The reality of an integrated digital care recordLiz Jones Project Manager IMT, Lincolnshire Health and Care Programme

Tracey Thrift Assistant Director ICT Programmes, United Lincolnshire Hospital

Trust

Adam Lavington Head of Primary Care Systems Enablement, NHS Arden and Greater East

Midlands Commissioning Support Unit

Ian Baldam Deputy Director of Informatics, Lincolnshire Partnership Foundation

Trust

Lincolnshire Health & Care - Care Portal

Lincolnshire Health & Care Economy• 5921 sq.km• 775,213 population• 1242K health economy• 4 CCGs• 1 main acute provider with 3 main sites• 1 community services provider• 1 mental health services provider• 1 Ambulance services provider• 101 GP practices• 1 upper tier local authority• 7 x lower tier local authorities

• Rural: 57% population in LECCG• Dispersed: 88 people per km2 in LECCG• Poor road infrastructure (51 minutes

lowest drive time between acute sites)• Poor telecommunications infrastructure

• Rural: 57% population in LECCG• Dispersed: 88 people per km2 in LECCG• Poor road infrastructure (51 minutes

lowest drive time between acute sites)• Poor telecommunications infrastructure

(But it is very beautiful, with great history and heritage, safe, with good schools, and very attractive property prices)

• The population age structure is older than England as a whole.

• 15.8% of the population are aged 0-14 years compared with 17.3% in England, whereas 9.9% are aged 75 years or over, compared with 7.8% in England.

• Population structures also vary within the STP area. Lincolnshire East has a higher proportion of older people (11.0%).

• 14.2% of the population live in the most deprived areas of England as defined by the Index of Multiple Deprivation (2015)

Quality:Keogh Review

Fragmented services

Population profile:Ageing population

Long term conditionsRising expectations from patients

Financial pressures:Deficit over £250m by 2020

Requirement from NHSE to balance books (STP)

Workforce issues:Recruitment and retention

Agency costs Viability of services due to staff shortages

The Challenges

• Strategic change programme involving all commissioners and providers• Commenced 2014• Six work streams: Planned Care, Urgent Care, Proactive Care, Women

& Children’s Care, Primary Care, Mental Health• Seven enablers: Workforce, Estates, Transport, IM&T, Contracting &

Commissioning, Finance• Now meshed with the Sustainability & Transformation Plan (STP)

LHAC VisionQuality, safety and sustainability for health and care services

Improved joint working of health and care professionals –an integrated service for patients

Providing the right care at the right time closer to patients’ homes

7 day a week services for local people through community 'neighbourhood' teams,supported by urgent care centres across the county

Hospitals ‘freed up’ to provide specialist or genuine

emergency trauma and time critical services

IM&T Enabler Group (IMTEG)

• All providers and commissioners• Commenced with an

infrastructure stocktake• Developed a system architecture• Conducted a requirements

analysis with all LHAC work streams

Care design Groups

•Planned Care•Urgent Care•Proactive Care•Mental Health & LD•Women & Children•Primary Care

Service Ambitions

•Self Care•Integrated Care•Care Navigation•Proactive Care•Care in the right place•Capacity optimised

Digital Enablers

•Integrated health records•On-line and remote patient processes

•Capacity Management•Integrated Communications•Networking and mobile•Collaboration services•Directories of services•Decision support technologies

Why deploy a Care Portal?• No.1 enabler (from Care Design Groups)

• Reduces risk and improves decision making

• Reduces duplication and waste

• Delivers Patient Online

• Analysis of portal data can provide rich insights

Key policy drivers are ‘The Power of Information’ (2012), ‘Personalised Health & Care 2020’ (2014), and the National Information Board Interoperability Strategy:

• Digital roadmaps

• 2016: Child Protection Information Sharing (CP-IS)

• 2018 : primary, urgent and emergency care should be operating without the use of paper records

• 2018: individuals should be able to record their own comments and preferences on their care records

• 2020: all care records should be digital, real-time and interoperable

Lincolnshire Care Portal History• Project started about 3 years ago

• Initial bid to the tech fund• £3m matched bid for integrated care portal including

patient portal

• Got through to the interview stage

• Failed at last hurdle

Lincolnshire Care Portal History – Lessons Learned• Too much of an IT led programme

• Lack of buy-in for “the vision”

• Failed to reach a “tipping point”

• Too expensive

• Heavy on infrastructure

• Governance not worked through

Specification and Procurement• Market research

• Reference sites, in particular Scotland, Northern Ireland, and Sweden• Engagement with care design groups on requirements analysis and design

sessions

• Involvement of 32 stakeholders from a variety of organisations and disciplines

• Proof of concept integrating 5 existing systems

• NHS Infrastructure bid £1M

• Framework procurement - InterSystems

SystemOne/TPP GP

Social Care SystemMOSAIC

TeleHealth/TeleCareMonitoring Platform

Summary Care Record

Clinician Social Care Worker Patient

Electronic Master Patient Index

EMISWebGP

CommunityHealth

Mental Health EPR

Acute

DepartmentalSystems

Anonymised Clinical Data Repository

Note: the systems detailed are for illustration and can easily be expanded.

Authentication Security Audit Logs

CompleteRecord

Charts DocumentViewer

Professional View

Authentication Security Audit Logs

Appointments Messages

Patient View

CompleteRecord Health

Links

Integrated Care RecordAggregated on demandConsent Management

Real Time AnalyticsPopulation HealthResearchReporting

Care PlansEnd of Life

Long Term ConditionsNow

FutureNotifications

Ambulance

Benefits• Improved clinical decision

making• Improved patient management

though the use of portal information to alert and case find

• Improved quality of care• Improved patient experience• Improved cost effectiveness

through reduced duplication• Increased time to care through

reduction in administrative burden

Risks

• The system is immature or dogged by

deployment problems

• Organisations fail to engage and share

records

• Suppliers refuse to cooperate• Information governance issues

compromise the project or slow it down

• We fail to realise the benefits and the

business case does not deliver

Care Portal Governance

Structure

STP/LHAC Governance

IMTEG

Care Portal Project Board

Clinical Reference

Group

User Group

Informatics Sub Group

Information Governance

Group

Technical Design Authority

Work Packages/Sit

Rep calls with ISC

Caldicott Guardians

Clinical Safety

Officers

First phase of systems to be surfaced in Care Portal

Sector SystemsAcute System C Medway PAS

HSS CRIS radiology results

WebV lab results

Mental Health Silverlink PCS PAS

Mayden IAPTus (IAPT)

Primary Care Summary Care Record

Mini Spine Services

Systems in Scope for future phasesSector Systems

Acute Electronic Discharge Documents, Outpatient letter, E-Obs & ChartingEnd of Life Care EPaCCSLocal Authority Adult Social Care - MOSAICPrimary Care TPP SystmOne & EMISCommunity WebV lab results & TPP SystmOne CommunityRadiology Images EMRADTertiary Sites North Lincs & Goole/Peterborough and Stamford + others

Independent Providers Test results/images

What’s happening now?• Opt-out consent model agreed• Two GP practice early adopters to test comms materials• Preparing for public awareness campaign to commence late September• Preparing for system testing• User registration• Preparing for technical and user training• Service Desk• Go Live end of October 2016• Scoping systems to connect for next phase

What does it look like?

http://lincolnshirehealthandcare.org/care-portal/

lhac@lincolnshireeastccg.nhs.uk

01522 718051