Driving the Dream of Integrated Health & Care Services · 2019-01-31 · OpenEHR PRSB (Professional...
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@oht_uk @NHSDigital #OHT17 Driving the Dream of Integrated Health & Care Services Wednesday 29 th November @INTEROPenAPI @NHSDigital @AireLogic @oht_uk #OHT17
Transcript of Driving the Dream of Integrated Health & Care Services · 2019-01-31 · OpenEHR PRSB (Professional...
@oht_uk @NHSDigital #OHT17
Driving the Dream of Integrated Health
& Care Services
Wednesday 29th November
@INTEROPenAPI @NHSDigital @AireLogic
@oht_uk #OHT17
@oht_uk @NHSDigital #OHT17
Welcome
@oht_uk @NHSDigital #OHT17
...a community that celebrates and promotes the extraordinary talents and
remarkable work that women and people with diverse backgrounds are achieving
in healthtech.
We inspire, support and champion greater inclusivity in healthtech because,
without ensuring diversity from the Board all the way to the frontline, the
healthtech industry will never reach its full potential.
One HealthTech is...
@oht_uk @NHSDigital #OHT17
Our Journey
● Established in the UK in December 2015
● First 18 months gathered 11,000 members
across 6 hubs
● Now spreading internationally
● Community-hub model: Each region is run by
local volunteers who spread love, passion and
enthusiasm for health technology in the best
way they see fit
@oht_uk @NHSDigital #OHT17
Why do we exist?
@oht_uk @NHSDigital #OHT17
Wearables
Genomics
Mental
HealthBig Data
Bio Tech
Block
Chain
Digital
Medicine
Cyber
Security
Health Tech
Funding
Fit Tech
Health Data
Analytics
Open Source
VRUX
Health
& Care
Apps
@oht_uk www.onehealthtech.com #OHT17@oht_uk @NHSDigital #OHT17
@oht_uk @NHSDigital #OHT17
Dr. Amir Mehrkar
Co-Founder, INTEROPen &
Senior Clinical Lead for
Interoperability, NHS Digital
Dr. Simon Eccles
Senior Responsible Officer for
Interoperability, NHS
INTEROPen Board Representatives
Standards Organisations
Networks & Others
BCS (British Computer Society)
Digital Health CCIO Network
Digital Health CIO Network
EMIS National User Group
Innovative UK - Knowledge Transfer Network
Klas Research
NHS HACK DAY
ALBs
Care Organisations
Alder Hey NHS Foundation Trust
Belfast City Hospital
Birmingham & Solihull LDR
Birmingham & Solihull Mental Health NHS Foundation Trust
Cambridge University Hospital
Connecting Care Partnership
Dorset Health & Care Community (Dorset CCG)
Great North Care Record
Greater Manchester Health & Social Care Partnership CDO
Health and Social Care in Northern Ireland
Holding Your Hand Limited
Humber, Coast and Vale STP
Humber NHS Foundation Trust
Imperial College Healthcare NHS Trust
Lancashire and South Cumbria STP
Leeds Teaching Hospital NHS Trust HL7 UKIHE UKOpenEHRPRSB (Professional Records Standards Body)
Health Education
England
Healthy London
Partnership
London Health and
Care Information
Exchange
NHS Digital
NHS England
162 Member Organisations
as of 20/11/17
Marie Curie UK
NHS Gloucestershire CCG
NHS South, Central and West CSU
NHS Lothian
North West London Care Information Exchange
North Tyneside CCG
North Yorkshire County Council (Adult Social Care Services)
Northumberland, Tyne and Wear NHS Foundation Trust
Salford Royal NHS Foundation Trust
Sheffield Health and Social Care NHS Foundation Trust
Somerset Integrated Digital Electronic Record
Taunton and Somerset NHS FT
Tower Hamlet/Newham/City Hackney/Waltham Forest CCG
University College London Hospitals NHS Foundation Trust
University Hospitals Southampton NHS Foundation Trust
York Teaching Hospitals NHS Foundation Trust
Northern Ireland CCIO Network
One HealthTech
OpenHealthHub CIC
SOCITM
techUK
IT Suppliers
AccuRx
Active Medicine
Advanced Health & Care
Aire Logic Ltd
Allocate Software
Allscripts
Answer Digital
Application Insight
Atos
Boots
Blackpear
BT
Cambio + Healthcare Systems
Capgemini
Capita Health Partners
Careflow Connect Ltd
Carelink (Piksel Ltd)
Cerner
CGI Group
CharityLog
CheckWare
Clinisys
CommonTime
CSC
Cyber Media Solutions
Deepmind Health
Deontics
Docman
Docobo
Digital Cognition
Ramsey Systems
Red Embedded Systems
Restart Consulting
Ripple
Servelec
Sitekit
Soliton IT
Solutions4Health
Shaping Cloud
Specialist Computer Centres
Stalis
Sunquest
SystemC
Targett Business Technology
Tiani Spirit
Tiny Medical Apps
TotalMobile
TPP
Trisoft Healthcare Ltd
Virgin Media Business
Vision Health
Wiggly-Amps
Wolters Kluwer Health
“HealthLanguage”
X-Lab
Intersystems
JAC Computer Services Ltd
JKM Care Solutions
Kainos Evolve
Mayden
Medelinked
Medical Connections
Medxnote
Microsoft Health & Life Sciences
Microtest
MphRx
myhealth
NHS Wales Informatics Service
NoemaLife UK
Northgate Public Services
Nottinghamshire Health
Informatics Service (NHIS)
Nth Dimension
OLM Systems
Open Mapping SoftwareOptum International
Oracle
Orion Health
Ortivus
OTTech Healthcare Consultancy
Outcomes Based Healthcare
Phillips Healthcare
Pinnacle Health Partnership
Prederi
psHEALTH
Pumpco
Quicksilva Systems Integration Solutions
Egress
Elsevier
EMIS Health
Endeavour Health
Enovacom
Epic
Epro
everyLIFE Technologies
Experis
Forcare
FreshEHR
G2 Speech B.V
GPC Group
Graphnet Health
HCI Group (Tech Mahindra Ltd)
Health Fabric
Health IntelliegenceHealthForge
Healthcare GatewayHealthlinkedHospediaHuawei TechnologiesIBMIMD-SOFTIMMJ Systems (Mediviewer)
IMSMAXIMSInhealthcareInidus LtdINPSIntelerad
Intelesant
What we trying to achieve:
GP connectRecord access
Transfer of CareeDischarge
Mandatory Required OptionalGP practice Admission details Assessment scales Patient demographics Procedures Social contextDischarge details Individual requirements Participation in researchClinical summary Medication and medical devices Investigations and procedures
requested Diagnoses Safety alerts Patient and carer
concerns, expectations and wishes
Allergies and adverse reactions
Plan and requested actions
Legal information
Distribution list Referrer details Information and advice given
Person completing record Investigation results
Academy of Medical Royal Colleges Headings
in Discharge Summary
How we’re trying to achieve it
(CareConnect curation):
CLINICAL MODELLING
e.g. Allergy
GP-RecordeDischarge
CareConnect FHIR Profile
First of Type Implementation SitesGDEs TRUSTS + ACUTE EPRS
+ GP Vendors
PHASE 1 proposalCLINICAL
FHIR TECHNICALTERMINOLOGY
VENDORSCLINICAL SAFETY
PHASE 2INTEROPen community
feedback
PHASE 3 approvedINTEROPen webex call
or workshop
Why we’re trying to achieve it:
www.interopen.org | @INTEROPenAPIJoin us: [email protected]
The Robin Hood Principle of Information Sharing
The duty of the information rich to SHARE* with
the information poor, for SAFER and more
PERSONALISED patient care.
#CollectShareUse so that #DataSavesLives
*to SHARE, not to steal!
The Robin Hood metaphor is light hearted but
also serious: together we are behind the drive to
make patients and citizens information rich!
The challenge
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Identities
Content
Dates
Content
Problems/Diagnoses
Content
Observations
Content
Medications
Content
Plan
Content
Free text
Verbage
Headings:Clinical community
via PRSBContent:Data elements
Multiple owners
SNOMED
DM&D
NHS number
Etc
Transfer of Care
document
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Meta-data
Verification
Security and IG
Information Model:
FHIR/ terminology
INTEROPen Board Representatives
Delivery: Underpinning national
capabilities
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Health /
Social Care
IT systems
GP
Acute
Community
Mental
Health
Ambulance
111
Pharmacy
Social Care
Digital Interoperability Platform Health /
Social Care
IT systems
GP
Acute
Community
Mental
Health
Ambulance
111
Pharmacy
Social Care
MESH
SSP
AP
I M
an
age
men
t
eRS EPS
Event Management
Service Subscriptions
National Record
Locator Index
National Portal
(SCRa)
Developer
Ecosystem
National
Failsafe
Spine Demographics
Spine Clinicals
Strategic
Authentication
Authorisation
Directories:
Orgs, Services, Users,
Roles, Endpoints
National Record Locator Service - will allow an authorised clinician, care worker and/or administrator, in any health or care setting, to access a patient’s information to support that patient’s direct care
Event Management Service - will facilitate the consistent sharing of nationally defined (patient) “events” from event publishers to recipients (consumers). Recipients may be identified by the creation of a “subscription” (rules) indicating the criteria of events that the recipient is interested in or needs to receive pub/sub).
Strategic Authentication - To provide a national health & social care digital identity which is secure, simple to obtain and trusted across national, regional and local services for legitimate access to clinical information at any location of patient care .
SCRa Redesign - The SCRa has been identified as an existing service we can ‘improve’ to deliver better access to patient information by removing some of the barriers that we were required to build into the current service (i.e. mandatory requirements for N3 and smartcards) and make more information available.
Delivery: Underpinning national capabilities
Data hubs
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Local Clinical
Record
Local Clinical
Record
Local Clinical
Record
Local Clinical
Record
Regional Data
hub
Regional Data
hub
NRLS
Science
Personal
Health
Record
SCRa
Data flow
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Local Clinical
Record
Local Clinical
Record
Local Clinical
Record
Local Clinical
Record
Regional Data
hub
Regional Data
hub
NRLS
Science
Personal
Health
Record
SCRa
Information Governance
• Local v. National/aggregate
• GDPR
• Consent
– Direct Care
– Supporting care
– Research
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Leeds Community Dietetics
AireLogic & Forms4Health
Mark Simpson
© Leeds Community Healthcare NHS Trust September 2017
Our project start
© Leeds Community Healthcare NHS Trust September 2017
Met Aire Logic through AHSN
Innovation important to LCH and Aire Logic
Uses of the forms4health tool
Getting the right pilot group
© Leeds Community Healthcare NHS Trust September 2017
Which cohort to use, Passport not right
IBS a better fit
Thought through success criteria
Functional Gut Disorder Form
• Nationally approved tool
• Standard for assessment
• Long for completion by hand
• Took most of appointment to complete © Leeds Community Healthcare NHS Trust September 2017
What Forms4Health did
• Took the form and made it look engaging:
• Allows better data capture:
• All while being straightforward and easy for the patient
© Leeds Community Healthcare NHS Trust September 2017
The Patient Experience
• An IBS Patient is referred and flagged as IBS at triage
• A text reminder is sent before the appointment
• Also send the link to the form, asking the patient to fill it.
• Patient fills the form in and sends it back
• Admin add to the record
© Leeds Community Healthcare NHS Trust September 2017
The Electronic Form – Benefits
• Saves time & a more patient centred consultation
• Greater patient engagement
• More Responsive
• Patient Self-Care
© Leeds Community Healthcare NHS Trust September 2017
Considerations/Problems
• Patient Engagement
• IG & Systems
• The ‘Tech Averse’
• ‘Tech Averse’ staff….
© Leeds Community Healthcare NHS Trust September 2017
The pilot now
• Within 6 months soft-launched to the staff
• Whole cohort engagement
• Comparisons and evaluations
• Patients described the form as “Well put together” and “Easy to use”.
© Leeds Community Healthcare NHS Trust September 2017
Evaluation
• Track how many of the forms are sent back
• Feedback from staff about time freed up in appointments
• The Dietetic service see standard IBS patients, and offer a specialist ‘FODMAP’2
service for patients it could help.
2 Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols © Leeds Community Healthcare NHS Trust September 2017
forms4health
Patient and clinician facing smart digital forms
Established in 2007 – three main streams of business, Consultancy, Development and Product (forms4health) year on year growth
Involved in the definition of the national interoperability approach, inc. GP Connect, Care Connect and Spine 2
Developed the recognised agile healthcare enterprise architecture method EA Light, to support organisations reviewing their ICT and deliver an organisational ICT roadmap for the future
forms4health now being used from Leeds to the US
ABOUT AIRE LOGIC
Clinical electronic forms platform capturing, presenting and graphing clinical data
Nursing assessments, EoL care plan, discharge summary, patient facing forms and many more
Smart forms: pre-population capability, skip logic, calculations, lightweight decision support, input validation, business logic
Building block approach to form development, rapid design and deployment –easy to replicate, proving cheaper to deliver
THE forms4health SOLUTION
Structured data for business intelligence, monitor, evaluate and report on the data
Working across a range of devices, iPad, smartphone, android tablets
Scalable, small numbers of forms to EPR
Can ‘gap fill’ for other solutions – provision of solutions for existing system gaps and full integration with existing solutions
Roadmap to integrate with clinical systems using GP Connect and / or Care Connect.
THE forms4health SOLUTION
• A case study
Severe workplace injuries
327 different form templates created by BAs and SMEs.
A week after go live:
6,000 completed forms
286 different form templates exercised.
675 patients
forms4health IN NUMBERS
CONTACT US
• Gill Smith
• 07557 882616
Mike Odling-Smee
07946 512754
www.airelogic.com
@AireLogic
1 Aire Street, Leeds, LS1 4PR, UK
Tel: 0113 468 8527
LTHT and Aire Logic partnership - PPM+ 'Leeds' way with an
NHS-built EHR
Martin Waugh – PPM+ Product Owner
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Enterprise Platform
City Wide Multi-Agency Integrated Record
Over
17,000
staff
Turnover
£1.17 billon($1.83 billion)
Over 1,100,000 Outpatients
Over 117,000 Inpatients
Over 108,000 Day Cases
Over 263,000 A&E Attendances
9,844 Babies born
175 Buildings114 wards
135 Departments & Clinical areas
And 69 Operating Theatres
About Leeds Teaching Hospital NHS Trust
PPM+
Regional
PPM1(Oncology)
LCRY&H
Genomics
TIE RIE
LTHT PPM Enterprise Platform
LABS
PAS
ClinicalSystems
Write AccessPlanned
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EPR 17,000 Active Users140+ Organisations ConnectedAccess Model: L-R, RBAC
Complex patient with all 5 tabs present
LCRFoundation
33,000 clicks on
the GP tab in August
2017
23,500 LTHT patient records
accessed in August 2017
Connecting each other
First of the demonstrator sites to label down to bed
space level and start unlocking the potential
Associates patient, to place, to product, to
process.Automatically updates
the e-whiteboard
Mobile ppm+ app allows access to e-forms within
the patient EPR at the bedside
LTHT, LCR andregional roadmaps
8 releases / month,major release every 6-8Weeks, zero downtime
Embeded delivery team
Implementation Support
Feedback
Clinically Led
Clinical stakeholder, delivery /prioritisation boards & clinical reference groups, Feature product owner
Continuous improvementsShow and Tell
Seamless integrated with trust staff –all passionate about quality delivery
Clinical staff – bridge between informatics and clinicians.
Feature toggling and RBAC means features can be enabled when service ready. Supports Pilots, full roll-out
In-house agile delivery
Enterprise platform
• Over 60 forms live• Can add new forms as a
publication• Building block approach• Can cater for small and
large use-cases – e.g. Resus
• 110 eWhiteboards(largest in Europe)
• 30 patients, 30 columns (~900 data items) refreshed once per minute
• Multi-patient View – peak stats, 20 per second
• Re-architecture – was 15s now 400ms
Enterprise platform
18 Internal systems(inc. PACS, Cardiology, eMeds)
9 neighbouring trusts
100 GP Practices(MIG and GP Connect)
4 National ServicesPDS (SMSP), SCR, eRS and CPIS
Enterprise platform
Her GP is concerned and calls the hospital Advice Line:
• complete e-form with GP• place on the electronic Un-
Planned Patient list (UPL)• arrange transfer to hospital
Arriving at assessment area:• produce and scan a GS1 compliant
wrist band• check medication list in real time
from her GP record• check her e-obs, trigger against
signs of sepsisAt the bedside:• medicines are prescribed
and administered electronically
• EDAN population is started• E-obs automatically update
the white board (AKI, Diabetic)
• electronic handover
Hospital Specialists & GP
Who can view?
GP is more informed, can run a virtual ward, and can provide better
and safer care to the patient. The district nurse can immediately view
the EDAN via the LCR & support Gladys at home
Who can view?
Patients GP
Gladys visits her local GP feeling
unwell, high temperature & fast
heart rate
Gladys is taken to Hospital
On discharge:• Electronic Discharge Initiation
Document, EDAN & discharge letter
• electronic distribution
Hospital Admission:Results & Images are returned into the EPR & viewable by clinician remotely
Patient Journey
4,500 PCAL assessments,
£150k cost saving
45,000 handover,
138,000 eObs
7,300eDANs
LTHT
Leeds Care Record
Cancer, Genomics
STP
Regional footprint
Questions?
Interoperability Across Urgent & Emergency Care
Presented by Amanda Neylon,
Digital Services Director Urgent & Emergency Care
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Our vision: Urgent & Emergency CareWe will help to deliver the national urgent and emergency care strategy by providing the digital infrastructure, algorithms and pathways we require.
60
What are we here to do?
• Develop new digital services to enable patients to access the
UEC system.
• Develop the next generation of clinical triage technology to
enable the patient to get to the right service at the right place at
the right time.
• Develop an open platform to support a single, national source of truth about urgent and emergency care service information.
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Are we driving fast enough?
A complex landscape
It’s not just about technology….
6350%* of the work necessary to establish effective
interoperability is people stuff
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Urgent & Emergency Care is heavily reliant on interoperability for several years now – it underpins our ability to flow patients through the different services involved
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Standard interoperability workflows can support organic innovation
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111 patients transfer to GP OOH
• Pharmacies are using them to receive referrals from NHS 111 for patients where they need urgent help with their medication avoiding having to pass patient details over the phone or via fax
• Emergency Departments are using them to electronically transfer a patient on to an Urgent Treatment Centre where they do not need ED specifically rather than a patient having to provide all of their details again
• Online tools are using them to provide a seamless journey into urgent care services where a need cannot be met purely online
• Ambulance services have used them to improve their patient handover between different regions (e.g. for border patients)
• And more…
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So what’s next in UEC?
New Specialist Models for
111
Prog 6 Patient
Relationship Mgmt
Prog 7 Access to Service
Info (A2SI)
Pro
g 5
Clin
ical
Tria
ge P
latfo
rm
Prog 8 Out of
Hospital Care
Dec 17 Dec 18 Mar 19
Domain E: EPS
Domain F: eRS
Domain C: GP Connect
Interoperability
Domain D: Integrated Care
Outcomes
Enhanced Triage
Urgent Treatment
Centre
Care
HomeAmbulance
Paed MH Frailty
PMPRPathway
s
Directory of
Service
A&E
UTC
PharmacySCR or Local
Shared Record
GP Practice
MH Crisis
End of Life
Urgent Care
Services
40% access
Funding ~ Apr 2018
111 Online
111 Phone
A&E
UTC
Clinical Triage
GP
Practices
(EMIS 55%)111 Phone
(Adastra
80%)
100%
Book
Appt111 Phone
OoH
Pharmacy
EPS
Directory of
Service
(tactical)
100%
access
Prescribe
GP Practice
100%
book
appt
Read History? –
Pharmacy specific
Wearables
Video consultation
Transfer of
triage data
Compliance Accuracy
Book
Appt
Records
access
Patient info
transfer
Repeat Caller
Service
GP
Practices
(TPP 38%)
Capacity &
Demand
Input
DataCDSS
Pilot
B
Interaction
s
Pilot
A
Pilot
C
Pilot
D
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Access to Service Information (A2Si) mission… will transform existing Directory of Service (DoS).
Enable Urgent & Emergency Care professionals to quickly and easily access wider range of reliable service information.
Ensure patients are effectively and safely referred to most clinically appropriate, convenient and available onward service.
Access to Services Information – Key Themes
We will;
• Migrate the DoS to a sustainable, scalable platform that delivers incremental improvements that supports Integrated Urgent Care.
• Ensure service information in the DoS is as accurate, complete and reliable as possible.
• Enable simplified, frictionless access to the DoS to a wider range of healthcare professionals e.g. via mobile apps, APIs etc.
• Supplement the existing service information with real-time availabilitydata about the demand on and capacity within all urgent care services.
• Create and implement a national standard for appointment bookingacross urgent care services.
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A2Si – Key products
National capacity and demand platform
• Will support third party applications (common data and
interoperability standards).
• Allow commissioners and providers to select from accredited
catalogue of products.
Appointment booking
• Working with UEC suppliers to provide appointment booking
standards across UEC care settings to reduce unnecessary
admissions to A&E.
Live Profile Updater
• Service to enable pharmacies to query own DoS data and specify
updates.
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Clinical Triage Platform –our vision… will be tailored to the needs of the individual; continual improvements in accuracy and timeliness being underpinned by both individual patient data and evidence of outcomes. Through accurate and personalised triage, CTP will contribute to intelligent demand management, promoting and supporting a sustainable, clinically effective, and financially affordable NHS.
Access to care through
multiple channels
Utilising patient data and
predictive modelling of patient
risk
Improved reporting provides
greater insight into service
demand
CHANNELS:
Telephone, Online, ED
face2face, Primary Care,
Urgent Treatment
Centre, Social Care
STANDARDS:
- Existing national standards
utilised where appropriate
- New standards developed
- Providing consistency of
data to allow interoperability
- Utilising standard APIs to
allow localised customisation
Performance
optimisation
utilising
outcome data
Triage data linked with patient
outcome data
Patients referred to most
appropriate care
1
9
2
3
4
5
6
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The future of Clinical Triage
ClinicalCall handler
Identify
Patient
PDS
Citizen
Identity
Patient
Medications
Record
Locator
EPS
GP
Practices
Prescribe
Authenticate
Find Patient
Get Records
TriageDiagnose &
Advise
Triage
Local Care
Records
Refine
Disposition
Get Appt
Slots
CDSS
Specialty
Modules
Multiple
endpoints
AllergiesConditions
Social Care
RecordsAdded
Create Appt.
and Transfer
Patient
PMPRDirectory of
Service(s)
Multiple
endpoints
Book and
Transfer
Single
endpoints
Personalise
Transfer
Patient
UEC Overview
Analysis - Outcomes
Medical RecordsTriage
Ph
on
e Clinical Decision Support System (linear)
On
line
Non-clinical Clinical
Pilot A
Pilot B
Pilot C
Pilot D
Dis
po
siti
on
Self Care Advice
Directory of Service
Mental Health
Personalise
Paediatrics
Frailty
Records Access
SCR
GP Practice
A&E
UTCs
Pharmacy
Patient Compliance
Disposition Accuracy
Appointmnt/ Referral
…
Triage data
Pathways
Non-linear Probabilistic
…
Current
Future
Enhance
National collections
EPS
Prescriptions
Audit Records
Appointments &Transfer of Triage Info
Prescribe
Feedback & Improve
Other Models?
Patientor Proxy
PDS
@oht_uk @NHSDigital #OHT17
Interop Open Surgery: Panel Q&A
Keep in touch…
@oht_uk
meetup.com/OneHealthTech/
www.onehealthtech.com
www.facebook.com/OneHealthTech/
tinyurl.com/lki-ohtuk
@oht_uk www.onehealthtech.com #OHT17@oht_uk @NHSDigital #OHT17
