the reality of an integrated digital care record
TRANSCRIPT
The reality of an integrated digital care recordLiz Jones Project Manager IMT, Lincolnshire Health and Care Programme
Tracey Thrift Assistant Director ICT Programmes, United Lincolnshire Hospital
Trust
Adam Lavington Head of Primary Care Systems Enablement, NHS Arden and Greater East
Midlands Commissioning Support Unit
Ian Baldam Deputy Director of Informatics, Lincolnshire Partnership Foundation
Trust
Lincolnshire Health & Care - Care Portal
Lincolnshire Health & Care Economy• 5921 sq.km• 775,213 population• 1242K health economy• 4 CCGs• 1 main acute provider with 3 main sites• 1 community services provider• 1 mental health services provider• 1 Ambulance services provider• 101 GP practices• 1 upper tier local authority• 7 x lower tier local authorities
• Rural: 57% population in LECCG• Dispersed: 88 people per km2 in LECCG• Poor road infrastructure (51 minutes
lowest drive time between acute sites)• Poor telecommunications infrastructure
• Rural: 57% population in LECCG• Dispersed: 88 people per km2 in LECCG• Poor road infrastructure (51 minutes
lowest drive time between acute sites)• Poor telecommunications infrastructure
(But it is very beautiful, with great history and heritage, safe, with good schools, and very attractive property prices)
• The population age structure is older than England as a whole.
• 15.8% of the population are aged 0-14 years compared with 17.3% in England, whereas 9.9% are aged 75 years or over, compared with 7.8% in England.
• Population structures also vary within the STP area. Lincolnshire East has a higher proportion of older people (11.0%).
• 14.2% of the population live in the most deprived areas of England as defined by the Index of Multiple Deprivation (2015)
Quality:Keogh Review
Fragmented services
Population profile:Ageing population
Long term conditionsRising expectations from patients
Financial pressures:Deficit over £250m by 2020
Requirement from NHSE to balance books (STP)
Workforce issues:Recruitment and retention
Agency costs Viability of services due to staff shortages
The Challenges
• Strategic change programme involving all commissioners and providers• Commenced 2014• Six work streams: Planned Care, Urgent Care, Proactive Care, Women
& Children’s Care, Primary Care, Mental Health• Seven enablers: Workforce, Estates, Transport, IM&T, Contracting &
Commissioning, Finance• Now meshed with the Sustainability & Transformation Plan (STP)
LHAC VisionQuality, safety and sustainability for health and care services
Improved joint working of health and care professionals –an integrated service for patients
Providing the right care at the right time closer to patients’ homes
7 day a week services for local people through community 'neighbourhood' teams,supported by urgent care centres across the county
Hospitals ‘freed up’ to provide specialist or genuine
emergency trauma and time critical services
IM&T Enabler Group (IMTEG)
• All providers and commissioners• Commenced with an
infrastructure stocktake• Developed a system architecture• Conducted a requirements
analysis with all LHAC work streams
Care design Groups
•Planned Care•Urgent Care•Proactive Care•Mental Health & LD•Women & Children•Primary Care
Service Ambitions
•Self Care•Integrated Care•Care Navigation•Proactive Care•Care in the right place•Capacity optimised
Digital Enablers
•Integrated health records•On-line and remote patient processes
•Capacity Management•Integrated Communications•Networking and mobile•Collaboration services•Directories of services•Decision support technologies
Why deploy a Care Portal?• No.1 enabler (from Care Design Groups)
• Reduces risk and improves decision making
• Reduces duplication and waste
• Delivers Patient Online
• Analysis of portal data can provide rich insights
Key policy drivers are ‘The Power of Information’ (2012), ‘Personalised Health & Care 2020’ (2014), and the National Information Board Interoperability Strategy:
• Digital roadmaps
• 2016: Child Protection Information Sharing (CP-IS)
• 2018 : primary, urgent and emergency care should be operating without the use of paper records
• 2018: individuals should be able to record their own comments and preferences on their care records
• 2020: all care records should be digital, real-time and interoperable
Lincolnshire Care Portal History• Project started about 3 years ago
• Initial bid to the tech fund• £3m matched bid for integrated care portal including
patient portal
• Got through to the interview stage
• Failed at last hurdle
Lincolnshire Care Portal History – Lessons Learned• Too much of an IT led programme
• Lack of buy-in for “the vision”
• Failed to reach a “tipping point”
• Too expensive
• Heavy on infrastructure
• Governance not worked through
Specification and Procurement• 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 - InterSystems
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 Health
Links
Integrated Care RecordAggregated on demandConsent Management
Real Time AnalyticsPopulation HealthResearchReporting
Care PlansEnd of Life
Long Term ConditionsNow
FutureNotifications
Ambulance
Benefits• Improved clinical decision
making• Improved patient management
though the use of portal information to alert and case find
• Improved quality of care• Improved patient experience• Improved cost effectiveness
through reduced duplication• Increased time to care through
reduction in administrative burden
Risks
• The system is immature or dogged by
deployment problems
• Organisations fail to engage and share
records
• Suppliers refuse to cooperate• Information governance issues
compromise the project or slow it down
• We fail to realise the benefits and the
business case does not deliver
Care Portal Governance
Structure
STP/LHAC Governance
IMTEG
Care Portal Project Board
Clinical Reference
Group
User Group
Informatics Sub Group
Information Governance
Group
Technical Design Authority
Work Packages/Sit
Rep calls with ISC
Caldicott Guardians
Clinical Safety
Officers
First phase of systems to be surfaced in Care Portal
Sector SystemsAcute System C Medway PAS
HSS CRIS radiology results
WebV lab results
Mental Health Silverlink PCS PAS
Mayden IAPTus (IAPT)
Primary Care Summary Care Record
Mini Spine Services
Systems in Scope for future phasesSector Systems
Acute Electronic Discharge Documents, Outpatient letter, E-Obs & ChartingEnd of Life Care EPaCCSLocal Authority Adult Social Care - MOSAICPrimary Care TPP SystmOne & EMISCommunity WebV lab results & TPP SystmOne CommunityRadiology Images EMRADTertiary Sites North Lincs & Goole/Peterborough and Stamford + others
Independent Providers Test results/images
What’s happening now?• Opt-out consent model agreed• Two GP practice early adopters to test comms materials• Preparing for public awareness campaign to commence late September• Preparing for system testing• User registration• Preparing for technical and user training• Service Desk• Go Live end of October 2016• Scoping systems to connect for next phase
What does it look like?
http://lincolnshirehealthandcare.org/care-portal/
01522 718051