current thinking on development of health and social care and integrated informatics alan hyslop...
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Current thinking on development of health and social care and integrated informatics
Alan Hyslopinterim Head of eHealth
Scottish Government Health & Social Care
Health and Social care in the digital age
So why is IT-enabled information sharingworking in some places?
Service improvement driven, not IT led
Therefore management and practitioner commitment
Continual investment in staff support and revising working practices given IT enablement
Trust in professional relationships fostered
If sharing is in the patient/client interests, mindset = one of good reason not to share.
Pragmatic and incremental progress. Not letting the best be the enemy of the good
Investing in IT enablement
But hang on, hasn’t NHS Scotland done big IT in its time?
eCare spend
IT-related Other
Emergency Care Summary
• Patient identity (address, telephone, CHI number, GP)
• Allergies and Adverse Reactions to medications
• Medication
- Repeat prescriptions in past 12 months
- One-off prescriptions in past 30 days
Used 3 million times last year, by A&E, GP out-of-hours, NHS24, ambulance, admitting clinicians
Major contributor to patient safety
National database covering 99.9% of the population that contains…
Investing in IT enablement
eCare spend ECS spend
IT-related Other
Emergency Care Summary– benefits
0
1.000.000
2.000.000
3.000.000
4.000.000
5.000.000
6.000.000
7.000.000
2002 2003 2004 2005 2006 2007 2008 2009 2010
₤
Present value of total annual costs Present value of annual benefits
So does that mean our re-freshed approach should be a new improved national IT
system, done differently?
NO!
So what is our current thinking?
1. Re-build relationships – clear signal about working in partnership - refreshed governance on that basis
2. Work collaboratively toward new health & social care information and IT strategy
3. One-size IT does not fit all
4. So clear signal about more flexibility around local solutions, underpinned by common set of standards and protocols.
Data Sharing Technologies Board
• Formed in November 2011 under LA chairmanship
• Representatives from Local Authorities and Health Boards. Membership will be extended to include other public bodies (eg Police) and Third Sector
• Transition from national “one size fits all” approach to a series of locally led initiatives
• Three strands of business:-– stewardship of the legacy National eCare IT – promote innovative and pragmatic information sharing
initiatives that result in better outcomes for service users– develop and oversee the implementation of the Health &
Social Care IT Strategy.
Policy
Relationship with other Strategies and Governance Bodies
National
ICT
Board
GIRFEC
LA
Strategy
Board
Other
eHealth
Strategy
Board
Health and Social Care ICT Strategy
Data Sharing
Technologies
Board
Adult Health & Social Care Integration
• Shared information is vital to improving the outcomes from integrated care services.
• All relevant information about a person’s care should be available electronically to professionals and ultimately to service users.
• There should be a presumption in favour of information
sharing with service users and staff.
• Personal information should only be shared for the integrated care purposes within the partnership’s information sharing protocol.
Data Sharing Technologies Board - Principles
Data Sharing Technologies Board - Principles
• Service users and staff should be engaged continually in improved use of information to achieve better outcomes.
• Robust information readily available to operational and strategic decision makers.
• Initiatives should optimise use of existing assets.
• Standards based approach to support convergence in line with the McClelland ICT Review.
AYRshare
NHS A&A
South Ayrshire CouncilSWIS SEEMIS
Social Work Education
East Ayrshire CouncilSWIFT SEEMIS
Social Work Education
North Ayrshire CouncilCareFirst SEEMIS
Social Work Education
FACE
Child Health
The Central Store approach, locally
held
Lanarkshire and now NHS Ayrshire and Arran and three
Ayrshire councils
AYRshare
NHS A&A
South Ayrshire Council
Social Workers Teachers
East Ayrshire Council
North Ayrshire Council
Social Workers School Nurses
Social Workers Teachers
HealthVisitors
CONCERNS ARE ADDRESSED EARLIER
Social Work
School
ChildHealth
Focus on actions andoutcomes
Alerts
PORTALUser’s
PORTAL
Health
Business System A
Business System B
Business System C
Health
Business System A
Business System B
Business System C
Local Authority
Education Application
Social Work Application
Integration Engine
Integration Engine
The Portal Approach
NHS GG&C/Renfrewshire Council and NHS Lothian/City of Edinburgh Council re-using existing clinical portal products
Integration Engine
Integration Engine
Other initiatives supported by the DSTB
• New CHI guidance allowing the CHI number to be used to provide integrated health and care
• Fife Council and NHS Fife developing the Scottish Accord for the Sharing of Personal Information (SASPI)
• Health and Social Care IT Strategy– Positioned to support to cover the full breadth of
health and social care inter-working– stakeholder consultation over 2013.– Aiming for final endorsement and publication in
2014– policy context….
No shortage of policy drivers…
• Adult Health and Social Care Integration Bill
• Children and Young People Bill (GIRFEC)
• Public Sector Reform (Future Delivery of Public Services – Commission led by Dr Campbell Christie)
• Government Economic Strategy
• National Public Sector ICT Strategy and Sectoral Strategies (John McClelland Review of Public Sector ICT Services).
• Next Generation Broadband (Scotland’s Digital Future).
• Scottish Wide Area Network.
• NHS Scotland Quality Strategy/20:20 Vision –> eHealth Strategy 2011-17.
• eHealth Person Centred Strategy.
• e-form, mostly filled in automatically with information held in GP practice electronic patient record
• co-created by GP practice with patient
• targeted for people most likely to need anticipatory/ out-of-hours care
• available electronically to NHS24, ambulance, community teams, A&E
co-created Key Information Summary
Section 1 – “Special Note”– Free text field of 2048 Characters– Expiry Date– Patient, Carer and involved staff details– Other demographics (eg. next of kin)
Section 2 – Current Situation– Medical Information and Diagnosis– ACP / Self Management Plan agreement– Home Oxygen
KIS contents
Section 3 – Care and Support details– Homecare support– Incapacity / Guardianship– Power of Attorney
Section 4 – Resuscitation– DNACPR– CYPADM (Children Resuscitation)– Current and Preferred Place of Care– any special instructions
Status: all prep work done; roll-out from April; part of GP contract
Futures:•Patient/carer access via web/ App, with section for self completion?•Extensible to other contributors to care?
How it works – builds on ECS IT infrastructure
ECSStore
NHS 24
A&E
Ambulance
others
Audit
trail
analysis
GP consultation
PracticeServer
Security and confidentialityAlarm at NHS IT breaches14 February 2013
The BMA in Scotland has expressed disappointment at the number of NHS IT breaches….. Figures published today show that hundreds of NHS staff have been reported for breaching IT guidelines in hospitals over the past three years…. 481 incidents…. At least 15 workers had been sacked or resigned as a result, while some were given counselling….
Scottish Government does indeed take security and confidentiality very seriously….
Comprehensive ranges of improvements, as set out in the NHS Scotland Information Assurance Strategy. But will never be complacent.
Final thought: Gall’s Law
A complex system that works is invariably found to have evolved from a simple system that worked.
The inverse proposition also appears to be true: A complex system designed from scratch never works and cannot be made to work. You have to start over, beginning with a working simple system.
(from John Gall's “Systemantics: How systems really work and how they fail)
