Post on 15-May-2018
Agenda
14:00 – 14:30 Digital Child Health overview
14:30 – 15:15 Child Health Information Standard and Events Catalogue
15:15 – 15:30 Break
15:30 – 16:00 Alpha phase
16:00 – 16:30 Maternity
16:30 – 17:00 Questions
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Digital Child Health – National overview
Presented by Thomas Burnett
Digital Child Health Programme Manager
Background to programmes
Healthy Children: Transforming Child Health Information, a
strategy commissioned by NHS England September 2015, delivered
July 2016, published November 2016.
NHS Digital work began July 2016 (Discovery)
Maternity Transformation Programme, formed on the back of the
National Maternity Review (Feb 2016). 9 Workstreams, 2 dedicated
to information services and technology.
NHS Digital handed remit for a Discovery period for Workstream 7:
Harnessing Digital Technology in September 2016.
Healthy Children – strategy vision
‘Knowing where every child is and how
healthy they are’
‘Appropriate access to information for all
involved in the care of children’
A number of current challenges
National Personal Child Health Record (PCHR) still on paper
Limited capability to manage children unregistered to GPs and offer them
preventative services
Deficiencies in managing local populations highlighted by National Incident
Team report, children at risk of missing out on preventative services
Healthcare professionals don’t have access to a core summary of child health
information, records are fragmented across systems
Services still very paper driven and manually intensive
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Public Health
EnglandP
ers
onal H
ealth
Pro
fessio
nal H
ealth
Public
Health Commissioners
Directors of Public
Health & Children’s
Services
Delivery of Healthy Child
Programme
(All Children)
Delivery of all other care services
(Some Children)
CHIS /
CHRD
CHIS /
CHRD
CHIS /
CHRD
CHIS /
CHRD
CHIS /
CHRDCHIS /
CHRD
School NursingPrimary CareHealth VisitingMidwifery
Education ServicesVoluntary ServicesMental Health
Services
Emergency &
Acute Services
Justice ServicesSocial ServicesCommunity
ServicesNeonatal Services
Maternity
Information Systems
Screening
Information Systems
Primary Care
Systems
GPESCYP DatasetCAMHs
Dataset
PCHR
90
CHRDs
Research & Policy
Maternity
Dataset
SCR
National Audit
Healthy Children – where do we start?
With the basic building blocks:
• A first layer of essential child health information for exchange
• A first phase of systems exchanging that information - Maternity, Child Health
GP systems and Personal Child Health Records
• A roadmap for growing the scope and sophistication of the information
exchange
• Adding in new services as they become available, for example, national
Failsafe for Healthy Child Programme
How it works
Primary Care
MaternityHealth Visitors
0-5
Child Health
Records School Nursing
5-19
National
Screening
Services
ePCHRNational Events
Management Service
National
Failsafe
Management
Service
Hub
Registration
Authority
Events
Design
Authority
Citizen
Identity
Relationship
Management
Public Health
Other New
Services
Regional support
Primary Care
Maternity
Health Visitors
0-5
Child Health
Records
National
Screening
Services
ePCHR
Public Health
National Events
Management Service
National
Failsafe
Management
Service
Hub
Registration
Authority
Events
Design
Authority
Citizen
Identity
Relationship
Management
Integrated
Digital care
Record
School Nursing
5-19
Local
eP(C)HR
Local Events
Management
Service Local Failsafe
Management
Service
Timeline touch points
2017/18 2018/19 2019/20
Key Event
Go Live date
NEMS and FPM Beta
complete
Programme Business
Case approved by
TDIB
NEMS & FPM
Business Case
Development
Complete
NFMS Business
Case
Development
Complete
NEMS
and FPM
Alpha
complete
NFMS Alpha
complete
NFMS pilot completeEvents
Catalogue
published
by PRSB
ISN
Interoperabi
lity and
FPM
Published
NEMS and
FPM pilot
complete
NEMS used by the
first organisations to
share data from the
events catalogue
ePCHR available to
first Parents/Carers/
Children with national
health record access
NFMS Beta
complete Events Catalogue
development
complete
NFMS used by the first
organisations to get
failsafe alerts
ISN for Failsafe
Published
Implementing the
Strategy
Philip M.J. Graham
Health Informatics Programme Director
Blackpool Teaching Hospitals
Maternity
Systems
GP
Systems Community
Systems
CHIS
National
Screening
Systems
Registration
SCR/PDS
Local IDCR /
Interface
Local
Access
Management
Health
National
Partner
Personal
Local failsafe
management
What next?
• Governance
• Build on the infrastructure
• Implement the phases
• In partnership
• To implement the Strategy
Maternity
Systems
GP
Systems Community
Systems
CHIS
Education
Systems
ePHR
National
Screening
Systems
Local
Authority
Systems
Failsafe
Management
Registration
SCR/PDS
Local IDCR
Access
Management
Commissioning
Population
Management
National events hub
Local events hub
Health
National
Partner
Personal
LPRES
We will cover
• Event definition
• Event content
• Professional Records Standards Body (PRSB) consultation
• Timelines
Where did it all start?
The strategy:
“Parents, families and carers will have an online record of their child’s health and development”“Professionals will have access to a core view of child health information at the point of care”
But where do you start? How do you define a Core View?• Maternity Dataset v1.0 and Children and Young Persons• PCHR (Personal Child Health Record)• OBS 2015
NHS Digital created the starting point around the events that should be exchanged for Professional, Personal and Public Health
Digital Child Health approach to events
• Something happens in the life of a child
• It may or may not be in the Healthy Child Programme or recorded in
the Red Book
• We call this a clinical intervention or occurrence
A visit to the GP
Newborn Infant Physical
Examination
Birth Writing a comment
in the child’s ePCHR
MMR immunisation
Digital Child Health approach to events
• Once this clinical intervention or occurrence has happened any number
of events are produced
• These are published to the National Events Management Service (NEMS)
HCP Clinical Intervention: Newborn
Physical Examination
Referral
Measurement
Physical Examination:NIPE
A Newborn physical examination
is performed – this is the clinical
intervention
After the clinical intervention a series of
events may be triggered
Digital Child Health approach to events
Professional, Personal and Public Health will be able to see the events
in the events catalogue
A GP may want to see
to all events relating to
all children under their
care
Public Health may only want to see certain events such as ‘measurements’ or ‘immunisations’
Parents may want to
see all events relating
to their child
What is an events catalogue?
• One document containing all ‘events’ based on the Healthy Child
Programme and the scope of the PCHR
• Gives enough information for all involved in the care of children to
understand the strategic direction, the current ways of working and data
flows
• Contains all clinical and non clinical data items broken down into each
event
• In future will allow public, professionals and personal health to decide
which events they want to send/share/publish and what events they want
to ingest/view/subscribe to
• The document will be iterative and future work will continue into the
Maternity and National Failsafe work
PRSB consultation
• Scope split down into 3 packages to be consulted upon covering all elements
of the PCHR and Healthy Child Programme
• 3 large consultations planned with health professionals, parents, public
health and suppliers with over 70 people attending
• NHS Digital provided the starting point of what information should be
exchanged
• Gain agreement on what clinical data items should be shared across
professional, personal and public health
• PRSB to gain sign off from Academy of Royal Colleges for a Community
Child Health Record structure and where each data item sits within the
record
Timelines
• Draft FHIR resources for Package 1 online now (feedback welcome!)
• Alpha design phase has begun on NEMS (collaboration welcome!)
• Package 2 and 3 consultation in June and July
• Events catalogue to be finalised by October and shared via GitHub
alongside draft FHIR resources
• ISN to be released in February 2018
Profiles
• Profiles are resources that have been constrained for a use case
– Cardinality
– Optionality
– Terminology
– Extension
Bundle example
DCH-BirthDetailsEvent-Bundle-1This 'DCH-BirthDetailsEvent-Bundle-1' Bundle resource profile is used as a container to collect a combination of the following resources, as ordered below, to fulfil the information requirements of a Birth Details Event:
• DCH-BirthDetailsEvent-MessageHeader-1
• CareConnect-DCH-BirthOccurrence-Encounter-1
• CareConnect-Organization-1
• CareConnect-DCH-Baby-Patient-1
• CareConnect-DCH-LengthOfPregnancy-Observation-1
• CareConnect-DCH-NumberOfFetusesInConfinement-Observation-1
• CareConnect-DCH-ActualDeliveryPlace-Organization-1
• CareConnect-DCH-ProblemsInBirth-Condition-1
• CareConnect-DCH-AbnormalitiesDetected-Condition-1
• CareConnect-DCH-ProblemsInPregnancy-Condition-1
• CareConnect-DCH-TypeOfDelivery-Procedure-1
• CareConnect-DCH-Delivery-Encounter-1
• CareConnect-DCH-Mother-Patient-1
• DCH-MotherAndBaby-RelatedPerson-1
• CareConnect-Location-1
Bundle example
MessageHeader
Encounter
PatientResponsible
OrganisationHealthcare
ProfessionalLocation
Service
Provider
Observation(Length of pregnancy)
Procedure(Type of delivery)
Observation(Foetuses in confinement)
Related
PersonMother
Alpha scope
• Who’s here
• What we’ve done so far
• What next?
• What are the risks / dependencies?
• How can you engage?
What we’ve done so far
Alpha Scope Definition
Strategic Alignment
Verifying the Use Cases
Delivery Alignment
When What
Early
2017• Ongoing Strategic Alignment
• Architecture / conceptual
exploration
• Project Scope clarification
April • Through the DDC “Front Door”,
tactical alignment, planning
• Defining a manageable Alpha
scope
• Approach to requirements
management
• Defining ways of working as part
of the Digital Interoperability
Platform agenda
Realigning the Alpha scope
• National Events Management Service (NEMS)
• National Failsafe Management Service (NFMS)
– Limited short term scope: child population
tracking of contact with health services:
Child Health Record Department
Health Visiting Service
Primary Care Service (GP)
School Nursing Service
– Longer term scope – Full failsafe management
Verifying and elaborating use cases
dfd Birth Notification DFD
Midwife
Search for
Mother
Maternity System
Maternity System
(Non PDS)
PDS
Find Mother's
NHS Number
Birth Notification
Application
Enter Birth
Details
Send Child's
NHS Number
Link Mother to
Baby
Submit Birth
Notification
CHIS
ONS
Registrars Online
National
Screening Store
Create Child's
NHS Number
Child's NHS
Number
Mother's Details
Mother's Details
Mother's Details
Mother's Details
Mother's NHS Number
Mother's Details
Mother's NHS Number
Mother's NHS Number
Birth Notification
Birth Notification
Birth Details
Child's NHS
Number
Child's NHS
Number
Birth Details
Child's NHS
Number
Birth Notification
Birth Notification
Child's NHS
Number
Birth Notification
Birth Details
Birth Details
Birth Details
Child's NHS
Number
Birth Details
dfd Vitamin K DFD
Midwife
Maternity System
Vitamin Kadministered
PCHR
CHRDVitamin K
Admin
CHIS
Further Doses(Oral)
GP
Health Visitor
AdditionalVitamin K
doses
Health VisitingSystem
GP
Administration DetailsFlimsy
Administration Details
Notified of additional doses
Administration Details
Vitamin K consent
AdministrationDetails
Administration Details
Administration Details
Notified of additional doses
Administration Details
AdministrationDetails
Administration Details
• Ensuring NEMS / NFMS requirements
align with events
• Data flows (publishers and subscribers)
for events in scope elaborated
• Building a solution as agnostic as we can
of the Business system / organisational
model to make it more sustainable
dfd Vitamin K DFD
Midwife
Maternity System
Vitamin Kadministered
PCHR
CHRDVitamin K
Admin
CHIS
Further Doses(Oral)
GP
Health Visitor
AdditionalVitamin K
doses
Health VisitingSystem
GP
Administration DetailsFlimsy
Administration Details
Notified of additional doses
Administration Details
Vitamin K consent
AdministrationDetails
Administration Details
Administration Details
Notified of additional doses
Administration Details
AdministrationDetails
Administration Details
Alpha timeline – what next?
When What
May • Requirement Elaboration
• Resource Allocation and prep for Sprint #1
June • Development
• Ongoing Requirement Elaboration
• User Research / Service Design (in parallel /
collaboration)
July – Sept • Iterating the above
October • Refinement / consolidation
November • Alpha Closure – checkpoint
• Prepare for Beta
Engage Users
Manage Expectation
Articulate the direction
Get feedback
ONGOING…
Engage Suppliers
Strategic Alignment
Transparency
What next - Healthy Child events in early scope
• Birth Notification
• Bloodspot
• 8-week immunisations
• HPV
• Population failsafe
Pattern 1
Pattern 2
Pattern 3
Pattern 4
Pattern 5
Failsafe
?
Original Alpha Scope Possible Updated Approach
Alpha ways of working
• Following the Government
Service Design Manual.
• Where applications are stood
up to explore an issue, these
will be made available for
experimentation, with test
data.
Alpha ways of working
• All latest developments
available through GitHub
• All discussions,
communications and
points of view contributed
by suppliers and users will
be openly available online
Alpha outputs
• One or more prototype(s)
• Documented evaluations of the prototypes from
business and technical viewpoints
• A recommendation of which approach is the best,
viable option to progress to beta phase
• Documented design of the best viable option, in
sufficient detail to support approvals by architecture
governance
What are our risks and dependencies?
• It’s part of a wider Digital Interoperability Platform
• The strategy encourages local equivalents (still aligning
to national standards)
• Ongoing feasibility and viability
• Citizen Identity dependency (and wider P2020 agenda)
Invitation for involvement in Alpha
• Opportunity for supplier and user communities to become
involved to both influence and learn
• Seeking different levels of involvement
• Open to the all supplier and user communities
• No financial support to suppliers or users to become
involved in Alpha
• If a future procurement is authorised a notice will be
published advising all strategic suppliers that a
procurement has commenced. Consequently there will be
no impact resulting from participation in the Alpha
Levels of involvement in Alpha
• Doers - suppliers and users who are willing to get their hands
dirty trying out aspects of the Alpha work
• Thinkers – suppliers and users who are willing to publically offer
views, advice or critiques
• Watchers – suppliers and users who just want to follow progress
Request for user involvement
• GPs
• Health Visitors
• School Nurses
• Other interested Health professionals
• Supplier user groups
dch@nhs.net
For more information
• Email:
– dch@nhs.net
• GitHub:
– https://github.com/DigitalChildHealth/Discovery-Alpha
• Health Developer Network:
– https://developer.nhs.uk/downloads-data/digital-child-health-fhir/
Supporting women, helping professionals
Harnessing digital technology in maternity transformation
Presented by Helen Harger
Senior Clinical Product Manager
What are we trying to help with?
• Numbers of births are increasing
• A changing profile in users of maternity services
• Changes in service usage and access
• Increasing demand for personalisation of care
• Wide variation in maternity pathways and their
effectiveness
• Recognition of a lack of access to mental health
services
• Missed opportunities relating to still birth and
appropriate interventions
Digital challenge
• Cultural reliance on paper notes, digital often used only for booking
and hospital care around birth and the early post-natal period
• Few building blocks for digital innovation, e.g. legacy maternity
systems, limited mobile working, variance in digital maturity
• Lack of reliable information reflecting national UK care provision and
consistency of access to national guidance on birth and care choices
for women
• No standards or core dataset for interoperable maternity systems
• Women-held maternity notes still on paper
• Time to administrate paper/technology interface is impacting time to
care
Three things
Digital tool Initially, an app to improve personalisation and choice by enabling access to
unbiased, evidence based and locally specific information about their own
circumstances, choices available and their own personal care plans
Behind the scenes ‘machinery’. Replacing paper processes with point-of-care
accessible electronic maternity records. The enabler for consistent capture
and movement of maternity pathway information between and within local
maternity systems, professionals and with women
Standards &
interoperability
Digital
maturity
Making life easier through appropriate adoption and uptake of technology.
Create a supportive framework for growing digital maturity and capability in
maternity services
>
>
>
Problems and priorities for professionals
73National Maternity Transformation Stakeholder Survey for WS 7 - Oct-Feb
Getting it right for women
What are the 3 biggest complaints you hear from women receiving
your care?
Poor Support/Communication
Lack of continuity of care
Delayed Care
Not enough time with HCPs
Lack of consistent advice/info
Having to repeat their history
Poor Accessibility
Too much Admin
Other
Technology should never be the entire solution… but can play a huge part
National Maternity
Transformation
Stakeholder Survey
for WS 7 - Oct-Feb
A record: standards and interoperability
• Standards needed to bring together the
multitude of supplier systems in use
across and within local maternity
systems
• Create a safe continuity of care and
‘continuity of carer’ approach whilst
maintaining choice
Improved choice for women:
example
Provider 1: antenatal
Provider 2: intrapartum
Provider 3: postnatal
• Enabling ‘capture once, re-use many’
www.digital.nhs.uk
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enquiries@nhsdigital.nhs.uk
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