Supporting safer care @anniecoops #datasaveslives 51
The half-life of data and Data Quality ‘Digital data does not decay like the information we record on paper. In a digital world data maintains its value and potentially has value beyond an individual person’s care’ @anniecoops 52 #datasaveslives
Getting to grips with data and consent 53
Nursing Terminology and Standards ‘We need national nursing information standards that we can apply across professional practice that will enable us to; examine nursing outcomes, share safely and support accurate artificial intelligence’ 54
The Future? @anniecoops #datasaveslives 55
Questions? @anniecoops Anne.cooper@nhs.net
Refreshments
Sharing for caring: The MIG Story - the past, present and potential Dr Mark Westwood, Dr Mark Dornan Dr Phil Stamp,
Mark Westwood • GP Partner since 1995 • Urban teaching practice Wallsend • CQC outstanding • CCIO North Tyneside CCG • Honorary Research Fellow Neurology Clinical Trials RVI (MS Trials ) • Co founder of GNCR concept • Primary care lead GNCR (CHC) • Financially challenging times in CCG • Proud to be part of organisation https://preview.tinyurl.com/y94u4gzm • • @geordiemedic @joinupITNOT mark.westwood @gncr.info
Chronology of IT Wall of Cool 1995 encrypted records paper based 2013 Role in CCG IT lead (CCIO) one session per • • week 1995 Wyse Terminal dot matrix printer • 2014 SRO for IDCR “interop Bid” … Successful • 1997 Gp with IT hat about to be connected to • but unfunded “super highway 2015 POC with MIG project , Northumbria ,NTW • 1998 home PC with AOL and internet • North Tyneside CCG Northumberland CCG 1999 PC based GP system with box in cupboard • 2015 upscale name to Great North Care Record ( • 1999 email …. X400 • co founder/founder ) CHC emerging as a possible 2000 Y2K .. • project 2003 upgrade to newer GV IT • Early 2016 POC had worked for NOT MIG project • 2004 Govt NPfIT program • DPC program started in earnest • 2005 >>2010 Roll out LSP program • May 2016 offered role Primary care Lead CHC • 2005 NHS mail • /Great North Care Record 2006 New Path Project • Late DEC 2017 kick start in North TynesideCCG • 2009 fully paper free with Path results cross platform appt booking and get to alpha • stage for a shared care record EOL POC 2010 Demise of LAN based systems • 2018 ……………..> TBD • 2010 Shared intranet in North Tyneside • 2012 NHS re shuffle ( lava lamp reset) • 2013 Could we “ Joinup NOT IT” 7 th March Live • theatre
October 2015 Tyne2tweed I tyneside Great North Citizens record Great North Care Record
Dr Mark Dornan GP, NGCCG, SRO for the Digital Care Program
Brian’s story- Why https:/learning.necsu.nhs.uk/ elearning/mark-dornan/story.html
The MIG story
Challenges • Regional • Local • Practices • Public
Recap - What is MIG & ISG? • MIG connects clinical systems e.g. GP practices with: • Out of Hours providers, Acute Foundation Trusts, Mental Health Trusts, Ambulance & NHS111 service. • MIG provides secure, real-time access to GP summary: • Medication (current, past and issues), Risks and warnings, Procedures, Investigations, Encounters, Admissions and Referrals. • ISG (Information Sharing Gateway) holds DSAs (Data Sharing Agreements) – • Web-based records management system -DSAs between organisations. • A framework for safeguarding information processing.
To Share or Not • Reasons for non-activation of sharing – The majority of those which have not activated sharing are from TPP SystmOne practices. – Some have responded saying that the ICO’s concerns re SystmOne EDSM sharing model are the reason they haven’t activated. • Statement from the ICO in relation to the potential risk to patient medical records held by GPs on TPP SystmOne – • ‘ICO is not advocating that users switch off data sharing at this stage. The ICOs concerns are centred on the fair and lawful processing of patient data on the system and ensuring adequate security of the patient data on the system. We continue to work closely with TPP...’ [Mar -17] • TPP making changes to SystmOne to address data protection concerns – TPP has confirmed it is piloting new functionality in its SystmOne electronic patient record, with a view to addressing data protection concerns raised by the Information Commissioner’s Office (ICO). [www.digitalhealth.net Aug-17]
GP Practices- 92%Signed up 88% Active 16145 records shared in Sept
GNCR Website www.greatnorthcarerecord.org.uk/?article=resource s-for-gp-practices www.greatnorthcarerecord.org.uk/about/information- for-care-professionals/ Includes: Video piece on the benefits/use of MIG Feedback from clinicians using the MIG Example Privacy Notice content Statistics, by CCG area, detailing where patients go for Emergency, inpatient or outpatient care FAQs IG Governance & Security info Latest on EDSM / ICO concerns (or other emerging issues) Surgery screen ads, patient leaflets & posters Glossary
The Future Local Area Organisation Region
We can’t afford.. … not to do this
Dr Phil Stamp A&E Consultant CCIO
Approximately 300 ED patients per day, around half arriving by ambulance
How it was before January 2016 …. • A&E Sources of information: • Patient and Relatives (“ I think it’s the blue ones doctor…”) • Outpatient letters & discharge summaries (if exist) • Referral letters (sometimes illegible) • Faxes from primary care (occasionally) • Hospital paper records (when available) • Summary Care Record (not best-fit for ED environment – limited, stand-alone, no single sign on) • It’s self -evident that a lack of information has the potential to lead to costly, unnecessary interventions and poor or inefficient patient care.
Worst case scenario: • The clinician puts together a vague, incomplete and inaccurate record based on patient recollections and out of date information and makes decisions based on this. • Fortunately, ED clinician’s have experience and training to be good at making the right decision based on the above with a strong emphasis on being cautious.
January 2016 • After rapid, region-wide engagement, explanations and reassurance about the consent model, The MIG went live and was available in Northumbria Healthcare’s clinical portal through single-sign-on. • Single-Sign-On effect: (for illustration purposes only, not MIG)
Accessing the MIG in ED
Consent
MIG
Benefits of the information sharing • 100s of pages of MIG accessed every day in my ED. • MIG saves time: • Primary and Secondary Care receptionists (less phoning & faxing). • ED doctors (more timely accurate information). • Patients processed more efficiently as easier access of information – supports <4 hour target. • Less stressed patients as accessing information they assumed we had already! – avoids repetition. • More appropriate clinical decisions as better information more easily available.
How MIG actually helps clinically 1. Accurate allergies 2. Current medications including recent prescriptions 3. A few patient examples: 1.Elderly confused lady – when Head Injury commented on in MIG. 2.Low BP in ED – confirmed to be normal for patient by reviewing MIG 3.Presence or absence of PMH helps steer management in multiple cases especially when the patient can’t speak for themselves ( eg drug or alcohol dependency, diabetes, dementia).
My ED wish-list for next phases of info sharing • Structured data rather than html view would allow the information to be incorporated into a digital ED record rather than just displayed on a monitor – this would save even more time – would just need to check the accuracy rather than copy it – could save perhaps 15-20 minutes per patient! • Emergency healthcare plans and even more primary care information • Development of a Regional Health Record with bi- directional flow of information – still too many silos!
Just amazing - reduces Yes - patient with Antibiotics started by GP guesswork, reduces risk, improves some cognitive but not yet on SCR: safety, improves effectiveness. impairment/ family Hydroxocobalamin - We’ve seen the benefits of record not readily dates last given (not sharing with S1 (diabetes), but accessible/ OOH even on the SCR were missing out on EMIS people; therefore unable to record). Temporal this has been hugely helpful to contact GP arteritis diagnosis – so them and their care surgery - able to saves phoning the GP to establish that abn check why on steroids. CXR had already recent weight - dosing if Much easier in the been addressed, etc not able to weigh on A&E to confirm admission, past weights regular guiding on wt loss. medications and Useful particularly within past medical orthogeri rotation as able to history, which has backtrack through all past issues been really useful On one occasion the to determine if/when patient on for older confused patent had been bisphosphonates and if had started on patients where treatment breaks (particularly Memantine by the important things useful on a weekend when GP would otherwise memory clinic it surgery closed) be missed was on the MIG but not SCR
Questions?
• WTF • What’s the Future
When was this written ? Patients will be able to view electronically, comment on, and add to, summary information about their health, through the national • “my healthspace ” secure web site. Whenever a clinician encounters a patient, they will be able to access demographic information to help identify that patient. • All clinicians will have access to multi-agency, multi-disciplinary assessment tools, for example to support the Single Assessment Process for • Older People. Patients will be able to exercise choice of providers at the source of referral, supported by information on the range and quality of services • available, and receive a confirmed booking. All clinicians will be able to schedule patient activities across multiple health care providers, as part of agreed care pathways. • All clinicians will be able to view electronically the results of tests requested by themselves and other clinicians. • All clinicians will be able to place clinical orders (for example for tests). • All clinicians will be able to view images electronically, taken at any NHS location in the X patch. • When a transfer of care takes place (for example a hospital discharge, completion of an outpatients appointment, completion of a visit to • Accident and Emergency, or completion of an encounter with NHS Direct, a Walk-In Centre, or an out-of-hours primary care service), information will be available electronically to all clinicians within four hours of the transfer of care. The information will include details of advice given, procedures performed, and medication prescribed. All clinicians will have access to a comprehensive range of tools for clinical record-keeping, including facilities for both structured and • unstructured recording, and including a variety of input methods such as voice, pen, barcode reading, and keyboards. All clinicians will have access to tools to systematically identify patients with chronic disease, or at risk of such conditions, who should be • offered packages of care activities and prevention. All clinicians will be able to prescribe electronically. • Patients, clinicians, and managers will benefit from greater efficiency, safety, and consistency of health services through the systematic and • planned use of all the above features.
Nought is free • Our digital child needs support • Landing on the doormat Which = 11.5 p patient @2.5M =£287,500 pa
MIG Use Grand Total 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 July August September
Perils of Cost centre • http://www.leanessays.com/2017/11/the-cost-center-trap.html • Do we need to think differently • Is IT to be treated differently • Can Joe’s stamp savings be kept for reinvestment
Context to our challenge https://www.jmir.org/2017/11/e367 Conclusions Implementing new technologies as part of changes to health and social care services is inherently challenging. While policy makers are calling for technology to be implemented rapidly and at scale, the reality is that when dealing with the multiple complexities of health and care, it is extremely difficult to go beyond small-scale demonstration projects. We hope that the NASSS framework will help implementation teams — and, at an earlier stage, technology and service designers — to identify, understand, and address the interacting challenges to achieving sustained adoption, local scale-up, distant spread, and long-term sustainability of their programs https://twitter.com/trishgreen halgh/status/9267083223042 25280?s=09
Think Do “How do we win” 28
North East Sharing Map on ISG
Social care: A digital perspective Ann Workman, ADASS Regional Chair (North East) and Director of Adults and Health, Stockton Borough Council
What if……. • Integrated IT System • Data Sharing Agreement • Consent • Multidisciplinary • Multi- Agency Team • Single Point of Access • Single Line Management • Locality Working
Social Care - Five Year Forward View 1. Helping people and families to stay well, connected to others and resilient when facing health or care needs. 2. Supporting people and families who need help to carry on living well at home. 3. Enabling people with support needs to do enjoyable and meaningful things during the day or to look for work. 4. Developing new models of care for Adults who need support and a home in their own community. 5. Equipping people to regain independence following hospital or other forms of health care.
The Digital Revolution • Smart Phones - two thirds of Britons use them. Potential is yet to be fully realised in social care. • Apps - thousands of Heath apps but uptake for health and care patchy. • Smart Assistive Technology - people with disabilities or long term conditions can use devices to help them perform tasks.
Transforming Social Care through the use of information technology • Sharing information and internet services. • Enabling people to interact with care services through digital channels. • Using information and technology to assist citizens to stay independent, support Well Being and prevent escalation of crises.
Social Care Workforce • Enabling care professionals to work from any base at any time. • Efficient, effective and working collaboratively across organisations.
Shared Care Record
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