Sharing information to
improve patient care in West
Sussex
Adrian Woolley
Head of Strategic IT
NHS Coastal West Sussex CCG
NHS Crawley CCG
NHS Horsham & Mid-Sussex CCG
June 2014
Sharing information to improve
communication & inform patient care
Photo: sparkle glowplug
The 15 million people in England with long
term conditions… their treatment and care
absorbs 70% of acute and primary care
budgets in England.
The issue…failure to provide integrated care
Fragmented care: the healthcare system…not being
considered in a whole system approach with social
care…
Lack of informational continuity: care records which
can’t be accessed between settings...
Reactive services, not predictive services: failure to
identify vulnerable people who might then be given extra
help to avoid hospital admission or deterioration /
complications of their condition…
LTCs
Admission Avoidance
Proactive care planning
Joint working between health and social care
End of Life care
Care providers can have ‘silos’ of information held
within their organisational boundaries
GP practice system
Hospitals
Community Nursing
Significant diagnosis
DNACPR
Admission Avoidance DES Care Plan
ECG
Diabetes clinic
In-patient discharge letter
Specialist nurse record
Contingency Care Plan
Mental Health
Dementia nursing
MH Crisis Plan
Social Services
Social Services visit daily
Care providers can have ‘silos’ of information held
within their organisational boundaries
GP practice system
Hospitals
Community Nursing
Significant diagnosis
DNACPR
Admission Avoidance DES Care Plan
ECG
Diabetes clinic
In-patient discharge letter
Specialist nurse record
Contingency Care Plan
Mental Health
Dementia nursing
MH Crisis Plan
Social Services
Social Services visit daily
A real time Read Only viewer for use in direct
patient Care, with Information derived from both
Health and Social Care
ROCI
Challenges for this type of project
•The classics – stakeholder engagement etc x n2.
•Information Governance, legal opinion
•Data access. Paternalism
•Commercial self interest of system suppliers
•Finding care plans
•Waiting for Spine 2
A Virtual IDCR
Live data (no data warehouse)
Live data (no overnight updates)
Consent to view at point of need
Real time messaging to multiple systems –
‘send pertinent information for unscheduled care’
GP
NHS No, Name, DoB
Hospital
Community Nursing
Integration Engine and
VIPER360 portal
Mental Health
RBAC
Social Services
Consent record for audit
What data could be available?
From GP (via MIG):
a patient summary
problems
diagnoses
medication (current, past and issues)
risk and warnings
procedures
investigations
blood pressure measurements
encounters, admissions and referrals
patient demographics
From SCR:
current meds
allergies
adverse reactions
From Community Trust
open referrals
From Social Services:
Main Address
Current Address
Placement Address
Allocated Worker, Open/Closed Agency
Providing Care Package Funded?
Emergency Next of Kin details
Does the Subject Have a Carer?
Is the Subject a Carer?
From Acute Trusts:
recent admissions & discharges
EDD
From care plan repository:
anticipatory care plans
LC
One place to find care plans = reduced conveyance by
ambulance.
A&E (ROCI)
Ambulance
OOH GPs
Data
readers
Sussex wide
care plan database
GP Admission Avoidance
DES care plans
Proactive
Care
Data sources
EoLC
Plans
Live data from the GP clinical system
Patient details
Examinations
Events
Summary
Investigations
Problems
Procedures
Risks & warnings
Potentially useful in admission avoidance
Recent tests
Biochemistry
ECG
Haematology
Imaging
Microbiology
Cytology
Others
Physiology
Urinalysis
So where have we got to?
• PIA and Information Sharing Agreement signed by relevant parties
• Trust Interface Engine (messaging technology) installed and operational.
• Several practices signed up to supplying data (MIG).
• Pull of MIG data through system tested and working.
• Social Services record to include NHS numbers
Next steps
• Turn on integration to Social Services data
• Turn on integration to Care Plan repository
• Clinical safety sign off
• Pilot go-live at A&E
Potential other applications of the technology
•Discharge planning / Alerting
•Hospital in-reach
•Planned Care
Thank you
adrian.woolley@nhs.net
Photo: garryknight