The Lincolnshire Care Portal

David Smith, Lincolnshire STP Digital Programme Lead

Liz Jones, Lincolnshire STP Digital Project Manager

• 4th largest county in England

• 5921 sq.km

• 775,213 population

• 4 CCGs – in progress of moving to 1

• Providers – 1 acute, 1 community, 1 mental health and 1

ambulance

• 85 GP practices

• 1 upper tier local authority with 7x lower tier

• Rural with poor road and telecommunications infrastructure

• 57% population live in rural areas

• 10% population are over 75

• 14% of the population live in deprived areas

• £212m ‘do nothing’ scenario deficit by 2023/24

2014 Strategic change programmeNow the Sustainability & Transformation Partnership (STP)

Background & Procurement

2013

• Bid to tech fund

• £3m matched bid

• Got through to

interview stage

• Failed at last

hurdle

2015-16

• Market research

• Reference sites, in particular Scotland, Northern Ireland, and Sweden

• Engagement with care design groups on requirements analysis and

design sessions

• Involvement of 32 stakeholders from a variety of organisations and

disciplines

• Proof of concept integrating 5 existing systems

• NHS Infrastructure bid £1M

• Framework procurement

• Contract awarded 2016 - InterSystems

The four modules

The Lincolnshire Care Portal

Care Portal - Healthshare

Patient Portal – Personal Community

Electronic Care Plans – Care Community

Analytics – Health Insight

SystemOne/TPP GP

Social Care SystemMOSAIC

TeleHealth/TeleCareMonitoring Platform

Summary Care

Record

Clinician Social Care Worker Patient

Electronic Master Patient Index

EMISWebGP

CommunityHealth

Mental Health EPR

Acute

DepartmentalSystems

Anonymised Clinical Data Repository

Note: the systems detailed

are for illustration and can

easily be expanded.

Authentication Security Audit Logs

CompleteRecord

Charts DocumentViewer

Professional View

Authentication Security Audit Logs

Appointments Messages

Patient View

CompleteRecord

HealthLinks

Integrated Care RecordAggregated on demandConsent Management

Real Time AnalyticsSmart Alerting

Risk StratificationPopulation Health

Care Plans

End of LifeLong Term Conditions

Now

Progressing with

maternity service

Notifications

Ambulance

Implementing 19/20

Implementing 19/20

Access & AuditMultiple ways to Access

Smartcard - Active Directory Integration - Direct Account

Role Based Access Controls (RBAC) determines what users can see and do.

Currently 2 roles in use – Clinician and Clinical Administrator. Social Care role for local authority social workers being

configured. Further roles can be configured if required. The greater the number of roles the more complex the administration.

Sealed Off Data Function can be used to ‘seal off’ particularly sensitive data from the integrated record, requiring users to state

why they need to view – this is audited.

Presence of ‘sealed off data’ is shown via a padlock icon on the patient record.

Ability to have option to view any sealed off data can be controlled via RBAC.

Supports concept of Legitimate Relationships

Users claim a legitimate relationship with the patient – for on-going care

Is option of one-time access where specific reason is given for why user needs to see the record, eg Emergency Admission/

Safeguarding where user does not have a relationship with patient.

Auditing Capability

Separate reporting area that IG colleagues can be given access to.

What can the Care Portal do?

Bring together selected patient

information from multiple

systems in real time, enabling

users to view an integrated

care record for the patient

What can the Care Portal do?Notify users when relevant events

occur and provide secure

communication between care providers

Successes

In progress

• Lincolnshire County Council – Adult social care system

• GP Connect for primary care

• Acute maternity system

• Mental Health Trust PAS

• EMAS

Deployment

• Over 5900 user accounts (over 50% of all clinical staff)

• Over 2800 active users

• Increasing each month

System Connections and Deployment

LIVE

• Acute Trust - Patient Administration System (PAS), Radiology reports, Lab test results, Electronic Discharge Documents &

Outpatient Letters

• Over 2 ½ million documents available to view

• Spine Mini Services –Patient Demographic Service, Summary Care Record, & Child Protection Information Sharing

• Surfacing data in real time

Scoping

• TPP Systm One Community

• Tertiary Sites – Peterborough & North Lincs & Goole

ChallengesCapacity to progress at pace

❖ Each system connection is a project in itself

❖ System Suppliers - differing levels of maturity and what’s in it for them?

Being First

❖ Difficult to predict complexity when First of Type - it’s new to NHS Digital and to us

❖ Can’t just lift and shift what others have done

Realising all the Benefits

❖ Increasing user numbers – needs to be enough of a pull to get people to come back

❖ Change Management

Community Health Services Trust – Assisted Discharge Stroke Service

User Feedback

• Able to access accurate and up to date patient information 7 days a week

• We know if a patient has actually been sent home /discharged so we can respond in a timely way to arrange their first visit

• Checking medical history prior to going out to initial assessment visits gives us more ability to moderate out therapy

approach and be better informed when speaking with patient and family – not having to repeat questions . Following

stroke, patients often have memory or communication problems so they find lots of questions difficult or distressing

• We can access the discharge letter, stroke diagnosis, scan results, onward referrals etc., building a picture of the patient

clinically and then triaging the right person to go out on that initial visit

• We do not duplicate referrals and like-wise we can chase them up on behalf of the patient– e.g. ophthalmology ,

videofluroscopy

• During our weekly MDT meeting one of the team accesses the care portal so we can get the full picture of the patient

past and present

Focus on Frailty

Care Portal Alert for Gainsborough Neighbourhood

Patients aged over 75 - Registered at specific GP practices

Admitted/discharged to a ULHT hospital

112 alerts between 28 May – 24 July 2019

Focus on Frailty

Care Portal - Frailty Video

The Potential

Savings from:

• Early interventions = less cost for long term care, promotion of self care, preventative measures, improves patient

outcomes

• Identification of frailty = less risk of inappropriate hospital admissions, appropriate care plans in place, at the right time

• More effective in-reach and appropriate case management

• Significantly improved communication and reduced duplication

The Patient

• Improved contacts through early interventions, improving experience

• Person centred care and support

• Enhanced care plans to improve care and support and reduced inappropriate hospital admissions which impact on not

just the patient but their family and carers

Focus on Frailty

The Lincolnshire Patient Portal

• Public website (unregistered content) and logged in content (registered)

• Digital Information source – news feeds/documents/leaflets/web links/videos

• Smart form capability

• Message Centre

• Patient access to view and contribute to record

• Proxy access capability

www.patientportal.lincolnshire.nhs.ukCurrent content is all available to the public.

It is maternity focussed for the initial launch.

Library of maternity information organised by theme.

Information can be links to information on other websites or

printed information made available as a pdf.

Affiliated with NHS.uk as trusted source of

information for searches and the NHS app library.

Smart Forms • Not just for self referrals

• For pre-op/pre-appointment

questionnaires, remote monitoring through

use of algorithms

• Reducing need for face to face

appointments

• Supports better quality and more efficient

care

• Supports personalisation

• Patient chooses how they want to be contacted.

• Improves patient experience

• Reducing time to be contacted by community

midwife.• Inclusion of delivery date calculator enables staff

to triage effectively to support improvement in

performance against 12+6 week KPI.

• Improves patient safety by getting relevant

tests/scans in a timely manner.

The WorkbenchWhere submitted forms are actioned

Where new forms are created and publishedWhere information can be sent to an individual or cohort of users

What’s the difference?• Circa 40 self referrals received since mid June

• Women referring in much sooner - at 4 to 6 weeks

• Supports public health agenda

• Supports local ambition to have blood tests complete and results back by 10 weeks

• Staff thinking differently

• Service seeing potential for further improvements

What’s to come?Patients logging in to view their record

• Data from consumer (eg Fitbit) and calibrated devices (eg

blood pressure monitor) can be uploaded to the Patient

Portal.

• Scoping pilot of wearable devices with cardiac rehab/heart

failure.

• Investigating use for diabetes monitoring.

• Readings visible to care portal users and patients in patient

portal

Electronic Care PlansPeople having proactive, personalised conversations which focus on what matters to them

Care Portal - Care Plans Video

• Template builder

• Enables multiple care team

contributors

• Plan can also be saved as a

static document to view in the

Care Portal

• Personalised Care and Support Plan

• Patient to be able to contribute to

Plan

• Surface relevant data from systems

connected to the Care Portal, eg

current meds and allergies

Analytics

Readings from wearable devices can

trigger smart notifications and be included

in analytics

Analytics

Over 80s at high risk of stroke

David Smith, Lincolnshire STP Digital Programme Lead

David.smith@lincolnshireeastccg.nhs.uk

Liz Jones, Lincolnshire STP Digital Project Manager

Liz.jones@lincolnshireeastccg.nhs.uk

Questions