Driving the Dream of Integrated Health & Care Services

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1 @oht_uk #OHT17 Driving the Dream of Integrated Health & Care Services Wednesday 29 #OHT17

2 Welcome #OHT17

3 One HealthTech is......a community that celebrates and promotes the extraordinary talents and remarkable work that women and people with diverse backgrounds are achieving in healthtech. We inspire, support and champion greater inclusivity in healthtech because, without ensuring diversity from the Board all the way to the frontline, the healthtech industry will never reach its #OHT17

model: Each region is run by local volunteers who spread love, passion and

4 Our Journey Established in the UK in December 2015 First 18 months gathered 11,000 members across 6 hubs Now spreading internationally Community-hub model: Each region is run by local volunteers who spread love, passion and enthusiasm for health technology in the best way they #OHT17

5 Why do #OHT17

6 Health Tech Funding Mental Health Big Data Bio Tech Digital Medicine Wearables Genomics Fit Tech Health & Care Apps Block Chain Cyber Security Health Data Analytics VR Open Source #OHT17

7 #OHT17

8 Dr. Amir Mehrkar Co-Founder, INTEROPen & Senior Clinical Lead for Interoperability, NHS Digital Dr. Simon Eccles Senior Responsible Officer for Interoperability, NHS

9 INTEROPen Board Representatives

10 Care Organisations Alder Hey NHS Foundation Trust Belfast City Hospital Birmingham & Solihull LDR Birmingham & Solihull Mental Health NHS Foundation Trust Cambridge University Hospital Connecting Care Partnership Dorset Health & Care Community (Dorset CCG) Great North Care Record Greater Manchester Health & Social Care Partnership CDO Health and Social Care in Northern Ireland Holding Your Hand Limited Humber, Coast and Vale STP Humber NHS Foundation Trust Imperial College Healthcare NHS Trust Lancashire and South Cumbria STP Leeds Teaching Hospital NHS Trust Marie Curie UK NHS Gloucestershire CCG NHS South, Central and West CSU NHS Lothian North West London Care Information Exchange North Tyneside CCG North Yorkshire County Council (Adult Social Care Services) Northumberland, Tyne and Wear NHS Foundation Trust Salford Royal NHS Foundation Trust Sheffield Health and Social Care NHS Foundation Trust Somerset Integrated Digital Electronic Record Taunton and Somerset NHS FT Tower Hamlet/Newham/City Hackney/Waltham Forest CCG University College London Hospitals NHS Foundation Trust University Hospitals Southampton NHS Foundation Trust York Teaching Hospitals NHS Foundation Trust Networks & Others BCS (British Computer Society) Digital Health CCIO Network Digital Health CIO Network EMIS National User Group Innovative UK - Knowledge Transfer Network Klas Research NHS HACK DAY Northern Ireland CCIO Network One HealthTech OpenHealthHub CIC SOCITM techuk Standards Organisations HL7 UK IHE UK OpenEHR PRSB (Professional Records Standards Body) ALBs Health Education England Healthy London Partnership London Health and Care Information Exchange NHS Digital NHS England 162 Member Organisations as of 20/11/17

IT Suppliers AccuRx Active Medicine Advanced Health & Care Aire Logic Ltd Allocate Software Allscripts Answer Digital Application Insight Atos Boots Blackpear BT Cambio + Healthcare Systems Capgemini

11 IT Suppliers AccuRx Active Medicine Advanced Health & Care Aire Logic Ltd Allocate Software Allscripts Answer Digital Application Insight Atos Boots Blackpear BT Cambio + Healthcare Systems Capgemini Capita Health Partners Careflow Connect Ltd Carelink (Piksel Ltd) Cerner CGI Group CharityLog CheckWare Clinisys CommonTime CSC Cyber Media Solutions Deepmind Health Deontics Docman Docobo Digital Cognition Egress Elsevier EMIS Health Endeavour Health Enovacom Epic Epro everylife Technologies Experis Forcare FreshEHR G2 Speech B.V GPC Group Graphnet Health HCI Group (Tech Mahindra Ltd) Health Fabric Health Intelliegence HealthForge Healthcare Gateway Healthlinked Hospedia Huawei Technologies IBM IMD-SOFT IMMJ Systems (Mediviewer) IMSMAXIMS Inhealthcare Inidus Ltd INPS Intelerad Intelesant Intersystems JAC Computer Services Ltd JKM Care Solutions Kainos Evolve Mayden Medelinked Medical Connections Medxnote Microsoft Health & Life Sciences Microtest MphRx myhealth NHS Wales Informatics Service NoemaLife UK Northgate Public Services Nottinghamshire Health Informatics Service (NHIS) Nth Dimension OLM Systems Open Mapping Software Optum International Oracle Orion Health Ortivus OTTech Healthcare Consultancy Outcomes Based Healthcare Phillips Healthcare Pinnacle Health Partnership Prederi pshealth Pumpco Quicksilva Systems Integration Solutions Ramsey Systems Red Embedded Systems Restart Consulting Ripple Servelec Sitekit Soliton IT Solutions4Health Shaping Cloud Specialist Computer Centres Stalis Sunquest SystemC Targett Business Technology Tiani Spirit Tiny Medical Apps TotalMobile TPP Trisoft Healthcare Ltd Virgin Media Business Vision Health Wiggly-Amps Wolters Kluwer Health HealthLanguage X-Lab

12 What we trying to achieve: GP connect Record access Transfer of Care edischarge

13 Academy of Medical Royal Colleges Headings in Discharge Summary Mandatory Required Optional GP practice Admission details Assessment scales Patient demographics Procedures Social context Discharge details Individual requirements Participation in research Clinical summary Medication and medical devices Investigations and procedures requested Diagnoses Safety alerts Patient and carer concerns, expectations and wishes Allergies and adverse Plan and requested Legal information actions reactions Distribution list Referrer details Information and advice given Person completing record Investigation results

Allergy PHASE 1 proposal CLINICAL FHIR TECHNICAL TERMINOLOGY VENDORS CLINICAL SAFETY PHASE 3

16 How we re trying to achieve it (CareConnect curation): CLINICAL MODELLING e.g. Allergy PHASE 1 proposal CLINICAL FHIR TECHNICAL TERMINOLOGY VENDORS CLINICAL SAFETY PHASE 3 approved INTEROPen webex call or workshop CareConnect FHIR Profile GP-Record edischarge PHASE 2 INTEROPen community feedback First of Type Implementation Sites GDEs TRUSTS + ACUTE EPRS + GP Vendors

Why we re trying to achieve it: Join us: membership@interopen.

poor, for SAFER and more PERSONALISED patient care. #CollectShareUse so that #DataSavesLives *to SHARE, not to steal!

18 Why we re trying to achieve it: Join us: The Robin Hood Principle of Information Sharing The duty of the information rich to SHARE* with the information poor, for SAFER and more PERSONALISED patient care. #CollectShareUse so that #DataSavesLives *to SHARE, not to steal! The Robin Hood metaphor is light hearted but also serious: together we are behind the drive to make patients and citizens information rich!

19 The challenge Transfer of Care document Headings: Clinical community via PRSB Identities Content Dates Content Problems/Diagnoses Content Observations Content Medications Content Plan Content Free text Verbage Content: Data elements Multiple owners SNOMED DM&D NHS number Etc 20

20 Verification Security and IG Meta-data Information Model: FHIR/ terminology 21

21 INTEROPen Board Representatives

22 Delivery: Underpinning national capabilities API Management Health / Social Care IT systems GP Strategic Authentication Authorisation Digital Interoperability Platform Health / Social Care IT systems Directories: Orgs, Services, Users, Roles, Endpoints GP Acute Spine Demographics Spine Clinicals Acute Community Mental Health Ambulance National Record Locator Event Management Service Index Subscriptions National Failsafe Community Mental Health Ambulance MESH 111 SSP 111 Pharmacy ers EPS Pharmacy Social Care National Portal (SCRa) Developer Ecosystem Social Care 23

23 Delivery: Underpinning national capabilities National Record Locator Service - will allow an authorised clinician, care worker and/or administrator, in any health or care setting, to access a patient s information to support that patient s direct care Event Management Service - will facilitate the consistent sharing of nationally defined (patient) events from event publishers to recipients (consumers). Recipients may be identified by the creation of a subscription (rules) indicating the criteria of events that the recipient is interested in or needs to receive pub/sub). Strategic Authentication - To provide a national health & social care digital identity which is secure, simple to obtain and trusted across national, regional and local services for legitimate access to clinical information at any location of patient care. SCRa Redesign - The SCRa has been identified as an existing service we can improve to deliver better access to patient information by removing some of the barriers that we were required to build into the current service (i.e. mandatory requirements for N3 and smartcards) and make more information available.

24 Data hubs Science Personal Health Record NRLS SCRa Regional Data hub Regional Data hub Local Clinical Record Local Clinical Record Local Clinical Record Local Clinical Record 25

25 Data flow Science Personal Health Record NRLS SCRa Regional Data hub Regional Data hub Local Clinical Record Local Clinical Record Local Clinical Record Local Clinical Record 26

26 Information Governance Local v. National/aggregate GDPR Consent Direct Care Supporting care Research 27

27 Leeds Community Dietetics AireLogic & Forms4Health Mark Simpson Leeds Community Healthcare NHS Trust September 2017

28 Our project start Met Aire Logic through AHSN Innovation important to LCH and Aire Logic Uses of the forms4health tool Leeds Community Healthcare NHS Trust September 2017

29 Getting the right pilot group Which cohort to use, Passport not right IBS a better fit Thought through success criteria Leeds Community Healthcare NHS Trust September 2017

30 Functional Gut Disorder Form Nationally approved tool Standard for assessment Long for completion by hand Took most of appointment to complete Leeds Community Healthcare NHS Trust September 2017

31 What Forms4Health did Took the form and made it look engaging: Allows better data capture: All while being straightforward and easy for the patient Leeds Community Healthcare NHS Trust September 2017

the form, asking the patient to fill it.

32 The Patient Experience An IBS Patient is referred and flagged as IBS at triage A text reminder is sent before the appointment Also send the link to the form, asking the patient to fill it. Patient fills the form in and sends it back Admin add to the record Leeds Community Healthcare NHS Trust September 2017

33 The Electronic Form Benefits Saves time & a more patient centred consultation Greater patient engagement More Responsive Patient Self-Care Leeds Community Healthcare NHS Trust September 2017

34 Considerations/Problems Patient Engagement IG & Systems The Tech Averse Tech Averse staff. Leeds Community Healthcare NHS Trust September 2017

35 The pilot now Within 6 months softlaunched to the staff Whole cohort engagement Comparisons and evaluations Patients described the form as Well put together and Easy to use. Leeds Community Healthcare NHS Trust September 2017

Evaluation Track how many of the forms are sent back Feedback from staff about time freed up in appointments The Dietetic service see standard IBS patients, and offer a

36 Evaluation Track how many of the forms are sent back Feedback from staff about time freed up in appointments The Dietetic service see standard IBS patients, and offer a specialist FODMAP 2 service for patients it could help. 2 Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols Leeds Community Healthcare NHS Trust September 2017

37 forms4health Patient and clinician facing smart digital forms

GP Connect, Care Connect and Spine 2 Developed the recognised agile healthcare enterprise architecture method EA Light,

38 ABOUT AIRE LOGIC Established in 2007 three main streams of business, Consultancy, Development and Product (forms4health) year on year growth Involved in the definition of the national interoperability approach, inc. GP Connect, Care Connect and Spine 2 Developed the recognised agile healthcare enterprise architecture method EA Light, to support organisations reviewing their ICT and deliver an organisational ICT roadmap for the future forms4health now being used from Leeds to the US

THE forms4health SOLUTION Clinical electronic forms platform capturing, presenting and graphing clinical data Nursing assessments, EoL care plan, discharge summary, patient facing forms and many more

39 THE forms4health SOLUTION Clinical electronic forms platform capturing, presenting and graphing clinical data Nursing assessments, EoL care plan, discharge summary, patient facing forms and many more Smart forms: pre-population capability, skip logic, calculations, lightweight decision support, input validation, business logic Building block approach to form development, rapid design and deployment easy to replicate, proving cheaper to deliver

THE forms4health SOLUTION Structured data for business intelligence, monitor, evaluate and report on the data Working across a range of devices, ipad, smartphone, android tablets Scalable, small

40 THE forms4health SOLUTION Structured data for business intelligence, monitor, evaluate and report on the data Working across a range of devices, ipad, smartphone, android tablets Scalable, small numbers of forms to EPR Can gap fill for other solutions provision of solutions for existing system gaps and full integration with existing solutions Roadmap to integrate with clinical systems using GP Connect and / or Care Connect.

41 forms4health IN NUMBERS A case study Severe workplace injuries 327 different form templates created by BAs and SMEs. A week after go live: 6,000 completed forms 286 different form templates exercised. 675 patients

42 CONTACT US Gill Smith Mike Odling-Smee Aire Street, Leeds, LS1 4PR, UK Tel:

43 LTHT and Aire Logic partnership - PPM+ 'Leeds' way with an NHS-built EHR Martin Waugh PPM+ Product Owner

44 City Wide Multi-Agency Integrated Record Enterprise Platform 45

45 About Leeds Teaching Hospital NHS Trust Over 1,100,000 Outpatients Over 263,000 A&E Attendances Over 117,000 Inpatients Over 108,000 Day Cases 9,844 Babies born Over 17,000 staff 175 Buildings 114 wards 135 Departments & Clinical areas And 69 Operating Theatres Turnover 1.17 billon ($1.83 billion)

46 PPM+ Regional PPM1 (Oncology) LCR Y&H Genomics Write Access Planned EPR 17,000 Active Users 140+ Organisations Connected Access Model: L-R, RBAC LTHT PPM Enterprise Platform LABS PAS TIE RIE Clinical Systems 47

47 Complex patient with all 5 tabs present

48 Connecting each other 33,000 clicks on the GP tab in August 2017 LCR Foundation 23,500 LTHT patient records accessed in August 2017

First of the demonstrator sites to label

49 First of the demonstrator sites to label down to bed space level and start unlocking the potential Associates patient, to place, to product, to process. Automatically updates the e-whiteboard Mobile ppm+ app allows access to e-forms within the patient EPR at the bedside

In-house agile delivery Clinical stakeholder, delivery /prioritisation boards & clinical reference groups, Feature product owner Seamless integrated with trust staff all passionate about quality

50 In-house agile delivery Clinical stakeholder, delivery /prioritisation boards & clinical reference groups, Feature product owner Seamless integrated with trust staff all passionate about quality delivery Clinically Led Embeded delivery team LTHT, LCR and regional roadmaps Feedback Implementation Support 8 releases / month, major release every 6-8 Weeks, zero downtime Continuous improvements Show and Tell Clinical staff bridge between informatics and clinicians. Feature toggling and RBAC means features can be enabled when service ready. Supports Pilots, full roll-out

51 Enterprise platform Over 60 forms live Can add new forms as a publication Building block approach Can cater for small and large use-cases e.g. Resus

refreshed once per minute Multi-patient View peak

52 Enterprise platform 110 ewhiteboards (largest in Europe) 30 patients, 30 columns (~900 data items) refreshed once per minute Multi-patient View peak stats, 20 per second Re-architecture was 15s now 400ms

53 Enterprise platform 18 Internal systems (inc. PACS, Cardiology, emeds) 9 neighbouring trusts 100 GP Practices (MIG and GP Connect) 4 National Services PDS (SMSP), SCR, ers and CPIS

GP is more informed, can run a virtual ward, and can provide better and safer care to the patient.

feeling unwell, high temperature & fast heart rate Who can view?

hospital Advice Line: complete e-form with GP place on the electronic Un- Planned Patient list (UPL) arrange transfer

letter electronic distribution At the bedside: medicines are prescribed and administered electronically EDAN

138,000 eobs Arriving at assessment area: produce and scan a GS1 compliant wrist band check medication list in real

54 GP is more informed, can run a virtual ward, and can provide better and safer care to the patient. The district nurse can immediately view the EDAN via the LCR & support Gladys at home Gladys visits her local GP feeling unwell, high temperature & fast heart rate Who can view? Patients GP 4,500 PCAL assessments, 150k cost saving 7,300 edans Patient Journey Her GP is concerned and calls the hospital Advice Line: complete e-form with GP place on the electronic Un- Planned Patient list (UPL) arrange transfer to hospital Gladys is taken to Hospital On discharge: Electronic Discharge Initiation Document, EDAN & discharge letter electronic distribution At the bedside: medicines are prescribed and administered electronically EDAN population is started E-obs automatically update the white board (AKI, Diabetic) electronic handover 45,000 handover, 138,000 eobs Arriving at assessment area: produce and scan a GS1 compliant wrist band check medication list in real time from her GP record check her e-obs, trigger against signs of sepsis Hospital Admission: Results & Images are returned into the EPR & viewable by clinician remotely Who can view? Hospital Specialists & GP

55 Regional footprint LTHT Leeds Care Record Cancer, Genomics STP

56 Questions?

57 Interoperability Across Urgent & Emergency Care Presented by Amanda Neylon, Digital Services Director Urgent & Emergency Care

58 Our vision: Urgent & Emergency Care We will help to deliver the national urgent and emergency care strategy by providing the digital infrastructure, algorithms and pathways we require. 59

59 What are we here to do? Develop new digital services to enable patients to access the UEC system. Develop the next generation of clinical triage technology to enable the patient to get to the right service at the right place at the right time. Develop an open platform to support a single, national source of truth about urgent and emergency care service information. 60

60 Are we driving fast enough? 61

61 A complex landscape

62 It s not just about technology %* of the work necessary to establish effective interoperability is people stuff

63 Urgent & Emergency Care is heavily reliant on interoperability for several years now it underpins our ability to flow patients through the different services involved 64

65 Standard interoperability workflows can support organic innovation 66

66 111 patients transfer to GP OOH Pharmacies are using them to receive referrals from NHS 111 for patients where they need urgent help with their medication avoiding having to pass patient details over the phone or via fax Emergency Departments are using them to electronically transfer a patient on to an Urgent Treatment Centre where they do not need ED specifically rather than a patient having to provide all of their details again Online tools are using them to provide a seamless journey into urgent care services where a need cannot be met purely online Ambulance services have used them to improve their patient handover between different regions (e.g. for border patients) And more 67

67 So what s next in UEC? 68

68 Prog 5 Clinical Triage Platform CDSS Interaction s Pilot A A&E UTC Pharmacy Pathway s 111 Online Pilot B 111 Phone (Adastra 80%) Clinical Triage Prog 7 Access to Service Info (A2SI) PMPR New Specialist Models for 111 Paed MH Frailty Pilot C 100% Pilot D 40% access Book Appt SCR or Local Shared Record Directory of Service GP Practices (TPP 38%) Dec 17 Dec 18 Mar 19 Input Data Urgent Care Services GP Practices (EMIS 55%) GP Practice MH Crisis End of Life Repeat Caller Service 111 Phone A&E UTC Capacity & Demand Interoperability Domain D: Integrated Care Compliance Outcomes 100% access 100% book appt Transfer of triage data Accuracy GP Practice Patient info transfer Urgent Treatment Centre Read History? Pharmacy specific 111 Phone OoH Records access Domain E: EPS Domain F: ers Domain C: GP Connect Enhanced Triage Pharmacy Prescribe EPS Directory of Service (tactical) Care Home Book Appt Ambulance Prog 8 Out of Hospital Care Wearables Video consultation Funding ~ Apr 2018 Prog 6 Patient Relationship Mgmt

69 Access to Service Information (A2Si) mission will transform existing Directory of Service (DoS). Enable Urgent & Emergency Care professionals to quickly and easily access wider range of reliable service information. Ensure patients are effectively and safely referred to most clinically appropriate, convenient and available onward service. 70

70 Access to Services Information Key Themes We will; Migrate the DoS to a sustainable, scalable platform that delivers incremental improvements that supports Integrated Urgent Care. Ensure service information in the DoS is as accurate, complete and reliable as possible. Enable simplified, frictionless access to the DoS to a wider range of healthcare professionals e.g. via mobile apps, APIs etc. Supplement the existing service information with real-time availability data about the demand on and capacity within all urgent care services. Create and implement a national standard for appointment booking across urgent care services.

71 A2Si Key products National capacity and demand platform Will support third party applications (common data and interoperability standards). Allow commissioners and providers to select from accredited catalogue of products. Appointment booking Working with UEC suppliers to provide appointment booking standards across UEC care settings to reduce unnecessary admissions to A&E. Live Profile Updater Service to enable pharmacies to query own DoS data and specify updates. 72

72 Clinical Triage Platform our vision will be tailored to the needs of the individual; continual improvements in accuracy and timeliness being underpinned by both individual patient data and evidence of outcomes. Through accurate and personalised triage, CTP will contribute to intelligent demand management, promoting and supporting a sustainable, clinically effective, and financially affordable NHS. 73

73 The future of Clinical Triage 1 Access to care through multiple channels 3 Utilising patient data and predictive modelling of patient risk CHANNELS: Telephone, Online, ED face2face, Primary Care, Urgent Treatment Centre, Social Care 2 Triage data linked with patient outcome data 5 4 STANDARDS: - Existing national standards utilised where appropriate - New standards developed - Providing consistency of data to allow interoperability - Utilising standard APIs to allow localised customisation 8 9 Patients referred to most appropriate care Performance optimisation utilising outcome data 6 Improved reporting provides greater insight into service demand 7

Clinical Call handler Identify Patient Find Patient Authenticate PDS Citizen Identity Added Social Care Records Patient Medications Allergies Conditions Triage Get Records Prescribe Triage Record

74 Clinical Call handler Identify Patient Find Patient Authenticate PDS Citizen Identity Added Social Care Records Patient Medications Allergies Conditions Triage Get Records Prescribe Triage Record Locator EPS Diagnose & Advise GP Practices Local Care Records CDSS Personalise Refine Disposition Specialty Modules Create Appt. and Transfer Patient Transfer Patient Directory of Service(s) Get Appt Slots Book and Transfer PMPR Multiple Multiple endpoints endpoints Single endpoints

75 Phone Disposition Online Patient or Proxy Pilot A Pilot B Clinical Decision Support System (linear) Non-clinical Mental Health Personalise Non-linear Pilot C Pilot D Clinical Paediatrics Frailty Probabilistic Triage Audit Records Self Care Advice Directory of Service Appointmnt / Referral Records Access Prescriptions PDS Medical Records Appointments & Transfer of Triage Info Prescribe GP Practice A&E UTCs Pharmacy SCR EPS Triage data Analysis - Outcomes Future Pathways Other Models? Feedback & Improve Patient Compliance Disposition Accuracy National collections Current Enhance UEC Overview

76 Thank

78 Interop Open Surgery: #OHT17

79 Keep in meetup.com/onehealthtech/ #OHT17

INTEROPen Community. #DataSavesLives #CollectShareUse. Luke Readman CIO East London Health and Care Partnership Co-Chair INTEROPen

INTEROPen Community. #DataSavesLives #CollectShareUse. Luke Readman CIO East London Health and Care Partnership Co-Chair INTEROPen INTEROPen Community #DataSavesLives #CollectShareUse Luke Readman CIO East London Health and Care Partnership Co-Chair INTEROPen www.interopen.org @INTEROPenAPI INTEROPen Board Networks & Others BCS (British