UK Care Agencies Integrate, Improve Services with Information-Gathering Solution

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1 Cambridgeshire County Council UK Care Agencies Integrate, Improve Services with Information-Gathering Solution Published: July 25, 2004 Solution Overview Company Cambridgeshire County Council Customer Profile The Cambridgeshire County Council (CCC) provides social care services to the elderly along with England s National Health Services under five county organizations called Primary Care Trusts. Business Situation CCC needed a mobile information-gathering and sharing solution to promote the multiagency service providers collaborating on an elderly patient s care team. Solution Description CCC created a Microsoft Office InfoPath 2003 form for the Tablet PC so that users could access and share patient data from diverse back-end systems while at the bedside or during discharge meetings. Benefits Provides better, integrated care Saves 3 million on data duplication Reduces administrative expense Expedites discharge planning Saves 100,000 on travel costs Software and Services Microsoft BizTalk Server 2004 Microsoft Office InfoPath 2003 Microsoft Office Professional Edition 2003 Microsoft Windows Server 2003 Enterprise Edition Microsoft Windows XP Tablet PC Edition Tablet PC Vertical Industries Government - Social Services Healthcare Providers Country/Region United Kingdom Solutions Collaboration Enterprise Application Integration Audiences Business Decision Makers Information Technology Professionals Knowledge Workers Cambridgeshire County Council (CCC) provides community care services to Cambridgeshire residents, often working with health care providers. To improve coordination between the two jurisdictions, it wanted to find a way for health and social workers to share information about elderly patients under the care of both disciplines. CCC used Tablet PCs with the Microsoft Office InfoPath 2003 information-gathering program so care workers can gather information while visiting patients at home or in the hospital and submit it to a Microsoft BizTalk Server 2004 messaging hub for access by other related agencies. InfoPath, working with this back-end system, is a key enabler for a

2 new multi-disciplinary Overview Assessment Protocol to reduce "bed blocking." CCC expects to save 3 million a year by eliminating assessment duplication and reduce administrative costs by 850,000. Situation As part of Britain's local government infrastructure, Cambridgeshire County Council (CCC) works to provide community services to Cambridgeshire residents. CCC's Social Services Department provides assessment and social care services to residents in need. With a higher than average percentage of people over the age of 65, in this county those in need are frequently the elderly. During the past few years, the National Health Service has developed several policies that endorse the government's mandate to improve the efficiency of healthcare and related services through information technology. CCC has demonstrated a proactive approach to this principle with several innovative projects that improve service to its residents by removing the barriers between healthcare agencies and social care services: two disciplines that often work together in caring for the elderly. One project was the merger of CCC's Social Services Department with community health and nursing services under the county's Primary Care Trusts (PCTs). "Residents don't have a choice about the service providers that work in their neighborhood, so local government is very serious about the concept of customer service," says Mark Howe, Manager of Elderly Peoples Services, Cambridgeshire County Council. "By reorganizing our service delivery model, we created a one-stop shop' for health and social services, resulting in better, more integrated care for our elderly." In a related move, CCC also evaluated new technologies that would support information sharing and streamline service delivery to the elderly. This evaluation was performed as a first step in preventing care professionals from collecting the same data in different jurisdictions when interviewing the same elderly client at first contact. InfoPath and the Tablet PC help us achieve anytime, anywhere access to any information stored in any system hooked into the BizTalk [Server] hub. The ramifications for improving care services are immense. "For an initial Contact Assessment, a healthcare worker would come to the client's home and ask questions, then a social worker would come and ask another set of questions, and probably 80 percent of them would be duplicate questions," says Alan Shields, Information Communication and Technology Manager at Cambridgeshire County Council. "We developed an application for the Tablet PC called the Cambridgeshire Assessment Tool (CAT) that defined which set of questions all care service providers needed to know about the client, and then made that information available to all care givers. In essence, the CAT made it possible to create one patient record to facilitate a team approach to patientcentered care. The Tablet PC provided a mobile computing platform that was natural to use when interviewing patients in their homes." The Tablet PC features a unique, convertible form factor that allows a care giver to fold back the screen and, holding the computer like a clipboard, use its pen-based computing capabilities to take notes unobtrusively while interviewing a patient. With its wireless capabilities, data can be sent to the PCTs' databases through General Packet Radio Service (GPRS) and Universal Mobile Telecommunications System (UMTS) which allows information to be sent and received across a mobile telephone network where it could be retrieved and used for developing care plans. Continuing the Integration Alan Shields Information Communication and Technology Manager, Cambridgeshire County Council

3 The CAT and the Tablet PC's success prompted CCC to extrapolate the concepts of mobile data collection and submission to more than just CCC's back-end system. CCC explored building what Shields calls an "architecture to share" to support the delivery of more services to the elderly beyond the initial assessment, right through hospital admission, treatment, discharge planning, and reentry into the community. "The CAT and the Tablet PC proved that Microsoft could deliver the mobile platform we needed on the front lines and gave us a scenario to prove the efficacy of remotely uploading data to a single destination," says Shields. "Now we needed an information-sharing solution that could share data with more agencies, even though they were running systems from different vendors. [See Figure 1.] And with more professionals involved throughout the treatment protocol, we also needed a collaborative solution that would help them access and share patient information using familiar forms during cross-agency meetings. These forms had to save data in a format that would be understandable by all agency systems. Only then could we achieve true multiagency integration in providing care services for the elderly." CCC needed to do two things: 1) develop a back-end architecture for sharing patient information currently stored in different care agencies and 2) create a front-end graphical user interface (GUI) for the Tablet PC that professionals representing those agencies could use to access and share patient information while developing treatment plans and protocols. Solution Even though CCC had long been a Microsoft shop, the department did evaluate other technologies before building a solution running on the Microsoft Windows Server System Figure 1: Services to be integrated integrated server software, using Microsoft BizTalk Server 2004 as the integration engine and XML as the data-specification standard. CCC uses a product from European Management System on the Tablet PCs. For end users, CCC chose the Microsoft Office System with the Microsoft Office InfoPath 2003 information-gathering program and Microsoft Office SharePoint Portal Server "We looked at Java-based technologies, but the simple fact was that Microsoft was way further along in its integration strategies than any other vendor," says Shields. "Microsoft has always provided excellent support and has been great about giving us access to the Microsoft Technology Center, where we worked together closely to develop this Social Care Mobility and Multiagency Working Proof of Concept." CCC based the foundation of its back-end integration strategy on a BizTalk Server hub into which diverse health and social service agencies can plug their back-end systems. If a CCC worker wanted to exchange information with the EMIS GP surgery system in a local hospital, then he or she would publish the message in XML with an EMIS tag to the hub. When the EMIS system polls the hub for messages, it retrieves appropriately tagged information to its data systems ready for access by authorized personnel at the hospital. Alternatively, the solution allows for the XML message to be represented in Web services so that users can access them as Web pages. A third-party solution called MultiVue enables consistent sharedclient identity across all systems. (See Figure 2.)

4 High-level Design "We were very impressed with BizTalk Server 2004 because it greatly simplified our integrating the agencies' systems using XML," says Shields. "But the integration story doesn't end there. Once we had this back-end architecture in place, we wanted care professionals to fully use its datasharing capabilities. Microsoft solved that problem through XML-enabled desktop productivity tools like InfoPath that share data with back-end systems. InfoPath and the Tablet PC help us achieve anytime, anywhere access to any information stored in any system hooked into the BizTalk Server hub. The ramifications for improving care services are immense." For CCC, Office InfoPath 2003 Figure 2: High-level design of solution provides a familiar GUI for care delivery professionals accustomed to filling out the myriad forms for a patient's chart or treatment plan. Clinicians and staff with InfoPath installed on their computer can fill out forms and save the data in XML format so that it can be reused elsewhere in the organization or routed with BizTalk Server into another agency's system. To foster team collaboration, CCC deployed an Office SharePoint Portal Server team portal to facilitate multiagency meetings where users can enjoy a single-access point to patient-centered information from different agencies. Benefits In many ways, InfoPath provides the key link between end users and the information they need to achieve true multidisciplinary care. CCC was quick to develop a new patient-assessment process that fully uses the many benefits of InfoPath reusable, accurate data, low overhead through reduced paper costs, and offline and Tablet PC support. And with the release of InfoPath 2003 feature enhancements as part of Office 2003 Service Pack 1 (SP1), CCC is fully using enhanced digital signature capabilities and improved inking support for Tablet PC users. Reducing Bed-Blocking "We are using SP1 for a new process called the Overview Assessment, which was developed to address the issue of bed-blocking so that elderly patients can be released into the community as soon as they are able with all appropriate health and social services set in place," says Howe. "This occurs at the opposite end of the treatment protocol than the initial Contact Assessment prior to the discharge of a patient from the hospital." Liz Sargeant, Director, Older People and Adult Services, Cambridge City NHS PCT, agrees: "The end goal is to expedite discharge from hospital and ensure that patients are not occupying beds when they don't need to be there. With the right information available to care providers, many patients could go home from hospital in a day, instead of staying for weeks." The Overview Assessment is designed to provide this information. Aptly named, it includes a summary of all information about a patient following entry to the hospital. Clinicians use a digital pen and the Tablet PC to enter information on an InfoPath form at the bedside both prior to and following surgery. With the InfoPath feature enhancements included in Office 2003 SP1, Tablet PC inked forms can be automatically recognized and transformed into typed text. The data is then published to the BizTalk Server hub and also to the Office SharePoint Portal Server where it is available for all care team members. Once a discharge date is set, Social Services staff, the ward consultant, and ward nurses meet to finalize the Overview Assessment and to reconfirm an appropriate multidisciplinary care package following discharge.

5 "At the Overview Assessment meeting, participants with Tablet PCs can download patient data from the Office SharePoint Portal Server site to populate the InfoPath form with current information to make informed decisions," says Howe. "InfoPath helps promote a team approach to care and expedites the discharge process. Under government guidelines, we need to comply with a 48-hour response after referral. After that we have four weeks to put individual care packages in place. There are penalties on social services departments for bed blocking' of 100 for every day a patient stays unnecessarily in the hospital." All summary information from the overview, including any new medication, is sent electronically to the patient's general practitioner. Instead of mailing a letter, this automated information transfer ensures better communication with the family doctor and improved data accuracy. And as InfoPath helps health and social care providers aggregate more data about hospitalized elderly and their needs after discharge, clinicians and staff can use this information as a strategic tool to expedite treatment plans. Says Howe: "InfoPath is changing our whole agenda. For example, by aggregating all the data about patient falls you know when someone is at risk of falling. You can then put a care package in place before there is a tragic accident." An Intelligent GUI While Shields is quick to state that the main benefit of InfoPath is the integration it enables with other products and systems, he also cites its inking capabilities when used with the Tablet PC as a natural fit for the healthcare industry. "Most healthcare forms require signatures, and we can design forms that provide verifiable, non-repudiated signing," he says. "InfoPath users can sign different portions of a form and see the form as it existed when a user digitally signed it. And for healthcare practitioners, the Tablet PC, digital pen, and ink-enabled forms create an intuitive, computerized version of the paper chart on a clipboard." Shields will also use InfoPath to develop intelligent GUIs from third-party applications that he can tailor to accommodate CCC's business processes. "Because many suppliers are opening up their database to XML, we can replace the default front-end with a GUI built in InfoPath that reflects our specific informationgathering needs," he explains. "InfoPath has a powerful, flexible design environment with conditions, data validation, multiple views, and pop-up messages we could write specifically for our users. InfoPath is a costeffective, intelligent GUI that promotes information-gathering efficiency and accuracy. That's immensely powerful." Integrated Care Saves Money Every public service involved in caring for the elderly is facing financial pressures. This InfoPath point-ofcontact is the latest phase in the evolution of the CAT, and when fully implemented within the next 12 months, will herald a paradigm shift in care delivery to free expensive staff resources from wasteful administrative tasks to focus on assessing, diagnosing, and caring for patients. "Instead of spending 70 percent of our time on administration and 30 percent on assessment and diagnosis, the figures will be reversed, with only three hours in every 10 spent on administration," says Howe. Elimination of assessment duplication and redundant information gathering throughout the treatment protocol will save money for health and social services under pressure to provide better care at reduced costs. Says Howe: "We are expecting to make considerable efficiency savings when the new system is fully operational in 2005 for 1,000 staff. An estimated 3 million a year will be saved on duplicated effort, 850,000 on administration and 100,000 on travel. What really matters, however, is that in one visit by one expert all a person's needs can be assessed and the relevant agencies alerted. That's patient-centered care." Microsoft Office is the business world's chosen environment for information work that provides the software, servers, and services that help you succeed by transforming information into impact. For more information about Microsoft Office System, go to: For More Information

6 For more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) In Canada, call the Microsoft Canada Information Centre at (877) Customers who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) in the United States or (905) in Canada. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to: For more information about Cambridgeshire County Council products and services, call or visit the Web site at: Microsoft Corporation. All rights reserved. This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY. Microsoft, BizTalk, InfoPath, SharePoint, Windows, Windows Server, and Windows Server System are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. The names of actual companies and products mentioned herein may be the trademarks of their respective owners. Press contact: Office SIG Principal