Dr Masood Nazir7 September 2012

“Digital Innovations supporting General Practice”

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Clinical Commissioning GroupsInformation for success

Dr Masood NazirDr Masood Nazir

General Practitioner & Clinical Lead IT - Hall Green HealthGeneral Practitioner & Clinical Lead IT - Hall Green HealthInformation & Quality Assurance Lead – Birmingham Cross-city CCGInformation & Quality Assurance Lead – Birmingham Cross-city CCGClinical Director IM&T – Clinical Director IM&T – Birmingham & Solihull NHS ClusterBirmingham & Solihull NHS ClusterClinical & Social Care Lead IT – NHS Midlands & East SHAsClinical & Social Care Lead IT – NHS Midlands & East SHAsChair North, Midlands & East SHA Clinical LeadsChair North, Midlands & East SHA Clinical Leads

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WHAT I’LL COVER……

Alignment of Technology to Clinical and Efficiency Measures in the Outcomes Framework

Adoption of Existing Technology to underpin Service Change

Digital Essentials: Things to consider that will help your bottom line….. “Why Not?”

What support is being provided nationally to help local delivery?

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Birmingham Cross-cityClinical Commissioning Group

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Our population

597,000 patients103 practices108 sites

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Bordesley Green, South Yardley, Small Heath, Acocks Green

LCN

Bordesley Green, South Yardley, Small Heath, Acocks Green

LCN

East Birmingham

LCN

East Birmingham

LCN

EdgbastonLCN

EdgbastonLCN

Hall Green LCN

Hall Green LCN

Kingstanding & New Oscott

LCN

Kingstanding & New Oscott

LCN

NorthfieldLCN

NorthfieldLCN

North East LNC

North East LNC

South Birmingham

LCN

South Birmingham

LCN

Washwood Heath LCN

Washwood Heath LCN

Information and Quality Assurance

Information and Quality Assurance

Senior Finance Officer

Senior Finance Officer

Accountable Officer

Accountable Officer

Informatics and LCNs

Informatics and LCNs Lay

MemberLay

Member

Consultant Advisor

Consultant Advisor

Nurse AdvisorNurse

AdvisorPartnership

Commissioning

Partnership

Commissioning

Primary Care

Redesign & Quality

Primary Care

Redesign & Quality

Secondary Care Redesign

Secondary Care Redesign

Contracting & QIPP

Contracting & QIPP

Mental Health (x2)

Local Authority(x2)

Mental Health (x2)

Local Authority(x2)

Urgent Care (2/3)

Elective Care (2/3)

Long Term Conditions (2/3)

Urgent Care (2/3)

Elective Care (2/3)

Long Term Conditions (2/3)

HEFT x2UHB x2

BCHBCHC x2

BWHROH

WMAS

HEFT x2UHB x2

BCHBCHC x2

BWHROH

WMAS

Lay Vice ChairLay Vice Chair

Local Commissioning Network Chairs

Local Commissioning Network Chairs

Chair of Local Commissioning Network Group

Chair of Local Commissioning Network Group

ChairChair

Birmingham CCGBoard Structure

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GainingAdvantage

Business As usual

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Central Care Record project Cloud collaboration tools

Asset Management/IT refreshGP Clinical Systems

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“ The more extensive a mans knowledge of what has been done, the greater will be his

power of knowing what to do”

Benjamin Disraeli

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RELEVANCE OF TECHNOLOGY TO HELP SUPPORT OUTCOMES

Technology Contributes to1. Urgent care clinical dashboards Outcome Framework:

• Enhancing quality of life for people with long term conditions• Improving people’s experience of accident and emergency services Reduced number of A&E attendances and the associated ambulance journeys ( Target 10% by 2014/15 )

2. Risk Profiling Outcome Framework: • Reducing premature mortality from the major causes of death • Reducing time spent in hospital by people with long-term conditions• Enhancing quality of life for people with long term conditionsReduced number of emergency admissions ( Target 20% by 2014/15)

3. Care Co-ordination Outcomes Framework: • Ensuring that people have a positive experience of care• Ensuring people feel supported to manage their condition• Enhancing quality of life for people with long term conditions• Improving the experience of care for people at the end of their lives• Reduced cost by supporting patients to die at their preferred place of deathReduced number of emergency admissions ( Target 20% by 2014/15)

4.Shared Decision Making - Patient decision aids

Outcomes Framework: • Improving people’s experience of care• Improving patient choiceReduced cost of discretionary surgery where it is clinically appropriate

5. Digital Essentials (Skype Consultations, Online Meeting Services, Managed Print, Digital Dictation, Digital Pens etc)

Reduced Running Costs

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1. URGENT CARE CLINICAL DASHBOARDSBACKGROUND

An Urgent Care Clinical Dashboard (UCCD);• displays information in a graphical, user-friendly way • helps GP Practices to more pro-actively manage and co-ordinate their

patient’s healthcare, • especially for the most vulnerable patients and those with long-term

conditions.

It provides;• near Real-Time information from the local Acute Trust(s) • on A&E attendances, admissions and discharges • combined with near real-time information from Out of Hours and the

Walk in Centre to each GP Practice; • enabling a whole system view of urgent care.

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1. URGENT CARE CLINICAL DASHBOARDSCASE STUDY- BENEFITS

• NHS Bolton efficiency saving of £300K p.a. from reduced A&E attendance• Reduction of emergency admissions by 4.7% in 10/11• 1000 GP practices covering a population of 6.3 million

KEYSites with live dashboards Sites in implementation phaseFurther scheduled dashboard deployments

NHS Stoke on Trent and NHS North Staffordshire

NHS Devon

NHS Torbay

NHS Plymouth

NHS Tees (NHS Hartlepool, NHS Middlesbrough, NHS Stockton-on-Tees, NHS Redcar & Cleveland)

NHS Gateshead

NHS County Durham and Darlington NE Lincolnshire Care Trust Plus and partners

NHS Calderdale

NHS Northamptonshire

NHS Leicester City, NHS Leicestershire County and Rutland

NHS Cambridgeshire

NHS Peterborough

NHS Luton

NHS North Essex

NHS Suffolk

NHS Oxfordshire

NHS Southampton

NHS Buckinghamshire

Central London Healthcare Partnership

South Cheshire and Vale Royal GP Commissioning Consortia

NHS Merseyside (NHS Liverpool, NHS Halton & St Helens, NHS Knowsley, NHS Sefton)

NHS Manchester

NHS Central Lancashire

Lancaster Morecambe Carnforth & Garstang CCG

NHS Oldham

NHS Tameside & Glossop

NHS Trafford

NHS Brighton and Hove

NHS East Sussex Downs and Weald

Medlinc CCG/NHS Surrey

1. URGENT CARE CLINICAL DASHBOARD IMPLEMENTATION SITES

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GPADS: GP Acute Data System

• Accessible via NHS Number from any of the acute activity reports

• Summary information from the primary care system, including demographic data, primary care diagnoses, acute activity in last six months and biometrics.

• Patient-specific A&E and inpatient admission reports

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2. RISK PROFILING

Risk profiling;• predicts the risk of adverse health events• such as emergency admission in the next 12 months • for individual patients based on their previous primary and secondary

care history • using a predictive algorithm.

This helps GP Practices;• identify patients who are suitable for support by case managers or

community matrons • who were not previously on GPs radars.

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2. RISK PROFILING

Case Study- Benefits

•Used by Devon PCT for case finding and proactive case management

•Has resulted in an overall reduction in emergency admissions by 4.11% over the last two years

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3. CARE CO-ORDINATION

The Challenge:Patients with long term conditions, and those approaching the end of their life need support across a range of care settingsBeing able to share information about care provided - including care plans and patient preferences, is essentialTo develop new national interoperability specifications to support a consistent approach and support wider adoption

Case Study:South West Electronic Palliative Care Co-ordination System (EPaCCS)Thousands of patients now achieving their preferred place of death, with less than 10% dying in hospital

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4. DIGITAL ESSENTIALSTHINGS TO CONSIDER THAT WILL HELP YOUR BOTTOM LINE…..

“WHY NOT?”

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4. REMOTE CONSULTATIONS USING SKYPE /ONLINE MEETINGS

Online Meeting Services (e.g. Skype) are being used to:

• Replace routine consultations where physical exams are not required

• Reduce DNAs

• Increase access to GP or consultation services.

OMS (Skype) is already being used by clinicians to hold consultations with patients from their own

homes (e.g. South Devon Healthcare NHSFT) and for Diabetes outpatient follow-ups in Newham,

reducing a 30-50% DNA to 16%.

£115K p.a. Estimated saving from community teams at NHS Derbyshire using Online Meeting

Services

Guidance is available from the QIPP Digital Technology team that;

• outlines how to run meetings safely and addresses key Information Governance points

• presents best practices for running safe meetings using Skype

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Virtual meetings and communication: some days I need a TARDIS

“Eat your lunch, sign prescriptions, answer queries from reception staff, get involved, pay attention and contribute!”

CCG Chair

Solutions (although not quite as good as a TARDIS):• Skype• Microsoft Office 365• WebExand many more . . .

i-Engage – Meetings from Planned Care Solutions using Microsoft Office 365. and RHUB TurboMeeting device for virtual meetings - 60 users 4 month pilot

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”In a nutshell, Office 365 enables me to be productive when I'm on the move.   Like many of my colleagues, I have a wide range of roles in additional to my clinical duties, which involves working from different locations.  Office 365 allows me to be paper-free, and ultimately more efficient; using my iPad I can always access the latest version of any file, at any time, from almost anywhere.  There are no admin boundaries and crucially Office 365 safe, secure and intuitive to use. It's a brilliant communication, and collaboration, tool which will grow with our changing priorities and ways of working.  I can't recommend it highly enough to all my clinical colleagues across the CCG."                                                               GP and CCG Information Lead

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4. THINGS TO CONSIDER THAT WILL HELP YOUR BOTTOM LINE….. “WHY NOT?”

Digital Pens

• £1235 per pen p.a. savings within maternity setting• NHS Portsmouth estimate £212K p.a. Savings across their maternity services

Cloud Storage

• Sandwell and West Birmingham CCG: •Office 365 provides a Real-Time collaboration Hub to 60 staff. •Delivered savings of £781 per month per 3 person virtual meeting, and £146 per board meeting.

Simple Tele-health: • Provides a text-based

tele-health reading, advice and reminder service led by NHS Stoke-on-Trent

• Extended diabetes study validates pilot findings: Flo reduces clinical time by 60% and increases meds compliance by 80%.

Online Access to GP Records

• Dr Amir Hannan is a GP in Hyde, UK.

• Developing a "Partnership of Trust" between patient and clinician, he has enabled over 11% of his patients (more than 1,300) to access their GP electronic health record on-line

• Provides all LTC patients with a clear understanding of the relevant pathway using Map of Medicine.

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4. THINGS TO CONSIDER THAT WILL HELP YOUR BOTTOM LINE…..”WHY NOT?”

Managed Print

• Unified delivery and management ofprinters, scanners and copiers for an organisation.

• Savings of up to 30% off the cost of printing

• Central Lancs Care Trust reports a return on investment after just 3 months and currentsavings running at over £50K per month.

Green IT – PC Powersaving

• To provide all Informatics Merseyside Partner Organisations with a unified PC Power Management product.

• Over £100k savings delivered post implementation.

• Return on Investment achieved within 5 months.

Telemedicine

• Interactive healthcare, allowing consultations with physicians live over video or capture images and data for diagnosis and followup later.

• Six acute trusts and seven PCTs across Lancashire and Cumbria expect savings of £1.8 million annually

Digital Dictation

• Saving of £69K from 11 radiologists in 5 months.

• Salford Royal FT on track to deliver benefits over £500K p.a.

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WHAT SUPPORT IS BEING PROVIDED NATIONALLY TO HELP LOCAL DELIVERY?

The QIPP Digital Technology Team have produced;

Implementation guide and toolkit for the Urgent Care Clinical DashboardTechnical & Information Governance guidance on risk profiling solutionsGuidance for electronic sharing of care plans, with a focus on LTCs and End of Life careGuidance for patient registration and authentication to online servicesDigital Essentials brochure – that NHS organisations should be looking to exploitFactsheet & Information Governance guidance on using Skype for online consultations / meetingsProcurement guidance for online meeting servicesWebsite with Interactive Map of local informatics initiatives

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NEW FUNDING TO SUPPORT SHARING OF INFORMATION

The Information Sharing Challenge Fund – a new fund announced on 31st August.

Available to local NHS organisations to develop new patient care improving and information sharing digital services e.g. Clinical Dashboards.

Three categories of award:1. New Stuff – totally new solutions

2. Development – by a new supplier

3. Rollout

To assist with application process webinars are being held in Septemberhttp://www.dh.gov.uk/health/2012/08/information-sharing-challenge/

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NHS TREASURE MAPInnovations – Promote, Share & Spread your GEMS

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M6

M5

M6

M1

M1

M54

M69

M40

M42

M50

M6 toll

9

1 4

Mobile Working

Sharing Information

Education

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SUMMARY Digital innovation has a key role to play in supporting

General Practice

It’s not new – much of this already exists…there is low hanging fruit

GPs to consider role of digital technology as part of service change

National enablers and case studies already available to assist with adoption.

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• Email: qippdt@nhs.net• Website: www.connectingforhealth/qipp

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