Connecting Care
Our story so far…
Andy Kinnear
June 2015
introduction to Connecting Care
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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 & what’s coming next
How our Governance framework works
How Connecting Care fits with the national strategy
Kinnear’s 5 key messages!!
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)
local need
“Adequate and timely information
must be shared between services
whenever there is a transfer of care
between individuals or services.”
“The information I have is
limited and frequently is
missing important
elements…”
“There needs to be better
communication between
‘in-hours’ and out of hours
services.”
“Services in all settings including
health and social care need to
improve their communication and
handover ”
“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
need…and I spend a lot of
time chasing it up…”
NOT having access
to accurate, timely,
shared information
is a ‘blocker’ to
providing highquality, effective,
efficient care…
“I don’t have access to
some important
information
electronically…”
“Better information would support
better safeguarding”
*Summarised from feedback from local clinicians
& practitioners during workshop events
national drivers
strategic alignment
5 year forward view: “Most countries have been slow to recognise and
capitalise on the opportunities presented by the information revolution……the
NHS has oscillated between two opposite approaches to information technology
adoption.....the result has been
systems that don’t
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”
Connecting Care partnership
project approach
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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 we’ve delivered so far
Presentation
Connecting Care Clinical Portal
Security & Privacy
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Patient Record
Authentication
Authorization
Single Sign-On
Patient Privacy & Consent
Relationships
Audit Logs
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Demographics
Laboratory
Radiology
Encounters
Allergies
Diagnosis
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Portal
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Medications
Problems
Procedures
Transcribed
Documents
Patient Search
Patient Lists
Patient Summary
Timeline
Flowcharts
Secure Messaging
Orion Health Applications
Third Party Applications
Integration
MiG
Rhapsody Integration Engine
Clinical Data Repository
Master Patient Index
GPs
Source Systems
NBT
Cerner
PAS
Weston
Cerner
PAS
UHB
Medway
PAS
RiO
Extracts X4
Adastra
End Of Life
Adastra
Out Of
Hours
Orders and
Results (CRIS
and Ultra) X2
Paris Social
Care Bristol
SWIFT –
North
Somerset
benefits approach
The backdrop: scope and theme of the pilot
The backdrop the scope &
theme of the
pilot
Analyse and
reflect
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Theme of ‘urgent and unplanned care’
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500 licences, shared across all partner
organisations teams
The hypothesis and framework used
The
hypothesis &
a framework
for assessing
benefits
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‘Better sharing of information and better
integrated information should have a
positive effect on the quality, efficiency and
cost of providing care’
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Framework based on MSP
A detailed methodology and plan
Capture and
review
A detailed
methodology
and plan
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Benefits realisation plan
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Based on Quality, Innovation, Productivity
and Prevention (QUIPP) themes
Connecting Care - benefits
The main benefits for me (as a clinician or social care professional) are:
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Confidence in my decision making is improved
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The quality of my consultation (or assessment) is improved
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I do not make unnecessary referrals or carry out duplicate assessments
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It saves me time (which can be used to provide care, or for other duties)
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I am more informed before a visit/appointment, which means I can provide more
timely/more appropriate care
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I have better relationships with colleagues
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My input into a patient/service user’s care can be seen by others, so the
recognition of my profession is increased
Connecting Care - benefits
The main benefits for my patients/service users are:
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They don’t have to keep telling their story (e.g. remembering / explaining
medications
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They receive safer, more appropriate care
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They have a better experience of the services offered, potentially with fewer
duplications or delays
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They might not have to be admitted to hospital
Connecting Care - benefits
Out of
hours care
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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 /
A&E
• 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
Saves appointments and visits
Saves admissions
Safer prescribing
Improved quality of consultation
Connecting Care - benefits
Community • Saves time in triage and assessment
• Saves time – reduces the amount of calls to GPs
care
• Saves unnecessary home visits
• Supporting risk management and safeguarding
Social care
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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)
Supporting referral management
Saves time in triage and assessment
Informs assessments & care planning
Saves installation and equipment costs
Supports risk management and safeguarding
Connecting Care - benefits
“Unable to obtain a
medication history
or allergy status
from the
patient….accurately
confirmed through
Connecting Care …”
Pharmacist, NBT
“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)
“Have been able to identify trends
which have then resulted in
swifter [safeguarding]
interventions…one case where
concerns would not have
increased without Connecting
Care…”
Social Worker Safeguarding team
“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
“Connecting Care is
brilliant…I use it to
triangulate information
““Information about
from service users, to
the patient’s
find out about other
diagnoses has helped
services involved so
our team decide
that I can contact them
which type of therapy
to inform my
to offer the patient”
assessments”
UHB
Bristol social worker
“it has enabled us to
commence discharge
planning earlier in the
patients stay to help
prevent delays later
on.”
Discharge Nurse
“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 - benefits
“On Monday I managed to obtain details for
22 patients on Connecting Care, I saved a huge
amount of time as I didn’t need to phone the
GPs and wait for the faxes to arrive” Acute
“Without Connecting Care
today I couldn’t have done
my job.” Pharmacist
Pharmacist
“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
“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
“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
Having access to
accurate, timely,
shared information
is no longer a
‘blocker’ to
providing highquality, effective,
efficient care…
“The extra patient detail
is useful when deciding
to stop drugs such as
anti-platelets and it
helps to identify risk
factors” Doctor
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
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
what’s next?
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In 2015 our key projects are
Rollout to 2000 users this year
Children's safeguarding project –
sharing information from our 3 local
authorities’ children’s systems
Document sharing – clinical and social
care documents shared in portal...and
‘sent on’ to other recipients (GPs) –
initial focus is eDischarge
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Lots of system replacements  (2
hospital PAS, 3 community systems, 1
social care system, 2 pathology
systems)
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New infrastructure, new data centre
with UHB hosting, re-write lots of our
‘core config’ to support improved
performance
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In the pipeline…
Rollout to 10,000 users +
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Pharmacy (sharing more – hospital
prescribing / community pharmacy)
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Supporting cancer care
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Mobile working, patient access
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Specialist systems (renal, maternity,
dental etc etc.)
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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
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And lots and lots more!!
Connecting Care governance
SYSTEM LEADERSHIP GROUP
Directors of
Finance Group
PROJECT SPECIFIC
BOARD(S)
Strategic
level
Connecting Care
PARTNERSHIP
PROGRAMME BOARD
Connecting Care
PROGRAMME TEAM
Connecting Care
SUBJECT SPECIFIC
SUB-GROUPS
Connecting Care
‘USER GROUP’
(Clinical & Social Care)
Oversight &
assurance
level
Connecting Care
MANAGEMENT GROUP
Delivery
level
Connecting Care
LOCAL PROJECT
TEAMS
Connecting Care governance
Orion Health
Contract for
services **
Specific
contract / SLA**
Connecting Care
partner / supplier
Main contract &
set of schedules
Supplier contract
Connecting Care
partner
** For example hosting of the system or
programme delivery or other support
services
Connecting Care
partner
Bristol CCG
Internal Contract /
Cooperation Agreement
Connecting Care
partner
Connecting Care
partner
Connecting Care
How does it fit with
national strategy?
strategic alignment
5 year forward view: “Most countries have been slow to recognise and
capitalise on the opportunities presented by the information revolution……the
NHS has oscillated between two opposite approaches to information technology
adoption.....the result has been
systems that don’t
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”
National Approach - Bringing together cohorts on
information sharing
Driving priority standards
for information sharing
Technology Fund
Applicants
Collective guidance on
breaking down “myths”
e.g. Royal
Marsden
Pioneers Wave
1
e.g. Barnsley
Pioneers Wave
2
e.g. Wakefield
Understanding common and
priority needs
“Pioneering
organisations”
e.g. Hampshire,
Bristo
l
Articulating direction of
travel
2
What’s the underpinning architecture?
MPI
Index
Demographics
Index to
IDCRs
Summary Care Record
Flags (e.g.
CPIS)
Discharge
meds
Use of national assets for key
flags and key documents
where national access needed
Clinical
Patient
Open APIs between
IDCRs enable
sharing across
these
Integration Platforms
Open Source
Middleware
SC
MH
Integration Platform
(e.g. Leeds)
Integration Platform
(e.g. Hampshire)
Use SCR APIs to bring
SCR content into IDCRs
Expose access to
IDCRs through APIs
Specific key documents
provided up to SCR for
national access
GP record
ectract
Com
Acute
SC
MH
Com
Meds,
allergies,
adverse
reactions
Acute
GP systems
remain main
point of curation
of record
SC
GP
Systems
MH
GP
Systems
Com
GP
Systems
Acute
GP
Systems
Integration Platform
(e.g. Britol)
IDCR
Patient
IDCR
IDCR
Referrals/
Discharges i.e.
transfers of care
(clinical
workflow)
Local Clinical System
Creation of local integrated digital care
records to support clinical access to
detailed care record and speciality
information.
Clinical access and
contribution to
integrated digital
care records and
summary care record
through their native
clinical system.
Patient access to
summary
information (SCR)
with ability to drill
down into
integrated digital
care records.
Access through
NHS Choices and
PHRs
PHR integration
platforms will enable
apps/PHRs access
to other APIs for – i)
transactions e.g.
use NHS referrals
API to book
appointments and
2) use APIs to
access information
from wearables etc
Patients also to be
able to contribute to
PHRs
2
KINNEAR’S - 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. Money…locally owned
money!
• Invest locally….seek national money too, but make
your local organisations put skin in the game
4. People….local talented • Hire really talented project people….we did, we do,
we always will
people
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
summing up
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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 & what’s coming next?
Governance Framework
Thank you for your time!
what does it look like?