Mike Jones

Director of IM&T & Performance / CIO

Northern Devon Healthcare NHS Trust

Devon Electronic Care Record

Vision for an Integrated Services Provider

Content

2

• Our Service

• Our EHR Approach

• Developing our Vision

• ‘Meaningful Use’ for our teams

Our Services

• 1,300 Sq. Miles

• 17 x Community Hospitals

• Main Acute Hospital

• Community Services (including social care)

• 4,700 staff

• Providing Integrated Services since 2008• Recent CQC (09/14) – Vast Majority Good, Acute medical

Outstanding

• CQC inspection team - “some of the best community services they had ever seen, really very impressive”

• Areas for improvement in A&E and End of Life Care

Our Services

Our EHR Approach

• Cerner Millennium aborted under NPfIT

• Southern Acute Programme Funding for - Acute EHR in conjunction with Gloucester/Yeovil

• “Smartcare” Collaborative

• OJEU Restricted Procurement- HSCIC procurement team support

- 8 year fully integrated, fully hosted

• ‘Virtual Hospital’ Evaluation (70% Quality & 30% Cost)- 200+ clinicians evaluating all aspects of functionality, useability

• Preparation for Implementation- Appointment Development of EHR Clinical Leaders

- Develop our EHR Vision & Blueprint

Integration and Community EHR

• Also out to procurement – similar OJEU

• Complete the fully integrated Care Record- Social Care / GP interoperability

- HL7, IDE Integration Engine

• Focus on Mobility - (800+ staff already using Android Tablets with offline

and online recording of care packages)

- SNOMED coding driving a ‘community tariff’ currently high agreement between algorithm and staff view of complexity• Simple, standard and complex tariffs

• Packages for DN, Therapists

EHR Success so far!

Organisation Readiness / Planning Architecture Benefits Focused

Mandate Procure Prepare Deploy Optimise & Reap

18m 2yr 1yr

Clinical Vision

• EHR Champions x 6- Surgical, Medical, AHP, Nursing/Prescribing

• Visits to HIMSS Level 6 and 7 Hospitals

• Oxford (Persistence / SSO), HSCIC Benefits Reviews

• Capture Blueprint of how things are done now- 14 clinical ‘pathways’

- 10 business ‘pathways’ (E.g. R&D, Safety)

• Plus:- Narratives from EHR Champion discussions with peers

- RCP/RCN Electronic Record Structure Guidance

- Other Drivers (PROMs, Devon wide strategy)

• VISION - Written by Clinicians for Clinicians

EHR Vision

• Written for clinicians by clinicians … with some professional editorial support

• At the heart of the Comms / Engagement plan

• Q. What will this do for me?

• ‘Validate’ the FBC benefits and determine perceptions of ‘grass roots’ vs. automatic benefits

• Basis for Benefit Realisation Plans and ownership of the Top 5-10 at dept. level

• Themes:- Duplication, Silo-working, Clinical Decision Making

Other Useful Sources

• Tech Fund VFM materials (shared across Trusts)

• e-Prescribing summary from Tech Fund 1

• Individual and team narratives of what doesn’t work now and needs to change translated into CSFs

• Clinical Champions are instrumental in bridging the gap between the ‘Programme’ and the ‘Business’- As part of Stakeholder Engagement Strategy

Excerpts

• Northern Devon Healthcare NHS Trust intends to invest in… known as… in order to…

• This will be a major change for us – perhaps as big a change as anyone has ever faced…

• However, it is an essential step if we are to deliver more effective, safer care …

• The change will affect everyone. Some people will find that their jobs are no longer needed in their current form, and some will find that they need to work in different ways. We will support staff who need to move into new roles, and provide everyone with the help that they need to use the new systems effectively.

• But at the end of the process, we expect to achieve a, b and c, and for this to improve every aspect of a patient’s journey through our services  

• What will the organisation will look like (HIMSS Stage 7+)?

• Describe how currently things differ from this.

• How will clinical practice will look and feel for nurse, doctor, AHP and clinical admin?

• Patient story is told through breakout panels.

Where Next?

• Clear Roadmap (HIMSS Levels / CDMI)

• Benefits Realisation Plans aligned to Year 1, Year 2 workflow changes

• Benefits tracked through locally defined ‘Meaningful Use’ framework

Local ‘Meaningful Use’

• No financial incentives but…U.S. Meaningful Use Goals

Translation to UK, Examples:

Patient Safety, Quality, Efficiency

NHS Patient Safety Thermometers- Mediction- Classic- Maternity Other National and Locally agree CQUINs  Monitor presence of infections  Compliance Medication Reconciliation (e.g in A&E) e-PMA use

Engage Patients and Families 

Friends and Family Test

Improve Care Coordination  

Measure the completeness and timeliness of onward referrals, admissions, and discharge summaries. Use of RCP guidelines for standards on record keeping.

Ensure adequate privacy and security 

Record and honour consent to share.Provide ability for patients to view records and record that patients have been offered this. 

Improve Population and Public Health

Collect relevant data items for public health monitoring and data set submissions to national colleges.

Questions and Comments

• Thank You!