The Map of Medicine in the
North West Update August 2009
James Walker
Map of Medicine Programme Lead NW SHA
Chief Information & Knowledge Office
The Map is a Core Component of NPfIT:
The Map of
Medicine
NHS Care Record
Service
Picture Archiving &
Communications
Electronic Transmission
Systems
of Prescriptions
Choose and Book
GP2GP
New National
Network
The Case for Change in Healthcare!
• The requirement to deliver World Class Commissioning
• NHS Operating Framework - working in a ‘cash
constrained’ environment PCTs judged by results
• Developing patient centric services, more personalised
care - services closer to home, money following the patient
• More choice of providers including independent sector
• More information / knowledge about what choices to make
• Greater emphasis on quality of services and outcomes –
PROMS – Commissioning for Quality (CQINS)
• Reconfiguration & Modernisation of Healthcare
• Patient Safety issues – Need to reduce medico-litigation
Closing the Gap
US data collated by Professor
Bill Runciman, President,
Australian Patient Safety
Foundation from McGlynn et al;
NEJM 2006 Vol 348; p2635-45
Semmelweis, Vienna 1847
•
•
High rates of death due to puerperal fever (childbed fever)
Women delivered by physicians
or students mortality rate
(13–18%)
• Women delivered by midwives
or trainees (2%)
Prof. Klein:
Inadequate hospital ventilation
Prof. Semmelweis:
Handling cadavers prior to delivery
Instituted mandatory hand washing
Mortality plummeted to 2%
Best, M et al. Qual Saf Health Care 2004;13:233-234
150 years later...Marshall and
Warren – Helicobacter pylori
•
•
•
•
Published seminal paper in the Lancet in 1983
NICE guidance 2000; Regimens to eradicate Helicobacter pylori
17 years to become standard best-practice
How many unnecessary gastrectomies and selective vagotomies?
c10,000
Drugs like Thalidomide, Cox-2 inhibitors
Overuse of antibiotics - MRSA and antibiotic resistance
Drug-drug interactions
Others yet to be identified
Highest rates for heart
disease and stroke
16% people
on benefits
Nearly a quarter of
children live in poverty
23% of adults
binge drinkers
The Case for Change in the NW
Highest rate for
long term mental
health problems
Average life expectancy 3
years less than the UK best
2nd highest rates - deaths from
cancer and smoking related illnesses
60% of adults
overweight or
obese
The Problem
Chronic Heart
Disease NSF
Diabetes Guidelines
SUS Data
Draft Service
Review
Population profile
Prescribing data
Internal
memorandum
My Documents
Business Objects
Reports
Public Health Team
Trust Board Report
NWSHA Map of Medicine RAG
Status January 2008 Map Views
Ashton, Leigh & Wigan
Blackburn With Darwen
Blackpool
A
B
C
Bolton
Bury
Central and Eastern Cheshire
D
E
F
Central Lancashire
Cumbria
East Lancashire
G
H
I
Halton & St Helens
Heywood, Middleton & Rochdale
Knowsley
J
K
L
Liverpool
Manchester
North Lancashire
M
N
O
C
Oldham
Salford
Sefton
P
Q
R
R
Stockport
Tameside & Glossop
Trafford
S
T
U
Warrington
Western Cheshire
Wirral
V
W
X
H
O
I
B
G
X
D
E
K
P
A
M
L J
W
V
Q
U N
F
T
S
NWSHA Map of Medicine RAG
Status April 2008 Map Views
Ashton, Leigh & Wigan
Blackburn With Darwen
Blackpool
A
B
C
Bolton
Bury
Central and Eastern Cheshire
D
E
F
Central Lancashire
Cumbria
East Lancashire
G
H
I
Halton & St Helens
Heywood, Middleton & Rochdale
Knowsley
J
K
L
Liverpool
Manchester
North Lancashire
M
N
O
C
Oldham
Salford
Sefton
P
Q
R
R
Stockport
Tameside & Glossop
Trafford
S
T
U
Warrington
Western Cheshire
Wirral
V
W
X
H
O
I
B
G
X
D
E
K
P
A
M
L J
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V
Q
U N
F
T
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NWSHA Map of Medicine RAG
Status September 2008
Ashton, Leigh & Wigan
Blackburn With Darwen
Blackpool
A
B
C
Bolton
Bury
Central and Eastern Cheshire
D
E
F
Central Lancashire
Cumbria
East Lancashire
G
H
I
Halton & St Helens
Heywood, Middleton & Rochdale
Knowsley
J
K
L
Liverpool
Manchester
North Lancashire
M
N
O
Oldham
Salford
Sefton
P
Q
R
Stockport
Tameside & Glossop
Trafford
S
T
U
Warrington
Western Cheshire
Wirral
V
W
X
H
O
= LHCs with Live
view on CSC instance
I
C
B
G
D
R
X
E
K
P
A
M
L J
W
V
Q
U N
F
T
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NHS NW Map of Medicine RAG
Status July 2009
Ashton, Leigh & Wigan
Blackburn With Darwen
Blackpool
A
B
C
Bolton
Bury
Central and Eastern Cheshire
D
E
F
Central Lancashire
Cumbria
East Lancashire
G
H
I
Halton & St Helens
Heywood, Middleton & Rochdale
Knowsley
J
K
L
Liverpool
Manchester
North Lancashire
M
N
O
Oldham
Salford
Sefton
P
Q
R
Stockport
Tameside & Glossop
Trafford
S
T
U
Warrington
Western Cheshire
Wirral
V
W
X
H
O
= LHCs with Live
view on CSC instance
All 24 PCT Led Local
Health Communities
have their own ‘view’ of
the Map of Medicine
I
C
B
G
D
R
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E
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L J
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V
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U N
F
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NHS NW Objectives for the Map
• To make the Map of Medicine available to all NHS &
Social Care organisations
• To inculcate Clinical Ownership & uptake of MoM
• To exploit the potential of the Map to support improved
care outcomes to support WCC & Healthy Horizons
• To facilitate improved Clinical Governance
• To implement an ‘evidence based’ knowledge tool
• To implement a sustainable MoM Programme
• To make the Map of Medicine a single point of
reference for patient-centric care, regardless of where
care is delivered: Primary, Secondary or Tertiary Care
• Developing a vision for the Map to support improved
care outcomes in NHS NW
Context - Current Status
• Sponsor - Alan Spours the NHS NW Chief Information &
Knowledge Officer (CIO) is driving the national NHS CIO
network for MoM adoption
• SRO Dr Andy Coley’s NHS NW Chief Clinical Officer & CoFounder of Clinical Leads Network www.cln.nhs.uk
• SHA resources in place to implement MoM & raise awareness
• 100% Technical enablement of MoM in the NW
• Utilisation of MoM in 22/24 PCT Led Local Health Communities
• Strong clinical engagement
• Utilising MoM to improve & standardise health care provision
• Utilising the Map to support enhanced quality of care in NW
• Striving to win ‘hearts & minds’ of clinicians
• At the early stage of a move towards BAU for MoM
Objectives of Map Roll Out in NHS NW What Are We Aiming to Achieve ?
 Facilitate Redesign & Delivery of Health Services:
 Delivering Patient Centred Services
 Empowering Patients & Clinicians
 Improving Quality of Health Care
 Delivering Seamless Services
 Making Better Use of Resources
The Map of Medicine is developed In
partnership with clinicians and….
What is the Map of Medicine?
Framework for
sharing clinical
knowledge across
care settings
Localisable
benchmark for
clinical
processes
Evidence
based care
pathways
available in
any setting
Saves re-inventing the content
wheel locally
How do I access the Map?
Access is via Smartcard and from within N3
Patient Access via NHS Choices website
http://healthguides.mapofmedicine.com
Registration Authority – Process
•
•
•
Registration Authority – process by which
users will gain access to NHS Spine
applications:e.g. MoM, Choose & Book,
ETP & Summary Care Record Service etc
Access to services by smart card
Single sign-on process described during
procurement
Users
Local
Network
/ N3
Smart Card
Plus PIN
Trust PC
NASP and LSP
applications
SmartCards – Will Look Like This..
Chip & PIN - Only a lot better looking!
James Walker
Modernisation
Programme Manager
E&N Herts NHS Acute
Trust
There is a clear need for improving
knowledge management
•
•
“The application of what we know already will have a bigger impact on health and
disease than any drug or technology likely to be introduced in the next decade.”
J A Muir Gray, Director of Clinical Knowledge, Process and Safety - Connecting for
Health, NHS
Improved knowledge management can help prevent and minimise:
•
•
•
•
•
•
•
Errors and mistakes
Poor quality healthcare
Waste
Variations in policy and practice
Poor patient experience
Overenthusiastic adoption of interventions of low value
Failure to get new evidence into practice
Localising the Map of Medicine
Localising the Map
Local Administrative Information
Clinical Localisation
– Adding administrative detail
– Changes to the national care
• e.g. contact details, clinic
pathways
information, opening times etc.
• adding, changing or deleting
• links to websites or intranet sites
information
– Simple process
– More complex involving stringent
local clinical governance
Rationale for localising the Map
•Improve communication of local information and local patient pathways
•Increase relevance as a knowledge, governance and communication tool
•Gain local ownership, adoption and support
•Knowledge sharing of international evidence & best practice
•Opportunity to map current practice
•Undertaking service redesign to:
meet government targets e.g. 18 week RTT
support Practice-Based Commissioning
•Improve transparency and communication across:
care settings (community/primary care/secondary care)
related departments
sectors
Supporting the Independent Sector
• ‘IS CATS Provider Care UK Provide Clinical Services to 10 Greater
Manchester PCTs
– The use of the Map will improve the quality of referrals into GM NHS
CATS as well as secondary care AND improve the quality of discharge
summaries
– IS CATS manages patients in the top 6 specialties: musco-skeletal
medicine including orthopaedics & rheumatology, ENT, Urology,
General Surgery and Gynaecology for 30% of these referrals for the 3rd
largest city in the UK
– IS CATS Provide services for part of the Pt journey
– The Map Pathways are visible across the GM Region in Primary & Acute
Sector
– Provides transparency for referral criteria & the Pt journey
– Clinicians from primary and secondary care clinicians agreed that the
management of such patients on 50 Pathways should be based on the
pathways in the Map of Medicine to ensure quality
Commissioning – Modernisation Developments
communicated via Map of Medicine in the Wirral
AMD Pathway Modernisation
Quantitative Benefits
Qualitative Benefits
Patients were waiting 10 weeks for appointments, this has been
reduced to 3 weeks. A real risk of patients losing their sight has been
addressed.
Data from 2008 is showing a saving of around £500 per patient for
30 patients per month
This single pathway development will save approximately £180,000
There are 100 pathways in development on the Wirral. Potential
savings can be assessed from all of these:
Map Supporting Reconfiguration
Cumbria PCT reconfiguration programme ‘Closer To Home’
•Referral Management based on the Map of Medicine Care Pathways.
•Referral Criteria reviewed with clinicians and published on the Map
In 2007/08, Cumbria PCT spent £12.5M on first referrals which was £406k
above expected (based on the England average). Potential savings can be
assessed:
£1M could have been saved if the 22 most extreme performing
practices reduced their referrals to match the England average.
£624k could have been saved if 10 practices reduced their referrals
to match the England average.
If this benefits work were applied to other workstreams the return could be
huge, they need to be quantified and realised in one or two areas and then
cascaded across the organisation and quantified.
Date source NHS Comparators data, https://nww.nhscomparators.nhs.uk/NHSComparators/Login.aspx
Map Supports World Class Commissioning
– World class commissioning will deliver better health
and well-being for all:
– People will live healthier and longer lives
– Health inequalities will be dramatically reduced.
– It will deliver better care for all:
– Services will be evidence-based and of the best
quality
– People will have choice and control over the
services that they use, so they become more
personalised.
– It will deliver better value for all:
– Investment decisions will be made in an informed
and considered way, ensuring that improvements are
delivered within available resources
– PCTs will work with others to optimise effective
care.
– The Map supports WCC Objective 5 – Provide
‘evidenced based care’
The Operating Framework signalled that
incentives and interventions will be directly linked
with Commissioning Assurance
“PCTs …be held to account for, and rewarded for, their
development towards world-class commissioning through one
national assurance system that will focus on commissioning
outcomes, competencies and governance”
Operating Framework 2008/09, page 46
Map Supports Advancing Quality
• Supporting ‘Advancing Quality’ (AQ)
– AQ a NW SHA World Class Quality Programme
– AQ incentivises Acute Trusts to consistently deliver
Quality
– AQ Indicators to be embedded in the Map of Medicine
– Primary Care see Referral Criteria
– Acute Trusts are rewarded to ‘Quality Care’
Advancing Quality Focus
• 5 Clinical Conditions
Acute myocardial infarction (AMI)
Heart failure
Community Acquired pneumonia
Coronary artery by-pass graft (CABG)
Hip/Knee replacement surgery
• 105 Clinical measures
• 3 year project evaluated Oct 2003 - Sept 2006
• Hospitals in top 2 deciles rewarded for quality scores
Advancing Quality Indicators to
be embedded in the Map of Medicine
• Evidence based consensus clinical measures
• Examples –
Aspirin at arrival (AMI)
Prophylactic antibiotic 1 hour prior to surgical incision (H&K)
Smoking cessation advice /counselling (CHF)
Blood culture collected prior to 1st antibiotic administration (P)
In patient mortality rate (CABG)
Map Pathways are end to end
Acute Hospital

Community Hospital 
Mental Health Trust 
Primary Care Trust
GP Practice
Ambulance Trust



Diagnostic & Treatment
Centre

Community Pharmacy
Social Service

NHS Direct

Integrated Working

 Patients cross organisational boundaries 
407 Pathways Available to patients via NHS
Choices website
http://healthguides.mapofmedicine.com
The Map supports Quality Measures
•Supports PROMS
•Supports CQUINS
•Supports PALS
•Supports Darzi Quality Indicators
Culture v
Technology
“The significant
problems we
have cannot be
solved at the
same level of
thinking with
which we created
them! –
Albert Einstein
Increasing Clinical Workload!
Programme Impact Summary – Map of Medicine
Programme overview / objectives
• The Map of Medicine offers high quality clinical information visualised in over 400 patient pathways. It serves as a single healthcare
knowledge source that will speed the delivery of evidence based best practice across healthcare organisations; this evidence is
continually monitored, reviewed and updated. The Map of Medicine is endorsed by the NHS and the NHS National Library for Health
(NLH) and is developing initiatives in partnership with the NHS Institute they work closely with the Royal Colleges, including the Royal
College of Physicians & the Royal College of GPs . The Map also work with NICE and the National Patient Safety Agency
• The Map of Medicine is working with EMIS & TPP to develop integration, they are also working with InPS and iSoft, and engaging with
Out of Hours plus Acute suppliers i.e.Lorenzo & Cerner, it is anticipated that integration will be incremental from 2009 onwards.
Benefit summary
Primary impact on
Key dependencies
Patients
• 407 Pathways available to patients on www.nhs.uk or
http://healthguides.mapofmedicine.com Patient pathways online.
• Increased patient confidence as pathways are evidence based
• Improved communication across organisational boundaries
• Increased patient safety through access to information
NHS staff
• Easier access to up-to-date information, 24 hours/day
• Supports healthcare planning, PbC reconfiguration, modernisation
• Enables demand management – Appropriate referral information
• Facilitates coordination between Health & Social Care
• Supports 18 Week RTT targets
• Provides knowledge support
• Supports Clinical Governance
GP practices
• Timely access to information to support patient care
• Clinical Governance updates
• Improved communication (Information Governance)
GP practices: Awareness of
changes to core business
processes.
• Information Governance
• Clinical Governance
Communication NICE, NSF
Data Set Change Notice
changes
• Integral to Modernisation
• Supports PBC
Acute Care
• Improved communication
• Improved Pt safety
• End to End Pt pathways
Unscheduled care settings:
A&E, OOH awareness of
local business process
redesign.
PCTs: Reconfiguration,
Planning resources;
Management of clinical &
patient information
Supports PBC
Internal
•Clinical ownership
•CEO ownership across LHC
•LHC Governance arrangements
•LHC resources
•Practice based Commissioning
•Advancing Quality Programme
•Smartcard access
•Stakeholder engagement
•World Class Commissioning
• Improved Pt safety, online access to BNF/NLH specialist libraries
• Supports Continuous Professional Development (CPD)
• Out-of-Hours patient care will be based on up to date pathways
External
•Map of Medicine
•Acute ownership/engagement
•GP practice sign up
•Urgent and emergency care
resources
•Local Service Provider – Key
Supplier of NHS systems as
hosts for HW
•Integration in strategic clinical
solutions: GPSoC, CaB,
Lorenzo, Cerner, Out of Hours
NHS NW Vision for the Map
What
By Whom
By When
Optimise the delivery of Quality Healthcare in the most appropriate setting by technically
enabling access to the Map across the NHS NW - Completed
JW
April 2009
Embed the use of the Map of Medicine as a key strategic tool for
reconfiguration/modernisation
JW
October 2009
All 24 PCT Led Local Health Communities to use the Map of Medicine as a core tool for
Commissioning of Services
JW
March 2010
Embed the Map as a core tool for providing clarity and transparency for who does what in
the clinical process
JW
March 2010
Embed the Map of Medicine as a core tool to support World Class Commissioning
JW
March 2010
Embed the Map as a Core tool to support the delivery of Transforming Community Services
JW
March 2010
Embed the Map as a core tool to support ‘High Quality Care for All’ Include the Map as a
reference tool in the ‘quality metrics’ process
JW
March 2010
Include the Map as part of the NHS NW SHA response to ‘Measuring for Quality
Improvement’,
JW
March 2010
Include the Map as a core tool to support the NHS North West Quality strategy
JW
March 2010
Inculcate the Map as a tool to support the SHA Quality Boards, Quality Accounts and
Quality Observatories.
JW
March 2010
Raise awareness and adoption of the Map of Medicine by patients and carers across the
NHS NW http://healthguides.mapofmedicine.com on the NHS Choices Website
JW
March 2010
Include Pathways and the Map of Medicine in GPSoC & Choose and Book contract
renegotiations
JW
September
2009
To embed the Map of Medicine as part of the NHS North West Deanery agenda
JW
March 2010
Darzi &
the Map
in the NW
Map Logins 2007/08
Map Logins 2008/09
Logins by Week
700
600
500
12.5%
12.5 %
400
300
12.5 %
12.5 %
12.5 %
12.5 %
200
100
0
12.5 %
Total Logins
12.5 %
Unique Logins
The Map of Medicine
in the North West a significant
Change Management Programme
A programme that will only succeed with
clinical ownership www.cln.nhs.uk
Thanks…..
NW SHA Map of Medicine lead
James.walker@northwest.nhs.uk