The NHS Information Revolution Conference

Health informatics – Driving integration and efficiencies across primary, secondary and community care

Tim Straughan

Chief Executive, NHS Information Centre for Health and

Social Care

Changing world….

Context

• Economic pressures (QIPP v cuts) • Health & Social Care Bill • Structural change • Future Forum • Open data/transparency • Patient- and citizen-centred approach – not

organisational-centred • Information Strategy

“Standards are the fundamental building block for the accurate

description and representation of health and social care activities. We rely upon them to underpin day-to-day activities both locally

and nationally”

“We do not sufficiently exploit the data we already collect. Our

ability to access useful information in the current

landscape is hampered by a number of factors; awareness, protocols, tools, complexity”

“Our system is increasingly reliant upon Quality information to

support operational and business processes; poor quality

undermines our ability to support those processes effectively, but we do not have a coordinated

approach to improvement”

“Our ability to understand and control The System is dependent to a large degree on

using, analysing and interpreting data gathered from the system. Unfortunately we have large gaps in coverage which

limits our ability to do this”

Key issues for the Information Strategy

• Open data/transparency • Data linkage • Concept of integrated care record • Standards across care settings and sectors • Roles

– national organisations – local organisations – Intermediaries/market place

Four dimensions of transparency

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Text Text

ACCESS TO MY DATA ACCESS TO DATA ON OUTCOMES

ACCESS TO MY COMMUNITY

ACCESS TO OTHER PEOPLE

‘An Information Revolution will remake society to give real transparency, choice and accountability’ David Cameron

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4

2

3

The patient

• We must design the system around the patient not the other way around.

• We must design the system so the patient is an active not passive recipient of care.

• Patients should have visibility of: – their own care plans and journeys – cost of their care – outcome of their care.

Overcoming barriers

• Avoid one-size-fits-all approach • Levers and incentives • Collaboration and co-production • Creative use of information from a number

of sources • Intelligence, analysis and expertise • Returns on investment over years not

months • Information governance

So where are we with information in….

• Secondary care – eg, UHB (local, national, international)

• Primary care – eg, Tower Hamlets – 36 EMIS practices (primary, community, secondary)

• Community care – eg, North East London NHS Foundation Trust – MIDAS – System 1 (activity, finance, HR)

• Social care – eg, Torbay (secondary, community, social)

East London & City Alliance

Sean Key, Programme & Business Manager Health Intelligence Unit East London & the City Alliance

EMIS Web in South Cumbria

Allows bi-directional sharing of clinical record across the local health community • All 21 practices now using EMIS • All community nursing teams • Specialist community teams (including short-term intervention service, single point of access for unscheduled admissions and liaison nurses) • Community wards • Read-only access to GP summaries by GP Out of Hours, and in primary care assessment service • Access now in secondary care settings

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Urgent Care Pathway (before April 2008)

GP Referral

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Four options

Walk In

Urgent Care Pathway 2010

GP/other clinician referral DGH

999 Ambulance

Short Term Intervention Service

(nursing/therapy/SW)

Community IV antibiotic service

Community respiratory team

Short term urgent Home Care

Community Urgent Care

Hub

Step-up Step-down

beds

Single point of access

Care Homes

DGH

DGH

Liaison Nurse

Liaison Nurse

Primary Care Assessment Service

Walk In

650

700

750

800

850

900

950

1000

1050

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

2008/09 2009/10 2010/11

Actual Trend

Non-elective inpatient spells

300

500

700

900

1100

1300

1500

1700

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

2008/09 2009/10 2010/11

Actual Trend

Non-elective excess bed days

Current sharing model

Enhanced sharing model to replace current model – in final testing

GP surgery

DN unit

Podiatry Unit

Podiatry Unit

DN unit

GP surgery

Shareable information

Manual share Automatic share

Make shareable View shared info

Opportunities for allocative efficiencies

• System-wide approach – organisational reconfiguration

• Pathway redesign • Care settings • Demand management • Prevention

All of the above need measures and evidence