Presented by Indi Singh at Commissioning Live at the NEC, 30th June

2. Strategic context for commissioners
Key clinical priorities
Working with local organisation on progressing
Key priorities for commissioners
Examples of what’s been achieved at a local level

3. Electronic record/case file
Capture information electronically for use
by me and others, at the point of care
Population health & care management
Analyse data effectively for the benefit of
the wider population
Decision Support
Receive automatic alerts and notifications
to help me make the right decisions
Remote & assistive care
Use technology to provide care remotely
Transfer of care
Seamlessly transfer information
between and within care settings,
to follow my patient
Asset & resource optimisation
Use technology to understand what is
happening and where, at all times

4. Urgent &
Emergency Care
End of life care Complex long-term
conditions
Mental Health

5. Every local area will:
assess and encourage progress
using a new Digital Maturity Index
create an annual digital roadmap
outlining steps towards being paper-free

6. the development of an open environment
for information sharing supporting
emerging models of care based on open
interfaces and open standards.
Open APIs
Open interfaces to enable information to flow across a
care pathway and to be accessed across geographies
Procurement
Guide
Interoperability
Handbook
Tools
Transfers
of Care
NHS
Number
Key Priorities
Tight standards for
key transfers of care
GP Systems
Open interfaces from national
systems such as SCR to simplify
access and contribution.
Expansion of SCR for access by
additional care settings and
additional critical information.
Summary
Care Record
Local Integrated Digital Care Records
(IDCR) that link health and social care
as main approach for delivering local
information sharing needs
Local IDCRs Professional
Through my system I can
directly access and
contribute to summary and
detailed care information
Citizen
Using my PHR I can
access care information
about myself and
contribute information
PHR
Patient Record Index
Ability to locate patient record information that
can then be accessed through open APIs

7. • “Interoperability” wide and expansive term and overly technical
• Breaking down “interoperability” into meaningful parts
• Key priorities e.g. use of NHS Number, Transfers of Care
• Key blockers e.g. information governance guidance
• Future direction – new ways of information sharing
• Scope across health and care
• Co-creation of products to assist local organisations, developed in
conjunction with local organisations such as Integration pioneers
• Facilitating communities on information sharing
• showing local best practice and direction of travel

8. Wave 2
Wave 1

9. Driving priority standards
for information sharing
Collective guidance on
breaking down “myths”
Understanding common
and priority needs
Articulating direction of
travel

10. Focus on NHS Number – driving up adoption and
use of the NHS Number across health and care
settings
• National baseline across health organisations in
use of NHS Number
• Guidance to local organisation for access to the
NHS Number
• Working with local pioneers on best practice and
case for usage
http://systems.hscic.gov.uk/nhsnumber/staff/factsheet.pdf

11. NHS Standard Contract 15/16 - new requirements:
1) Sent by provider of Acute services, by an NHS Trust or an NHS Foundation Trust to a GP, NHS Trust or NHS Foundation Trust – must be by
secure email or direct electronic transmission from 1 October 2015
2) All providers must be able to send and receive Discharge Summaries or Post-Event Messages using all applicable Delivery Methods
Option until
end of 2015
Option until
end of 2016
2017
Onwards
Unstructured
Free Text
Locally Approved
Template
Structured
Headings
(including free text)
Coded Elements
Currently
May Release
June/July Release
Paper Email - PDF Kettering - XML Structured Message (CDA)
The larger the cross,
the higher levels of variation
of content and structure

13. • 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
• Our first deliverable has been a shared ‘view only’ electronic patient
record (using the Orion Health ‘portal’)
is the Bristol, North Somerset and South Gloucestershire
programme, dedicated to using technology to support:

14. 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 times – reduces time trying to find out information
• Reduces risks – where patients unable to inform clinicians about relevant
information/fax errors etc.

15. “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 was logged by
district nurses is a goldmine of information. We saved
20 minutes on the telephone and managed to find the
reason for patient’s insulin being discontinued.”Discharge
Nurse
“The extra patient detail is useful when deciding to
stop drugs such as anti-platelets and it helps to
identify risk factors.”
Doctor
“Without Connecting Care today I couldn’t
have done my job.”
Pharmacist
“In cases where we are dealing with a person who is
being supported by Rapid Response and the district
nurses, Connecting Care comes into 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
“Connecting Care has been really helpful tonight. Could not
do it 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. With CC I was able to work
out that all that should have been done, had been done.”
OOH
Doctor
Having access to accurate, timely, shared
information is no longer a ‘blocker’ to
providing high-quality, effective, efficient care

16. 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

17. 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
A sample of some possible financial benefits:

18. Line of business systems that ‘share’
• You cannot share paper data easily
• Good electronic ‘line of business; systems that share data are critical
Integration Partner • Integration is tricky, find a software partner who ‘gets it’
Money – locally owned money • Invest locally – seek national money too, but make your local
organisations put skin in the game
People – local talented people • Hire really talented project people – we did
SPIRIT
• Overrides everything else
• Stamp on ‘organisationally centric’ thinking at every single opportunity
• Command the moral high ground that the patients/citizens best
interest occupies

19. Evidence from episodes of unscheduled care at Southampton and
Portsmouth hospitals
Unsuccessful View – An attempt was made to access the HHR record for the patient,
but not data was available, because:
• GP practice not sharing
• GP using TPP SystmOne (not currently able to share data)
• Patient from Prison or Armed forces)
No Attempt View - No attempt was made to access patient’s record on HHR
Deep Dive View – Patient’s HHR record was accessed during the course of the
episode and data available in the record

20. Discharge Destination
HHR View Status
Deep Dive
View
Unsuccessful
View
Admission 2,286 282
Discharged – no follow up 250 10
Percentage patients admitted 72%* 81%*

21. Avg Pathology
Tests/Pt
Deep Dive
View
Unsuccessful
View
Significance
Biochemistry 50.3 60.27 0.01*
Cell Path 0.05 0.04 0.14
Haematology 59.1 66.9 0.01*
Medical Imaging 1.05 0.56 0.01*
Microbiology 3.32 3.45 0.37
All Tests 113.9 131.2 0.01*
* Statistical significance <0.01

22. Excellent Start but we want more…..

23. Hospital and GP data
100/107 GP practices live
1500+ users
Access being rolled out across:
Mental healthPrimary Secondary Community Integrated Neighbourhood teams