Connecting CareOur story so far –

why, what, how, cats etc….

Health Insights - BRISTOL21st 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.”

“Services in all settings including health and social care need to improve their communication and handover ”

“The information I have is limited and frequently is missing important elements…”

“Better information would support better safeguarding”

“I don’t have access to some important information electronically…”

“If I had better information then it would help me evaluate risks when deciding whether to admit a patient…”

“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 local clinicians & practitioners during workshop events

NOT having access to accurate, timely, shared information

is a ‘blocker’ to providing high-

quality, effective, efficient care…

“There needs to be better communication between ‘in-hours’ and out of hours services.”

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.

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 – why?

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 2013Start project – phase one of Connecting Care

March 2013

First go-live (key systems and roles) December 2013Approvals / finances agreed / planning for second phase

October 2013 to May 2014

Full Business Case and benefits case June 2014End of phase one of Connecting Care July 2014Start of wider rollout August 2014

• Demographics• Laboratory• Radiology• Encounters• Allergies• Diagnosis

Clinical Data RepositoryRhapsody Integration Engine

Orders and Results (CRIS

and Ultra)

GPs

RiO Extracts

• Authentication• Authorization• Single Sign-On• Patient Privacy & Consent• Relationships• Audit Logs

• Patient Search• Patient Lists• Patient Summary• Timeline• Flowcharts• Secure Messaging• Orion Health Applications• Third Party Applications

E-Mail

Secure Inbox

Mobile

Notifications

Presentation

Integration

Source Systems

Security & Privacy Patient Record

• Medications• Problems • Procedures• Transcribed

Documents

Portal

Connecting Care Clinical Portal

Master Patient Index

MiG

NBT Cerner

PAS

Weston Cerner

PAS

Adastra End Of

Life

SWIFT – North

Somerset

UHB Medway

PAS

Adastra Out Of Hours

Paris Social Care - Bristol

Connecting Care – what information?

Patient DemographicsPractitioner Details (Registered GP, Community nurse, social worker etc.)MedicationsAllergies, Adverse reactions notedDiagnosesSome progress notes (community)Radiology Reports, Pathology Reports & imagesExistence 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 episodeOutpatient episodesDischarge Emergency AttendanceEnd 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 for 22 patients on Connecting Care, I saved a huge amount of time as I didn’t need to phone the GPs and wait for the faxes to arrive” Acute Pharmacist “I used Connecting Care to find vital

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” Discharge Nurse

“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

“The extra patient detail is useful when deciding to stop drugs such as anti-platelets and it helps to identify risk factors” Doctor

“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

Having access to accurate, timely,

shared information is no longer a

‘blocker’ to providing high-

quality, effective, efficient care…

“Without Connecting Care today I couldn’t have done my job.” Pharmacist

“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

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

Early 2010 – Small first meeting – setting the

vision, getting people around

the table

Early 2011 – falter a bit. But we carry on…and gather momentum.

Considering options for trials, proof of concept…national frameworks etc.

Late 2011 – decide

procurement strategy and

go for it!

2012 – in procurement…

competitive dialogue.

More interest – new partners

come on board

2013 – We’re off!

Project starts

It takes time to build a partnership

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

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