Will informatics deliver integrated care? · Will informatics deliver integrated care? ... of 6.3 million transactions . What is health informatics? Click to edit master footer style

Will informatics deliver integrated care? SIHI Conference 10th September 2014

Martin Severs, Clinical Professional Lead and Caldicott Guardian

HSCIC:

Who are they?

Are they part of the NHS?

2

August 2014: Work by MORI on behalf of NHS England

What we do

We set standards that protect

patient’s confidential information, reduce

bureaucracy and improve data quality

We operate essential technology services

that support the health and care system

We collect, analyse and publish

national data and statistical information

that helps inform decision making

We develop the next generation of

national data and information systems

Who we are

What we do

NHS Mail

600,000 registered

users

GP2GP

89% of clinicians

agree it improves

patient experience

The Spine

Contains 80

million records

NHS Choices

Handles 29 million

enquiries a month

Electronic

Prescription

Service

Potential to save the

NHS £179M a year

Informing public

discussion

3,000 news stories

used our statistics

What we do

GP Payments

Service

Calculates and pays

over £7.2 billion

annually

Choose and Book

50 million patients

referrals reached

Statistical

reports

220 statistical

reports published

Screening

Helps to detect over

13,500 invasive

cancers

National Back

Office

Manages accuracy

of 6.3 million

transactions

What is health informatics?

Click to edit master footer style

• Health Informatics in the UK is defined as:

• … the knowledge, skills and tools, which

enable information to be collected, managed,

used and shared to support the delivery of

healthcare and promote health” (‘Making

Information Count’,

• A Human Resources Strategy for Health

Informatics Professionals, Department of

Health 2002)

What is integrated care?


• Integrated care – also known as integrated health, coordinated care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems

• Ref: Wikipedia

What is integrated care?


• WHO gives the following definition:

• Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency

• Gröne, O & Garcia-Barbero, M (2002): Trends in Integrated Care – Reflections on Conceptual Issues. World Health Organization, Copenhagen, 2002, EUR/02/5037864

Will health informatics deliver integrated care?


• Necessary but not sufficient

• Discuss 7 additional considerations that will make it more likely that health informatics will be able to deliver integrated care – Autonomy

– Commercial sector

– Person as an actor

– Small data

– Big data

– Standards particularly data standards

– Finance

Autonomy


• Autonomy is the dominant moral force in

westernised society

– Policy: Choice, openness, transparency

– ‘Me’ and ‘my’: health, record, body, decisions

– Control: When and where I need it

• Major Impacts

– Record access ► patient recording

– Complex IG rules ► national consent system

– General choice ► Choice for my situation

Autonomy


Commercial sector


• Commercial Sector produce useful products

and services for you and me

– Apps

– Medical devices [with embedded software]

– Analysis services

– Data processor services

• Major impacts

– Them & us ►rich ecosystem

– Public provision ► enabling Public and private

– Relative stagnation ► Dynamic innovation

3rd Party Dependency What else is required?

• Education – Implementors

– End users

• Tools

• Knowledge / Rule bases

• Data Acquisition – User interfaces

– Quality measures and CQI activities

• Localisation – Translation

– Cultural adaptation / extension

Terminology

Tools

Education

Localisation

Person as an actor


• Person as an actor – Improving health

– Managing illness

– Reducing health and social care costs [direct and indirect]

• Major impacts – Prescribed education & rise of apps/medical devices

with software embedded

– Compelling cases [time, access, convenience etc]

– Shift in data source and control and Doctor-Patient relationship

Small data


• Small data [the forgotten component]

– About data about each of us as individuals

– About our direct care and the staff that care for us

– About letters, discharge summaries, etc

– About decision and knowledge support for front line

staff

• Major impacts

– Focus on quality of care via quality of record

– ICT as a tool for clinicians not a master

– Major socio-technical revolution in usability in real life

to support better care not divert clinicians away from it

Big data


• Big data – find more effective ways of preventing or managing

illnesses;

– advise local decision makers how best to meet the needs of local communities;

– promote public health by monitoring risks of disease spread

– map out pathways of care to streamline inefficiencies and reduce waiting times

– determine how to use NHS resources most fairly and efficiently

– Open up a whole new stream of research around complex medical conditions or simple conditions and complex treatments or both!

– Ascertain new and important relationships between genomics and illness & outcomes

Standards


• Standards especially data standards – All talk and no action

– Failure of decisions associated implementation is costing too much

– Value from investment is impaired and failure prevents a stable platform for innovation

• Major impacts – Consensus to consortium standards

– Local idiosyncratic to international

– Push to pull [Professions, Policy, Finance, IT]

– Crucial for integration of service

Clinical Terminologies & other data standards:

Who are they for?

Human to Human

Human to Human (through Machine) Machine as passive conduit

NOW

eMachine as active agent : DSS

EPR as Knowledge Representation

Terminology as software component

FUTURE

Finance


• Finance

– Gaining better value from investment

– Reduce costs [NHS consuming GDP by 2030]

– Reduce waste of needless duplication

• Major impacts

– ICT to improve care performance

– ICT to shift activity from staff to patients

– ICT to deliver health promotion to reduce long terms costs

– Invest now to save later

Good information is an important part of making sure people stay healthy and get the best care

The Power of Information, Department of Health

Documents

Will informatics deliver integrated care? · Will informatics deliver integrated care? ... of 6.3 million transactions . What is health informatics? Click to edit master footer style