID at practice level • Flexible enterprise views with strong controls on what data is shared with whom • Multiple Dashboards able to focus in on topics with a robust query tool for advanced users • Live data from primary care systems able to link to other data sources
- 36. Activity, Capacity and Demand Dashboards to show
- 41. All User TypesExtended Hour Report Sun Sat Fri Thu Wed Tue Mon Morning Evening Weekend 92.25 Extended Slots / Week % Routine 5.25% Per 1000 Patients 15.8 Unused 16.3 (17%) Target / Week 685 # Weeks Met Target 32 (80%) 4,219871 Extended Minutes / Week Total extended slots 10% Booked same day 50 60 70 80 90 100 Jan 15 Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Allocated Extended / Week Extended§ 8% Routine 16% Unused Extended 14% Routine 10%3% Telephone Extended Routine Session Holder Extended Week Avg %UnusedMorning Avg Age Sex%Re-attend (Routine) Paul, N R (Dr) 1,098 (25%) 21 178 (10%) 9% (7%) 42 Bromley, P (Dr) 100 (2%) Evening 820 (26%) Weekend 8% 802 (19%) 18 0 (0%) 8% (8%) 48652 (60%) 150 (9%) 11% 698 (16%) 16 568 (72%) 15% (9%) 450 (0%) 130 (8%) 16%Robertson, L (Dr)
- 42. All User TypesActivity Trends 2995 Patients Seen Unique Patients 1814 Only seen in extended 205 (11%) Avg Attendance / Patient 1.33 Bromley, P (Dr) 802 (19%) 18 0 (0%) 8% (8%) 48652 (60%) 150 (9%) 11% 698 (16%) 16 568 (72%) 15% (9%) 450 (0%) 130 (8%) 16%Robertson, L (Dr) Registered 92% Usual GP 33% DNA 5% Routine (3%) Cancer Rheumatoid Arthritis CVH Heart Failure Stroke CHD COPD Asthma Diabetes Hypertension 5 - 16 17 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+ Age/Sex Breakdown Disease Register Breakdown 12.1 mins Average Waiting Time 0 5 10 15 20 Routine Weekend Evening Morning
- 43. All User TypesDNA Report 3.88% DNA Percent / Week Total 2,742 Average / Week 51 Session Holder Extended Week Avg Avg%Re-attendWeekend 1.0 1.5 2.0 2.5 3.0 5-Jan 5-Feb 5-Mar 5-Apr 5-May 5-Jun 5-Jul 5-Aug 5-Sep 5-Oct 5-Nov 5-Dec Per 1000 Patients 0.12 Patients With DNAs 2104 (9.35%) Day & Time Breakdown 0 2 4 6 0 1 2 3 4 5 Extended Routine Joint Session Slots 137 (5.1%) Routine 3.8% Extended 6.2% Routine vs Extended Hour Session Holders
- 44. All User TypesDNA Report Session Holder DNAs Week Avg Routine Avg Age Paul, N R (Dr) 1,098 (25%) 21 42 Bromley, P (Dr) 100 (2%) Extended 820 (26%) 802 (19%) 18 48652 (60%) 150 (9%) 698 (16%) 16 450 (0%) 130 (8%)Robertson, L (Dr) Session Holders Sex 2995 DNA Patients Unique Patients 1814 Avg DNA / Patient 1.33 Registered 92% Usual GP 33% COPD Asthma Diabetes Hypertension 55 - 64 65 - 74 75 - 84 85+ Age/Sex Breakdown Disease Register Breakdown With a prior urgent attendance Recurring DNAs (5.4%) 0 20 40 60 80 4+ 3 2 1 390 35%
- 45. All User TypesDNA Report 0 10 20 30 Cancer Rheumatoid Arthritis CVH Heart Failure Stroke CHD COPD Asthma Diabetes Hypertension 10 8 6 4 2 0 2 4 6 8 10 0 - 4 5 - 16 17 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+ Age/Sex Breakdown Disease Register Breakdown DNAs against booked appointment date 0 5 10 15 20 25 Same Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14+ Days between booking date and appointment date 0 10 20 30 40 50 60 1 2 3 4+ Weeks between booking date and appointment date
- 46. All User TypesDNA Report Session Type Breakdown Session Type DNAs Week Avg Routine Avg Age Antenatal 1,098 (25%) 21 42 Medication Review 100 (2%) Extended 820 (26%) 802 (19%) 18 48652 (60%) 150 (9%) 698 (16%) 16 450 (0%) 130 (8%)GP Morning Sex Slot Type Breakdown Session Type DNAs Week Avg Routine Avg Age Antenatal 1,098 (25%) 21 42 Medication Review 100 (2%) Extended 820 (26%) 802 (19%) 18 48652 (60%) 150 (9%) 698 (16%) 16 450 (0%) 130 (8%)GP Morning Sex Patient Location MAP
- 49. 0 200 400 600 800 1000 1200 1400 1600 1800 Wilsden Surgery (NP34234) Cullingworth Medical Practice (NP34234) Hebdon Bridge Surgery (NP34234) Kilmenny Practice (NP34234) Harden Surgery (NP34234) Ridlesdon Surgery (NP34234) Bingley (NP34234) Baildon Smith Practice (NP34234) Guiseley Surgery (NP34234) Series 1 1,500 1,550 1,600 1,650 1,700 1,750 1,800 1,850 5-Jan 5-Feb 5-Mar 5-Apr 5-May 5-Jun 5-Jul 5-Aug 5-Sep 5-Oct 5-Nov 5-Dec Appts/1000Patients (NP3402) Bingley
- 50. So what's the point? • It should allow us to automatically report activity where needed • It is allowing PMs to plan future capacity better • It can provide information on work done and by whom for appraisals and performance management • It can tell you who is needing/using the care and let you come up with new models of care • It can show affects of altering the system • It can help you understand mergers/acquisitions • Ability to build dashboards to investigate data • Lots more..
- 51. Other things we are working on: or trying to get up and running • GPAsk – a Q&A forum for clinicians and admin staff in a GP Federation including – News Events Jobs and Questions • Early adopter of EMIS remote consulting – Enterprise S&R and their new Video consultations platform. • ECG project – with Technomed • POCT - with Allere • Automatic Form creation with Niche Health • Read Coding/ Scanning project with a partner. • Out/In sourcing digital dictation with Lexacom? • Speech recognition with Nuance • GP order comms – with Sunquest • Pt Messaging project with iPlato • Looking at Medefer – referral avoidance
Editor's Notes
- Good Morning to you all. What a great opportunity it is to be with you all today to tell you about some of the success stories that have happened in primary care In my role as Head of Digital Primary Care Development at NHS England, my main remit is to support the development of a Digital Primary Care Service that is focused on: Improving access for patients and citizens Reducing bureaucracy for GPs – making better use of resources Today I would like to share with you some of the great work in primary care so far.
- There has been some amazing work happening, particularly in the Prime Minister’s GP Access Fund which covers 25k practices and 18m patients. 7 digital capabilities have been tested to support GPs to empower patients to take more control of their own Health.
- To make the vision real for patients and citizens we need to get the digital basics right: Ensure real time access to patient data when they come to our care providers Making sure that harm is reduced through digital data sharing between clinicians Everybody to have better access to apps and digital tools that will support their health and care. Digital technologies offer opportunities to improve communication as well as drive efficiencies. two-thirds of the adult population now have smartphones. The NHS could make better use of basic technologies, such as email, to enhance communications with patients. Patients having access to their own information as an aid to efficiency and shared decision making. This would be a solution to story fatigue that patients often face due to clinicians not having access to records.
- Further info: 14% of patients are signed up to online services nationally (including online appointment booking, repeat prescriptions and access to records). However, there is massive variation across the country. The ambition is for every practice to have 10% of their patients accessing online services this year. Call to action: people can go on to NHS Choices and find out how many patients are signed up for online services and also find out how to access online services from their GP
- The publication “making time in general practice” by the Primary Care Foundation and NHS Alliance showed evidence that: 6% of appointments could have been directed to other professionals in the practice and not the GP 4% of patients could of self-cared without clinical advice Research revealed if 30% of patients accessed their detailed care record twice a year in a practice of around 10K patients this would significantly reduce telephone calls by 8,020 and appointments by 4,747 with a cost saving of £29 per patient taking into account the back office efficiencies.
- Sources: 49% of adults in GB look online for health-related information [source: ONS, Internet Access – Household and Individuals: 2015 http://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/bulletins/internetaccesshouseholdsandindividuals/2015-08-06#internet-activities] Google [https://googleblog.blogspot.co.uk/2015/02/health-info-knowledge-graph.html] NHS Choices
- I’m pleased to introduce Hasib Aftab, Head of IT for Camden CCG and Dr Aythen Sohrabe, GP Clinical Lead in Camden. Camden have pooled knowledge and expertise from the CCG, primary and secondary care to tackle the problem of late and mis-diagnoses of Diabetes and Chronic Kidney Disease in the area. Using EMIS Web they are using searches, tools and tracking to make early, intelligent diagnoses of Diabetes and CKD. The programme is working incredibly well and they have recorded over 700 additional diagnoses for CKD and 700 additional diagnoses for Diabetes since the programme began.
- I’d like to introduce Dr Neil Paul, a GP in Cheshire, who is a huge technology champion. He was the IT lead for his local CCG and writes a popular monthly column on Digital Health, which you may have read. Neil is spearheading a project with the GP Federation, (covering 28 practices) and the CCG, who have pooled resources to create a revolutionary business intelligence toolkit. This tool auto extracts data from participating EMIS systems and provides granular reports which can be used to predict demands on the service and enable more effective business planning.