Connecting Care Our story so far

1
Connecting CareOur story so far

• Andy Kinnear
• June 2015

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introduction to Connecting Care

• What is Connecting Care?
• Connecting Care Why?
• Local drivers
• National drivers
• Who the partners are
• What we have delivered so far
• What are the benefits?
• What can Connecting Care offer whats coming
  next
• How our Governance framework works
• How Connecting Care fits with the national
  strategy
• Kinnears 5 key messages!!

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what is Connecting Care?

• Connecting Care is the Bristol, North Somerset
  and South Gloucestershire BNSSG programme,
  dedicated to using technology to support -
• Better information sharing between local health
  and social care organisations
• Joining up information to ensure care is focused
  around the individual and their needs
• Improving better, safer and more joined-up care
• Supporting increased efficiency in the delivery
  of health and social care services
• Ensuring that the people who are providing care
  have the information they need, when they need it

Our first focus has been the delivery of a shared
view only electronic patient record (a portal
sharing our IDCR)
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local need
There needs to be better communication between
in-hours and out of hours services.
Adequate and timely information must be shared
between services whenever there is a transfer of
care between individuals or services.
NOT having access to accurate, timely, shared
information is a blocker to providing
high-quality, effective, efficient care
The information I have is limited and frequently
is missing important elements
Services in all settings including health and
social care need to improve their communication
and handover
I dont have access to some important
information electronically
If I had better information then it would help
me evaluate risks when deciding whether to admit
a patient
There are delays in getting hold of information
that I needand I spend a lot of time chasing it
up
Better information would support better
safeguarding
Summarised from feedback from local clinicians
practitioners during workshop events
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national drivers
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strategic alignment
5 year forward view Most countries have been
slow to recognise and capitalise on the
opportunities presented by the information
revolutionthe NHS has oscillated between two
opposite approaches to information technology
adoption.....the result has been
systems that dont talk to each other and a
failure to harness the shared benefits that come
from interoperable systems..In future we intend
to take a different approach
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Connecting Care partnership

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project approach

• 2011 Vision
• 2012 Procurement
• 2013 Staged approach
• First stage (pilot) started in March 2013. Key
  deliverables
• A working system for 500 users
• Evaluation of benefits
• Stage one themed on urgent unplanned care
• 2014 A business case for the second stage .Second
  stage started Dec 2014 (next 5-7 years)
• FYFV PUBLISHED
• 2015 GROWTH
• Stage two will extend the breadth depth (10,000
  more users, more information sharing)

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what weve delivered so far
Presentation
Connecting Care Clinical Portal
Security Privacy
Patient Record
Portal

• Patient Search
• Patient Lists
• Patient Summary
• Timeline
• Flowcharts
• Secure Messaging
• Orion Health Applications
• Third Party Applications

• Demographics
• Laboratory
• Radiology
• Encounters
• Allergies
• Diagnosis

• Authentication
• Authorization
• Single Sign-On
• Patient Privacy Consent
• Relationships
• Audit Logs

• Medications
• Problems
• Procedures
• Transcribed Documents

Integration
MiG
Clinical Data Repository
Rhapsody Integration Engine
Master Patient Index
GPs
Source Systems
NBT Cerner PAS
SWIFT North Somerset
Weston Cerner PAS
Paris Social Care - Bristol
Orders and Results (CRIS and Ultra) X2
UHB Medway PAS
Adastra Out Of Hours
Adastra End Of Life
RiO Extracts X4
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benefits approach

• The backdrop scope and theme of the pilot
• Theme of urgent and unplanned care
• 500 licences, shared across all partner
  organisations teams
• The hypothesis and framework used
• Better sharing of information and better
  integrated information should have a positive
  effect on the quality, efficiency and cost of
  providing care
• Framework based on MSP
• A detailed methodology and plan
• Benefits realisation plan
• Based on Quality, Innovation, Productivity and
  Prevention (QUIPP) themes

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Connecting Care - benefits

• The main benefits for me (as a clinician or
  social care professional) are
• Confidence in my decision making is improved
• The quality of my consultation (or assessment) is
  improved
• I do not make unnecessary referrals or carry out
  duplicate assessments
• It saves me time (which can be used to provide
  care, or for other duties)
• I am more informed before a visit/appointment,
  which means I can provide more timely/more
  appropriate care
• I have better relationships with colleagues
• My input into a patient/service users care can
  be seen by others, so the recognition of my
  profession is increased

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Connecting Care - benefits

• The main benefits for my patients/service users
  are
• They dont have to keep telling their story (e.g.
  remembering / explaining medications
• They receive safer, more appropriate care
• They have a better experience of the services
  offered, potentially with fewer duplications or
  delays
• They might not have to be admitted to hospital

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Connecting Care - benefits
Out of hours care Saves appointments and visits Saves admissions Safer prescribing Improved quality of consultation
Pharmacy Safer prescribing provides access to allergy and GP prescribing information Saves time Reduces the amount of time calling GP practices Safer communication reduces errors
Hospitals / AE Safer care patient background, context and medications Saves time reduces time trying to find out information Reduces risks where patients unable to inform clinicians about relevant information / fax errors etc
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Connecting Care - benefits
Community care Saves time in triage and assessment Saves time reduces the amount of calls to GPs Saves unnecessary home visits Supporting risk management and safeguarding
Social care Supporting referral management Saves time in triage and assessment Informs assessments care planning Saves installation and equipment costs Supports risk management and safeguarding
General practice Reduces burden on practice administrators Supports risk management and safeguarding Increased confidence in better care being provided outside of the practice Immediate access to GP records (new registrations)
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Connecting Care - benefits
I now use Connecting Care on almost every case I
deal with it (approx. 25 cases per shift).  It
always makes a difference and adds value.  Every
shift, acute admissions are avoided. Doctor
(out of hours)
Massive difference in time spent accessing
information. On average I can access the GP
record within 30 seconds compared with 15-20
minutes taken via telephone or via fax Critical
Care Pharmacist Manager UHB
it has enabled us to commence discharge planning
earlier in the patients stay to help prevent
delays later on. Discharge Nurse
Unable to obtain a medication history or allergy
status from the patient.accurately confirmed
through Connecting Care Pharmacist, NBT
3 cases identified on Connecting Care today that
were already allocated to a health practitioner
(BCH OT or IMCS OT) so did not require referrals
to BCC OT. Occupational Therapist Bristol City
Council
Connecting Care is brilliantI use it to
triangulate information from service users, to
find out about other services involved so that I
can contact them to inform my assessments
Bristol social worker
Have been able to identify trends which have
then resulted in swifter safeguarding
interventionsone case where concerns would not
have increased without Connecting Care Social
Worker Safeguarding team
Information about the patients diagnoses has
helped our team decide which type of therapy to
offer the patient UHB
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Connecting Care - benefits
On Monday I managed to obtain details for 22
patients on Connecting Care, I saved a huge
amount of time as I didnt need to phone the GPs
and wait for the faxes to arrive Acute Pharmacist
Without Connecting Care today I couldnt have
done my job. Pharmacist
Having access to accurate, timely, shared
information is no longer a blocker to providing
high-quality, effective, efficient care
I used Connecting Care to find vital information
for the diabetes nurses . The information logged
by district nurses is a goldmine of information.
We saved 20 minutes on the telephone and managed
to find the reason for patients insulin being
discontinued Discharge Nurse
In cases where we are dealing with a person who
is being supported by Rapid Response and the
district nurses, Connecting Care comes in to its
own. All the notes from visits are documented and
it can save at least 30-40 minutes on duty cases
of this nature Social Worker
The extra patient detail is useful when deciding
to stop drugs such as anti-platelets and it helps
to identify risk factors Doctor
Connecting Care has been really helpful tonight.
Could not do without it. Particularly in the case
of an old lady with XX who I could not reach on
the phone. Without Connecting Care this would
have resulted in a visit and probably her door
being broken down. But with CC I was able to work
out that all that should of been done, had been
done. OOH Doctor
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what can Connecting Care potentially offer?

• A sample of some possible financial benefits
• Admissions Prevention
• 10,000 users could see annual saving of
  1,036,288 from admissions prevented by using
  information in Connecting Care
• Based on a Department of Health reference cost
  2012/13 of 1,436 for a unplanned admission and
  only the same rate of stated admissions prevented
  in the pilot
• Reducing duplicate assessments
• 10,000 users could see a annual saving of
  179,520 on stopping the duplication of
  assessments as a result of using information in
  Connecting Care
• Based on cost savings if the same rate of stated
  admissions prevented during the pilot continues
  based on 60 for an average cost of a face to
  face assessment by a community nurse -
  Department of Health reference cost 2012/13

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what can Connecting Care potentially offer?

• A sample of some possible financial benefits
• Time savings - calling other organisations
• 10,000 users could see a annual saving of
  155,278 of people time as Connecting Care
  users spend much less time calling other
  organisations for information
• Based on salary cost savings if only one call per
  week per user is saved where the medium salary
  between NHS bands 7 to 8 is used.
• Reducing home visits
• 10,000 users could see a annual saving of 68,000
  on stopping unnecessary home visits as a result
  of using information in Connecting Care
• Based on cost savings if the same rate of stated
  home visits prevented during the pilot continues
  based on 60 for an average cost of a face to
  face assessment by a community nurse -
  Department of Health reference cost 2012/13

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whats next?
In 2015 our key projects are In the pipeline
Rollout to 2000 users this year Children's safeguarding project sharing information from our 3 local authorities childrens systems Document sharing clinical and social care documents shared in portal...and sent on to other recipients (GPs) initial focus is eDischarge Lots of system replacements ? (2 hospital PAS, 3 community systems, 1 social care system, 2 pathology systems) New infrastructure, new data centre with UHB hosting, re-write lots of our core config to support improved performance Rollout to 10,000 users Pharmacy (sharing more hospital prescribing / community pharmacy) Supporting cancer care Mobile working, patient access Specialist systems (renal, maternity, dental etc etc.) Sharing more information from within hospitals e.g. assessments, care plans Enable sharing of richer end of life plans Better support for some workflow / pathways And lots and lots more!!
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Connecting Care governance
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Connecting Care governance
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Connecting Care
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strategic alignment
5 year forward view Most countries have been
slow to recognise and capitalise on the
opportunities presented by the information
revolutionthe NHS has oscillated between two
opposite approaches to information technology
adoption.....the result has been
systems that dont talk to each other and a
failure to harness the shared benefits that come
from interoperable systems..In future we intend
to take a different approach
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National Approach - Bringing together cohorts on
information sharing
Driving priority standards for information
sharing
Technology Fund Applicants
Collective guidance on breaking down myths
Pioneers Wave 1
Pioneers Wave 2
e.g. Royal Marsden
Understanding common and priority needs
e.g. Barnsley
e.g. Wakefield
Pioneering organisations
Articulating direction of travel
e.g. Hampshire, Bristol
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Whats the underpinning architecture?
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KINNEARS - 5 reasons we have been successful..
1. Line of business systems that share You cannot share paper data easily Good electronic line of business systems that share data are critical
2. Integration Partner Integration is tricky. Find a software partner who gets it
3. Moneylocally owned money! Invest locally.seek national money too, but make your local organisations put skin in the game
4. People.local talented people Hire really talented project people.we did, we do, we always will
5. SPIRIT Overrides everything else Stamp on organisationally centric thinking at every single opportunity. Command the morale high ground that the patients/citizens best interest occupies
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summing up

• What is Connecting Care?
• Why have Connecting Care?
• Strategic alignment - UHB
• National drivers
• Who are the partners?
• What have we delivered so far?
• What are the benefits? Tangible results so far
• What can Connecting Care offer whats coming
  next?
• Governance Framework
• Thank you for your time!

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