reference number leading the way in e health 25 th may,2010 e health innovation
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REFERENCE NUMBER
Leading the way in e Health25th May,2010
E Health Innovation
2
The current challenge? The current challenge?
3
Three key questions…
Can we ride the perfect storm?
Financial challenge..
People challenge..
Ageing population..
Where should we aim?
Point or whole system?
How innovative can we be?
Disruptive or play safe?
4
Demographic change for population aged 65+ ScotlandPotential impact on emergency bed numbers 2007-2031
0
2000
4000
6000
8000
10000
12000
14000
16000
Y/E Mar 2007 Projected2011
Projected2016
Projected2021
Projected2026
Projected2031
Year
Be
ds
9%24%
41%61%
84%
Calendar year ’07 estimate
P Knight Scottish GovernmentA major challenge for Scotland-24%
more beds by 2016, 84% by 2031
NHS Tayside+148 beds 2016+517 beds 2031
5
Compelling areas for improvement..T12
Emergency Admissions / Beds04/05 65+ 04/05 All 08/09 65+ 08/09 All Target Mar 09
PerformanceTarget for 2010/11 Direct Cost
Saving
AdmissionsNHS Scotland 191871 467392 215691 522219 172684NHS Tayside 15534 37139 17128 40105 13981Angus CHP 4260 9292 4647 10164 3834Dundee CHP 6341 16424 6338 15989 5707Perth&Kinross CHP 4960 11455 6154 13967 4464Bed DaysNHS Scotland 2811244 3956421 2904447 4106840 2530120 374327 12.9% 140,747,102£ NHS Tayside 223092 306900 232588 316855 200783 31805 13.7% 11,958,755£ Angus CHP 58816 79902 58716 80260 52934 5782 9.8% 2,173,882£ Dundee CHP 99980 138106 90097 126080 89982 115 0.1% 43,240£ Perth&Kinross CHP 64639 89248 83867 110609 58175 25692 30.6% 9,660,154£ Multiple AdmissionsNHS Scotland 37072 43618NHS Tayside 2981 3431Angus CHP 830 920Dundee CHP 1233 1300Perth&Kinross CHP 902 1209Multiple Admissions Bed DaysNHS Scotland 1302384 1474086NHS Tayside 104042 114670Angus CHP 28763 29084Dundee CHP 47772 46032Perth&Kinross CHP 26567 38968
source ISD December 2009To year end 2008/09
Compelling challenge, local variation?
Reference: ISD Online National Statistical Information Publication
December 2009.
6
Our approach? Our approach?
7
Steps to Better Healthcare- a whole systems approach..= Constraint
A&E
in-patient
out-patient
rehab
day case
acute services
acutereceiving
ward(Med/Surg)
MIU
SAS
OOH
OOH, urgent & emergency services (community)
NHS 24
GDP
GP
Community Pharmacists
family health services
Optom
refer to GP
sub-contractout-reach
Specialist acute care
tertiary services
routinedischarge
complexdischarge
LocalAuthorities
Partner & Vol organisations
refer on-going community care
Walk-In
RadiologyEndoscopy
GP referral
GP direct
access
GP referral
day patient
OutpatientClinic
Community Services – partnership model with LA
Home Visit
district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)
elderly care
Care in the community
Community (day) Hospitals
mental health
Day Patient
Inpatient
other
OutpatientClinic
Community Services – partnership model with LA
Home Visit
district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)
elderly care
Care in the community
Community (day) Hospitals
mental health
Day Patient
Inpatient
other
Laboratory
GP feedback
= Queue Before Activity
= Target Challenge
= Trend in Volume
= Known Issue
= Suspected Issue
Q
T
T
T
acutereceiving
ward(Med/Surg)
out-patient
Q
routinedischarge
complexdischarge
Q
T
Q
C
Q
Q
C = Constraint
A&E
in-patient
out-patient
rehab
day case
acute services
acutereceiving
ward(Med/Surg)
MIU
SAS
OOH
OOH, urgent & emergency services (community)
NHS 24
GDP
GP
Community Pharmacists
family health services
Optom
refer to GP
sub-contractout-reach
Specialist acute care
tertiary services
routinedischarge
complexdischarge
LocalAuthorities
Partner & Vol organisations
refer on-going community care
Walk-In
RadiologyEndoscopy
GP referral
GP direct
access
GP referral
day patient
OutpatientClinic
Community Services – partnership model with LA
Home Visit
district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)
elderly care
Care in the community
Community (day) Hospitals
mental health
Day Patient
Inpatient
other
OutpatientClinic
Community Services – partnership model with LA
Home Visit
district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)
elderly care
Care in the community
Community (day) Hospitals
mental health
Day Patient
Inpatient
other
Laboratory
GP feedback
= Queue Before Activity
= Target Challenge
= Trend in Volume
= Known Issue
= Suspected Issue
Q
T
T
T
acutereceiving
ward(Med/Surg)
out-patient
Q
routinedischarge
complexdischarge
Q
T
Q
C
Q
Q
C
Community Care Services
Prescribing
Patient focused mgt plan approach to reducing multiple admissions in
over 75's
Improve Capacity & Flow in Medicine and
RVH
Enhance the Ambulatory Care service offered in
Ward 15
Streaming Access A/E
Quality Discharge Communications
End to end Orthopaedic pathway hip/knees
Variation in GP referral rates
Efficiencies in General Surgery OP Clinics
Information provision and coding (e.g. The
Gap)
Develop use of Community Hospitals -
improve use/flow
Community Nursing -patient contact
time/anticipatory care
AHP activity -rebalance the activity towards community
Community Diagnostics - to support Community
Hospital model
Prescribing PracticeAnti-microbials
Patients still on medicines they no
longer needMedicines
at Admission
ElectiveUrgent & Emergency
Projects overlapping more than one stream will require cross cutting team resource
CKD - IT enabled Pathway
Pre-assessment screening
Virtual Ward Self Management
Community Care Services
Prescribing
Patient focused mgt plan approach to reducing multiple admissions in
over 75's
Improve Capacity & Flow in Medicine and
RVH
Enhance the Ambulatory Care service offered in
Ward 15
Streaming Access A/E
Quality Discharge Communications
End to end Orthopaedic pathway hip/knees
Variation in GP referral rates
Efficiencies in General Surgery OP Clinics
Information provision and coding (e.g. The
Gap)
Develop use of Community Hospitals -
improve use/flow
Community Nursing -patient contact
time/anticipatory care
AHP activity -rebalance the activity towards community
Community Diagnostics - to support Community
Hospital model
Prescribing PracticeAnti-microbials
Patients still on medicines they no
longer needMedicines
at Admission
ElectiveUrgent & Emergency
Projects overlapping more than one stream will require cross cutting team resource
CKD - IT enabled Pathway
Pre-assessment screening
Virtual Ward Self Management
Improve efficiency for all 36 Outpatient Clinics .
Elective
Medicine for the Elderly
Urgent & Emergency
Prescribing
Reducing wastes and cost in prescribing
Community Care Services
Integrated Care (Virtual Ward)Deliver proactive care management via
combined model
Business Support Unit
Mental Health
8
A whole system challenge, typical NHS board..
A&E Inpatients
Acute Wards
75,979
55,464 (73%)Discharged
10,631 (14%)IP Admission
9,877 (13%)Acute R/C Admission
38%
A&E Attends
26,077Acute Attends
16,200GP/other Refer
62%
17,730 (68%)IP Admission
7,800(30%)Discharged
Direct Access
44,242Total U&E IP Admission
15,881Direct Access
(28,361)
547(2%)Other Care
Acute Patient Non Elective~ £86M Virtual Ward savings 3% ~ £2.5m pa 5% ~ £ 4.3m pa10% ~ £8.6m paSGHD HEAT T6, T8, T10 , T12
9
Doing the right things..
HEAT 1 HEAT 2Corp
3HEAT 1 HEAT 2 HEAT 3
HEAT T6
HEAT T8
HEAT T10
Corp 1
Corp 2
HEAT T12
HEAT HEAT
There is objective evidence that the Board is
able to track progress against key targets and
perform well at a tactical level
Triple Aim
Integrated ResourceFramework
10
Who are the whole system
stakeholders?
Who are the whole system
stakeholders?
11
Desire
Adopt
Our Future
Prioritise Outcome based
response
TaysideCommunity
Today
TaysideCommunityTomorrow
What do youSee?
What do youWant?
What now?Make it real!‘Test of Change’Demonstrators
Learn
Align BenefitsRealisation
Art of the probable?
Truly needsBased!
ImpactAssessment
We are here
26/05/10
T12 Emergency Bed Days over 65’s
T6 Long Term Conditions admissions
Patient experience
Community team effective patient facing time
Medication Concurrence
VIRTUAL WARD AIMS TO DELIVER £2.0-2.5M RECURRING SAVINGS VIRTUAL WARD AIMS TO DELIVER £2.0-2.5M RECURRING SAVINGS
Triple Aim – LTC Whole Care Continuum
Acute Patient Non Elective~ £86M Virtual Ward savings 3% ~ £2.5m pa 5% ~ £ 4.3m pa10% ~ £8.6m paSGHD HEAT T6, T8, T10 , T12
12
Multi-disciplinary stakeholder engagement / outcome Patients Carers Voluntary organisations Care Home representatives Home Care representatives Community/Practice Pharmacists GP’s cross section Practice Managers Specialist Nurses District Nurses Allied Health Professionals
E Health Service Improvement Senior Management repsSocial CareTelehealth / Telecare reps
Mental Health Professionals
Secondary Care – Ward
Community Hospitals
A&E
OUTCOMESAgreed Predictive Modelling was keyE Health was a key enablerLocal stakeholder engagement keyLearn from best practice LocalNationalUK/Global wide
13
LEVEL 5HIGHLY
COMPLEXCO-MORBIDITY
Macro IntegratorNHS Tayside and Councils
816
8163 LEVEL 4
COMPLEXCO-MORBIDITY
LEVEL 3SUPPORTED SELF CARE
CO-MORBIDITY
LEVEL 2SUPPORTED SELF CARESINGLE LTC
LEVEL 1PREVENTIONWELLBEING
PREDICTED RISK PROFILE
LEVEL 4COMPLEX
CO-MORBIDITY
LEVEL 3SUPPORTED SELF CARE
CO-MORBIDITY
LEVEL 1/2SUPPORTED SELF CARESINGLE LTC
LEVEL 1PREVENTIONWELLBEING
MICRO INTEGRATORS
0
0.5%
0.5%
5.0%
5.0%
20.0%
20.0%
80.0%
80.0%
100.0%
LEVEL 3SUPPORTED SELF CARE
CO-MORBIDITY
LEVELS OF CARE
Long Term Conditions
VIRTUALWARD
ANTICIPATORYCARE PLANS
PATIENT PASSPORTS
CASEMANAGEMENT
Asthma22935
COPD8795
Diabetes15808
HBP56918
CHD19341
Triple Aim – LTC Whole Care Continuum
14
Initial LTC ReferralPEONY
Combined Model
Unplanned Referral
Elective Referral
Case Finding
e Health infrastructure
Receive & CaptureReferral
AllocateCase
Manager
Assess
ProduceAnticipatoryCare Plan
Patient Passport
Diagnostic Intervention
Generate Referrals
ServiceCase
Finding
Urgent Intervention
Integrated Care
PlannedIntervention
Integrated Care
ReviewAnd Assess
Identify Cases Initiate Case Management Care Assessment & Planning Care Delivery & Review
Typical Integrated Care Model Next Future State
Single Point of Access 7*24
Updatepatientrecord
Updatepatientrecord
Service Menu
Patient, Carer,
ProfessionalInfo request
UpdatepatientRecord with ACP/PP
SKILLS MIXPLANNING
15
Federated / Locality Model
Anticipatory Care
Case Management
Virtual Ward
Treatment
Diagnostics
Enablement
Rehabilitation
Telehealth
Telecare
Locality Budgets
Local Diagnostics
Strategic GP Lead
Integrated Prescribing
Budgets
Community Hospital
Lo
calit
y C
o-o
rdin
ato
r Ward
Co
-ord
inato
r
Perth & Kinross Virtual WardTest of Change’ demonstrator
© Crown Copyright. All rights reserved [2008]
Local Profiles
Total Population – 11,123
65+ – 2,525
Under 65 – 8,598
(GRO Scotland 2006)
16
E Health opportunity E Health opportunity
17
Integrated Care – information architecture
Glu
e
Integration Platform
Ac
ce
ss
De
vic
eU
se
r
Se
cu
rity
ServiceDirectory
Ap
pli
ca
tio
ns
Clinical Portal
Clinician Manager Administrator Patient
PMS GPCommunity
Health&Social
Vir
tual
D
atab
ase
Se
rvic
e
Sta
ff I
DR
BA
C
TELEHEALTH
TELECARE
PREDICTIVE RISK
BUSINESS ANALYTICS
VirtualWards
CaseManagement
HealthCoaching
Prevention
Collaboration
18
E Health success
E Pharmacy
E Health success
E Pharmacy
19
ePharmacy
Live nationally in June 2006 used by 800,000 patients
All pharmacies able to register patients on national database
and issue prescriptions
All reimbursement claims electronic.
Minor Ailments Service (eMAS)
Acute Medication Service (eAMS)
Chronic Medication Service (eCMS)
Progress and benefits to patients throughout Scotland
> Live nationally in July 2009 used by every person who visits a GP practice or Pharmacy> 900,000 prescriptions per week processed (95% of total)> First full end-to-end UK ETP solution> Increased efficiencies in Prescription processing> Patient Safety benefits (Emergency Care Summary) > All GP Practices, pharmacies and NSS connected
> Infrastructure live May 2009, national roll out Q1 2010> First GP and Pharmacy sites in early adopter phase – NHS Fife> Allows GPs to issue six or 12 month prescriptions> Reduction in patient visits, reduced costs > Dispensing information back to GP Practice> Medicines management savings
20
ePharmacy
Core Infrastructure
A
A
GP (1000)
Pharmacy (1200)
NSS PSD ~ Atos Origin
GP System
CP System
ePharmacyMessage
Store
InformationServicesDivision
Payment processElec msgs via N3
network
Elec msgs via N3
network
CHI
Forms sent to PSD
PatientRegistration
Service
ePay rules engine
Scanning and messageprocessing
21
ePharmacyElectronic Transfer of Prescriptions Process
RxRxRx
Barcoded prescriptionform(s) produced
BarcodesScanned
Electronic messagesent & result received
ePMSPMRPMR
Pharmacy system uses elec datato support
ePMS
Issue medicationand submit claim
Paper form
Elec Msg
RxRxRx
Prescription form(s)received at pharmacy
Electronic messagessent to ePMS
ePMS GP GP
RxRxRx
22
Key focus areas?Key focus areas?
23
Key Focus Areas?
Collaboration
Supporting the whole system
Extended health and social care networks
D2D business
Supporting people living with Long Term Conditions
Older People’s Services
Scotland’s economy
Business Analytics
Performance Management
Communication
HEAT Targets / Quality Strategy in Scotland
In England? QIPP ??