Herding Cats
The Bristol ‘Connecting Care’ Programme
The Bristol story of Interoperability between organisations
who don’t naturally interoperate
Andy Kinnear
Introduction
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Connecting Care – why was it needed and what is it?
Who is involved – our partnership
Update on where we are
What are we buying?
Our plans & next steps
Managing the ‘behaviours’
Connecting Care – why is it needed?
“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 ”
“I don’t have access to
“I can’t call people in the
middle of the night for
information…”
“There are delays in getting
hold of information that I
need…and I spend a lot of
time chasing it up…”
*Summarised from
feedback from clinicians
during workshop events
Clinical leaders told
us that NOT having
access to accurate,
timely, shared
information is a
‘blocker’ to
providing highquality, effective,
efficient care…
some important
information
electronically…”
“Sometimes I just have a piece of
paper and I’m not sure who
wrote it or when”
Connecting Care – what is it?
Clinical leaders told us that NOT
having access to accurate, timely,
shared information is a ‘blocker’ to
providing high-quality, effective,
efficient care…
Connecting Care is our response to
the call from our clinical leaders across
Bristol and beyond for better, more
joined-up information
Connecting Care is our name for the
BNSSG Interoperability Programme.
We aim to deliver a detailed, local
shared patient record that pulls
together health and social care
information - providing a unified /
holistic view that can be used to
facilitate improved care provision and
clinical decision-making
Connecting Care – what is it?
• Pan-community project involving 13 local health & social care
organisations
• Pulling together & integrating information from primary,
community, mental health, acute care and social care in order
to support point of care
• Taking a staged approach –
– Stage one will focus on urgent and unplanned care (12 months)
– This will involve iterative development methods, a lot of learning, very
close working with clinicians who are part of the pilot, close working
with the technical supplier and a firm focus on exploring benefits – to
support the delivery of a Business Case for the full strategic solution
Connecting Care – what? Scope
• General
– Taking a staged approach – first stage is for 12 months.
– Key deliverables
• A working system
• A Business Case for the second stage
– Second stage contract will be for 5 years (plus extension)
• Clinical / care ‘theme’
– Stage one intends to focus on urgent & unplanned care
– Stage two will be for wider use (long term conditions, other pathways,
‘patient portals’…and whatever else we choose to do)
• Numbers of users
– Stage one c.300+
– Stage two – 10,000+
Connecting Care – our partnership
• South West Commissioning Support (SWCS) - leading the
programme
• 3 Acute trusts - North Bristol Trust, University Hospitals Bristol
Trust, Weston Area Health Trust
• 3 Local Authorities - Bristol City Council, North Somerset
Council, South Gloucestershire Council
• 3 Community Providers - Bristol Community Health, North
Somerset Community Partnership, South Gloucestershire
Community Health Services
• 3 CCGs - 110 GP Practices
• Ambulance - Ambulance Service
• Mental Health - Avon & Wiltshire Partnership Trust
Connecting Care – What are we buying?
What?
Details
Systems
(First stage will
include a
minimum of 10
interfaces)
GP Systems (EMIS, EMIS Web, INPS)
Civica PLC – PARIS
Northgate Swift
Cerner Millennium
McKesson (System C) Medway
CSE Healthcare – RiO for community in BNSSG
Advanced Healthcare – Adastra
Adastra End of Life Care record
Sunquest ICE
User numbers
Stage one – c. 300
Stage two – up to 10,000 (or more)
User views
Stage one will have a minimum of 6 patient/client centric
views; these will be tailored to the role of the user
Stage two could increase, depending on needs and additional
functionality
Connecting Care – what information?
Patient Demographics
Practitioner Details (Registered GP,
Community nurse, social worker etc.)
Medications
Allergies, Adverse reactions noted
Diagnoses
Lifestyle factors
Immunisations
Clinical Correspondence and letters
Latest progress notes
Radiology Reports, Pathology
Reports & images
Existence of / details from Care
Management Plans
Tests ordered (past and future)
Referrals, Scheduled appointments
(future), Appointments (past),
Home visits (past), Home visits
planned (future)
Inpatient episode
Outpatient episodes
Discharge Details
Emergency Attendance
Clinical / Care Assessments
Social Care Assessments
End of life wish details
Connecting Care – What are we buying?
What?
Why?
Partnership and
Capability
Portal ‘product set’ from Orion Health which includes:
• an integration engine (Rhapsody) to support the
linking of records.
• an eMPI (Enterprise Master Patient Index) NextGate
Training
Will allow us to develop Connecting Care on into the
future
Professional services
Business case and benefits support
Technical support on how we integrate data
Service/operational
support
Technical assistance and support post go-live
Connecting Care – where are we?
• Completed a complex procurement process (competitive
dialogue)
• Signed contracts in February 2013
• Started work on the project last month
– Governance in place
– Scoping the work with our local clinicians and social workers
– Project planning, solution design and information governance
deliverables all underway
Connecting Care – timeline
What?
When?
Sign Contracts
February 2013
Start project – phase one of
Connecting Care
March 2013
First go-live (key systems and roles)
August 2013
Business Case available (and initial
benefits case)
October 2013
Full business & benefits case
December 2013
Approvals / finances agreed /
planning for second phase
October 2013 to January 2014
End of phase one of Connecting Care
February 2014
Start of wider rollout
April 2014
Connecting Care – Behaviours
The ‘herding cats’ challenge –
Connecting Care characterised by:
• Multiple organisations with multiple agenda
• Multiple clinician professions with multiple priorities
• Multiple system suppliers with multiple commercial interests
But there is only ONE patient
Connecting Care – Behaviours
The ‘herding cats’ challenge –
Characteristics of successfully meeting that challenge:
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Leadership
Vision
Direction
Individuals
yeah yeah yeah
But managing ‘behaviours’ is key to cat herding
Connecting Care – Behaviours
The ‘herding cats’ challenge –
Recognise and work on the different elements –
• Political dimension
• Personal dimension
• Human behaviours
• Organisational behaviours
• Interests, motivations and blockers
• Time and timing
Connecting Care – Behaviours
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Work at it - it doesn’t happen by accident
Accept it is going to take time
Create ‘independent brokerage’
Recognise different interests and work to accommodate
Recognise vested interests and pander to them where necessary
Give everyone reasons to be at the table
Encourage collegiate behaviour, liking each other being happy
about the programme
Appeal to the greater good
Bring dissenters inside the tent
Deal with key stakeholders individually and in groups, formally
and informally – be flexible in your approach
Be trustworthy, honest and open….but a little clandestine now
and then ;-)
Connecting Care – behaviours
It takes time to build a partnership
Early 2010 –
Small first
meeting –
setting the
vision, getting
people around
the table
Late 2011 –
decide
procurement
strategy and
go for it!
Early 2011 – falter a
bit. But we carry
on…and gather
momentum.
Considering options
for trials, proof of
concept…national
frameworks etc.
2013 –
We’re
off!
Project
starts
2012 – in
procurement…
competitive
dialogue.
More interest –
new partners
come on board
Connecting Care – Behaviours
The ‘herding cats’ challenge –
“When my cats aren't happy, I'm not happy. Not because I care
about their mood but because I know they're just sitting there
thinking up ways to get even”
Percy Shelley
Connecting Care – Thank you
Thank you for your time
Andy.Kinnear@swcsu.nhs.uk