#cciolip
Technology supported
transformation in
Health Visiting
Services
Coleen Milligan
Technology Supported Transformation in Health
Visiting Services
Coleen Milligan
National Clinical Implementation Lead
What Will Success Look Like?
• Parents will have access to their child’s health records electronically;
• Families will be able to access electronic advice, education and support;
• Health Visitors will have mobile technology to improve access, quality and
productivity;
• Mobile technology will enable information to be available at the point of
service delivery and electronic capture of information will be the norm;
• Once recorded, data will be available for numerous purposes e.g.
commissioning including contracting and performance, reducing double entry
and transcription errors;
• Information collected will also support delivery of QIPP, education, research,
public health interventions, clinical audit and demonstration of clinical
outcomes.; and
• Robust sharing of information arrangements will be in place between agencies
to facilitate ‘joined up’ services for families’ at all levels of the service model
The Future – Opportunities and Challenges
The Potential – Supporting The
Service Model
Building virtual communities
• On line communities national e.g. Net mums
Personal and family health records
• Electronic Care Record (>10 million Summary Care Records)
• Health Space – NHS Portal to navigate services and access service >173HealthSpace Accounts
• Digital / electronic ‘Red Book’ 2016
Online services
• Access to online services (NHS Choices >1000,000 visits per year)
• Health visiting direct
• Electronic repeat prescriptions
• Choose and book / electronic booking of appointments
• Tele health Tele medicine
• Apps for medical symptoms / self care
The Potential – Supporting The
Service Model
Information on line
• NHS Local/Public Health Information on line
• Digital Advice Service for Families 2012 (>2 million messages sent per month
via NHS mail to remind patients of appointments)
• Digital Babies 2012
Information sharing
• Sharing information through NHS e mail
• Information sharing NHS mail – nhs.net, Local Government - .gcsx.gov.uk,
Police National Network - .police.uk, or pnn.police.uk, orscn.gov.uk, or
cjsm.net
Productivity
• Mobile working
What Would Good Look Like:
Antenatal Visit
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The antenatal visit had been scheduled using a rostering tool, booked
electronically with parents and a text reminder sent.
In the home the Health Visitor accesses the maternity record and birth plan using
laptop, and discusses with the parents. They discuss mother’s intention to breast
feed and HV identifies local breast feeding support groups for parents.
The HV demonstrates to parents validated information web sites for parenting
advice and information and introduces virtual community sites such as
Netmums/Mumsnet etc
The Health Visitor shows the parents the local HV service offer on local website
and talks about what will happen once midwife discharges mother (using the
electronic professional pathway). She leaves contact details including an email
address for parents to contact for further questions and advice
Information about the antenatal visit, including information on outcomes is
recorded electronically in the clinical family record.
Information from the clinical record is available to the organisation to report on
activity and performance.
What Would Good Look Like:
2 – 2half Year Review
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Health visiting team has been alerted to review due by routine reporting from Systmone via
the waiting list function linked to HV team availability via Outlook. Once an appointment had
been identified an invitation letter was emailed/texted to the family and a reminder text was
sent just before the appointment. This helps keep the DNA rates down and makes better use
of clinical time.
As local services are working towards integrated health and foundation years review at 2 the
family are seen at the Children’s Centre. The child’s record is be accessed via a mobile device
and information from the review entered directly into the clinical record at the point of
service delivery. This information is only entered once but then is shared as appropriate
When the child and parent/carer come for their appointment, the review is carried out using
the electronic Ages and Stages assessment. Online resources Websites, apps. teaching videos
are used during the review to assist parents where necessary. Information for the parent is
recorded in the Electronic Red Book. E customer feedback is encouraged which is recorded
once and available for instant analysis.
In addition to the clinical information the time it took to do the review, travel time, any
referrals required etc is also entered. This allows reports to be created from the ‘rich’
information in the clinical information system.
The final task is to remove the child from the 2.5 year list and place him/her on the
appropriate list for the next review
What Would Good Look Like: Health Visiting
Healthy Child Programme Service Planning And
Delivery
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The Health Visiting team have contributed to the JSNA. They are now using this and
other public health data and local community information to identify priorities for
action to improve health outcomes/reduce inequalities in the local community
The identifies one local estate as an outlier for high incidence and admission for
childhood home accidents. This is confirmed by the paediatric liaison service
A health improvement group is formed within the local community with
representatives from the health service, children’s centre,, fire service and schools
and all information available is pooled and shared electronically. This enables a
shared action plan to be agreed which includes
Virtual home tour to identify where safety equipment is needed
Email/text address is created for families to loan or purchase equipment
Information regarding fire safety / free smoke alarm is made available on a app for
mobile phones
App for first aid in the home is developed and made freely available
Families informed of local child care programmes by text reminders
Joint outcomes for the action plan agreed with the community and monitored
Benefits For Staff
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Agile working
Reduction in travel
Increased productivity
Electronic diary
Access to decision making support tools
Instant messaging to colleagues and GPs
Secure transfer of information (NHS Mail)
Real time action – sent a change of new born baby’s name to Child Health
Team during consultation with mum
• Access and use of standardised care plans e.g. Nursery Nurses using a
standard template for behaviour management
• Ability to access real time information and run reports
• On line access to organisation policies and procedures
Benefits For Staff Will Lead To:
• Improved satisfaction / morale due to improved efficiency
• Ability to be flexible in where they start and finish the working
day
• Once only data entry
• Ability to make referrals and appointments at point of service
delivery
• More effective use of clinical time
• Ability to use on line educational tools and programmes
• Ability to promote self care with use of on line information
• Ability to share information appropriately and effectively
• Providing Health Visitors with the technology at work which they probably
use and feel comfortable with in their social lives
What Needs To Happen To Make
The Possible The Norm?
• Up front investment
• Wide scale deployment of mobile technology to Health Visitors
• Wide scale deployment of an electronic clinical application which can be
used in a connected and disconnected modes
• Clinical Information Knowledge Management and Decision Support software
• BNF on line
• Clear measures to demonstrate benefits and return on investment / QIPP
and productivity gains
• Demonstration of information on line from national / local educational
sources
• Cultural change within the profession
• Cultural change and across agencies especially in regard to sharing
information
• Clear benefit realisation measures
What Local Services Need To Do
To Make This Happen
• Undertake assessment of information and technology requirements – tool
available
• Complete state of readiness for mobile working – tool available
• Prioritise investment for the deployment of mobile technology
• Have a robust implementation plan
• Provide business change support at a local team level
• Provide project management for implementation
• Provide responsive and timely IT support
• Measurement benefits to demonstrate on going improvements and
increased family satisfaction with services
• Rapid replication of what we know works
What The National Health Visiting Programme Could Do To
Make This Happen?
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Production of Options Appraisal of approaches to implementation (Incremental
approach v big bang)
Development of ‘Return on Investment’ tool for mobile working and pilot of the use
of emerging technologies to provide evidence for future use and benefits to local
families and Health Visiting
Development of standard scorecard for the measurement and assessment of the
impact of Health Visiting and development of a performance scorecard to capture all
performance and outcome measures
Identification of improvements in robustness of connectivity, disconnected clinical
applications, intra operability between systems and national information sharing
protocols (in partnership with Informatics Directorate)
Commencement of discussion with industry and educational organisations to develop
Clinical Information Knowledge Management and Decision Support software
Development of ‘core templates’ to ensure clinical applications capture all HV
information requirements
Provision and promotion of National Clinical Leadership – Cultural change / Use of
technology / Change Management Skills
Creation of a couple of whole scale demonstrator sites to provide the NHS with the
evidence on the benefits possible
What The National Task Force
Could Do To Make This Happen?
• Supporting and communicating the vision for information and technology in
Health Visiting
• Leading cultural change in the professions/ organisations and across agencies
• Contributing views from service users on technology supported services
• Making case for investment within organisational networks
• Supporting and driving information sharing across agencies
• Publishing information from national studies and educational resources
• Influencing training and education for staff to be competent and confident in
using mobile technology -Inclusion of informatics in HV training, training
when deploying technology and on going support post implementation
This is technically and culturally
do it !
possible – so lets
Can we afford not to?
Thank you for your attention