www.connectingforhealth.nhs.uk/qipp
Telehealth: PHMR Development Review
Richard Trusson
NHS Technology Office DH Informatics Directorate
www.connectingforhealth.nhs.uk/qipp2
Agenda• Why do we need Interoperability?• Previous work: Whole System Demonstrator (WSD) and the 9
use cases• Recent work: PHMR Specification Development• Lessons learned• What’s next?
– Draft specifications for others– PHMR early adopters
www.connectingforhealth.nhs.uk/qipp3
Cholesterol Monitor
Blood Pressure Cuff
Glucose Meter
Pedometer
Sensor Networks
Lights, Doors, Windows, Motion, etc.
Records•NHS•Housing•Social Care•Personal Health
Elderly Living Independently
Home Hub
Care Professio
nals
Out of Hours
Carer response servi
ce
Tele-carer
Emergencyservices
Friends and Family
Limited Offerings
No integrationIncreased Offerings
Integration requiredIncreasing Integration Complexity
Service Hub
Why Do We Need Interoperability?
www.connectingforhealth.nhs.uk/qipp5
Value of Information Integration
Business / Service Requirement
Information Requirement
Cross and Multi-Service Working
Effective Sharing of Information
High Quality Supporting Information
Ease of AccessEase of
Consumption and Use
Previous work: WSD and the 9 use cases• DH wanted investigation into the shared information needs for
supporting patient care under telehealth
www.connectingforhealth.nhs.uk/qipp6
• Working with clinicians, GPs, Nurses, etc., patients and the industry we investigated what they needed. This lead to 9 use cases.
Previous work: WSD and the 9 use cases
Use Case
Name Description
UC001 Refer Patient for Assessment The capability to allow clinicians to electronically refer patients to care managers for telehealth assessment
UC002 Assess Patient for Telehealth Monitoring
The capability to allow clinicians to share telehealth assessment results with other members of the care team
UC003 Enrol patient on the Telehealth programme
The capability to notify care team members that the patient is receiving a live telehealth monitoring service.
NOTE: this functionality is thought to be covered in UC009 in which patient status updates are sent to care team members.
UC004 Install & Commission Telehealth Equipment
The capability for a clinician to electronically submit an order for the appropriate telehealth equipment from suppliers (pending installation in the patients home)
UC005 Create/Update Telehealth Care Plan
The capability to allow clinicians to share details of a patient’s care plan with care team members
UC006 Create Telehealth Patient Record The capability to auto-populate patient telehealth records by drawing on existing sources, for example, PDS.
UC007 Monitor Readings Against Telehealth Care Plan
The capability to allow care team members to routinely view a summary of patients’ telehealth data in their local systems.
UC008 Provide Care The capability to allow those clinical users whose primary system is a non-telehealth system, to update the telehealth system with details of any patient intervention carried out by them. These updates will then be made available to the other members of the care team either directly through accessing the Telehealth system or through regular updates within the PHMR.
UC009 Send Notification The capability to update care team members as to the status of the patient
www.connectingforhealth.nhs.uk/qipp7
• We also identified user concerns and issues
Previous work: WSD and the 9 use cases
Right
info
rmat
ion,
right
qua
lity E
asy to
consume
& use
Easily accessed
Volume of data
PrioritisationData overlap
Clinician agreementClarity of
purpose
Ownership of patient record
Clinical autonomy
Medication record
Speed of access
Action acceptance
Speed of comprehension
Clarity of addressee
Linked to relevant clinician
Linked to right patient
Messaging Assurance
Import effort
Update frequency
Professionalliability
KeyRed – most importantBlue - important
Audit trail of changes/ messages
www.connectingforhealth.nhs.uk/qipp8
• From– Understanding the business needs– Defining the use cases– Identifying the user concerns
…the PHMR technical demonstrator message specification was prioritised
• This sent vital signs information from the telehealth system (Philips Motiva) to the GP system (EMIS Web) and addressed many of the identified user concerns,– right information, known quality, controlled amounts, easily
accessed, easy to use.
Previous work: WSD and the 9 use cases
www.connectingforhealth.nhs.uk/qipp9
• In early 2012 we ran a workshop at Intellect to revisit and verify the use cases.
• We identified an additional case – click through• Set message priorities. Top three were:
– Personal Health Monitoring Report– Clinician Response Message– Referral Message
• Initiated a program of work to develop the PHMR – as a result of the technical demonstrator this was the most advanced.
Recent work: PHMR Specification Development
www.connectingforhealth.nhs.uk/qipp10
The PHMR sends vital signs information from a telehealth service provider to a system with a legitimate interest – i.e. a GP system. The frequency of updates and range of vital signs reported on can be defined by the receiver.
•Working with the ITK team a series of WebEx meetings were run to review, verify and update the requirements.•A draft message specification was released for comment.•In August 2012 this was re-released, with updates, as a Release Candidate message ready for early adopters to start developing against.
All work for this is posted on the ITK NHS Networks site.http://www.networks.nhs.uk/nhs-networks/interoperability-toolkit-itk
Recent work: PHMR
www.connectingforhealth.nhs.uk/qipp11
• The engagement and development model, overall, worked.– Using WebEx– Using NHS Networks website– Gathering feedback– Reaching agreements
• Challenges:– Gathering feedback was harder than expected at times– Compressed time lines– Personal emails were better than generic ones
• Would we do anything differently next time?– Have longer timelines– Publish dates for all meetings at the start, if possible– Look to ‘public’ events for mid term discussion, if possible– Shared development environment
Lessons Learned
www.connectingforhealth.nhs.uk/qipp12
• PHMR: Continue to work with NHS and Industry early adopters to support implementation of the PHMR (vital signs) message. To date there are seven organisations, 2 GP system providers and the rest telehealth service providers, signed up.
• Clinician Response Message and Referral Message: use outputs from the Workshops this afternoon to inform message development and drive towards early adoption in first half of 2013.
• Work with the NHS, Industry, 3millionlives, dallas and others to support the adoption of telehealth and the implementation of interoperability standards across the board.
What’s Next?