Connecting Care Our story so far…

1. Connecting CareOur story so far… Andy Kinnear June 2015

2. introduction to Connecting Care • What is Connecting Care? • Connecting Care – Why? • Local drivers • National drivers • Who the partners are • What we have delivered so far • What are the benefits? • What can Connecting Care offer & what’s coming next • How our Governance framework works • How Connecting Care fits with the national strategy • Kinnear’s 5 key messages!!

3. what is Connecting Care? Connecting Care is the Bristol, North Somerset and South Gloucestershire [BNSSG] programme, dedicated to using technology to support - • Better information sharing between local health and social care organisations • Joining up information to ensure care is focused around the individual and their needs • Improving better, safer and more joined-up care • Supporting increased efficiency in the delivery of health and social care services • Ensuring that the people who are providing care have the information they need, when they need it • Our first focus has been the delivery of a shared ‘view only’ electronic patient record (a ‘portal’ sharing our IDCR)

4. local need “There needs to be better communication between ‘in-hours’ and out of hours services.” “Adequate and timely information must be shared between services whenever there is a transfer of care between individuals or services.” NOT having access to accurate, timely, shared information is a ‘blocker’ to providing high-quality, effective, efficient care… “The information I have is limited and frequently is missing important elements…” “Services in all settings including health and social care need to improve their communication and handover ” “I don’t have access to some important information electronically…” “If I had better information then it would help me evaluate risks when deciding whether to admit a patient…” “There are delays in getting hold of information that I need…and I spend a lot of time chasing it up…” “Better information would support better safeguarding” *Summarised from feedback from local clinicians & practitioners during workshop events

5. Royal College of Physicians’ “We must revolutionise the way we use information. We must create pathways in which information moves with patients across the system in real-time” Caldicott 2:“For the purposes of direct care, relevant personal confidential data should be shared among the registered and regulated health and social care professionals who have a legitimate relationship with the individual.” Victoria Climbié(The Laming Report): “...systems were crude and information failed to be passed...information systems that depend on the random passing of slips of paper have no place in modern services” Caldicott 2: “people also expect professionals to share information with other members of the care team, who need to co-operate to provide a seamless, integrated service. …” DoH Winterbourne View Final Report: “All local authorities and their local safeguarding partners should ensure they have...information-sharing processes in place across health and social care to identify and deal with safeguarding...this requires a multi-agency approach including all partners” national drivers

6. strategic alignment 5 year forward view: “Most countries have been slowto recognise and capitalise on the opportunities presented by the information revolution……the NHS has oscillated between two opposite approaches to information technology adoption.....the result has been systems that don’t talk to each other and a failure to harness the shared benefits that come from interoperable systems…..In future we intend to take a different approach”

7. Connecting Care partnership

8. project approach • 2011 Vision • 2012 Procurement • 2013 Staged approach • First stage (pilot) started in March 2013. Key deliverables: • A working system for 500 users • Evaluation of benefits • Stage one themed on urgent & unplanned care • 2014 A business case for the second stage .Second stage started Dec 2014 (next 5-7 years) FYFV PUBLISHED • 2015 = GROWTH Stage two will extend the breadth & depth (10,000 more users, more information sharing)

9. what we’ve delivered so far Presentation Connecting Care Clinical Portal Security & Privacy Patient Record Portal • Patient Search • Patient Lists • Patient Summary • Timeline • Flowcharts • Secure Messaging • Orion Health Applications • Third Party Applications • Authentication • Authorization • Single Sign-On • Patient Privacy & Consent • Relationships • Audit Logs • Demographics • Laboratory • Radiology • Encounters • Allergies • Diagnosis • Medications • Problems • Procedures • Transcribed Documents Integration MiG Rhapsody Integration Engine Clinical Data Repository Master Patient Index GPs Source Systems SWIFT – North Somerset NBT Cerner PAS Weston Cerner PAS Paris Social Care - Bristol UHB Medway PAS Adastra Out Of Hours Orders and Results (CRIS and Ultra) X2 Adastra End Of Life RiO Extracts X4

10. benefits approach • The backdrop: scope and theme of the pilot • Theme of ‘urgent and unplanned care’ • 500 licences, shared across all partner organisations teams • The hypothesis and framework used • ‘Better sharing of information and better integrated information should have a positive effect on the quality, efficiency and cost of providing care’ • Framework based on MSP • A detailed methodology and plan • Benefits realisation plan • Based on Quality, Innovation, Productivity and Prevention (QUIPP) themes

11. Connecting Care - benefits The main benefits for me (as a clinician or social care professional) are: • Confidence in my decision making is improved • The quality of my consultation (or assessment) is improved • I do not make unnecessary referrals or carry out duplicate assessments • It saves me time (which can be used to provide care, or for other duties) • I am more informed before a visit/appointment, which means I can provide more timely/more appropriate care • I have better relationships with colleagues • My input into a patient/service user’s care can be seen by others, so the recognition of my profession is increased

12. Connecting Care - benefits The main benefits for my patients/service users are: • They don’t have to keep telling their story (e.g. remembering / explaining medications • They receive safer, more appropriate care • They have a better experience of the services offered, potentially with fewer duplications or delays • They might not have to be admitted to hospital

13. Connecting Care - benefits

14. Connecting Care - benefits

15. Connecting Care - benefits “I now use Connecting Care on almost every case I deal with it (approx. 25 cases per shift).  It always makes a difference and adds value.  Every shift, acute admissions are avoided.” Doctor (out of hours) “Massive difference in time spent accessing information. On average [I can] access the GP record within 30 seconds compared with 15-20 minutes taken via telephone or via fax” Critical Care Pharmacist Manager UHB “it has enabled us to commence discharge planning earlier in the patients stay to help prevent delays later on.” Discharge Nurse “Unable to obtain a medication history or allergy status from the patient….accurately confirmed through Connecting Care …” Pharmacist, NBT “3 cases identified on Connecting Care today that were already allocated to a health practitioner (BCH OT or IMCS OT) so did not require referrals to BCC OT”. Occupational Therapist Bristol City Council “Connecting Care is brilliant…I use it to triangulate information from service users, to find out about other services involved so that I can contact them to inform my assessments” Bristol social worker “Have been able to identify trends which have then resulted in swifter [safeguarding] interventions…onecase where concerns would not have increased without Connecting Care…” Social Worker Safeguarding team ““Information about the patient’s diagnoses has helped our team decide which type of therapy to offer the patient” UHB

16. Connecting Care - benefits “On Monday I managed to obtain details for 22 patients on Connecting Care, I saved a huge amount of time as I didn’t need to phone the GPs and wait for the faxes to arrive” Acute Pharmacist “Without Connecting Care today I couldn’t have done my job.” Pharmacist Having access to accurate, timely, shared information is no longer a ‘blocker’ to providing high-quality, effective, efficient care… “I used Connecting Care to find vital information for the diabetes nurses . The information logged by district nurses is a goldmine of information. We saved 20 minutes on the telephone and managed to find the reason for patients insulin being discontinued”Discharge Nurse “In cases where we are dealing with a person who is being supported by Rapid Response and the district nurses, Connecting Care comes in to its own. All the notes from visits are documented and it can save at least 30-40 minutes on duty cases of this nature” Social Worker “The extra patient detail is useful when deciding to stop drugs such as anti-platelets and it helps to identify risk factors” Doctor “Connecting Care has been really helpful tonight. Could not do without it. Particularly in the case of an old lady with XX who I could not reach on the phone. Without Connecting Care this would have resulted in a visit and probably her door being broken down. But with CC I was able to work out that all that should of been done, had been done.” OOH Doctor

17. what can Connecting Care potentially offer? A sample of some possible financial benefits: Admissions Prevention 10,000 users could see annual saving of £1,036,288 from admissions prevented by using information in Connecting Care Based on a Department of Health reference cost 2012/13 of £1,436 for a unplanned admission and only the same rate of stated admissions prevented in the pilot Reducing duplicate assessments 10,000 users could see a annual saving of £179,520 on stopping the duplication of assessments as a result of using information in Connecting Care Based on cost savings if the same rate of stated admissions prevented during the pilot continues – based on £60 for an average cost of a face to face assessment by a community nurse - Department of Health reference cost 2012/13

18. what can Connecting Care potentially offer? A sample of some possible financial benefits: Time savings - calling other organisations 10,000 users could see a annual saving of £155,278 of ‘people time’ as Connecting Care users spend much less time calling other organisations for information Based on salary cost savings if only one call per week per user is saved where the medium salary between NHS bands 7 to 8 is used. Reducing home visits 10,000 users could see a annual saving of £68,000 on stopping unnecessary home visits as a result of using information in Connecting Care Based on cost savings if the same rate of stated home visits prevented during the pilot continues – based on £60 for an average cost of a face to face assessment by a community nurse - Department of Health reference cost 2012/13

19. what’s next?

20. Connecting Care governance

21. Connecting Care governance

22. Connecting Care

23. strategic alignment 5 year forward view: “Most countries have been slowto recognise and capitalise on the opportunities presented by the information revolution……the NHS has oscillated between two opposite approaches to information technology adoption.....the result has been systems that don’t talk to each other and a failure to harness the shared benefits that come from interoperable systems…..In future we intend to take a different approach”

24. National Approach - Bringing together cohorts on information sharing Driving priority standards for information sharing Technology Fund Applicants Collective guidance on breaking down “myths” e.g. Royal Marsden Pioneers Wave 1 Pioneers Wave 2 Understanding common and priority needs e.g. Barnsley e.g. Wakefield “Pioneering organisations” Articulating direction of travel e.g. Hampshire, Bristol

25. What’s the underpinning architecture? Acute Acute Acute Com Com Com MH MH MH SC SC SC Creation of local integrated digital care records to support clinical access to detailed care record and speciality information. Clinical access and contribution to integrated digital care records and summary care record through their native clinical system. IDCR IDCR IDCR Referrals/ Discharges i.e. transfers of care (clinical workflow) Local Clinical System Clinical Integration Platform (e.g. Leeds) Integration Platform (e.g. Britol) Integration Platform (e.g. Hampshire) Patient access to summary information (SCR) with ability to drill down into integrated digital care records. Access through NHS Choices and PHRs PHR integration platforms will enable apps/PHRs access to other APIs for – i) transactions e.g. use NHS referrals API to book appointments and 2) use APIs to access information from wearables etc Patients also to be able to contribute to PHRs GP Systems GP Systems Open APIs between IDCRs enable sharing across these Use SCR APIs to bring SCR content into IDCRs Expose access to IDCRs through APIs Specific key documents provided up to SCR for national access Open Source Middleware GP Systems GP Systems Patient Integration Platforms GP systems remain main point of curation of record MPI Index Summary Care Record Meds, allergies, adverse reactions Patient GP record ectract Demographics Index to IDCRs Flags (e.g. CPIS) Discharge meds Use of national assets for key flags and key documents where national access needed

26. KINNEAR’S - 5 reasons we have been successful…..

27. summing up • What is Connecting Care? • Why have Connecting Care? • Strategic alignment - UHB • National drivers • Who are the partners? • What have we delivered so far? • What are the benefits? Tangible results so far • What can Connecting Care offer & what’s coming next? • Governance Framework Thank you for your time!