Challenge and Scope Commissioners Organisations Services Population
Wigan Borough Vision Health and social care services should support people to be well and independent and to take control of their own care. Health and social care services should be provided at home, in the community or in primary care, unless there is a good reason why this should not be the case. Health and social care services in our Borough should be safe and of a high quality and part of an integrated system led by primary care.
Organisational Foundation • Electronic Records (Digital Maturity) • Cloud Computing • Tier 2 DataCentre (first NHS Accredited) • Wigan Community of Interest Network (CoIN) • Shared Primary/Community IP Telephony Platform • ShareToCare Governance Structure
What we have achieved… • Integration & Sharing – Robust Information Governance – Medical Interoperability Gateway (MIG) • Process • Deployment • Successes • EPaCCs – New BI Apps to support Acute care – Child Protection Information System – Single View – Risk Stratification – Electronic Document Transfer – Native in Context Displays - MIG, CPIS, SCR, GP to GP development
Shared Record Bridgewater Leigh Walk in Centre WWL Hospital Pharmacy North West Boroughs Partnership Pharmacy WWL Hospital Emergency Care GP Extended Access Service Bridgewater GP Out of Hours Service St Ann’s Hospice Wigan and Leigh Hospice WWL Hospital Palliative Care Team Integrated Safeguarding and Public Protection Team Bridgewater Allied Healthcare Professionals Bridgewater District Nursing Bridgewater MSK CATS Service Local Authority Early Intervention Team North West Boroughs Partnership RAID Team Local Authority Hospital Team North West Boroughs Partnership Wigan Assessment Team Local Authority Locality Teams Local Authority Initial Assessment and Out of Hours Teams WWL Hospital Mortuary WWL Hospital Clinical Ward Managers Safeguarding Teams WWL Hospital Anaesthetics CCG Continuing Healthcare Team
Delivering Benefits 24/7
What we have achieved… • Infrastructure – GovRoam – Integrated locations (Hindley Town Hall, Lilford Centre, Leigh Sports Village) – Telephony • Agile Working – Community Services – Adult Social Care – Children’s Social Care and Early Help • Decision Support – DXS Point of Care • Empowering the Population – People Powered Technology – Patient Online + MyAccount – Text Messaging
Where are we going • Agile Working • People Empowerment • Single Version of the Truth – Professionals – SQL Azure – Population • Remote Consultations • Cloud services – Care Homes • National/Standards Based Integration – Out Patients • IoT – building self reliance • Identity Defined and independence Workspace • Enhanced Shared Care Record
Agile Solution Provides • Ease of use – Just open and work • One user – one device • Work from anywhere – Lan/WiFi/4G – Always connected Intelligent VPN • ‘Do IT Anywhere’ – PC based in office type experience • Online full clinical desktop with 3 rd party views • Seamless online/offline mobile record application
Single Version of the Truth (SVOTT) • To ensure everyone is seeing and using the same information. • To increase our knowledge of the location population. • To make Health & Social Care services safer and more efficient.
Digital Health and Care • Using Skype for Business for Tele-health • Workstream 1 – Scheduled Care – Offered for Follow Ups (where appropriate), also exploring its use for Referral Assessment Services • Workstream 2 – Unscheduled Care – Improving Triage, Assessment & Communication between Primary, Community & Acute Care Smart Devices (IOT) • People Powered Technology – assistive living rollout ongoing • Pilot underway for Business Intelligence
Work Programme Digital Health & Paper Free Real time Whole Care at the point data System Building of care analytics Intelligence self reliance
Manchester Connected Health Ecosystem Paul Morris (NHS Bolton CCG) The Bolton Care Record
Implementing the Bolton Care Record Presentation by: Paul Morris
What is the Bolton Care Record? The Bolton Care Record (BCR) is a way of bringing together the relevant parts of a patient’s health and social care records. Currently held in separate systems by different care organisations that are responsible for looking after them. NHS hospitals, community services, out of hours services, social care & 49 GP Practices 300,000 population 1 of 10 localities in Greater Manchester
Why the Bolton Care Record? NHS England has been working with patients and clinicians to try and identify ways of ensuring that patients and clinicians are able to gain maximum benefit from their consultations. To enable this to happen, there is a target that the NHS should be paper free at the point of care by 2020.
Why this is important for our patients? More than 75% of the Bolton population think this already happens! Joined up care is safer care Faster care in an emergency More time spent on the patient instead of going over the same information Patients don’t need to remember lots of medication or who they have seen, its in their records
Access to the Bolton Care record Note: only authorised clinicians and healthcare workers from the above organisations have access to the Bolton Care Record and only where direct care is being provided with consent. Other legal gateways exist including emergency care and where a person doesn’t have the capacity to provide consent.
Information Governance and consent Information Governance - Governance structures for all aspects of the Bolton Care Record, including information governance, are established and include representatives from all of Bolton’s key partner organisations within the Care4Bolton partnership. NHS Bolton Clinical Commissioning Group retains overall responsibility for ensuring that the governance structures operate effectively. Explicit consent is always be requested from the individual patient before any information held in the Bolton Care Record is accessed. Patient identifiable information can only be accessed for direct care purposes and will always be fully auditable. Patients can opt out at any time.
Systems Data is collected from existing systems. Data is then fed into a single system. Data is joined up and presented in an easy to view format for the clinician.
Our Implementation (so far) … Future 49 Practices (100% population) Organisational Go-Live Migrate to GM wide instance Governance Tertiary Hospital (Cancer) Leadership on Fully in Place 9 GP Practices Ambulance Service Board Emergency Department Other Acute Providers Care Plans Oct Jul Jun 2016 2017 2018 Sep Feb Sep Dec 2016 2017 2017 2018 Now… Engagement Information Sharing 43 Practices (88% population) Starts Protocol & Local Acute Trust Information Sharing Community Services Agreement Sign Up Adult Social Care GP Out of Hours Mental Health
Communications and Engagement To inform the public we have developed a communications and engagement plan to support this work. The CCG has conducted extensive engagement with the people of Bolton, staff and other stakeholders to ensure that there is widespread understanding of the Bolton Care Record.
Challenges? Partner organisations have been nervous about sharing data. Information Governance – holding to our principles GPs see the least immediate benefit
How is it making life easier? Wealth of information Improved informed decision making Improved patient safety and experience Reduced emergency admissions Reduced calls to GPs missing information Release of staff time to care
What’s next? Full local rollout Include other tertiary and acute providers Patient portal Maintain trust in the data sharing model Develop GM wide consent and sharing protocol Local Health & Care Record Exemplar
Manchester Connected Health Ecosystem Ben Green (University of Manchester) Developing & Operating a TRE
Trustworthy Research Environment (TRE) Ben Green • TRE Operations Manager • CHC Information Security Manager • ISO27001 Implementation Lead ben.green@manchester.ac.uk 07766 924161
Trustworthy Research Environment • What is the TRE? • Who is the TRE for? • ISO27001 Certification • Connected Health Cities • The TRE service • TRE Projects
Trustworthy Research Environment What is the TRE?
Trustworthy Research Environment • A secure research data centre for the Greater Manchester ‘Learning Health System’ • Recently achieved ISO 27001 certification & 100% on NHS IG Toolkit level 3 • Controls informed by public involvement – building a ‘social license’ for health data sharing
Trustworthy Research Environment • Bespoke facility for health data research • Information security assurance for Citizens’ Juries, funders & data providers • N3 connection for NHS data transfers • Information governance support • Priority is maintaining confidentiality, integrity and availability of data
HeRC Trustworthy Research Environment (TRE) • Private Cloud build on 600 CPU cores, 2TB memory with 150Tb of AES256 encrypted highly resilient storage • Direct connection to the NHS N3 network • ISO 27001 certified Information Security Management System (ISMS)
HeRC Trustworthy Research Environment (TRE) • Hosted at the Centre for Health Informatics at the University of Manchester • Protected by strong physical/procedural security controls (inc. UoM Security Team) • Security controls tested by Penetration Testing contractors and internal audits
Trustworthy Research Environment TRE Core Principles “We make it very difficult to identify an individual from their TRE account credentials” “We avoid sending passphrases to people” “When importing research sensitive data into the TRE, minimise the number of physical storage locations throughout the transfer” “The TRE Service will create and maintain an asset register containing a record for each raw dataset imported into the TRE” “The TRE Service logs all activity related to network traffic, service status and data handling” “The TRE is routinely tested to make sure its security controls continue to operate that the require levels” Where feasible, every file belonging to a TRE user or project will obtain an asset record managed within the scope of the ISMS Sensitivity is not a good measure of personal information Projects operating within the TRE shall experience a negligible risk of reidentification We will only allow data to be imported and made accessible to an individual if there is corresponding IG paperwork that approves this transfer, and names the individuals who have been granted access. “All critical data in the TRE is backed up onto secure offsite storage facilities”
How the TRE works VM VPN VPN HeRC TRE VM ISMS VPN VM controlled environment full control over access rights no proliferation of datasets no re-identification audit trail
Trustworthy Research Environment
Trustworthy Research Environment • Analytical research projects – Windows and Linux VMs available • Service hosting including – Internet of Things clinical trials – clinical audit and feedback dashboards
Trustworthy Research Environment The TRE is for: • Academic research staff • Clinical scientists • Statisticians developing algorithms • Health economists • Software engineers/vendors
Trustworthy Research Environment ISO27001
Trustworthy Research Environment
Trustworthy Research Environment ISMS Processes ISMS Event and Incident Management ISMS Communication and Stakeholder Management ISMS Document Management ISMS Improvement ISMS Management ISMS Risk Management Staff Induction and Exit Training and Competency TRE Asset Management TRE Data Management TRE Information Governance TRE Infrastructure and Security Management TRE Operations TRE Physical Security TRE Project and User Account Management TRE User Competency and End-Point Security
Trustworthy Research Environment ISMS Processes (TRE) ISMS Event and Incident Management ISMS Communication and Stakeholder Management ISMS Document Management ISMS Improvement ISMS Management ISMS Risk Management Staff Induction and Exit Training and Competency TRE Asset Management TRE Data Management TRE Information Governance TRE Infrastructure and Security Management TRE Operations TRE Physical Security TRE Project and User Account Management TRE User Competency and End-Point Security
Trustworthy Research Environment
Trustworthy Research Environment Connected Health Cities “A Connected Health City is a civic partnership in which care services, science, technology, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as a by-product of delivering care.” The information nucleus of the CHC, owned and trusted by the public, is the Ark:
Trustworthy Research Environment “An Ark is a trustworthy, regional combinatorial innovation centre for health and social data analysis, producing timely, actionable information for the care of the population it serves”
Trustworthy Research Environment
Trustworthy Research Environment
Trustworthy Research Environment
Trustworthy Research Environment Hardware and Software Infrastructure • Security Operations Centre • System Configuration • Highly resilient storage (routinely tested) • Secure software engineering
Trustworthy Research Environment Information Governance • Support with Data Sharing Agreements/Contracts (Registered and using the Information Sharing Gateway) • Bespoke CHC Privacy Impact Assessments • Participation in GM/NHS IG working groups • Collaboration with UK Data Service and UK Anonymisation Network
Trustworthy Research Environment
Trustworthy Research Environment Data Management • All data encrypted in transit and at rest • All raw data catalogued and cross- referenced against IG paperwork • Guarantee integrity during data import • Secure data destruction
Trustworthy Research Environment TRE Operations • Service helpdesk • Safe Research Data Use training courses (e.g. SURE) • Project support • Scientific software support • Analytical support
Trustworthy Research Environment Examples of projects hosted in the TRE • Neighbourhoods and Dementia - http://www.neighbourhoodsanddementia.org /statistics-programme-staff/ • CHC Stroke - https://www.connectedhealthcities.org/resea rch-projects/using-technology-data-improve- diagnosis-treatment-strokes/
Trustworthy Research Environment • CHC Wound Care – https://www.connectedhealthcities.org/research- projects/wound-care/ • CHC BRIT - https://www.connectedhealthcities.org/research- projects/using-data-tackle-antibiotic-resistance/ • NHS Test Beds - https://www.healthinnovationmanchester.com/la unch-nhs-test-beds-wave-2/ • Current setting up various projects with Salford Royal FT
Trustworthy Research Environment • Numerous projects utilising data extracts from Salford Royal (SRFT / SIR) • CFHH
Secure and transparent data handling Practice Practice data always stay on N3 system University of Manchester Secure Data Facility Dashboard on N3 Data Extractor Analytics
Trustworthy Research Environment CHC BRIT
Trustworthy Research Environment Questions? tre-support@manchester.ac.uk
Group Discussion & Refreshments Challenges & Opportunities of Data Sharing and delivering Data Driven Healthcare? Barriers to adoption, utilisation & scaling across GM? • What can we learn from the approach taken so far? • Who needs to be involved & how? • What are our digital assets? • @Man_Inf @healthinnovmcr @ECHAlliance #McrEcosystem
European Connected Health Alliance Bringing needs and solutions together for the Future of Health ECHAlliance Update Andy Bleaden International Projects Manager ECHAlliance andy@echalliance.com www.echalliance.com info@echalliance.com @echalliance
About European Connected Health Alliance Community Interest Company CIC (non-profit organisation) 650+ member organisations who – feel free to join us! Companies, policy-makers, researchers, health & social care providers, patients, insurances … 16,500+ experts / professionals 40+ countries Europe, USA, Canada, China where international network of ecosystems (100+ ecosystem meetings a year) what H2020 international communication Global Connector projects events / dissemination www.echalliance.com & groups / & networking expert workshops services
ECHAlliance Membership: recent new members www.echalliance.com under ‘Members’ JOIN US
ECHAlliance Ecosystems: Goals / Objectives The ecosystem goal is to create ‘permanent’ mutually beneficial partnerships , which improves the delivery of health and social care , at the same time as providing economic benefits. An Ecosystem brings together a community of multi-sector stakeholders , interested in developing a joint health agenda, aiming to address and find common solutions to challenges facing your region . The main benefit of working together in an Ecosystem is the multiplier effect and of collaborating in an International Network of Ecosystems.
ECHAlliance Ecosystems: Basic Principles Ecosystem Principles: • Multi-sector stakeholders gathering • Based on a geographic zone • Permanent, with regular meetings • Shared strategy & action plan • Light governance via working group • Accessible to all (no barriers) • Lead with a need • Member of an International network • Patients / Citizens at the centre
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