Collaborative e-care: health information exchange for enhanced care Wednesday, March 2, Charles Gutteridge MD Barts Health NHS Trust UK

Transcription

1 Collaborative e-care: health information exchange for enhanced care Wednesday, March 2, 2016 Charles Gutteridge MD Barts Health NHS Trust UK

2 Conflict of Interest Charles Gutteridge MD Has no real or apparent conflicts of interest to report.

3 Agenda Health economy of East London Commissioning for value Collaborative e-working in East London How are we doing? Lessons learnt

4 Learning Objectives Identify lessons learnt in delivering integrated care across traditional healthcare boundaries Distinguish how best to use health information exchange to support clinical and business objectives in health delivery systems Describe the key steps towards building self care delivery platforms

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10 1.2 M people US 1.6B budget

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12 3 core elements to our programme A people s health data movement Empowering clinicians with point of care information and outcomes data Developing data for population health

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14 Enhanced service aims 1. Increase practice availability to patients 2. Identify patients at high risk of emergency admissions 3. Improve hospital discharge processes and coordinate care 4. Internal provider reviews of emergency admissions and ED attendances 5. Patients satisfaction surveys

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17 3 key interventions Linking electronic health records Health information exchange Outcomes tracking

18 Risk stratification Co-ordinated care East London Integrated Care Programme Very high (Consent) Reduce emergency attendances High (Enrol) Moderate Low Reduce emergency admissions Very low QAdmission algorithm Improve outcomes

19 Clinical case. Julia Hippisley-Cox, and Carol Coupland BMJ Open 2013;3:e by British Medical Journal Publishing Group

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25 Reasons for attending the ED Pain Shortness of breath Generally Unwell Fall Chest Pain Confusion Chest infection

26 Primary diagnosis at discharge (ICD-10) LRTI UTI Gastroenteritis IHD COPD Heart failure Superficial injury Fracture Electrolyte imbalance Unspecified chest pain Unspecified fall / collapse Unspecified abdominal pain Unspecified MSK pain

27 1 ED attendance 3,024 7,074 4 ED attendances 510 Target population for community-based intervention

28 The answer is in the data? Current algorithm Dependent on structured data in primary care record Focuses on medical problems Social history and functional status not included Hypothesis Point of care narrative information = most accurate May indicate factors increasing risk of attendance ED clerkings Barts Health ED: 7 years of electronic documents NLP & ML Mathematical modelling and visualisation

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30 3 different community approaches Community matrons Waltham Forest Newham Tower Hamlets Face to face Community matrons Face to face Rapid response team Telephone consent 8 networks Care navigators Telephone consent Health analytics GP EMIS web EMIS community GP EMIS web EMIS community Feedback from hospital systems Cerner Millennium HIE Cerner-EMIS

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32 In 2011 systematic programme guideline, IT decision support and recall,

33 Flu vaccination 1 st and 2 nd best in London. In 2011/12 Newham 18/31 THamlets 9/31

34 CCG Variation in high cost - low benefit medicines

35 % Age 65 yrs or more: Pulse Check in 5 yrs Jan 2014 June 2015 City and Hackney 60.8% 88.2% Tower Hamlets 54.3% 78.8% Newham 35.9% 72.6%

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37 Questions Thank