"taking forward information sharing"
TRANSCRIPT
Taking forward Information SharingHealth Insights June – July 2106David WallerInteroperability Engagement Lead, NHS England
Strategic context
Breaking down “interoperability”
What this means for professionals and citizens
Current priorities
Working in conjunction with localities and the market
The development of an open environment for information sharing supporting emerging models of care based on open interfaces and open standards.
Open APIsOpen interfaces to enable information to flow across a care pathway and to be accessed across geographies
Local shared care records that link health and social care as main approach for delivering local information sharing needs
Tight standards for key transfers of care
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 IndexAbility to locate patient record information that can then be accessed through open APIs
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
• Breaking down “Interoperability”
• Key priorities - NHS Number, Transfers of Care
• Focus on opening up key systems (Open structured APIs) for key clinical priorities based upon industry standards - FHIR
• Working directly with localities and clinicians on needs and market on solutions – the “Community”
• Not seen as national organisations in an ivory tower
• Supporting localities to be more “informed customer” in implementing information sharing approaches
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97% Of localities using NHS Number as primary identifier when sharing information
66%Of localities sharing discharge summaries electronically
StandardsLevers Incentives Service change Technical Capability
Professional endorsed standards
• Developed initially by the Royal College of Physicians (RCP) and published in July 2013
• Signed off as fit for purpose by
50 organisations that give professional leadership to the medical, nursing and clinical professions
• Adopted by the Professional Records Standards Body (PRSB)
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Discharge summaries
Nov 2015
March ‘16
National Information Board
Interoperability Strategy published
Over 95% of hospitals using NHS Number in
clinical correspondence
Launch Interoperability Community bringing together localities,
vendors and national organisations
Over 70% of hospitals sharing discharges
electronically
Use of FHIR APIs for
workflow and accessing
record starts
Discharges shared using professionally endorsed
clinical structure
Key APIs Transfers of CarePrimary IdentifierFocus on key priorities
Change the dynamic
Nov‘15
Jan‘15
Nov‘14
Sept‘16
Dec‘16
End of life care prompting key preferences
Vaccinations andimmunisations history
Visual comparison of medicationsPrescribing alertsEncounter timelines
Long term conditions(trending and recall)
Pre-populationof pre-operative assessment
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Clinical Scenario Drivers/Benefits
Why Structured and Real-time
Elements on GP Record Needed Supplier Capability
1.Visual Comparison of Medications
Drivers: • Medication errors are the third most prevalent source of reported patient
safety incidents in England• Prescribing errors are the most important cause of medication errorsBenefits: • Reduction of safety issues on manual transcription• Medication errors reduced as have up to date medication list• Time taken to have to compare across tabs/systems
Cannot create a consolidated list from sets of information that are in different read-only views.
Have up to date medication information.
• Medications EPRs systems e.g. Cerner, Orion, Allscripts and shared records already able to provide functionality
2.Prescribing Alerts
Drivers: • Medication errors are the third most prevalent source of reported patient
safety incidents in England• Prescribing errors are the most important cause of medication errorsBenefits: • Reduction in safety incidents due to lack of contra-indications
Cannot proactive prompt from information that is in a read-only view.
Have latest allergy, problem information
• Medications • Allergies• Diagnosis• Problems
EPRs/shared record systems e.g. Allscripts, Connecting Care are already able to provide functionality
3.Long-term condition patients(trending and recall)
Drivers:• Reduction in avoidable cost for long term condition management e.g. an
estimated 80% of the costs of diabetes come from the management and treatment of avoidable diabetes-related complications
• Recalling people safely on time – e.g. repeat obs/testBenefits:• Proactive intervention in long term condition management• Avoiding unnecessary drug administration• Avoiding safety incidents where drugs administered incorrectly as have
real-time access to latest trend information
Cannot proactive prompt from information that is in a read-only view.
Have access to latest readings and their trend to manage intervention.
• Medications• Diagnosis• Problems• Investigations• Observations
Some EPRs/shared records already able to provide trending and recall functionality
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Clinical Scenario Drivers/BenefitsWhy Structured and Real-time
Elements on GP Record Needed Supplier Capability
4.Prompting on key preferences
Drivers: • NICE guidance on improving end of life for people in their last days• Improved efficiency in care provision – 111 workflowBenefits: • Enables patients to die in accordance with their patient preferences
e.g. in their preferred place of death. • Efficient and appropriate use of services in co-ordinating care for the
patient e.g. sending ambulance to admit into hospital when patient wishes to die at home.
Cannot proactive prompt from information that is in a read-only view.
Have latest information on key preferences e.g. preferred place of death.
Specific preferences/flags • DNR• Preferred place
of death
111 service EPACCS systems (e.g. Adastra, Graphnet)
5. Encounter Timeline
Drivers: • Safeguarding • Improved efficiency in care provisionBenefits: • Ensuring appropriate intervention based upon having holistic view on
patient’s touchpoints with the service.
Cannot create a timeline from information spread across a set of different read-only views.
Need to have latest view on all touchpoints in crisis period.
Encounter (including care setting, encounter type, clinician type and associated clinical information)
EPRs/IDCR Portal already able to provide this e.g. Connecting Care portal
6. Vaccinations and Immunisations History
Drivers:• Avoid duplicate immunisations/vaccinations • Aid recall system for children• Aid frail and elderly who are immuno-surpresed Benefits:• Enables correct intervention based upon accurate history – important for
Digital Children's strategy
Cannot proactive prompt from information that is in a read-only view.
Have latest vaccination information e.g. child health.
• Immunisations• Medication• Allergies
EPRs systems e.g. Cerner, Orion, Allscripts already able to provide functionality
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Clinical Scenario Drivers/BenefitsWhy Structured and Real-time
Elements on GP Record Needed Supplier Capability
7.Pre-population of Pre-operative Assessment
Drivers: • Improved patient experience of not having to repeat same information or
attend unnecessary appointments• Improved efficiency in care provisionBenefits: Reduction in administration burden leading to:• Improved patient experience• Improved productivity of clinicians
Cannot pre-populate forms from a read-only view.
Have access to latest record information to go onto the form.
• Medications• Allergies• Diagnosis• Problems• Investigations• Observations
Hospital PAS systems
Example of alerting against allergies when prescribing Example of encounter timeline
AppointmentsManage appointments in order to co-
ordinate access to care
Access RecordAccess a patient’s care record for the
purpose of direct care
Tasks Manage tasks in order to work effectively
across care settings
eDischargeDischarges from inpatient care back to
the general practitioner
A&E eDischargeInformation sent to the general
practitioner from an A&E attendance
Ambulance
Social Care
Referrals
Emerging needs
Creating a common and open set of APIs to support information sharing across health and care
Defining the key clinical information sharing needs.
Prioritising the key APIs.
Group members e.g. CCIOs, CIOs, Vanguard, Pioneers, PMCFs, NHS England.
Outlining the accreditation approach for APIs.
Group members e.g. TechUK, CIOs, suppliers, HSCIC.
Defining the key underpinning components and policies, e.g. security and authentication.
Group members e.g. HSCIC, suppliers, CIOs, TechUK, NHS England.
Establishing and creating the required APIs based on clinical information sharing needs.
Group members e.g. suppliers, innovators, CCIOs, CIOs, NHS England, HSCIC.
Made up of the above organisations, the Project Boardis responsible for the assurance and governance process.
Links to existing communities and
signposts tools and products.
• The board will be made up of representation from across the stakeholder community:
• Builds on models from other geographies e.g. Commonwell.
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