Integrated  Digital  Care  Record  Programme  

April  2015  Dean  Davidson  

BDCT  -­‐  IDCR  Programme  Manager  

Na@onal  NHSE  Accelerator  Sites:  

Bristol:  University  Hospitals  Bristol  NHS  FT,    North  Bristol  and  Weston  Area  Health  Trusts,    CCGs,  Community  providers,  CSU,  Out  of  Hours  providers,  Local  Authori@es  

Cumbria:    Cumbria  Partnership  NHS  FT,  Cumbria  CCG,    University  Hospitals  of  Morecambe  Bay  FT  (UHMB)  and  North  Cumbria  University  Hospitals  NHS  Trust  (NCUHT)  

Bradford  &  Airedale:  Bradford  District  Care  Trust,  Airedale  NHSFT  (Acute),  Bradford  Metropolitan  Council  (Local  Authority),  Bradford  Teaching  Hospital,    3  Bradford  &  Airedale  CCGs  All  87  GP  prac@ces  

2

Working  in  Partnership:    

 

Global  Evidence  Base  (1):  Literature  Review  Conclusion:  • Prevalence  of  eHealth  systems  is  good,  but  prolifera@on  of  detailed  Social-­‐Health  Informa@on  Exchange  (S-­‐HIE)  is  low.  • Few  regions/countries  have  delivered  systems  that  transfer  real-­‐@me  detailed  informa@on  between  providers.  • Evalua@on  of  systems  suppor@ng  S-­‐HIE  do  not  offer  a  persuasive  argument  &  examples  are  not  homogenously  transferable.    • Successes  in  propaga@on  of  emergency  summary  record  access  mostly  a]ributable  to  a  ‘Top-­‐Down’  mandate  and  funding.    • Lack  of  stakeholder  engagement  in  the  design  and  implementa@on  of  systems.    • Historical  model  of  ‘Siloed’  care  provision  does  not  readily  lend  itself  to  pa@ent-­‐centred  integrated  services.  

Global  Evidence  Base  (2):  Literature  Review  Conclusion:  •  Governance  and  policy  arrangements  around  the  consent  model  to  

implement  sharing  have  yet  to  be  established  in  many  regions.  •  Eventual  establishment  of  interoperability  and  data  transfer  

standards  have  enabled  the  evolu@on  of  system  deployments  •  Technology  implementa@ons  in  favour  of  systems  to  enable  care  

pathways,  designed  by  clinical  prac@@oners,  is  emerging.  

Recommenda:on:  •  It  is  impera@ve  that  the  Health  and  Social  care  economy  move  rapidly  

to  establish  what  a  fully  shared  record  should  contain,  what  priority  different  stakeholder  groups  place  on  the  varied  informa@on  available  and  what  such  a  shared  record  will  enable  for  the  redesign  care  models  to  facilitate  a  sustainable  and  tangible  S-­‐HIE.    

Integrated Digital Care

Record

Community Nursing

Information

Out of Hours

Child Health Admin

GP Records

Mental Health

Summaries

Airedale Acute Patient

Records

Bradford Acute

Summaries

Local Authority

Programme  Overview  

Programme  Overview  What  is  the  IDCR?  • A  shared  electronic  service  user  record  across  Health  and  Social  Care  • Provide  access  to  all  primary,  secondary,  ter@ary  and  social  care  prac@@oners  who  have  a  legi@mate  rela@onship  with  that  service  user    • Access  to  relevant  informa@on  at  the  point  of  care  • It’s  a  cri@cal  enabler  of  the  Integrated  Care  for  Adults  Programme  (ICAP)  

Local  Stakeholder  Groups  

Pa@ents  

GPs  &  LMC  

Community  Services  

Mental  Health  Staff  

Local  Authority  Staff  

Acute    Trust  Staff  

CCG  &  NHSE  

Working  in  Partnership  •  This  project  supports  the  delivery  of  an  IDCR  through  an  fully  integrated  sobware  solu@on  in  conjunc@on  with:  –  Airedale  NHS  Founda@on  Trust  (ANHSFT)  -­‐  NHS  –  Bradford  District  Care  Trust  (BDCT)  -­‐  NHS  –  City  of  Bradford  Metropolitan  District  Council  (CBMDC)  –  Local  Authority  –  Bradford  Teaching  Hospitals  NHS  Founda@on  Trust  (BTHFT)  -­‐  NHS  –  NHS  Airedale,  Wharfedale  and  Craven  Clinical  Commissioning  Group  –  NHS  Bradford  City  Clinical  Commissioning  Group    –  NHS  Bradford  Districts  Clinical  Commissioning  Group    

Integrated  Care  for  Adults  Programme    

What  is  ICAP:  • An  ambi@ous,  mul@-­‐organisa@onal  transforma@on  programme  across  health  and  social  care  • Covering  Bradford  and  Airedale,  dovetailing  services  delivered  in  Craven  with  North  Yorkshire  Council.    • ICAP  takes  a  holis@c  view,  is  pa@ent  focused  and  will  deliver  IDCR  resul@ng  in  ‘right  care,  in  the  right  place,  first  @me’,  for  local  people.    

Coordina@ng  Care  

Coordina@ng  Care:  • General  prac@ce  • Community  nursing  • Community  therapy  services  • Mental  Health  • Social  Services    • Intermediate  and  secondary  care  providers    

Integrated  Care  Aims  

The  main  aims  of  ICAP  are:  •  Integrate  health  and  social  care  around  the  needs  of    individuals,  delivered  locally  

•  Reduce  costs  associated  with  unplanned  admissions  •  Increase  community-­‐based  capacity  and  capability  •  Increase  access  to  rehabilita@on  to  support  health,  well-­‐being  and  independence  

Underpinning  Aims  of:  

“Func@onal  silos”  Vs  Pa@ent  centric:  Traditional Approach New Approach (Patient Focused) Care is based primarily on visits by or to specialists Care is based on continuous healing relationships

within a multi functional team

Professional autonomy drives variability in methodologies

Care is customised to patients needs and values

Professionals control care as one speciality at a time – resulting in “pass the parcel”

Diagnosis of patient need is the source of control

Information is a record (passive) Knowledge is shared and information moves freely and instantaneously (prompts, warns and escalates)

Decision making is based on narrow training and experience

Decision making is evidence based via multi-function diagnosis and action

“Do no harm” is an individual responsibility Safety is a system property and is managed by a team

Secrecy is necessary Transparency is necessary – information flows rapidly (pushed?) to all who need it

The system reacts to fragmented needs – no “system view” of patient care

Needs are anticipated by cross functional “round the table” diagnosis and care planning

Cost reduction is sort function by function and not by elimination of waste and duplication from the total process

Waste is continually decreased by careful team orientated process design and leadership. Care becomes proactive and anticipatory

Preference is given to professional roles over system performance needs

Team based co-operation among clinicians and technicians is a priority

Where  did  we  start?  

Where  did  we  think  we’d  get  to?  

What  are  we  aiming  for?  

IDCR  Plans  

•  Each  of  the  3  main  partners  have  a  number  of  work  streams  in  place  to  establish  an  IDCR:  – BDCT  –  5  SystmOne/RiO  Integra@on  streams  – ANHSFT  –  5  op@misa@on  of  SystmOne  streams  – CBMDC  –  3  streams  suppor@ng  the  deployment  of  SystmOne  ini@ally  in  to  Adult  Social  Care  Services  

Approach:  Eliminate Simplify Integrate Automate

The  use  of  paper  referral  forms  

   Duplica@on  of  data  

entry      

Duplica@on  of  similar  assessments  

   Paper  discharge  summaries

   The  Referral    process  

   The  SPA  

administra@ve  process  

   Informa@on  sharing  

   Access  to  services  

 

Transfer  of  informa@on  between  clinical  systems  &  

providers      

Poten@al  merge  of  the  rolls    

during  triage

   Registra@on  of  

pa@ent(s)  in  clinical  system  

   Data  quality  checking  

   Pa@ent  demographic  

updates  and  matching  

 

(ESIA Source: Peppard and Rowland 1995)

BDCT  Programme:  BDCT  Programme:  

BDCT  Programme:  Stream  1:  Review  Rio  func@onality  and  

 upgrade  improved  version    Stream  2:    Electronic  referrals  and  RiO  

 electronic  discharge  no@fica@on  to    GPs  

 Stream  3:  Clinical  Record  Viewer  (SystmOne  

 CRV)  for  Non-­‐urgent  care  RiO  users    Stream  4:    RiO  Integra@on  for  wider  health  &  

 social  care  community  (Sharing  RiO    Informa@on)  

 Stream  5:    Clinical  Systems  Op@misa@on  

Integra@on  Message  Transfer:  

RADT Integration for all

Services

Patch-wide Integrate Digital Care Record

BDCT  Stepping  Stones  

Basic Transactional Integration for SPoA

Read Only Access to Primary Care Record for Acute RiO Users

RADT Integration for Acute

Mental Health

Stage One

Stage Two

Stage Three

Stage Four +

RADT = Referrals, Admissions, Discharges & Transfers

Now support the Integrated Care for Adults

Programme (ICAP)

“Right care, Right place, First time”

ANHSFT  Programme:  Stream  1:    E-­‐discharge.    Stream  2:    Electronic  Prescribing  and  Medicines  

   Administra@on.    Stream  3:    Service  Reques@ng  na@ve  to    

   SystmOne.    Stream  4:    SystmOne  PAS  system  enhancements  

   including  bed  management.    Stream  5:    Therapies  on  to  SystmOne.    

CBMDC  Programme:  Stream  1:    Unifica@on  of  social  care  records  with  

   health  records  in  the  District    Stream  2:    Support  social  workers  in  the    

   budgetary  elements  associated  with      care  planning  

Stream  3:    Alloca@on  of  enablement  services  to      op@mise  individual’s  capability,  prior      to  final  assessment  for  a  care        package.  

Programme  Objec@ves:  As  per  NHSE  Expression  of  Interest  &  Integrated  Care  for  Adults  Programme:    1.  Integrate  care  across  primary,  secondary,  community  health  

and  social  care  around  the  needs  of  individuals,  delivered  locally.  

2.  Reduce  costs  associated  with  unplanned  admissions  and  unnecessary  appointments.  

3.  Increase  community-­‐based  capacity  and  capability.  4.  Increase  access  to  rehabilita@on  to  support  health,  well-­‐being  

and  independence.  5.  Coordina@on  of  care  packages  reducing  gaps  and  overlaps  in  

service.          

Actual  Benefits:  Improved  informa:on  sharing:  

!        Improve  pa@ent  and  staff  experiences  !      Improved  clinical  accessibility  to  client  data  !   Reduced  clinical  risks  (through  loss  of  paper)  !   Reduc@on  in  medica@on  errors  and  treatment  delays  

Reduced  duplica:on  of  effort:  !      Reduced  data  entry  duplica@on  !      Reduced  administra@ve  overheads  (QIPP)  !      Support  achievement  of  Integrated  Care  Programme  

BeMer  U:lisa:on  of  Scarce  Resources:  !      Increase  in  releasing  @me  to  care  !      Scalable  solu@on  development  through  joint  working  !      Informed  developments  of  patch-­‐wider  integra@on  solu@ons  

Lessons  Learned:  1.  Bridge  the  gap  between  senior  managers  and  users  

(Communica@on,  Communica@on,  Communica@on)  

2.  Make  sure  the  service  is  ready  for  the  change                    (Healthy  Ambi@ons  roll  out,  consistent  system  usage  &  consistent  terminology)  

3.  Plan  for  resistance,  by  ascertaining  levels  of  current  Vs  required  commitment  from  stakeholders  

4.  Sharing  of  informa@on  is  not  possible  without  some  form  of  “Interagency  Sharing  Agreement”                                              (Senior  IG  level  buy  in,  informa@on  sharing  cultural  &  review  data  controller  models)    

5.  Start  Small,  be  flexible  and  focus  on  the  objec@ve        (especially  with  suppliers)  

6.  Include  these  lessons  in  future  stages……  

A  word  from  our  sponsors:  

“When  organisa@ons  compete  but  don’t  offer  to  integrate  their  services,  the  result  is  clear  they  don’t  get  the  business”.    “It  is  in  the  interests  of  every  provider  to  offer  the  greatest  possible  degree  of  integra@on.  Even  with  those  they  are  compe@ng  directly  against”.  

HPI, 2012 Source: http://www.healthpolicyinsight.com/

Working  in  Partnership  

We’re  in  safe  hands:  

Jeremy Hunt, Health Secretary – Sept 2012

Programme  Contacts:  

•  Dean  Davidson  -­‐  IDCR  Programme  Manager  -­‐  Bradford  District  Care  Trust  Mob:  07508  108  754  Email:  Dean.Davidson@bdct.nhs.uk  

•  Doman  Cath  -­‐  Programme  Director  Integrated  Care  -­‐  Bradford  City  and  Districts  CCG’s                                                  Cath.Doman@bradford.nhs.uk