Connecting Care
Our story so far –
why, what, how, cats etc….
Health Insights - BRISTOL
21st May 2014
Connecting Care – why?
“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.”
NOT having access
to accurate, timely,
shared information
is a ‘blocker’ to
providing highquality, effective,
efficient care…
“Services in all settings including
health and social care need to
improve their communication
and handover ”
“I don’t have access to
“If I had better information
then it would help me
evaluate risks when
deciding whether to admit
“There are delays in getting
a patient…”
hold of information that I
need…and I spend a lot of
time chasing it up…”
some important
information
electronically…”
“Better information would
support better safeguarding”
*Summarised from feedback from local clinicians
& practitioners during workshop events
Connecting Care - why?
New national announcements strongly support the ‘duty to share’ as
being part of ‘duty to care’
• From Integrated Care and Support: Our Shared Commitment (May
2013)
“In order to deliver person-centred coordinated care, data relating to individual’s risk
factors, identified needs, care plans and status should be shared at the following levels
within appropriate time frames:
– Between patients, people who use services and care providers such as clinicians, to
enable self-management and build independence
– Between front line workers, to enable coordination and continuity of care at transitions
between services throughout the care pathway”
•
From The Information Governance review March 2013 (‘Caldicott 2’)
“People using health and social care services are entitled to expect that their personal
information will remain confidential… However, people also expect professionals to
share information with other members of the care team, who need to co-operate to
provide a seamless, integrated service. So good sharing of information, when sharing
is appropriate, is as important as maintaining confidentiality.
Connecting Care – why?
Clinicians told us that NOT having access
to accurate, timely, shared information
wastes time and is a ‘blocker’ to
providing high-quality, effective,
efficient care…
Connecting Care is our response to the
call from practitioners and clinicians
across BNSSG for better, more joined-up
information to support local care and
local pathways.
Connecting Care will deliver a detailed,
local shared patient record that pulls
together health and social care
information - providing a unified view
that can be used to facilitate improved
care provision and decision-making
Connecting Care - what is it?
• Connecting Care is a clinical system interoperability
programme……aka a new way of safely sharing health & care
information.
• Authorised professionals see a single electronic view of
specific, up-to-date, clinical information
• Initial focus on the ‘clinical portal’
• Connecting Care is a partnership between NHS organisations
and Local Authorities
• Connecting Care is the ‘brand’ we use to encompass our
complex portfolio of interoperability projects
• Delivered with our partner and established expert supplier
‘Orion Health’
Connecting Care – staged approach
Connecting Care’s first year is a pilot year
themed on urgent and unplanned care.
The aims of the first year are to –
• Test the concept
• Test the technology – can we do it /
does it work?
• Understand what we would need to do
to make it more ‘mainstream’
• Understand the benefits – to patients,
organisations, the local health and
social care economy, to clinicians and
practitioners
• Build the costs for a business case
• Establish if we can work together and if
we (collectively) want to take this
further
Connecting Care is a partnership between –
• CCGs - South Gloucestershire, Bristol and
North Somerset CCGs
• Acutes - UH Bristol, North Bristol Trust
and Weston
• LAs - Bristol City Council, North Somerset
Council, South Gloucestershire Council*
• Community providers - South
Gloucestershire, Bristol and North
Somerset
• Out of Hours provider (Brisdoc)
• CSU - South West Commissioning Support
• AHSN – West of England
• Mental health - AWPT*
• Ambulance - South West Ambulance *
Some partners are actively taking part in the first year
pilot and are contributing resource, direct funding and
active support. Other partners are Board members* but
are not taking an active part yet
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)
December 2013
Approvals / finances agreed /
planning for second phase
October 2013 to May 2014
Full Business Case and benefits case
June 2014
End of phase one of Connecting Care
July 2014
Start of wider rollout
August 2014
Presentation
Connecting Care Clinical Portal
Security & Privacy
•
•
•
•
•
•
Patient Record
Authentication
Authorization
Single Sign-On
Patient Privacy & Consent
Relationships
Audit Logs
•
•
•
•
•
•
Demographics
Laboratory
Radiology
Encounters
Allergies
Diagnosis
•
•
•
•
Notifications
Portal
Medications
Problems
Procedures
Transcribed
Documents
•
•
•
•
•
•
•
•
Secure
Inbox
Patient Search
Patient Lists
Patient Summary
Timeline
Flowcharts
Secure Messaging
Orion Health Applications
Third Party Applications
E-Mail
Mobile
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
Adastra
End Of Life
Adastra
Out Of
Hours
Orders and
Results (CRIS
and Ultra)
Paris Social
Care Bristol
SWIFT –
North
Somerset
Connecting Care – what information?
Patient Demographics
Practitioner Details (Registered GP,
Community nurse, social worker etc.)
Medications
Allergies, Adverse reactions noted
Diagnoses
Some progress notes (community)
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
Emergency Attendance
End of life wish details
Connecting Care – Project Information
• 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 has focussed on urgent & unplanned care
– Stage two will be for wider use (long term conditions, other pathways,
‘patient portals’…40+ projects in the stage 2 pipeline)
• Numbers of users
– Stage one c.300+
– Stage two – 10,000+
Connecting Care – Benefits
“On Monday I managed to obtain details “Without Connecting Care
for 22 patients on Connecting Care, I
today I couldn’t have done
saved a huge amount of time as I didn’t
my job.” Pharmacist
need to phone the GPs and wait for the
faxes to arrive” Acute Pharmacist
“I used Connecting Care to find vital
“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
“over the weekend I was able to find out
drugs that a patient was taking (very
useful). This enabled a management plan
to be put in place immediately-I stopped
his antihypertensives” Acute Consultant
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”
Having access to
accurate, timely,
shared information
is no longer a
‘blocker’ to
providing highquality, effective,
efficient care…
Discharge Nurse
“Connecting Care has been really helpful
tonight. Could not do without it. Particularly
in the case of an old lady with serum
toponins 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
“The extra patient detail
is useful when deciding
to stop drugs such as
anti-platelets and it helps
to identify risk factors”
Doctor
Connecting Care – Project Information
• Profile
– Connecting Care has been announced of one of three ‘NATIONAL
EXEMPLAR’ sites for clinical system interoperability
– Attracting national and international attention
– Is helping other work in the BNSSG health community through
increased profile as we use technology to support care
Sir Bruce Keogh, NHS
Medical Director visiting
Frenchay Hospital in March
2014 to view the Connecting
Care portal
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 –
Recognise and work on the different elements –
• Political dimension
• Personal dimension
• Human behaviours
• Organisational behaviours
• Interests, motivations and blockers
• Time and timing
Leadership, vision, direction, blah blah blah…..
But ‘BEHAVIOURS’ are all critical to success
Connecting Care – Behaviours
•
•
•
•
•
•
Work at it - it doesn’t happen by accident
Accept steady progress - it is going to take time to deliver
Create ‘independent brokerage’
Recognise vested interests - pander to them where necessary
Encourage ‘friendship’ - like each other & be happy
Appeal to the greater good – stifle organisationally centric thinking
early
• Bring dissenters inside the tent
• Deal with key stakeholders individually - formally and informally –
be flexible in your approach
• Be trustworthy, honest and open - but leave room for clandestine
thinking 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
Any Questions?
Andy Kinnear | Director of Business Intelligence and Informatics
T: 0117 900 2552 | M: 07967 005 871 | andy.kinnear@swcsu.nhs.uk | www.swcsu.nhs.uk
South West Commissioning Support | South Plaza, Marlborough Street, Bristol BS1 3NX
Andy_Kinnear