Title: Smartcare - a Foundation for excellent patient care through a strategic approach to IT www.smartcaredevon.co.uk
1Smartcare - a Foundation for excellent patient
care through a strategic approach to
ITwww.smartcaredevon.co.uk
- Alison Diamond
- Chief Executive
- Northern Devon Healthcare NHS Trust
2A Trust Experience
- Who and what we are
- What we wanted to solve
- Our approach
- Successes to date
- Next steps
3Bude
From To Time (mins)
Bude Barnstaple 55
Bude Plymouth, Exeter, Truro 80, 75, 80
Ilfracombe Barnstaple 25
Ilfracombe Plymouth, Exeter, Taunton 130, 90, 85
Ilfracombe Axminster 105
4Trust profile
- North Devon District Hospital in Barnstaple
- 17 Community Hospitals
- Integrated health and social care teams
- Community nursing and therapy services
- Specialist community services pan Devon
- We cover just over half of Devon
- Serve 484,000 people (740,000 Devon total)
- Over 1,700 square miles (2,500 sq m Devon total)
- Acute
- Serve 165,000 people
- Over 700 square miles
Turnover 2013/14 223m
5Our Integrated Business Plan (IBP)
6Smartcare Why? How? What?
- Why?
- Patient need only tell their story once and staff
will have access to a multi disciplinary records
in all settings - How?
- An EHR programme that is transformational and
clinically lead - What?
- EHR across Acute and Community Settings
- Interoperability with all other local systems
7Principles for staff
- Single Sign On including Tap in and Tap out
mobility - Fast, reliable and clinically acceptable local IT
- Easy access to WiFi and safe, secure mobile
access - Off Line working (Community)
8Meaningful Use of EHR
Internal Informing
External Informing
- Managing Clinical Quality
- Clinical Decision support tools
- Evidence-base part of care giving process
- Managing Operational
- Performance
Decision Making (Information) _______ Ways Of
Working (Technology)
- Patients accessing their records
- Informing to differentiate NDHT
- Demonstrate we know and care for the populations
we serve - Helping Commissioners manage demand better
- Better contracting outcomes for us (coding,
revenue per case)
Reshaping
Optimising
- Electronic Correspondence
- Virtual Health Record (through Health Information
Exchange) - Clinical Portal
EHR
- EPMA
- Order Comms
- Clinical Noting
- CPOE / CDS
Inside the Organisation Outside the Organisation
9EHR Programme
- Smartcare EHR comprises
- TrakCare (Intersystems) for Hospital Based care
- RIO (Servelec) for community / home based care
- Ensemble / Healthshare (Intersystems) for
interoperability platform - In 2015/16 introduce full Digital Observations,
Handover, Hospital at Night EWS Escalations
(products Nervecentre Welch-Allyn) - Adopt clinical noting early on in the programme
in what is a clinical foundation first phase - Retain Winscribe (or similar) for digital
dictation and voice recognition to assist with
EHR data capture - 2-3 year roadmap of transformation
10Year 1 Architecture Summary
11Tele-health in Ophthalmology
- Routine follow up for patients with glaucoma(wet
AMD to follow) - Local access to care for patients
- Remote retinal pressures and photography
undertaken by technicians - Centrally reported and treatment planned any
changes in medication to patient and GP within 5
days
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14Outcomes
- 20,000 ophthalmology patients, 8000 i.e.40 of
patients seen in local community - 30 increase in productivity for consultants
- Opportunities to develop the technician role
15GP order comms
- Rolled out to all the practices that use the
pathology services at the acute hospital through
2014/15. - This was clinically led and clinical pathway
based GP/Microbiology. - The pilot for the work was to rationalise the
requests for urine microscopy and culture to
those patients that needed it. - Work based on order sets
- The net result now that the implementation is
complete stemmed the growth from an annual 3-4
to flat growth - This has led to a commissioner QIPP - 300,000
last year - 65,000 new business from North Cornwall
16Complexity and Community Data/PAS
- Foundation built from collection of CIDS
- Mobile devices to over 800 staff
- CIDS (through COMPAS in-house App)
- Works offline as well
- Devices support other new ways of working
- Developed packages of care approach to data
collection - Refined through pilot in teams with highest
levels of completion and accuracy - Refined further through shadow monitoring and
independent inter-rater agreement of complexity
for cohorts vs. actual recording in COMPAS - Algorithm derived to ascertain community tariff
17Outcome
- Used to demonstrate our increasing demand and
acuity of casemix and secure an additional 1.25m
on 14/15 contract vs. 13/14. 1.5m on15/16
contract vs. 14/15 - Pushing for adoption and move away from block
contract - High levels of staff adoption demonstrates the
value to them and the productivity and service
demands they face
18Next Steps
- Refine patient pathways to new lean models -
for ops team and clinicians to design - Sign off that EHR fit for purpose
- Roll out of EHR to hospital sites
- Contract for EHR for community to be signed and
move to implementation phase - Review and evaluation to ensure benefits
realisation
19Questions and Comments