New Models of Care Strategy for Vanguards and Pioneers

Our values: clinical engagement, patient involvement, local ownership, national support

New Care Models: Pioneers and Vanguards

#futureNHS

1. New Care Models Technology Support Offer 2016/17 – Mark Golledge & Helen Arthur

2. Taking Forward Information Sharing – Indi Singh

3. Local Vision – An overview of the journey and learning to date from:• Morecambe Bay – Paul Charnley, Interim CIO I3 Service• Connected Nottinghamshire – Andy Evans, Programme Director• Islington – Mark Futerman & Stephen Latimer, ICT Development and Support• Tower Hamlets – Charles Gutteridge, CIO

4. Q&A with the Panel

Session Outline

Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS

New Care Models:The Context

Helen Arthur - Technology LeadVanguards Programme


NHS Five Year Forward View• Published in October 2014

• A shared vision across seven national bodies

• New care models programme key to delivery

• Focuses on both NHS and care services



National Information Board

Five Year Forward View

National Information Board (digital strategy underpinning FYFV) National Information New Care Models

Domain 1 Domain 2 Domain 3

Domain 4 Domain 5 Domain 6

Integrated care pioneers

Integrated personal

commissioningVanguards

Test beds Healthy new towns

Harnessing Technology


Strategic Context

Clinical engagement

Patient involvement

Local ownership

National support


Our Core Values

1 Cornwall and Isles of Scilly

2 South Devon and Torbay

3 South Somerset

4 North West London

5 Islington

6 Camden

7 Waltham Forest, East London and City

8 Greenwich

9 Kent

10 Southend

11 West Norfolk

12 Stafford

13 Cheshire

14 Worcestershire

15 Nottingham City

16 Nottingham County

17 Greater Manchester

18 Sheffield

19 Blackpool and Fylde Coast

20 Wakefield

21 Airedale, Wharfedale and Craven

22 Leeds

23 Vale of York

24 South Tyneside

25 Barnsley

1

2

3

1049

5 68 7

12

13

19

14 15

21

1117 16

18

2022

23

24

25

• The integrated care pioneers programme was launched in November 2013 and is focussed on the integration of health and social care – with arm’s length bodies signed up to support pioneer sites to develop their new integrated models of care

• The programme is supporting change and innovation at a local level, sharing learning across the pioneer network – with support from national experts

• 25 sites have been announced – some sites are also vanguards / IPC sites


Integrated Care Pioneers

5 new models of care with a total of 50 vanguards:

Integrated primary and acute care systems

Multispecialty community providers

Enhanced health in care homes

Urgent and emergency care

Acute care collaboration

9

14

6

8

13

https://www.youtube.com/watch?v=BFJzCemX7AM&feature=youtu.be


50 Vanguards Developing their Visions Locally




50 Vanguards Developing their Visions Locally

Our values: clinical engagement, patient involvement, local ownership, national support

New Care Models:Information & Technology

Mark Golledge - Informatics Lead Local Government Association

#futureNHS

Need for close alignment of activity and communications across the New Care Models programmes, building on the work already delivered and responding to the feedback.


Developing a Streamlined Plan

Online Learning

Environments

Information and Guidance

Co-Design and Learning Collaborative

Bespoke activity (and support where required) to pilot / test new ways of working or resolve challenges

Incr

easi

ngly

bes

poke

eng

agem

ent

Activity which is shared with the wider health and care system for wider use / deployment

Coordinated activity across the new care models to capture learning and produce common guidance / case studies / evidence

Bespoke Support /

Pilot Activity

Simplify

Standardise

Share

Digital strategy

Integrated systems

Information sharing

Digital citizens

Data for outcomes, research and commissioning

Remote assistive technology

Supplier engagement and procurement of digital services locally and at scale


Developing a Streamlined Plan:7 Core Themes

Collaborate with others working on similar objectives to:

Ensure consistent messaging

Maximise resources and opportunities

Avoid overburdening stakeholders

Align with national strategy/policy via the NIB and harness existing expertise

Look for opportunities to standardise and replicate (principles not systems)

Facilitate networking and sharing of problems, solutions, learning

Provide focussed support tailored to local vision


Principles of Working

• More intensive support / engagement with Vanguards and pioneers: e.g. identifying front runners and fast followers to work with around the core themes

• Activity to capture learning / case studies / evidence across the New Care Models:e.g. as with work to produce blueprint for information sharing

• Activity to share and disseminate more widely with the rest of the health and care system:e.g. as with dissemination, webinars and regional workshops on information sharing


What this Means in Practice

Building choice of high quality support for commissioners

Taking forward Information Sharing

Indi SinghHead of Enterprise Architecture

Building choice of high quality support for commissioners

Strategic context

Breaking down “interoperability”

What this means for professionals and citizens

Current priorities

Working in conjunction with localities and the market

End of life cure prompting key preferences

Vaccinations andimmunisations history

Visual comparison of medicationsPrescribing alertsEncounter timelines

Long term conditions(trending and recall)

Pre-populationof pre-operative assessment

The development of an open environment for information sharing supporting emerging models of care based on open interfaces and open standards.

Open APIsOpen interfaces to enable information to flow across a care pathway and to be accessed across geographies

Local Integrated Digital Care Records (IDCR) that link health and social care as main approach for delivering local information sharing needs

Tight standards for key transfers of care

Local IDCRs Professional

Through my system I can directly access and contribute to summary and detailed care information

Citizen

Using my PHR I can access care information about myself and contribute information

PHR

Patient Record IndexAbility to locate patient record information that can then be accessed through open APIs

Open interfaces from national systems such as SCR to simplify access and contribution.

Expansion of SCR for access by additional care settings and additional critical information.

Summary Care Record

97% Of localities using NHS Number as primary identifier when sharing information

66%Of localities sharing discharge summaries electronically

StandardsLevers Incentives Service change Technical Capability

AppointmentsManage appointments in order to

co-ordinate access to care

Access RecordAccess a patient’s care record for the

purpose of direct care

Tasks Manage tasks in order to work effectively

across care settings

eDischargeDischarges from inpatient care back to

the general practitioner

A&E eDischargeInformation sent to the general

practitioner from an A&E attendance

Ambulance

Social Care

Referrals

Emerging needs

Creating a common and open set of APIs to support information sharing across health and care

Defining the key clinical information sharing needs.

Prioritising the key APIs.

Group members e.g. CCIOs, CIOs, Vanguard, Pioneers, PMCFs, NHS England.

Outlining the accreditation approach for APIs.

Group members e.g. TechUK, CIOs, suppliers, HSCIC.

Defining the key underpinning components and policies, e.g. security and authentication.

Group members e.g. HSCIC, suppliers, CIOs, TechUK, NHS England.

Establishing and creating the required APIs based on clinical information sharing needs.

Group members e.g. suppliers, innovators, CCIOs, CIOs, NHS England, HSCIC.

Made up of the above organisations, the Project Boardis responsible for the assurance and governance process.

Links to existing communities and

signposts tools and products.

Informatics and Interoperability Supports Better Care Together

Update from the IM&T workstream for Morecambe Bay Vanguard

Morecambe Bay365,000 people1000 square miles

Supporting the service redesign work performed by the clinical workstreams

• Planned Care – working speciality by speciality • Ophthalmology

• MSK

• Rheumatology

• Respiratory (etc.)

• Out of Hospital – Cumbria – Integrated Care Communities

• Out of Hospital – Lancashire - Integrated Care Communities

• Women’s and Children’s – Apps

• In Hospital

LPRES

QlikView

Integrated Analysis – Proof of Concept

Advice and Guidance/Shared records

Real reductions in referrals• up to 60% in some cases• Direct access for imaging

Operational level • Escalation and monitoring• Tariff agreements• Integration with EPRs

What is the National Replicability Value Perspective

• Telehealth –the technology is standard but we have also developed standard operating procedures and change management checklists for other organisations to follow.

• Shared Records –with LPRES and hospital access to SCR and MIG data form GPs we are opening up new ways of working. This is underpinned with the Information Sharing Gateway portal which is also used widely outside of the Bay

• Advice and guidance – as well as the technology we can provide a contracting model, a change process and guidelines on how it could be implemented

• Dashboards and Data Warehouse – this work is probably being repeated around the country but we can contribute by developing expertise in the handling of the disparate data sets in realtime/neartime

• Community engagement – working with Millom to develop plans for the collaboration between organisations and the community

Reflections/lessons learnt to date

• The Technology is the ‘easy bit’• The technology exists and works ‘out of the box’

• Should we be?• Clinically led and react/second guess emerging requirements; or • Technology led and lead clinical and management thinking?

• There are many challenges in getting this technology implemented as follows:• Knowing what is possible • Sharing the vision between clinicians and managers and informatics people• Not knowing exactly what is required and what will work – Think Big, Test Small, Scale Fast • Dealing with multiple stakeholders and their agendas/IT plans whilst trying to work as a team • Working against the “perverse incentives” such as being measured and funded on the basis of

activity you are actually trying to reduce.

Service Objectives 2016/17

• Close 2 inpatient wards (90 day process) • Reduce consultant outpatient clinics by 25 clinics per week • Save circa £5m in year - RoI on value proposition funding• No impact on

• Trajectories • Quality of care

• Challenge on funding for IM&T investment.

Connected Nottinghamshire Programme established 2013

5 Vanguard Programmes (PACS, MCP, Care Homes, U&EC and Acute Shared*)

3 Wave 1 Prime Ministers GP Access Projects2 Better Care Fund Pioneers

1 Care Act TrailblazerPopulation circa 1.2 million

Andy Evans, Programme Director

“Integrate /join up care using technology as an enabler”The technology requirements are all the same

• Risk Stratification– We use a local tool and the Devon Algorithm

• Information sharing– IG sorted for direct care– >80% of GP records available across health system– Good Community Services sharing– Mixed Secondary Care sharing– Limited Mental Health sharing– Some Social Care

• Electronic Workflow (tasks/actions/referral/notifications)– eReferrals– TPPs1 Tasks– This is the hardest one

Workflow

Information Sharing

What are we really trying to do?

• The technical projects are easier than building the relationships

• If you don’t have good relationships you wont get where you need to

• Pretty much all new models of care need the same capabilities

• Its worth the time for the elicitation requirements work early – because it will make life easier later and it will help the business understand their issues

• Do not underestimate;– The complexity of Data Quality and Records Management issues, these will both

create friction

– The time it takes to agree an IG framework for sharing

Lessons to share/we have learnt from others?

Mark Futerman & Stephen Latimer, ICT Development and Support

Local Vision – An overview of the journey and learning to date

Up and running• NHS Adapter: Ability to receive discharge notifications from hospitals and GP

referrals directly into Liquidlogic’s LAS using TDK Messaging.

Soon to be Completed• Access to the PDS spine from LAS (our social care system)

Current• The IDCR/IPHR: The Integrated Digital Care Record (for professionals) and

Integrated Personal Health Record (for residents).

Selected Health and Social Care Integration Projects

• Allows us to receive notices of Admission, Discharge and Discharge Cancellation from a partner hospital (the Whittington, Royal Free goes live soon) via Quicksilva’s adapter service.

• A template is completed by ward staff within the hospital’s PAS system and sent via nhs.net to an email address hosted by Quicksilva.

• The adapter converts it into XML and sends onto our LAS via GCSx.

• This appears as a task in LAS and is automatically placed into the group worktray of the appropriate team (e.g. GP referrals are received by the Access team).

• We are a pioneer authority. HSCIC have confirmed that it is likely that this will be taken up nationally.

NHS Adapter

• Enables nominated LAS users to verify LAS demographic data against data held about people on the NHS Spine.

• The PDS does not hold any clinical or sensitive data items such as ethnicity or religion. The PDS is a component part of the Spine.

• The Spine is the name given to the national databases of key information about service users’ health and care.

• Users need smart keyboards and a Smart card; and to be registered with the NHS registration authority at the Whittington.

PDS (Personal Demographics Service)

• The IDCR will allow health and social care professionals in Islington to view records containing collected data from multiple data sources for individuals they help.

• The IPHR will allow individuals within the borough to view their own records and will include some elements which they will be able to modify.

• Phase 1 go-live date provisionally set for September 2016.

• Phase 1 partners include the Whittington, the Out of Hours Service, Camden and Islington Mental Health Trust, University College Hospital and the London Borough of Islington (Adults and Childrens services).

• The consent model likely to be adopted will be explicit.

The IDCR and the IPHR

Portal Services

Electronic Master Patient Index

Integration EngineBT Developed Adaptors to Clinical and Social Care Systems

Clinician

Context

Management

Patient

Summary

Charts Detailed

Care

Record

Secure

Messaging

Clinical

Document

Editor

Appointments Secure

Messaging

Charts Health

Links

Clinical Provider Portal Patient Portal

UCLH

Interface

Whittington

Health Interface

EMIS Web

GP

C&IFT

Interface

OOH/ Adastra

BT Data

Centre

Health

Platform

Audit Logs

Analytics and

Reporting Products

Clinical Data

Repository

Social Care Worker Patient / Carer

Social

Services

Spine Smartcards / Soft-Token Two Factor

Authentication

N3 and internet

Royal Free

Interface

Homerton

Interface

London

Ambulance

EOL/ CareUK NMUH

Interface

Moorfields

Interface

CNWLFT

Interface

IDCR/IPHR Logical Architecture Overview

Possible View of IPHR

Charles Gutteridge

Creating value: The Tower Hamlets Vanguard

What is an MCP – Key Characteristics

3 Core Elements for Transformation

• A people health data movement

• Empowering clinicians with point of care information and outcomes data

• Developing data for population health

Ris

k s

tratif

icat

ion

Co-

ordi

nate

d ca

re

Reduce emergencyattendances

Reduce emergencyadmissions

Improve outcomes

QAdmission® algorithm

(Consent)

(Enrol)High

Moderate

Low

Very low

Very high

East London Integrated Care Programme

Background

• Provision of careMultiple teams across local health economy

• Current metricsSUS data - not actionable in real time

• SuggestionFocussed datasets using live information, used by teams

Patient at home

Social Care

Mental Health

Primary Care

Barts Health Community Teams

Condition specific

ArCaRe (COPD)Heart FailureDiabetesPalliative CareLearning disabilities

Integrated CareTH: Care navigators

WF: IC Co-ordinators

NH: Rapid Response

DIS

CH

AR

GED

Inpatient Teams involved with discharge planning

DIS

CH

AR

GED

DIS

CH

AR

GED

D

ISC

HA

RG

ED

EmergencyDepartment

DIS

CH

AR

GED

NHS numbers of patients enrolled on IC(List supplied by CSU)

NHS numbers of subgroup: co-morbidity = x(Based on Read code for ‘x’ in GP record)

Interrogate Barts Health datawarehouse(ED attendance, IP admissions)

Deriving Actionable Datasets Using Existing Metrics

Focussed, actionable data used by clinical teams

Output: e.g. Patients with COPD

Clinical Analytics Service

• Training and learning– Data science seminars– Mentoring and 1:1

• Desktop data extraction

• Advisory service– SNOMED expertise– Data visualisation

• Data linkage

Health & Medicine

New Models of Care Strategy for Vanguards and Pioneers