The London Digital ProgrammeMike Part – Programme Lead London Digital Programme, Head of Digital NHS England (London region)

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London is different

Key$Data$•  9m#people#living#in#an#area#

25#miles#wide#and#25#miles#deep#

•  1500#GP#prac8ces#•  1500#Dental#prac8ces#•  1800#Pharmacies#•  400#Op8cians#•  30#NHS#Trusts#•  Hundreds#of#formal#and#

informal#care#organisa8ons##•  32#CCGs#and#32#Councils##

NHS Trust NHS Foundation Trust

7#Footprints#for#Local#Digital#Roadmaps#

Unique$$problems$•  People#Move#around…..#•  Organisa8ons#deliver#different#

types#of#care#to#people…..#•  Organisa8ons#use#different#

systems……#•  We#have#30#‘emergent’#

informa8on#exchanges#that#don’t#talk#to#each#other#

•  How#do#we#connect#the#pa8ent?#•  Informa8on#Governance#‘rules’#

protect#the#data#but#may#not#protect#the#pa8ent#

3

Sustainability &Transformation Goals

Integrated$ Accessible$ Proac:ve$ Faster$ Personalised$

Demand$and$Cost$of$delivering$care$ Outcomes$

4

Changing the dynamic

Connected#&#ac8vated#pa8ent#

Clinical$Workload$Ac:vated$Ci:zens$

&$Pa:ents$

Carer$

ConnectedTeams$

5

Sustainability &Transformation Plan Footprints

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New Models of Care

STPs#New#Models#

of#Care#

Ac8vated#Ci8zens#

Requires#a#Health#and#

Care#Informa8on#Exchange##

In#order#to#connect#data,#services#and#

apps#

Magnet#for#Innova8on#

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London Digital Programme

1  The need for London-wide collaboration is established

2  There is a particular focus in year one on Primary Care, Urgent and Emergency Care and Cancer

3  CCGs have recognised that the development of digital services and standards based interoperability solutions to support key workflows need at-scale attention

4  Our ambition is for a set of local roadmaps that tell a consistent story to our patients (where this is relevant)

5  Our focus is on the citizen/patient – not the organisation.

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Digital Design Principles for patient-centric integrated and proactive care

1.  Connect the citizen to all of their records and those who care (once).

2.  Put citizens/patients in control. 3.  Provide ‘utility’ to drive ‘informed’ consent from the citizen and use of data by clinicians.

4.  Focus on the journey through care and the opportunities for data exchange, digital transactions, subscription based services and alerts to transform them.

5.  Agree and adopt ‘standards’

6.  Create a trusted environment for information exchange and the use of connected apps

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Dimensions of Integrated Care

0%?#

0%?#

50%?#

10%?#

0%?#

50%?#

0%?#

30%?#

20%?#

40%?#

60%?#

?#

5%?#

•  To#know#when#something#happens##

•  To#be#in#the#conversa8on#

•  To##make#things#happen#

•  To#know#who#will#visit#and#when#

•  To#be#able#to#set#(consent)#preferences#and#enable#or#limit#sharing#

•  To#be#able#to#connect#to#informa8on#and#services#(once)#via#the#channel#of#their#choice#

0%?#

0%?#

50%?#

10%?#

0%?#

50%?#

What$people$want$

How well are we doing?

•  To#know#when#something#happens#

•  To#share#pa8ent#set#preferences#and#consents#

•  To#be#able#to#find#data#in#real#8me#

•  To#be#able#to#view##share#and#update#care#plans#

•  To#be#able#to#work#on#the#move#

•  To#E#transact#

•  To#trust##external#data#

•  To#share#data#with#pa8ents#and#carers#

20%?#

0%?#

Care$providers$$want$

30%?#

20%?#

40%?#

60%?#

?#

5%?#

How well are we doing?

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The Activated Citizen

• General enquiries

• Access to comparative data

• Directory of service,

•  self-serve information

• Symptom checkers

• Book appointments, • Order repeat

prescriptions, • Access records and

test results, • Monitor and track

progress, • Receive alerts and

reminders, • Use social prescribing

• Contribute to care plans,

• Use decision aids, • Manage personal

budgets, • Use health apps and

environmental controls,

• Use remote monitoring,

• Video consultations and web-chat

• Peer to peer support

•  Integrated Personal Commissioning-managing an integrated budget for the totality of my health

•  and care needs

Citizen as active self serve

Citizen as active administrator

Citizen as active commissioner

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Digitally enabled care spectrum (illustrative)

•  I can book appointments and order prescriptions.

•  I can access my local health records

•  I can interact digitally with my GP when it is convenient to me

•  I can see that the health professionals who care for me are talking to each other but I can’t see evidence of communications with social care

•  I am communicating with my clinicians using the app of my choice

•  I am using digital services that can connect to my record via a trusted information exchange

I am making/receiving electronic referrals with/from health care organisations.

I can locate and view health record within my local care community setting. I can work remotely

•  My record is being created electronically

I am using an electronic system to record what I do , I can order diagnostic tests and view electronic results

•  I can enable information sharing within my carers and health professionals via the preferences I set in my citizen account

Time#

• My carers and I can track my progress in real time.

•  I can initiate care when I need it

•  I can help my carers out.

I can see that my patient has consented to information sharing. I can locate and view diagnostic images in real time without leaving my application. I can locate & view a crisis data set for any patient in London I can view and edit care plans.

I can subscribe to receive electronic alerts and notifications I can order all services digitally I can exchange coded clinical documents with any clinician in London I can view any record using the federated consent service

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Local Digital Roadmaps Assess/$diagnose$

Entrance Treatment$

Build# Op8mise#

Care$Prevent$

SelfI$service$

Op8mise# Op8mise#Grow#

Predic8ve#Data#Targeted#Informa8on#

Digital#access#Tele#access#E#referral#E#transac8ons#

E#orders#E#reports#

E#records#E#prescribing#E#workflow#E#discharge#

Shared#records#Workflow#

Mobility#Connected#devices#Aler8ng#O

rganisa

8on#

Place#

Lond

on#

Digital#Transac8ons#

Mobility#Connected#networks#Aler8ng#

A#Ci8zen#Account#providing#the#means#for#the#pa8ent#to#connect#(once)#,#enable#informa8on#sharing#and#connect#to#(all)#of#their#data#via#digital#channels#(includes*federated*consent*&*iden1ty)*

A#record#locator#service#and#consent/iden8ty#registry#(IHE*message*driven*architecture)*

Subscrip8on#services##

Standards#based##informa8on#exchange#

Tools#for#data#controllers#

A#trusted#environment#for#atfscale#informa8on#exchange#

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Changing the dynamic

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Federated Information exchange using IHE standards

London#Record#Locator#Service#

Record# Record#

Birmingham#Record#Locator#

Service#

Record# Record#

Lancashire#Record#Locator#

Service#

Record# Record#

My#app#

My#Doctor#

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The London Health & Care Information Exchange

Interoperability#‘Hub’#services#and#supported#standards##Ci8zen#Account# Single#Sign#on#

As$a$ci:zen:###My#ci:zen$account$will#allow#me#to:#•  Give#in#forma8on#(once,#in#advance)#•  Set#consents#(once,#in#advance)#•  Set#up#proxies#(for#carers)##•  Confirm#my#iden8ty#(once,#in#advance)#and#access#data#in#all#

of#my#records#and#transact#with#the#NHS#via#the#‘app#of#my#choice’#

•  Locate#my#records#and#see#who#is#viewing#them#•  Get#involved##

As$someone$delivering$care:###The#Informa8on#Exchange#will#allow#me:#•  To# locate# and# access# pa8ent# data# (in# realf8me)# from# all#

connected#systems##•  Understand#and#take#account#of#pa8ent#preferences#•  To#‘trust’#requests#for#data#from#pa8ents#via#the#app#of#their#

choice#•  To#access#this#data#via#my#own#clinical#desktop##•  Allows#me#to#subscribe#to#receive#alerts#and#no8fica8ons##•  To#track#the#pa8ent#through#their#journey#

No8fica8ons#and#aler8ng#

Record#loca8on#

Federated#Iden8ty#Management#

Federated#Consent#Management#

XDS#

Data#exchange#

FHIR# CDA# SMART#XDSi#As#a#supplier#–#use#of#standards#will#make#integra8on#with#other#systems#much#easier.#

Trusted#data#sharing#

OnfBoarding#

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Application Provider On-Boarding Process to access the Health & Care Information Exchange

• Data#Controller#receives#request#for#onfboarding.#• Data#Controller#approves#onfboarding#request,#creates#the#provider#account#and#issues#a#security#token#to#the#applica8on#provider#and#allows#access#to#H&CIE#test#environment#

• Data#controller#issues#an#implementa8on#guide#to#the#applica8on#provider#on#‘How#to#Integrate#to#the#H&CIE’#

Integra8on#

• Applica8on#provider#follows#the#implementa8on#guide#to#integrate#with#the#TEST#H&CIE#environment#using#their#security#token#issued#to#carry#out#informa8on#crea8on#and#retrieval#

• Applica8on#provider#submits#their#applica8on#to#the#relevant#NHS#organisa8on#to#amain#clinical#and#technical#approval#and#due#diligence#

• Upon#approval#the#applica8on#provider#uploads#their#applica8on#to#the#NHS#online#services#to#be#made#available#for#use#by#the#clinician#or#ci8zen#

Accredita8on#

Prefrequisites#

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Workflow: Application Integration – For a citizen to use an application to view & update clinical information/medical records

Ci8zen#has#authorised#the#applica8on#to#access#their#clinical#informa8on#by#senng#their#informa8on#sharing#preferences#and#approved#by#a#data#controller#from#the#relevant#NHS#organisa8on#

Security#

The#applica8on#must#integrate#with#the#H&CIE#Iden8ty#Service#in#order#to#authen8cate#the#ci8zen#prior#to#record#updates#and#retrieval#The#applica8on#must#support#SAML#based#security#tokens#

Applica8on#must#support#IHE#XDS#structured#messages#to#update#clinical#data#Applica8ons#must#support#CDA#structured#clinical#informa8on#in#order#to#view##&#update#the#data#Applica8ons#must#support#FHIR#bases#structured#messages#in#order#to#request#for#subsets#of#clinical#informa8on#(browserfbased#and#desktop#applica8ons)#Applica8ons#must#support#SMARTfFHIR#based#structured#messages#in#order#to#view#and#update#subsets#of#clinical#informa8on#(on#a#mobile#device)#

Informa8on#Exchange#

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Applications: Technologies to support

Browserfbased/Desktop#applica8ons#

Tokenfbased#authen8ca8on#(SAML)#

IHE#XDS#/XDA#

FHIR#

Mobile#Applica8ons#

Tokenfbased#authen8ca8on#(SAML)#

SMARTfFHIR#(Post#2017#use#FHIR)#

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Changes to an application flow and interactions to integrate with the H&CIE (Browser-based and Desktop application only)

H&CIE#(Informa8on#Exchange)#

Authen8cate#User#

Applica8on#

Local#DB#

Iden8ty#Service#

Registry#Register#or#locate#data#

2

3

Retrieve#Data#

1 Save#Data##(locally)#

Repository#4

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The London Health & Care Information Exchange - Roadmap

Locally#defined#documents#&#

images#Unfconsented##

CDA#V3##U&EC##treatment#summary#

CDA#V3#Pa8ent#

Preferences#U&EC/Cancer#

aler8ng#

CDA#V3#Cancer#treatment#Plan#

Consented#via#Ci8zen#Account#

CDA#V3#Crisis#data#set#

R1:#Consented#via#CMC#R#2#Consented#via#Ci8zen#Account#

CDA#V3#Discharge#Summary#

R1:#Consented#via#CMC#

R2:#Consented#via#Ci8zen#Account#

CDA#V3#EOL#care#plan#

NB#Discharge#to#GP#and#

discharge#to#social#care#

Cohort$1:$2016/17$Organisa8ons#wishing#to#deploy#realf8me##IHE#standards#based#informa8on#exchange#to#support:#1.  PanfLondon#Crisis#triage#2.  Panf#London#End#of#life#care#3.  Panf#London#Transfer#of#care##

•  from#hospital#to#GP#•  from#Hospital#to#social#care#

Cohort$2:$2017/18$Ci8zens#&#Organisa8ons#wishing#to#develop#and/or#deploy#realf8me##IHE#standards#based#informa8on#exchange#to#support:#1.  Informa8on#exchange#via#a#‘ci8zen#account#2.  PanfLondon#Cancer#Treatment#3.  Pan#London#Transfer#of#care##

•  From#U&EC#senng#to#receiving#loca8on#4.  PanfLondon#support#for#care#planning#

Cohort$3:$Organisa8ons#wishing#to#deploy#realf8me##IHE#standards#based#informa8on#exchange#for#local#purposes#

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