Delivering interoperability in England

1. Delivering interoperability in England Dr Grant Kelly CfH SNOMED Clinical Lead Office of the Chief Clinical Officer

2. What is OCCO? • 200 odd clinicians • Building EPR acceptability and content • Clinical drivers • Putting in the Clinical Heart • Aligning clinicians with tech and standards • 300,000 to be brought on board • …To solve….…

4. A bit of a mess • Needs organising • Needs a programme • Needs a business case • Clinical • Political • Admin • National • Perpetual

5. How? • Tying together CfH clinical activities • Governance • Organisation • Employment • Sales • Benefits • Removing obstacles

6. Office Support Manager – Hazel Chappell Support Officers – Pam Bainbridge, Launa Broadley, Joyce Charlesworth + 1 Fitness to lead BAMM Clinical Leaders Network Training & Accreditation Medical Leadership in change management The Office of the Chief Clinical Officer Chief Clinical Officer: Michael Thick WKS 01 Clinical Office Medical Directors for the National Programme Mark Davies and Simon Eccles • Group Director – Alan Perkins • - Programme Manager – Dora Hague OCCO Programme Board NPfIT Clinical Executive (see next sheet) WKS 02 Governance of Clinicians Ian Scott Programme Manager – Simon Massarella WKS 03 Clinical Stakehokder Management Simon Eccles & Marlene Winfield Programme Manager – Simon Massarella WKS 05 Clinical Safety Maureen Baker Clinical Change Barbara Stuttle / Susan Osborne Programme Manager – Rowena Herbert Clinical Content Mark Davies Programme Manager – Rowena Herbert National Clinical Leadership (part of WKS 01) • See next sheet Clinical Content Strategy Clinicians Support Service Clinically Safe Practice Clinical Change & Business Support Patient Engagement S t r u c t u r e d r e c o r d s t h i n k i n g • Early Adopter Project • Implementation Guidance • current best practice • future service improvements • current policy priorities • - Prescribing Risk Minimisation • Right Patient Right Care - Safer Handover • Safer Implementation • - Database of NPfIT Clinicians Continuous Prof Development • HR: recruitment, placement, appraisal • Patient info • Liaising with patientgroups Clinical Engagement National Clinical Content Development SNOMED Implementation • Clinician comms • Professional bodies Clinically Safe Systems • Engagement, Promotion and communications, • training Clinical Activity Assurance Media • Development of Safe Standards in IT • CCN 61 assurance • Safety Incidence Management Process • National Integration Centre • Audit / review of clinical input • Gap analysis and recommendations • Reporting and escalation on level of clinical input • Clinical spokespersons • Clinician Media briefings • Columns, article support • Communications links with government and DH Clinical Content Assurance Framework Mobile Working business process and approach, assessment of mobile technologies in prescribing, infrastructure and implementation guidance • SNOMED utilisation • logical data model Conferences & Events Clinical Safety Implementation & Training • Presentations/speaker slots • Exhibitions • Workshop sessions • Training • Skills database ECare Pathways • design and implementation of systems in NHS Common Core Components Do Once and Share

7. Why? • Create the functioning EPR • Improve sharing • Improve satisfaction • Improve the patient journey • Support the process • Support safety • Improve interoperating using records

8. Why keep records? • To make decisions • In the middle of the night • In the part-absence of knowledge • As the most junior • When the patient is in most danger • And handover was 4 hours ago • And 12 patients ago • ….sharing knowledge….

9. Why share externally? • GP’s present 168 hrs • Work 48 hrs • 120 hours of uninformed cover • Right when it’s most needed • Completely unavailable • Doesn’t stack up in any direction • Not interoperable

10. Clinical Standards? EWTD – max continuity 13 hours No knowledge transfer standard Partly legible Always written by others Maybe lost Maybe an unfamiliar assembly of data Not conducive to good care ……….It could be you…………

11. RCP record-keeping project • Basic text standards already • Supported by CfH • Aimed at handover/discharge • Becomes a transfer of care standard • Assumes a messaged structure • Assumes a paper mentality • Ok to get started • What IS the eventual EPR architecture?

12. EPR Chicken and egg • We can’t teach other clinicians what we don’t know • We don’t know what Techs can build • Techs don’t know what we want • Techs can’t build what we can’t describe • Beset by insolubles • A recipe for dissatisfaction • No perfect development path • …..We have to forge ahead…

13. What’s worked so far? • PACS • GP2GP • C&B • Common factors? • Clear business case • Clear requirements • Interoperating

14. What isn’t sorted yet (arguably)? • The relationships….. HL7 & CDA openEHR 13606 Archetypes SNOMED Logical data model/Architecture Care Record Elements MIM Terminfo

15. Delay breeds imagination • The DH Informatics Review • To decide information requirements • To decide delivery • Therefore the mechanisms • And the ‘shape’ of the EPR • This week • And there’s NLOP…

16. What do clinicians want? • They don’t know (pace GP-land) • Something to get started with • Something to complain about • Something they’ll all have a view on • And will disagree on • Then we can find some common ground

17. What else does CfH want? • SNOMED now mandated into contracts • HL7 templates to normative (rigorous binding) • HL7 tooling to IT standard 3 • HL7 governance processes • Long-term strategy? V4? • Implementation-focussed approach (cf IHTSDO) • Harmonisation with related standards (13606, etc)

18. If we don’t get a move on……. Thank you