Roadmap vision Digitally Enabled Dorset

Transcription

1 NHS Dorset Clinical Commissioning Group Roadmap vision Digitally Enabled Dorset SUPPORTING PEOPLE IN DORSET TO LEAD HEALTHIER LIVES 1 P a g e O c t o b e r

2 1. Contents 2. Version Control STP and Digital Roadmap Vision Technology underpinning the Sustainability and Transformation Plan Scope Our Dorset priorities a. Our 2020 Digitally Enabled Ambition b. The costs to Digitally Enable Dorset c. National context d. Meeting the Martha Lane-Fox challenges e. Wachter review findings f. Universal capabilities Organisation and our approach to delivering the LDR Roadmap a. Leadership, Clinical Engagement and Governance structure Delivering a Digitally Enabled Dorset Empowering the public, supporting wellbeing, prevention, self-care and the expert person a. Access to own records b. Improving communication with our citizens c. Personal Held Records and co-production d. Supporting People in Accessing Digital Resources Joined up shared care records a. Health and Social Care Community-wide work b. Trust Level Technology c. One NHS in Dorset Acute Vanguard Work d. Our Interoperability Journey Helping staff to deliver efficient care a. Baseline and progress against Digital Maturity key capabilities b. Collaboration, harmonisation, innovation c. Moving to paper-free practice in all care settings d. Universal use of NHS Number e. Supporting transformation of services f. Supporting joined up primary care g. Specialist and Regional services h. Prisons and Custody health Enabling mobility for all care settings P a g e O c t o b e r

3 a. Wide area networking b. Remote and Mobile Access c. Data Centre consolidation and Cloud opportunities d. Disconnecting data from applications e. Innovative technology System intelligence and decision support a. Decision support b. Artificial Intelligence and Machine Learning c. Whole systems intelligence Supporting Innovation in Digital Care Supporting Networked Expertise a. Portfolio of work b. Dorset Information Sharing Charter (DISC) c. Funding d. Digital Shared Services e. Change management f. Benefits Management g. Risk Management h. Rate limiting factors Wider participation - Independent sector and others Glossary Annex A: Sample person centred journeys a. Long Term condition Joan s story b. Planned Care Hip Operation Eva s story Annex B: Capability trajectory for Dorset Annex C: Overview of significant shared projects Annex D : Digitally Enabled Portfolio Costs Annex E : Universal capabilities templates a. Professionals across care settings can access GP-held information b. Clinicians in U&EC settings can access key GP-held information c. Patients can access their GP record d. GPs can refer electronically to secondary care e. GPs receive timely electronic discharge summaries from secondary care f. Social care receive timely electronic Assessment, Discharge and Withdrawal P a g e O c t o b e r

4 g. Clinicians in unscheduled care settings can access child protection information. 73 h. Professionals across care settings made aware of end-of-life preferences i. GPs and community pharmacists can utilise electronic prescriptions j. Patients can book appointments and order repeat prescriptions Annex F : Information Sharing Approach P a g e O c t o b e r

5 2. Version Control Version Changes By Date 1.0 Constructed from elements shared with Dorset Andy Hadley 26/4/2016 Informatics Group members 1.1 Review against draft STP document Andy Hadley 22/5/ Issued to Dorset Informatics Group for review Andy Hadley 24/5/ CCIO review CCG - Craig Wakeham, Poole Rupert Andy Hadley 2/6/2016 Page, comments throughout 1.4 Updates from RBH/Poole - Peter Gill and DHC Nick Andy Hadley 9/6/2016 Jenvey on trajectory. Annexes refreshed 1.5 Comments from BoP , case management and Andy Hadley 13/6/2016 CPIS Elaine Strathern. Additional detail to Universal Capabilities. 1.6 Comments throughout from CCG CIO Stephen Andy Hadley 19/6/2016 Slough, Lisa Trickey, DCC, and check against LDR Checklist 1.7 Review with Dorset Informatics Group (DIG) Andy Hadley 24/6/ Addition of comments and textual corrections. Stephen Slough 27/06/ Addition of comments from Quality Assurance Group Stephen Slough 28/06/ Released Version Stephen Slough 29/06/ Update following NHS England feedback - Universal Andy Hadley 30/09/2016 capabilities, Code4Health, Specialist and Custody Health 2.2 Addition of elements to cover Digital Shared Services, Andy Hadley 11/10/2016 project portfolio, and Wachter, updated innovation 2.3 Updated Dorset Care diagram and stakeholder photo Andy Hadley 20/10/ Feedback from SRO, DIG and NHS England (Wessex) Andy Hadley 26/10/ Final version for October submission Andy Hadley 31/10/ Correction of paragraph numbering issue Andy Hadley 29/12/ STP and Digital Roadmap Vision The vision set out in Our Sustainability and Transformation Plan (STP) is that we want to change our system to provide services to meet the needs of local people and deliver better outcomes. The Digitally Enabled Dorset workstreams aim to underpin that vision. This Local Digital Roadmap sets out the vision for partners in Dorset to undertake the Digital Transformation journey over the next 5 years 2016 to 2021, underpinning changes to the system to provide services to meet meet these needs and outcomes. Note that throughout this document we have attempted to refer to those who use health and care services as people, rather than the variety of different terms that our services use. 5 P a g e O c t o b e r

6 The Five Year Forward View 1 (5YFV, October 2014) from NHS England sets the context for transformation of healthcare delivery. Many of the changes are critically dependent on the power of information and technology, and the National Information Board (NIB) was tasked to set a strategy: Personalised Health and Care Using Data and Technology to Transform Outcomes for Patients and Citizens 2, which includes a target that, by 2020, there will be fully interoperable electronic health records so that patient s records are paperless, and to empower patients/service users/clients/citizens with access to view and update their own records. The Forward View for General Practice 3 aims to grow and develop the primary care workforce, drive efficiencies in workload and relieve demand, modernise infrastructure and technology, and support local practices to redesign the way modern primary care is offered to patients. 2. Technology underpinning the Sustainability and Transformation Plan People living in Dorset, and those visitors who need to use health and social care services expect that we will guide them to the most appropriate service, including digitally enabled options, and we will provide integrated and efficient care which is well documented, and uses prior knowledge of the individual to give them the best support available. Where they want it, the person should have easy appropriate access to their record, the opportunity to contribute to it, and to link with their Personal Health and Care Records. Likewise, carers and family members should, where the person consents, have the requisite facility to view and contribute. As technology becomes more sophisticated, personal monitoring devices built into wristbands, watches and smartphones are capable of capturing physiological data, and interpreting this directly for the person, or sharing with experts in their care. We must grasp opportunities to use this with people where this is their choice, and empower, with appropriate access, carers and voluntary and third sector organisations working with people Dorset embarked on a service transformation agenda in This has identified significant planned changes to the delivery of health and social care services, which as all the clinical strands identified, will need to be underpinned by good access to shared records, and increasingly intelligence led decision making. Over the period of this plan, the locations where care is being delivered, and the methods of delivery will change. Digital technologies will play a significant enabling role to support this, alongside workforce development, digital technology is seen as a key enabler to the Sustainability and Transformation Plan (STP) vision. 1 Five Year Forward View 2 Personalised Health and Care 2020 : 3 Forward view for GP practices 6 P a g e O c t o b e r

7 FIGURE 1 : DORSET STP PRIORITIES AND ENABLING STRANDS The Sustainability and Transformation plan considers three priorities. 1) Prevention at scale for the whole population, 2) using Primary Care and Integrated Community Based services wherever possible to keep people from needing to attend hospital, and 3) networking the Acute provision in Dorset to meet the highest clinical standards. All of this transformation is supported by the two strands of strong Digital and Workforce enablement. The development of the Dorset STP included significant consultation during the Clinical Services Review with members of the public, patient groups, GPs, and with other staff at all of the various NHS, Local Authority, voluntary and third sector providers of care across the county. At many of these meetings, there were common themes relating to frustration from the public about repeating information to different care givers, or this not being known, and from staff wasting time casting about for information in order to efficiently provide care, or being unsighted on information that would have been relevant. Having joined up electronic records was a key feature in most of the outcome reports. To help people visualise the development of the Sustainability and Transformation plan (STP), we have worked on a number of example scenarios where we have mapped out the interaction with health and social care services during the progression of a person s journey. Digital elements of transformation have been included. Examples are given at Annex A. 7 P a g e O c t o b e r

8 FIGURE 2 : CONSULTATION ON DEVELOPING THE DORSET CLINICAL SERVICES REVIEW The Digitally Enabled Dorset roadmap underpins all three elements of the Sustainability and Transformational plan, as summarised in Figure 3. Our portfolio of projects support this work as indicated. FIGURE 3: HOW OUR DIGITAL ROADMAP SUPPORTS THE TRANSFORMATION AGENDA 8 P a g e O c t o b e r

9 Some of the national challenges are more significant locally, as we have an age profile in Dorset which is significantly older than the national average, and this reflects in the numbers of people living with one or more chronic diseases, or registered with a disability. Our workforce is stretched, and the cost of living on the South Coast is high. We therefore need innovative use of technology to support and develop our workforce, and to support people with complex needs. Recognising there are sometimes opportunities for saving time in one setting, by investing time elsewhere, the technology must be easy to use, and enhance delivery of care. We will empower staff by connecting our various clinical and social care repositories to support the point of care processes, transcending organisational boundaries, and in support of the efficient flow of people. Over the next 5 years, the role of personalised care, predictive analysis of populations based on analysis of large datasets, knowledge of Genomics, and the prospects for drug therapies targeted at the individual will become key tools. All of these require joined-up intelligent records at point of care, and for teams of specialist and supporting staff to have real-time access to complete information about the person they are treating. Our county is a mix of rural and urban areas, with a range of transport and telecommunications challenges, areas of urban deprivation and rural isolation. Whilst we can expect improved connectivity, available bandwidth will always remain behind that available for large urban metropolitan areas. We need our Digital landscape to cope with this and to support our staff and people living in all parts of the county. We need to ensure that our teams have appropriate skills and knowledge to fully exploit the potential for use of technology to transform care, and that we have a skilled Informatics workforce in place to support them. We also have ideal opportunities to work with the digital industry, Universities, to be supported by the Wessex Academic Health Science Network (AHSN) and with many talented innovative organisations based right here in Dorset. To develop our ambition, we held two stakeholder events, in January 2016 (with 130 attendees) and October 2016 (with 200 attendees) with representation from all NHS and local authorities, Ambulance, Fire, Police, voluntary organisations and patient/service user groups, and with external speakers from around the country, to help develop our vision for the digital future. FIGURE 4 : JANUARY 2016 DELEGATES AT DORSET DIGITAL VISION 2020 MEETING 9 P a g e O c t o b e r

10 Our aim to work together and shape the paper-free vision for Dorset was developed via these two digital vision meetings, discussions at Dorset Informatics Group meetings, and iterations of this document and supporting annexes. This has included reviews against the developing Sustainability and Transformation Plan drafts, and emerging national guidance. FIGURE 5 : OUR DIGITAL FUTURE - DORSET CARE RECORD AND BEOYOND - OCTOBER 2016 We have good longstanding relationships between all partners delivering health and care to our population. We must ensure that the appliance of technology enhances those links, and enables teams working across the area to work seamlessly. 3. Scope This Local Digital Roadmap (LDR) covers the geography of Dorset, all health and social care organisations within the county, plus Southwestern Ambulance which provides 999, 111 and out-ofhours care. We include linkage to NHS organisations in the surrounding counties of Hampshire, Wiltshire, Somerset and Devon as they also provide care for Dorset residents. In addition, there are a range of independent and charitable providers who contribute to health and social care for our population, and are considered in scope. The document has been developed in partnership with all the key providers within our footprint, between all the technical and practitioner Digital Technology leads for the main Health and Social Care partners in the county. Borough of Poole Bournemouth Borough Council Dorset County Council Dorset County Hospital Foundation Trust Dorset HealthCare University Foundation Trust Poole Hospital NHS Foundation Trust 10 P a g e O c t o b e r

11 Royal Bournemouth and Christchurch NHS Foundation Trust Southwestern Ambulance Service NHS Foundation Trust NHS Dorset Clinical Commissioning Group (and 96 GP practices) Particularly as we are a holiday destination, the roadmap also plans for linking to health and care records from elsewhere to provide continuity of care for visitors to the county, and to be inclusive sharing appropriate information with voluntary and third sector organisations who sign up to the Dorset Informaton Sharing Charter. We are also working actively with our neighbouring STP geographies and national exemplars to support patient flows and adoption of best practice. The document has been formally reviewed by the CCG Quality Assurance Group and submitted to the Dorset System Leadership Team in support of the Sustainability and Transformational Plan. 4. Our Dorset priorities a. Our 2020 Digitally Enabled Ambition Within the next 5 years, the ambition is to establish a fully integrated digital pathway for management of long term conditions. Using prevention at scale to keep the population healthy, and enabling people to live independently as long as possible, for frontline staff to take a more preventative approach and to focus their time on people who require active intervention. By expanding our current Telehealth and assistive technology services, moving to a model which is proactive, and utilising a range of wearable devices and self-management options, our goal is to develop the next generation of digital health and care solutions which offer greater choice to people in how they manage their health and wellbeing, and to empower clinicians and practitioners to be more effective in their roles. Within a secure environment we will empower teams working with people to have all relevant information about the person at their fingertips, and update this in real time. This will support the personalisation agenda, including targeted medicines, genomics, and the appropriate use of technology. The person will have much better access to information about their condition and planned care, and where they desire, carers or others will be enabled to access on their behalf. This will enable us to establish early diagnosis for people with emerging long-term conditions before they become ill. By using our care in the community expertise we 11 P a g e O c t o b e r

12 All the Health and Social Care organisations in the county are heavily committed to an ongoing programme of digitising their existing records. For primary care, most practices have been working in a paper light fashion for some years, and they struggle with a daily influx of paper from other Health and Social care settings. We have started work on moving this incoming tide to automated structured messages, and to facilitate meaningful and timely exchange. There is more to do. Secondary care providers are in transition. Two of the Acute Trusts recently digitised their paper record archives. The third, and our community/mental health provider have this work to do. One Acute Trust is in the process of implementing a clinical viewer to present a single summary of care to clinicians. Another Trust is migrating between solutions. Electronic Prescribing and Medicines Administration (EPMA) is fully implemented in one Acute, and still to do in the rest of the Acute, Community and Mental Health sectors. There is much that we can learn from each other, and willingness across the piece to consider how unifying and standardising information systems will assist with the service transformation, and One Acute Network that the Sustainability and Transformation Plan demands. The three local authorities are all refreshing their case management systems, working together on key aspects. For some time, local authorities have been responding to the digital agenda shifting to a self-service model to manage demand. The introduction of the Care Act has seen some work in this area with much more to do to enable service transformation. In addition, mobile working with practitioners able to access and update records whenever and wherever will be more efficient and support the timely recording of information to share with other partners. Our Public Health service works across all three, and commissions preventative and early interventional work. Guidance to the public, particularly on prevention and self-help needs to be more joined up between partners. We have good working relationships across our borders, with several neighbouring Trusts accessed by our residents, especially Yeovil, Salisbury, Lymington and Southampton. For example, one quarter of the activity for Royal Bournemouth Hospital comes from Hampshire residents. A key element of the Sustainability and Transformation Plan for Dorset is the development of Integrated Care Services in community hubs. This will require seamless cross-organisational working. Primary care and Community care is in transition. Technology is focal to supporting new ways of working, with federated or merged services providing care across wider geographies, practices coordinating to better use GP and other clinical time in supporting high impact settings, e.g. visits to care homes. Independent sector services are not well linked with other organisations and the shared records agenda. Their needs and contribution must be factored in as we need to support the ecosystem of health and social care providers, voluntary care organisations working with our population and with health and care services. b. The costs to Digitally Enable Dorset The programme of work to digitally enable Dorset has been costed over the next 5 years as 20M capital ( 4M per year), and 33M revenue ( 6.6 M per year). In order to transform businesses to capitalise on use of digital channels in other industries, 5-10% of total revenue is a benchmark, and 12 P a g e O c t o b e r

13 as far back as the Wanless report of 2002, a doubling of NHS spending on ICT to support integrated records was recommended. 4 Programme Capital Revenue (5 year total) Shared Care Records 8.5 M 5.4 M Intelligent Working 2.0 M 310 K Self Care 435 K 465 K Digital Shared Service 880 K - Enabling Technologies 7.3 M 29.8 M Total Portfolio 19.3 M 36.6 M This headline figure is broken down in support of our work portfolio as follows (and in more detail in Annex D); c. National context The Five Year Forward View makes a commitment that, by 2020 there would be fully interoperable electronic health records so that patient s records are paperless. This was supported by a Government commitment in Personalised Health and Care 2020 that all patient and care records will be digital, interoperable and real-time by In February 2016, the Secretary of State announced 4.2bn of funding for NHS technology, including 1.8bn to create a paper-free health and care system. The 16/17 Planning Guidance 5 introduced the concept of place-based Sustainability and Transformation Plans (STPs). The STP guidance 6 published in February 2016 stated that, in developing STP content and ensuring delivery of transformation, local health and care systems should harness the opportunities that digital technology offers. The best plans will be coherent across all elements, including digital. It is clear that digital has a significant role to play in sustainability and transformation, including for example delivering primary care at scale, securing seven day services, enabling new care models and transforming care in line with key clinical priorities. A number of recent reviews have confirmed how clinically led improvement, enabled by digital technology, is vital to driving forward increased productivity gains. Revealing existing working practices that mask unwarranted variation and supporting the introduction of radically new models of co-ordinated and fully participatory care. These include publications by the Nuffield Trust on delivering the benefits of digital health care 7, Baroness Martha Lane Fox s work on increasing digital health literacy and access to information 8, Dr Robert Wachter s exploration of clinical informatics Imison C, Castle-Clarke S, Watson R and Edwards N (2016) Nuffield Trust P a g e O c t o b e r

14 leadership 9, Dame Fiona Caldicott s work on behalf of the Care Quality Commission on public confidence and data management 10 and Lord Carter s review examining operational productivity in hospitals 11. Becoming a digitally enabled health care provider is not about replacing analogue or paper processes with digital ones. It is about rethinking what work is done, re-engineering how it is done and capitalising on opportunities afforded by data to learn and adapt. Delivering the benefits of digital healthcare: 2016, Nuffield Trust There is a significant agenda for personalisation of health and care to individuals, ensuring that we involve the person and their carer in decisions about them, supported in their own community. Some of this is summarised in the Think Local Act Personal 12 framework. Developed in parallel with this plan, the Sustainability and Transformation plans (STP) are predicated on three factors, which Digital Roadmaps must support for health and social care communities; Closing the health and wellbeing gap Closing the care and quality gap Closing the finance and efficiency gap Our local ambitions will be shaped by and measured against the national work, and the Dorset STP response. The way we design and approach services must put people at the heart of our overall system. d. Meeting the Martha Lane-Fox challenges Four key recommendations 13 from Martha Lane- Fox to the National Information Board to encourage digital inclusion were; 1. Reaching the furthest first making sure those with the most health and social care needs who are often the least likely to be online, are included first in any new digital tools being used across the NHS. 2. Free Wi-Fi in every NHS building to enable self-monitoring, and maintaining social contact. 3. Building the basic digital skills of the NHS workforce to ensure that everyone has the digital skills needed to support people s health needs P a g e O c t o b e r

15 4. An ambitious target that at least 10% of registered patients in each GP practice should be using a digital service such as online appointment booking, repeat prescriptions and access to records by 2017 We will ensure that these principles are included in our plans for Dorset. e. Wachter review findings The Wachter review has highlighted the importance of training and empowering well qualified clinicians with advanced informatics training in every Trust. All organisations in Dorset have been encouraging the development of CCIOs, associates and equivalent social care practitioners, including encouraging active participation in national DigitalHealth 14 forum. The review focussed on digitisation in the Acute Hospital setting, and highlighted the focus on implementing in a phased approach. Dorset Health and Social Care partners recognise the benefits of working together to achieve these digital and interoperability objectives. f. Universal capabilities The national plans define a series of capabilities which are expected to feature in every local delivery plan. These plans must demonstrate clear momentum between now and end-march 2017 and substantive delivery by end-march In Dorset, we have been proactive and early implementers of elements like Summary Care Record and Electronic Prescription service, and have already promoted use of SCR for sharing end of life care plans. Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions Clinicians in urgent and emergency care settings can access key GP-held information for those patients previously identified by GPs as most likely to present (in U&EC) Patients can access their GP record GPs can refer electronically to secondary care GPs receive timely electronic discharge summaries from secondary care Social care receives timely electronic Assessment, Discharge and Withdrawal Notices from acute care Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly Professionals across care settings made aware of end-of-life preference information How are you ensuring that IT systems GPs and community pharmacists can utilise facilitate person-centred care and electronic prescriptions smooth transition for people using Patients can book appointments and order repeat services? prescriptions from their GP practice Dorset PPEG Guide for personcentred discussions P a g e O c t o b e r

16 Our plans for delivering these universal capabilities are attached at Annex E 5. Organisation and our approach to delivering the LDR Roadmap a. Leadership, Clinical Engagement and Governance structure All Dorset Health and Social Care organisations are represented on the Dorset Informatics Group (DIG). A forum for senior clinical, social care and technical leaders to set priorities and respond to emerging clinical needs. It has the remit to drive forwards the shared Digital agenda arising from the Dorset transformation agenda, and responding to national strategies to implement the vision of paperless practice, across the Dorset Health and Social Care community. Within the overall Sustainability and Transformation Plan (STP) programme, the Dorset Informatics Group (DIG) is responsible to the System Leadership Team (Chief Executives of NHS Trusts and Directors of Social Services). Membership of the DIG group consists of the Chief Clinical Information Officer (CCIO) or practitioner equivalent, plus the Chief Information Officer (CIO) or other senior technical lead, patient representatives from the CCG Patient and Public Engagement Group and some other key clinicians. The Local Digital Roadmap has been developed collaboratively through the Dorset Informatics Group, and individual meetings with with CCIOs, CIOs and other stakeholders. We held Digital Transformation Events in January and October 2016 to develop the vision with a wider group of stakeholders. Alignment to the STP has been achieved through regular links with the prime authors of that document, and shared review. FIGURE 6 : GOVERNANCE STRUCTURE FOR DORSET INFORMATICS GROUP 16 P a g e O c t o b e r

17 The Senior Responsible Officer (SRO) for this work is the Director of Transformation for the CCG, who also oversees the Sustainability and Transformation Plan work. The Digitally Enabled Dorset work is considered a key enabling strand in the overall Dorset STP. The DIG Board hold accountability for development and delivery of the LDR. It includes membership from all partners, including a range of clinicians and practitioners, and invited patient representation. 6. Delivering a Digitally Enabled Dorset Our programme is divided into the following key areas, each with leads identified for implementation, expanded in subsequent sections ; Empowering the public with prevention and self care Joined up shared care records Supporting care closer to home, enabling mobility for all care settings System intelligence and decision support Supporting networked expertise, o organisation to deliver, enabling technologies and supporting innovation 7. Empowering the public, supporting wellbeing, prevention, self-care and the expert person Public sector organisations lag behind many others in enabling people to access services digitally. Increasingly people deal with a range of companies and agencies digitally, and expect to be able to do so with the NHS and their social care organisations. Where the requirements of a person are simple, this brings advantages to all, and efficiencies to the service, which in turn frees capacity for those people with more complex need, and for those who are not accessing services digitally. At our Dorset 2020 Digital vision meeting in January 2016, Anya de Iong, our PPEG chair, and a patient representative, whilst welcoming the more advanced technologies, was pleading for getting 17 P a g e O c t o b e r

18 the basics right. Actively engaging with the person, ensuring that they have access to the relevant information, guidance and advice were key ideas. Some of these public facing facilities are being worked on nationally, and we will need to ensure organisations in Dorset are all playing our part in providing relevant local information; NHS.uk National service, A rework of the NHS.uk website is under development at and We need to ensure that Dorset organisations are accurately represented on where commissioning pathways are changed, that these are reflected on their material, and that where patients are commenting on services, that they respond and take notice. 111 National service, local hub SWAST, but calls taken anywhere. Relies on NHS Pathways and a Directory of Service ereferrals Apps SMS messaging National service, redeveloped Choose and Book National accreditation of Health related applications National framework for GP practices The Directory of Service as used by 111 is now available for staff in other care settings to access. This requires some reconfiguration to utilise, but can contribute to ensuring that treatment options are identified where these may be otherwise unknown to professional staff. Enhanced advice and guidance. We need to monitor developments and make use of additional features as these become available and workable. Signposting people to existing and accredited self-help advice and guidance. The National Information Board intend to provide an accreditation Kitemark for apps by Dorset primary care choice of MJOG 2-way texting facility. Providers have separately procured systems. Where possible and with patient choice, move to . To support people in becoming active partners in their own care, and the early help and preventative agenda to reduce demand on the system the following resources have been developed in Dorset: Site Link Purpose Commissioner My Health My Personalised support for Dorset CCG Way people living with a My life my care LiveWell Dorset condition Information and advice about care and support for adults in Bournemouth, Dorset and Poole Free support to change your lifestyle 3 Local Authorities Public Health Dorset These resources include describing a range of assistive technology in place, and telehealth for people with long-term conditions. 18 P a g e O c t o b e r

19 We will develop these further including a digital marketplace for health and social care support. We join up ways to signpost people to appropriate online resources to help them to self-serve general and personalised support. Particularly for people living in the rural community, access to network capacity and skills will be assisted via the Dorset Superfast Broadband initiative. a. Access to own records GP practices are providing online access for patients to their records, requesting repeat prescriptions and the ability to book appointments where they choose. In Dorset practices, 99% of practices are set up for patients to view records 14% of patients are registered and enabled to book appointments online 0.3% of patients are registered to view their full record The Martha Lane-Fox challenge sets targets for 10% access by the end of 2017 We are therefore setting a more ambitious target for Dorset of 25% enabled to book online by the end of 2016/17 and 50% during the following year. The new local authority Case Management systems provide a portal access for the public to support self-assessment and digital interaction The Dorset Care Record is intended to provide a unified view of care across settings, and a means for people to view records where enabled by their professionals by 2018 The DCR viewer will be extended to provide a public portal enabling people to contribute to their own records. This will also be available to those carers or others that they trust to see appropriate information. A key development will be use of identity criteria to authenticate access to records about a person. We will actively monitor and collaborate in building on the national initiatives as these emerge. b. Improving communication with our citizens The use of online methods to research and access services, and to communicate with organisations are becoming second nature to many people. Wide spread adoption of such communication streams will drive up efficiencies in our services, and enhance the experience of care for the people we serve. Enabling , Instant Messaging and Skype options for communication supports flexibility and convenience for the citizen, avoiding time consuming journeys for often very brief clinical interaction. The same technology can also improve the support and learning opportunities for staff to discuss progress and advice and guidance for the person, and smooth the workflow for busy reception and support staff. This includes in particular reducing the numbers of face to face outpatient appointments. Update notifications on progress during investigation and treatment provide reassurance to the recipient, and reduce their need to contact whilst anticipating results. Control of the method of contact needs to be placed with the consumer. 19 P a g e O c t o b e r

20 SMS Text Messaging The CCG have enabled practices to take advantage of a framework for advanced SMS Messaging with MJOG. 83 practices are now live (Sept 2016), with 563,000 SMS messages sent to patients in May This included 2,000 appointment cancellation replies, saving wasted clinic slots. Top sender (size adjusted) was Crescent surgery in Boscombe. This initiative has seen a drop in patients missing booked appointments. Thousands Sept 16 total SMS messages by practice c. Personal Held Records and co-production We will grasp the new opportunities for personal held records, patient contributed records, and information contributed from wearable and other devices. Making this information accessible from people who may choose from a variety of solutions that will develop over time, and co-ordinating the input from various players will be key. We will also need to establish and be clear on the degree of interaction that a person can expect from professionals, as not all information can be collected and acted upon. We will need to explore automated mechanisms to distil and alert practitioners to key information, and create solutions in co-design with those we serve. The Dorset Neurology Service, funded by Innovate UK Digital Health, has launched a project for epilepsy, as one model of long term conditions. This has been developed with academic and industry partners and has been presented nationally and internationally as a new model 20 P a g e O c t o b e r

21 of care provision 15. It features a patient held smartphone application linked securely to a cloud-based patient portal. The team have integrated wearable technology to help detect and record seizures as well as lifestyle information. Patient contributed data is securely fed into the clinical record, with team-based notifications driving clinical workflow and intuitive visualisation of relevant clinical data. Advice can be provided back directly to the patient through asynchronous text-based information or by scheduling telephone or video calls. The advice provided is available to other healthcare professionals directly in the clinical record. Formal trials are planned for early 2017, with the intention of withdrawing routine outpatient follow-up appointments for epilepsy. The team are already working on other neurological conditions using the same model. The Dorset Neurology Service is also collaborating with industry partners on an Innovate UK funded project to allow third party applications to securely connect to clinical records, facilitating co-production of health records 16. This work has developed out of the Epilepsy Networks Project. Person held record / circle of care 17 Dorset County Council are taking part in a European Research project to consider how technology can be used to help people remaining independent collecting information from sensors and apps to trigger alerts to informal and formal circles of care. Mental health service crisis and care plans within Dorset HealthCare depend heavily on coproduction, and mood diaries are currently logged via an app, and ed directly to the clinician We will look to understand and validate the calibration of Point of Care devices, which may be purchased by the individual, and calibrated to a different standard than clinical devices. Further innovation will be encouraged (see section 12), and we need to find ways via the commissioning process to ensure that this work is sustainable. d. Supporting People in Accessing Digital Resources One of the Martha Lane-Fox challenges is to ensure that we reach the furthest first, to those who may be least likely to be online Circles of Care 21 P a g e O c t o b e r

22 Dorset County Council are leading on a Superfast Dorset broadband project 18 to improve access to faster, more reliable broadband connections, especially in the rural areas around the county. This also includes supporting digital champions and skills training organisations to help those who have not been online before. We will work with these organisations, and with patient and carer representative groups to enhance access to, and awareness of digital options for people to access health and care information and records. Our attempts to catch up will, because of our rural geography continue to be behind the curve, as the term Ultrafast Broadband 19 heralds the next generation of capacity. We also recognise that for some people, there is no desire to use digital channels. In encouraging people towards digital options, we will aim to safeguard and create capacity for those who need support, encouragement and facilitation, but also those who choose non-digital routes to health and care. 8. Joined up shared care records For a variety of reasons, across our multiple organisations and recording systems, today sharing of information does not always happen in a timely or robust way. The shared Dorset Care Record will revolutionise the work for many staff, saving many phone calls to build up a picture of progress for a person in the care of multiple teams. Practice Manager, Weymouth The Health and Social Care organisations within Dorset will work together to identify which existing systems are fit for the future, particularly where services are being moved from specialist settings to community or a distributed networked setting. Key tests will be ensuring that relevant information can easily be shared with practitioner and patient portals, and that where multiagency teams require access, this can be readily built into their workflow. The Sustainability and Transformation Plan (STP) envisages Prevention at Scale, Integrated Community Services, and one Acute Network supporting care. This will increasingly require collaborative decisions about information storage and sharing in support of joined up care. The Dorset Informatics Group provides a forum to engage and agree priorities across the community. We also have a standing group working collaboratively on the Information Governance framework, and developing trust and tools to facilitate sharing information within the legal framework, and respecting consent of the individual. a. Health and Social Care Community-wide work 18 Dorset Superfast Broadband Openreach CEO: Now Is The Time To Go From Superfast To Ultrafast Broadband 22 P a g e O c t o b e r

23 In support of the STP the IT solutions will need to work across all Health and Social care settings and buildings, to support mobility of clinicians and practitioners, and visibility of the end to end journeys undertaken by the public through their interaction with our services. Working together in partnership, and with contributions from the people we serve, we aim to prioritise the following work; The Dorset Care Record Develop a single place for health and social care staff to efficiently obtain a shared overview of the current and historic health and care for a person Provide a facility for creating and disseminating joint care plans Enhance visibility of which teams and individuals are working with a person Swiftly alert staff to changes in circumstance which may affect the care they provide Personal Portal In parallel with the Dorset Care Record work, this will enable people to - track their own records of interactions with health and social care organisations, and view letters, results and reports - share their record with carers or others - contribute to elements of their record - link with Person Held Records and potentially wearable technology Dorset Information Sharing Charter Ensure that information is securely held, that only authorised staff can access it and that where a person has asked for information not to be shared that this is respected. Provide a framework that empowers our staff to share information about a person with others involved in the care of that person, to Dare to Share, and to underpin that with clarity about individual sharing purposes and models. Diagnostics Improve the sharing of results of diagnostic reports, tests and images coming from various providers, so that these are available wherever patients present, to speed diagnostic decisions, and reduce duplication. Enhance the capability for the Radiology departments across the county to work as one, especially with cross-cover by Radiologists able to schedule and report on images taken elsewhere. Shared technology to support a joint Pathology service. Transfers of Care Having achieved the transfer of inpatient discharge documentation via electronic messages we will work together to replace other paper flows with messages, and to move to those with greater structure to support incorporation and re-use of meaningful data. Increase use of the national ereferrals system for planned care events. Develop efficient mechanisms for advice and guidance. Enable access to Directories of Service and pathways to support Urgent and Unplanned care for people and the professionals who support them, linking with the 111 service. 23 P a g e O c t o b e r

24 Enhance information flowing back to GP practices from 111, 999 and out of hours services, including information about non-conveyed patients, and timely information about unplanned admissions and integration between systems. Standards Implement the Academy of Royal Medical Colleges guidelines on headings and content of documentation Move to SnomedCT for describing healthcare diagnosis and intervention Working with suppliers, and influencing the national initiatives to use technical standards for information sharing b. Trust Level Technology The three Acute provider organisations in Dorset have taken an incremental clinical portal approach retaining specialty-specific solutions where these add value, but ensuring that these integrate with and populate the Trust-wide clinical solutions. They have an ongoing body of work to ensure that these are reviewed and either updated or migrated. Inevitably there are solutions that are specialised to departments in one organisation. To support the transformation ambitions of the STP, solutions need to be developed/supported/procured which enable full access to staff off the hospital campus, potentially mobile in patient s homes, but certainly in a variety of health and other settings. Dorset HealthCare have taken a single record approach to their two main areas of work, Mental Health and Community Services. The community services solution is the same as the majority GP system in the county, and therefore records can readily be shared, with patient consent. Further work needs to be done to improve interoperability. c. One NHS in Dorset Acute Vanguard Work In response to the priorities in the STP, and following a successful national vanguard bid, the three Acute Trusts in Dorset are working to reconcile and collaborate on shared records for patients who may traverse between sites for care with different conditions over their lifetime, or within a single period of care. A range of key specialties are working together to create a networked service, which will need to be underpinned by connected and combined Information Systems. Some IT systems have historically been procured in parallel, with the same solution implemented at two or all three Trusts. There is a body of work to bring these into a single shared resilient configuration across the three where it is useful to patient care and organisational efficiencies. Within the Vanguard work there is an initiative to review the ICT function across the three Acute Trusts, with a view to maximising sharing of scarce skills and solving common issues together. This needs to ensure that it fits with community and primary care and with emerging models of care. The Trusts have agreed to prioritise through the shared Dorset Informatics Group. d. Our Interoperability Journey 24 P a g e O c t o b e r

25 Our collaborative work to develop the Dorset Care Record under the Better Together initiative has built on previous effort between partners to exchange information between organisations. FIGURE 8 : DORSET PLAN ON A PAGE There have been a number of previous multiagency initiatives, some examples; Admissions and Discharge Notification : a nightly feed from the Dorset Providers, plus Salisbury and Yeovil Hospitals is parsed via an integration engine to provide GP practices and specific community staff with lists of patients known to them who were admitted. People on shared caseloads : Dorset County council take a nightly feed of patients known to Dorset HealthCare Mental Health services, and combine with information from their current and historical Case Management systems to enable staff to contact relevant teams Electronic Transfer of Care Documentation : The community have gone beyond the national mandate to moving discharge and other documentation outbound via messaging (and excluding transfer). This work is ongoing, and building to incorporate the A&E discharge, and AoMRC headings standard work. Care co-ordinators in Integrated Health and Social Care community teams have been granted access to a range of health and social care systems in order to build a picture of the frail elderly people that they work with. These have relied on goodwill between partners, backed with Information Governance review and approval, and local technical expertise. Internally, the NHS providers all have integration engine technology, and staff with some capacity and skills in national and international messaging standards around HL7 2.x, ITK, MESH, DICOM and exposure to the possibilities of IHE XDS and HL7 FHIR. 25 P a g e O c t o b e r

26 With the Dorset Care Record initiative, we have the opportunity to build on this, and to encompass the tactical exchange of information listed above into a shared portal environment. We have also worked collaboratively to ensure that requirements specifications for potential feeder systems include reference to the existing and emerging national standards for Interoperability. For services which require a significant parallel effort from multiple teams working with the patient, the use of a single shared record may be more appropriate to ensure seamless care. This approach has been taken in a number of Primary Care and Community settings, where sharing and updating the full record ensures that the whole team is working with the latest information. We are working to maximise use of national capabilities, summarised in the diagram below. Work on Dorset Care Record will drive forwards our collaboration on these key areas over the life of the plan; FIGURE 9: CAPABILITIES FOR INFORMATION SHARING - NATIONAL VIEW We have been active participants in the national discussions on Interoperability, organised a standards based connectathon as part of our recent system procurement, and have offered to be first of type for the GP Connect work to link primary care to our shared records. 9. Helping staff to deliver efficient care People are increasingly organising their lives across agencies via digital means. However, it is important and recognised that not everyone has digital skills or enthusiasm, and the primary reason for frontline staff to be employed is to care appropriately for people. The efficiency and safety of health and care that we provide is dependent on good record keeping, sharing and using information and we must equip and support our staff to deliver safe and effficent care, and get the best from the technology. Technology has a critical role to play in the transformation of the health and social care services for us. On its own it cannot be expected to provide that silver bullet to resolve all issues. It needs to be used as a toolset to enable, and where possible streamline and expedite changes to process. The 26 P a g e O c t o b e r

27 need for change has to start with a clear demand, enable improvement for people involved in the delivery of the process and ultimately improve the outcome for people affected by the process. Technology therefore is a tool to support achieving the aim, not the reason for change. Consequently, our roadmap and IT Strategy developed across all health and social care partners must underpin the Sustainability and Transformation Plan priorities, and address each of these three factors. Investment in training, in ensuring that systems empower rather than hinder users in their workflow, delivering robust system availability and good performance as experienced by technology users. These are all important elements of our plans, largely invisible unless they fail. Design and Usability of systems is a key determinant to successful uptake, they must be intuitive to the point of needling little training. In procuring systems, we must ensure that users have a good opportunity to assess the offerings and their scores are adequately regarded in the evaluation. Interoperability, the mechanisms to exchange data between different systems within organisations, between health and social care partners and with personal held records is key to successfully reducing the inefficiencies and frustration of double entry. In addition, it will reveal missing important information that is known in other parts of the service. Use of Open API technology and insisting that suppliers adopt open standards for messaging and data exchange is vital. The community have been innovative in pushing suppliers towards the standards based approach. a. Baseline and progress against Digital Maturity key capabilities Organisations in Dorset have all been working actively towards the ambition of Digital enabled healthcare. Significant recent projects include; Theme System Trust(s) Records EPR Digitised Casenotes Community Records Mental Health system upgrade Case Management System (Adults) Royal Bournemouth (RBH) RBH and Poole Dorset HealthCare (DHC) Dorset HealthCare (DHC) Borough of Poole Orders GP requesting for Pathology Poole Hospital Medication Electronic Prescriptions and Drugs Dorchester (DCH) Administration Decision Support Frailty index Primary Care Transfers of Care Discharge Summaries via MESH All providers (national mandate) 27 P a g e O c t o b e r

28 Remote and Assistive Care EPS Repeat prescriptions Project for Rural Frail Isolated people CCG, practices and pharmacies Dorset County Council To deliver the challenge of paperless practice by 2020 all NHS provider organisations in England were invited to self-assess their level of progress on the journey to paper-free care as at February Social care organisations were invited by Socitm 20 to complete a similar baseline assessment. The current position and forward trajectory for Dorset NHS provider organisations is summarised in the following graph, and in more detail at Annex B. This is based on discussions with CIO and CCIO colleagues FIGURE 10 : SECONDARY CARE DIGITAL MATURITY INDEX FEB 2016 AND PLANS b. Collaboration, harmonisation, innovation A number of enabling technologies will support seamless working between staff from different agencies working together. Secured between partners, and to any external user Universal access for mobile connectivity Presence, instant messaging and desktop audio/video conferencing Currently protected via IronPort encryption. NHS organisations move to NHSMail2 or linked technology. This will require reworking of existing secure exchange of , and retraining across partners. We are constrained by our rural geography and the economics of mobile connectivity. Ensuring that Health and Social Care staff can access Wi-Fi at any H&SC premises. Docking stations to enable hot-desk working Corporate solutions enable secure exchange of information, linking these will enable us to work as one. Skype for Business has been implemented across the CCG, is planned for primary care, and is being rolled out at the County Council. We need to work with 20 society for IT practitioners in the public sector 28 P a g e O c t o b e r

29 Collaboration Business Intelligence Networks Devices partners across the county on linked up solutions. Collaborative platform to enable sharing of information and resources between partners. Office 365 and SharePoint or equivalent. Common tools, sharing of expertise and collaborative working Migration from NHS N3 Network to the Health and Social Care network (HSCN) High capacity triangulated networking between key sites, and improved network resilience within large sites. We will need to continue to invest in mobile devices, and to be responsive to exploiting new device types which enable staff to work efficiently with software as this develops. c. Moving to paper-free practice in all care settings We need to be joined up across the various sectors. This relies on information being captured and updated digitally in each, reimagining work and redesigning with the person at the centre. Our Digital Maturity Baseline Assessments and other discussions have highlighted the following priority areas for development; Primary Care Mostly existing practice is paperless the biggest source of paper are letters from secondary care. We plan to move these to structured electronic messages. Scanning Lloyd George envelopes Once the legal frameworks allow these will be scanned and paper copies destroyed, freeing physical space for clinical care. Consistent access to diagnostic results from all providers Improved notification of pending discharge from Acutes Acute Hospitals The Digital maturity index highlights the main gaps. For Poole and RBH, electronic prescribing and drugs administration (EPMA) At RBH, electronic requesting of diagnostics (pathology, radiology, cardiology, endoscopy) Scanning paper case notes for Dorset County Hospital A combined clinical layer for Dorset County Hospital Exchange of correspondence and test results to follow the patient Community / Mental Electronic prescribing and drugs administration (EPMA) Health Scanning paper case notes Consolidating use of digital systems, spreading best practice Social Care All 3 authorities are changing their case management systems for both adults and children s services Adoption of use of NHS Numbers in children s services Electronic referrals from partners Sharing information with and from providers of care Communications from Acutes about pending discharges Ambulance, 111 and out of hours Internally mostly already electronic. Exchange of information with others needs to be enhanced Charities, third sector and voluntary Challenges of collecting NHS number, recording on an electronic record and sharing information with NHS organisations 29 P a g e O c t o b e r

30 Independent sector Efficient exchange of information with NHS and social care organisations needs to be established All settings Dorset Care Record shared summary and patient accessible record Wi-Fi in all sites for multi-agency staff and for the public d. Universal use of NHS Number NHS Number is the key identifier for all NHS systems, and for Adults Social Care. We anticipate the remaining main partners will hold NHS Numbers to uniquely identify people during 2017/18. The three Local Authorities Children s Case Management systems are being populated in advance of their upgrades. There is still a challenge for small organisations delivering care and for specialist and sensitive areas like sexual health, family planning, prisons and forces healthcare, and we are encouraging them to join the county-wide Information Sharing approach. e. Supporting transformation of services The Dorset Better Together programme and the Clinical Services Review both highlighted the need for integrated records to support key themes; A. Self-help, online and telephone contact for people who choose this option (preserving staff capacity for those who cannot use digital channels or choose otherwise). B. Integrated health and social care teams working seamlessly around the person, co-located in community hubs. C. Clinical networks across the Acute hospitals to ensure round the clock specialist cover availability, and people can be treated closer to home with specialist backup. Children s health and care services across the county are undergoing a transformation. The overarching outcomes of what we aim to achieve through an integrated community Children s health services model is that children and young people will have improved health and wellbeing through: - getting better at spotting problems early on, prevent where possible and provide the right support in a timely way if needed. helping parents to become more self-reliant in their communities. sharing and using information to ensure that our services reach vulnerable children and protect them from experiencing poorer outcomes. having a single, clear, easily understandable system of support that makes the most of new technology and innovation. working more effectively together, providing care closer to home: - local authorities, schools, health services and the voluntary sector to build capacity within local communities. We will develop digital services to enable and support these new ways of working. This will release clinical and practitioner time to concentrate on the people who need care most. 30 P a g e O c t o b e r

31 f. Supporting joined up primary care Patient journeys are becoming more complex and involving a range of health and care organisations. The GP clinical record has historically been the one place where summary information from everywhere comes together. We have made progress on moving some of the key incoming communications to electronic messaging directly into clinical systems. Much further work needs to be done to remove paper exchange across the service. We will invest in mobile technology to support Primary Care staff working on visits to patient s homes, care and nursing homes, and when in other care settings. This will replace static machines in clinic rooms with plug in hubs so that the clinician has access to the same device and software wherever they are working. Network connectivity and bandwidth are critical factors in this aspect of our digital service landscape. To support out of hours, federated practice working and unplanned care in other settings, the GP records need to be shared with appropriate safeguards and patient consent. We have been working to share key information via Summary Care Records (SCR), including enhancing the SCR and encouraging standardisation on a single Primary Care system platform. This will ensure the full record can be viewed and updated in an expedient manner. As tactical moves during 2016/17 we will implement; Contributing to enhanced SCR for patients with an Advanced or End of Life care plan to support OOH and Ambulance services viewing the record. EPRCore in the Acute hospital ED and admission ward settings for a more complete summary. Progress towards the Dorset Care Record to create a unified view across health and care settings. Supporting standardised primary care systems to underpin federated practices, and community hub working. We will develop a Single Active Directory domain for GP practices to support greater flexibility in file sharing and shared working across Federations. Roll out instant messaging and presence across Health and Social Care partners (Skype and similar). Videoconferencing to improve team working and reduce journeys. FIGURE 11 : CCG STAFF BRIEFING VIDEOCONFERENCE Co-ordinating Microsoft licensing to achieve economies of scale and shared working spaces (Office 365 and SharePoint). Developing opportunities for integrated telecommunications that support federated working. g. Specialist and Regional services Patients from Dorset with complex and rare conditions are referred to a number of specialist centres outside the county, particularly Southampton University Hospital, United Bristol Hospital, and several London Trusts. We will work with neighbouring LDR areas, and with 31 P a g e O c t o b e r

32 these Trusts to use technology to enhance continuity of care, and ensure that summaries of care given elsewhere are shared as appropriate. h. Prisons and Custody health Dorset were innovators in the use of SystmOne in support of clinical services, firstly for the Prisons Health team, and then for Custody Health. These have both now been adopted nationally, and we will continue to work with the services commissioned for Health and Justice 21 Some years ago, we installed videoconferencing links for telemedicine in the Prisons Estate in Dorset, and extending the use of this with local providers will be explored. 10. Enabling mobility for all care settings To maximise the value of investment in infrastructure and staff training and to support mobility and multi-agency working for all our staff, we recognise a need to collaborate and co-ordinate our technology infrastructure. Investment in Wi-Fi networks throughout the NHS estate for staff from all agencies, and for patients/visitors, to meet the Martha Lane Fox Wi-Fi challenge. Working with partners to enable reciprocal access in local authority and other public buildings. Docking stations for roaming clinical staff and practitioners in multi-agency clinical rooms. Enabling integrated health and social care teams to work seamlessly. Use of secure cloud technologies and robust shared infrastructure. Innovative technologies to support timely data entry and interaction in a range of settings. We have initiated discussions with several potential strategic suppliers in the mobile carrier space to address a key problem our staff have across the service landscape; signal coverage. Several carriers have stated that if we award them a contract they will invest in boosting network coverage for the county. Coupled with an agreement to use public Wi-Fi services this has the potential to drastically reduce our connectivity blackspots across both rural and urban areas. a. Wide area networking Many GP practice networks connecting them to external resources are working beyond capacity. Their connection was based on historic sizing, but general workload and the prospects for undertaking virtual appointments and increasing exchange of information between partners will require faster connections with greater bandwidth. The investment we have already made in separate connections to support Wi-Fi in GP practices has taken some of the pressure, but providing public Wi-Fi in all care settings is a new challenge P a g e O c t o b e r

33 Our community provider has similar issues serving many small sites, and a Community of Interest Network (CoIN) between their main sites, which needs refreshing. To support One Acute Network, in particular diagnostic quality image transfer, high capacity triangulated resilient inter-site links are planned to be implemented between the Acute Trusts. Increasingly to support integrated health and social care teams, outreach with Acute hospital staff working in community settings, care staff working in schools, homes and a variety of other settings, we will need to ensure that all health and social care staff have appropriate connectivity wherever possible to support their front line duties. The NHS Network (N3) is nationally being migrated to a framework for Health and Social Care Network (HSCN 22 ), transitioning in March This will provide an opportunity to be more joined up in our provision, but also some challenges around how this is funded and supported. We are creating a Network Architects Group to create our System wide approach to networking. The local authorities have been enabling access for other agencies to use in council offices and public Wi-Fi access in some residential and care homes. We are aiming to work collaboratively on a common approach to public Wi-Fi access on public sector premises. b. Remote and Mobile Access Whilst the costs for mobile data telephony are reducing, connectivity remains a significant and real challenge in parts of both the rural and urban landscape. In particular Dorset HealthCare have invested heavily in mobility of their workforce, with over 1000 staff issued with laptops and SIM cards to enable working in patient homes and other settings. Together with the CCG they have invested in a shared Wi-Fi network infrastructure in GP practices, providing secured access back to N3 and Trust resources. This has also been made available in a more ad-hoc way to other Health and Social Care organisations. We are aware of the national GovRoam 23 initiative for shared Wi-Fi infrastructure, and Dorset Police and Dorset County Council have been working to implement a Pan-Dorset network. All agencies are currently considering options, and we will converge this work. The CCG have been seeking to equip GPs and other practice staff with mobile devices in place of fixed equipment, and to implement this in a way that enables visiting staff from other organisations to work effectively. All partners will need to work towards enabling others to connect via their networks to shared and remote resources. A strategy to make this easy for non-technical staff to plug in and connect will be developed. A Pan-Dorset multiagency public sector Wi-Fi approach is being pursued. 22 Health and Social Care Network (HSCN) 23 GovRoam started in Holland, being promoted in the UK via 33 P a g e O c t o b e r

34 We will also seek collaborative opportunities to procure or develop mobile applications for staff to support effective working to support effective access and ease of use. Each organisation will continue to be responsible for the security of the devices used by their staff, and the information stored on their resources. We aim to leverage use of NHS Smartcards for local authentication purposes, and alternative authentication techniques as these become available. c. Data Centre consolidation and Cloud opportunities Amongst the partners, each has one or more datacentre. Maintaining the required resilience and capacity is becoming increasingly uneconomic against cloud based opportunities. Health and Social Care partners will look together at opportunities for consolidation and where appropriate use of secure cloud based hosting. We will take due regard for the levels of resilience required for emergency or major incident working. Southwestern Ambulance have indicated that to preserve 999 resilience they will continue with locally hosted services into the medium term. Gartner Says By 2020, a Corporate "No Cloud" Policy Will Be as Rare as a "No Internet" Policy Is Today 24 d. Disconnecting data from applications Proprietary systems create their schemas according to their own data dictionaries. This creates problems in combining information from multiple sources, but more particularly in ensuring continuity of clinical information between changes in clinical service or IT system provider. Other paradigms should be explored. The concept of Vendor Neutral Archives for imaging are well known, and reduce the disruption at boundaries and at contract end. Using a H&SC owned data schema and buying or building applications that use this is a concept adopted within the NHS Digital Code4Health 25 initiative, using largely open source technologies, and the Apperta 26 foundation as a repository for tested code and managed services. We will evaluate opportunities to adopt this approach. e. Innovative technology To make it easier for people to control their health and care, and to optimise the use of clinical and practitioner time in documenting and communicating care, we envisage progressing alternative human-machine devices including; - Hands free and gesture based devices - Digital paper - Blended reality and Virtual Reality, and immersive computing - Holographic computing e.g. HoloLens, Vitae VR June P a g e O c t o b e r

35 - Digital gloves e.g. Air Mouse, Leap Motion - Gamification - Machine Learning - The Internet of Things enabling environmental control and alerting It will be important to use Business Process Management (BPM) to optimise processes and to harness the Digital Skills on our doorstep at both Bournemouth University and local private sector companies. More details in section System intelligence and decision support a. Decision support As the service transformation progresses and new services to people are developed, we will develop a Directory of Service facilities for professional staff, and intelligent decision support resources for the public to signpost them to appropriate services. This includes self-assessment for entitlement to social care service, and self-care for minor conditions. Additionally, decision support algorithms will have a role in encouraging alternatives to attending the Accident Department or the GP. We will evaluate, implement and promote automated triage facilities to support those people who are able and choose to use digital means to contact services. This will free staff capacity to deal with those people with more complex needs, and those who do not have access to digital technology. Decision Support Tools to assist in diagnosis, treatment and care of people will be procured. As personalised and genomics based medicine progresses, these will become increasingly sophisticated and necessary to support practice across the range of care settings. b. Artificial Intelligence and Machine Learning We will seek opportunities for utilising automation, artificial intelligence and machine learning. This will benefit both clinical and administrative processes. Progress is currently being considered in the following areas; - Highlighting variance and deterioration - Assisting in diagnosis of rare cancers - Histology breast cancer diagnosis - Radiology image recognition to aid diagnosis - Identification of potential duplicate records - Public Health data visualisation c. Whole systems intelligence As Genomics and personalised healthcare proceed bringing together information about a person into a single record, or linking elements together intelligently, will bring direct benefits to care of that person. Understanding the needs of the population and the efficiency and effectiveness of health and care services also require a joined up approach to information. We will build the 35 P a g e O c t o b e r

36 capability to link relevant information together to improve the health and care of individuals and the population. This will be undertaken with respect the confidentiality of information about individuals and person identity appropriately pseudonymised to protect anonymity. Where a person has opted out of data sharing by notifying agencies this will be respected. Elsewhere bringing together such information has helped services to better support communities by identifying those most in need of targeted support, and ensuring that services are optimally located to serve the population as demographic changes and building development alters the profile of our communities. Whilst Business Intelligence has been considered separately for individual organisations to date, bringing together a community of business intelligence/information professionals to build trust and collaborative working is essential to joining up health and care, and achieving our shared transformation plans. We are networking our digital services to achieve this FIGURE 12 : DATA, INFORMATION, KNOWLEDGE AND WISDOM PYRAMID We need to plan how to include wisdom generation or thoughtflow in to frontline systems. How do we influence the frontline decision-making and ensure organisational knowledge is shared by surfacing big data at the point of care? We will take advantage of techniques used by tools increasingly used in other industries, such as Google DeepMind, whilst safeguarding personal 36 P a g e O c t o b e r

37 identifiable information. As personalised medicine and the use of Genome information becomes more prevalent, the importance of this real-time decision assistive technology will increase. To support the system-wide business intelligence work, we will develop appropriate arrangements for handling and combining person identifiable information. 12. Supporting Innovation in Digital Care Innovation is crucial to the continuing success and development of any organisation or company. Within the NHS and local authorities, this means transforming outcomes for people through the application of innovative technology, providing choice and empowering people to self-mange and installing the individual as the conductor of their own health and wellbeing orchestra. Dorset has become a rich landscape of opportunity, housing the UK s fastest growing digital economy comprising of over 300 digital and creative organisations employing over 8,000 people, some of whom are already working with health and social care partners to deliver innovative solutions. With the unique health and wellbeing demographic of Dorset, the power of cross sector collaboration between these two areas is explosive. We need to establish an ecosystem that supports and encourages collaboration which: a) Addresses the key needs of our frontline staff The goal of any digital solution needs to add value to the clinical and practitioner frontline staff environment reduction in paperwork/administration, monitoring, analysis innovation needs to support development of tools and solutions that enhance the role of clinicians and staff, reducing time spent on systems management and increasing time spent delivering person centred care. Working closely with those delivering care is essential to ensure we understand where the most value can be delivered. b) Maintains security of information about a person Information Governance is a vital element in the developing landscape of digital health solutions. With the rapidly expanding range of Wi-Fi enabled peripherals, wearables, monitoring platforms and digitally enabled information capture tools, our challenges around security of personalised information have increased. It is therefore vital that we incorporate this element into our innovative thinking, to ensure secure and robust solutions are developed. We are investigating ways to leverage the use of NHS Smartcard to additionally provide unified single sign-on for local systems and use of alternative authentication mechanisms as these become available. c) Links as appropriate with main clinical and case management records within the county To deliver truly integrated care, any proposed solutions need to consider inter-operability and integration with existing systems. For clinicians and practitioners to deliver fast and effective care and patients/service users to have an improved experience, which includes access to their information, we need to ensure that all solutions communicate with each other, with subject consent, so as to provide a true and accurate picture of the individual. 37 P a g e O c t o b e r

38 d) Recognises the value of the intellectual property and development effort of our staff Across Dorset we have many staff that will contribute to our innovation efforts in developing digital health solutions. Understanding the implications of intellectual property as part of the innovation and development process is a key element within WIRED. Through this platform, we aim to utilise the power of staff involvement in developing solutions for our future. As outlined in our 2020 Digital Ambition in section 4, within the next 5 years, the ambition is to establish a fully integrated digital pathway for management of long term conditions, enabling people to live independently as long as possible, for clinicians and practitioners to take a more preventative approach and to focus their time on people who require active intervention. By expanding our current Telehealth and assistive technology services, moving to a model which is proactive, utilising a range of wearable devices and self-management options, the goal is to develop the next generation of digital health and care solutions. Through the creation of collaborative relationships, we are committed to delivering innovative digital solutions to health and wellbeing, through focussed collaboration between clinical, digital, academic and life sciences sectors, targeted at the following strategic priorities: Prevention at scale Integrated Community Services One Acute Network The goal is to develop and deliver solutions which support these priorities reducing admissions to A&E, reducing variation in health and wellbeing outcomes, delivering care closer to home, improving continuity of care and the patient experience, in a cost effective and financially sustainable way. At the time of writing several collaborations are underway, with specific regard to ground breaking work implementing the use of Virtual Reality into existing mental health pathways. Gamification concepts are also currently being explored as part of a strategy to address Prevention at Scale. 38 P a g e O c t o b e r

39 FIGURE 13: POSTER FOR OUR SECOND INNOVATION SHOWCASE EVENT The scope of the ambition within NHS Dorset CCG to adopt and implement digital solutions into current pathways and practices is broad, with the intention to establish Dorset as national and international leaders in digital health solutions. As part of this transformation, our Digital roadmap needs to accommodate emerging and developing technologies that can be applied to support and enhance clinical services and patient experience, such as: Virtual Reality Video Gaming Rehabilitation Computational simulations/modelling Artificial Intelligence Portable Diagnostics Blockchain encryption Genome sequencing Assistive technologies / Rehabilitative Robotics Community connectivity / Circle of Care All of these disciplines are represented within the network of collaborators working together, and it is our ambition to integrate them into the service landscape to transform how we deliver healthcare in Dorset. 39 P a g e O c t o b e r

40 13. Supporting Networked Expertise a. Portfolio of work A portfolio of projects has been initiated to enable the digital transformation outlined in this roadmap. This will be overseen by the Dorset Informatics Group, and managed by partners. A lead has been identified for each strand of the portfolio. b. Dorset Information Sharing Charter (DISC) Health and social care organisations in Dorset have been working together to renew the information sharing arrangements between them. This was launched in January 2016 with the Information Commissioner participating at a Dare to Share event at the Poole Lighthouse. The Dorset Information Sharing Charter 27 is the high level agreement which enables the lawful and secure exchange of personal information between partners, to support appropriate data sharing in the best interests of the person to which it relates. DISC aims to provide Dorset partner agencies with a robust foundation for the lawful, secure and confidential sharing of personal information between themselves and other public, private or voluntary sector organisations that they work, or wish to work, in partnership with. It will enable all partner organisations to share information safely and provide a more integrated service for residents. Any organisation signed up to the charter is provided with access to a toolkit of documents to assist information sharing within their organisation and across partner organisations. Underneath this arrangement, the specific details of an exchange or share of data will be detailed in a Personal Information Sharing Agreement (PISA). Individual PISAs will be developed and agreed by the Information Governance leads of participating organisations who need to share personal information to enable services. All the main Health and Social Care services in the county are signed up to the DISC to underpin the sharing of information about people in their care. Signup from Individual GP practices is currently underway (47% signed up by Oct 2016) with DISC participation a vital first step for any new partners. c. Funding The partners via agreements at the System Leadership Team and with the Dorset Informatics Group (DIG) recognise the importance and the enabling nature of this agenda. We have resolved; a. To use the DIG to share plans and priorities, and investment intentions b. Where possible and useful to co-ordinate system implementation c. To move towards a shared investment stream P a g e O c t o b e r

41 d. To work together to enable universal access for staff roaming across organisations e. To collaboratively bid for external funding To enable this, the group are combining Dorset wide capability and resources to deliver this ambitious agenda. We are aware of potential external sources of funding from; the Primary Care Estates and Technology Development fund, The 4.2 billion Technology fund, including: 1.8 billion to create a paper free NHS, which includes 900m of capital investment to put in place primary and secondary IT systems that will work together seamlessly, with an extra 400m for running costs. 1 billion for infrastructure, cyber security and data consent; 750 million to transform out-of-hospital care, including digital primary care, medicines, social care digitalisation and digital urgent and emergency care; 400 million for enabling the NHS to become digital, including a new website NHS.uk, apps, free Wi-Fi and telehealth; and 250 million for data for outcomes and research. We are also investigating local partnerships, including with the local Universities and digital industry. d. Digital Shared Services To efficiently support the shared agenda, the four Informatics Services supporting NHS organisations in the county are considering combining to form a single shared IT service across the three Acute Trusts, Dorset HealthCare and the CCG entities, also providing IT support to GP practices. We will continue to collaborate with the three local authority IT Teams. e. Change management The Dorset Informatics Group will oversee the programme of shared work arising from the roadmap. This will be managed according to the Managing Successful Programmes (MSP) Framework, and Prince2 project management methodology. A Portfolio Management function is being setup to coordinate this for the entire Sustainability and Transformation Plan (STP), and the digital programme. We will need very proactive clinical and management leadership to successfully deliver change, with a clear vision of what needs to be achieved, why it is important to partners, our population and staff. Each organisation has CCIO and CIO leadership and recognises the huge behavioural change that will be required to successfully achieve the transformation. We are setting up a competency centre to develop skills in transformation and change management. There will be a need for significant education, marketing and awareness amongst the population of the opportunities for care closer to home and the benefits of accessing the range of new services and self-help opportunities. Supporting this will be a programme of planning, stakeholder engagement, understanding and overcoming barriers to change, being prepared to flex the programme to accommodate changing circumstances, and celebrating and sharing successful steps on the journey. 41 P a g e O c t o b e r

42 The detailed organisational structure has not yet been finalised, but it is anticipated that a Change Authority will be required for overseeing and approving any significant changes to scope of the programme as it affects the partners. Unless devolved to a sub-group the Dorset Informatics Group will undertake that role. The change authority will; Capture a planned change to scope, cost or time Examine the impact on the objectives and business case, and severity Propose evaluate and recommend options to move forwards Decide on a preferred course of action, and escalate if required Implement the change f. Benefits Management The benefits approach will sit within that of the overall Sustainability and Transformational plan. To ensure that benefits are identified, shared and driven through the Health and Care system within Dorset, they will need to be proactively managed throughout the entire investment lifecycle. In implementing changes across multiple organisations, the benefits may arise in a different organisation to that which needs to invest time or money, and visibility of the tracked benefits will aid partners in further investing in shared projects. A benefits management plan and benefits log will be maintained at a programme level with planned benefits for significant projects feeding the shared log, making use of the HSCIC/ NHS Digital benefits framework 28. Our programme will support and compliment the patient benefits as outlined in the Sustainability and Transformation Plan. The quality, experience and satisfaction of citizens should be enhanced, but every prevented visit to an NHS service also results in a saving, potentially up to: 31 for a GP visit, 114 for an A&E attendance, and 3,283 for an inpatient stay in hospital. A assessment on transforming public services using technology assesses the cost savings of shifting channel between face to face, phone and web based consultations as based on; 28 HSCIC Benefits Framework 42 P a g e O c t o b e r

43 Moving some work to phone and web based interactions makes our services more accessible for people, often around the clock, and more efficient and less costly for the public service. g. Risk Management As part of developing business cases individual projects will maintain risk and issues logs and report these via highlight reports to the Dorset Informatics Group (DIG). A programme-wide risks and issues log will be maintained and reported as required via the portfolio management office. DIG members will work together to mitigate and resolve risks so far as is possible. The Risk Management will follow the Prince2 Management of Risks approach: Identification of risks (or positive opportunities) Assessing the likelihood, impact and proximity Planning to avoid, reduce, fall back, transfer or accept the risks Implement the plan with a clear risk owner and response Communicating throughout to ensure partners are aware and able to assist in mitigation h. Rate limiting factors Frontline staff welcome changes and systems that will enhance their job and visibly improve the care of people they work with. However, the transition from existing to new ways of working can be challenging and initially disruptive. Good communication and participation will assist in minimising issues. We believe that our capacity to achieve this exciting agenda will be constrained by; Factor Issue Mitigation Funding Aligning funding mechanisms, and uncertainty about status or success on bids may delay elements Information governance Capacity Interoperability Culture change Organisational changes Concerns about data subject consent, and entitlement to share between organisations The same key technical resources are required to achieve multiple parts of the programme, plus existing internal work for agencies. The Open API framework for interoperability will be differentially adopted by existing suppliers Behaviour and organisational culture Likely Local Authority boundary changes, and future NHS reorganisation Maintaining flexibility of the programme, bidding for available funds, and persuading partners to invest together for common good. Early work on Dorset Information Sharing Charter, and changes to Caldicott principles provide framework to promote sharing. Scheduling to avoid clashes, use of external resource to bolster capacity, and exploring ways to share, standardise and trust each others resources. Lobby suppliers and the centre to engage in the benefits for all from standardised Open API based interoperability, and ensure that it features in all new procurements. We need to communicate early and often to ensure that the need to change is understood, and provide adequate training on good systems people find easy and helpful to use. Ongoing process, we need to ensure that the roadmap provides tools to work across organisational boundaries and through changes. 43 P a g e O c t o b e r

44 14. Wider participation - Independent sector and others Dorset was an early innovator in the use of Primary Care/GP systems for prisons health and custody suites. This has now become a national initiative, and a current priority is enabling staff who are caring for inmates to get access to their prior Primary Care clinical records. Where practices are using the same system, this will be seamless, otherwise we anticipate a role for GP Connect. We will explore opportunities to work with the police and fire services 29 on using digital services to help with protection of vulnerable individuals and jointly signposting people to appropriate services, and support emergency planning and major incident response with Local Resilience Forum partners. The big data opportunities for targeting preventative measures are already being demonstrated elsewhere. The following is a non-exhaustive list of Independent organisations providing health and care for people in Dorset, and they will need to be involved in our plans. Many of these have been engaged through the quality improvement processes surrounding commissioning care; Organisation Commissioned and available services Systems, and established links Tricuro Three Local Authorities Social Care Hocas Arms Length organisation, including re-ablement BMI Harbour Hospital, Poole Orthopaedics, Pain management, diagnostics, Physiotherapy, Cancer Care, Cosmetic Surgery, Private GP services BMI Winterbourne Hospital, Dorchester Nuffield Bournemouth Hospital Orthopaedics, Oncology, Cosmetic Surgery, Endoscopy, General Surgery, Ophthalmology, diagnostics Orthopaedics, diagnostics, private GP Links to Poole Hospital PACS archive Links to Dorchester Hospital PACS archive Newhall Hospital Salisbury Orthopaedics, endoscopy, variety EPR, PACS for Spinal work Virgin Health Lyme Regis GP and community care TPP SystmOne Help and Care Alzheimer s Society Advocacy Memory Support Care and residential homes Domiciliary care providers 29 Fire as a health asset 44 P a g e O c t o b e r

45 Weldmar Hospices, Dorchester and Weymouth Lewis Manning Hospice, Poole AECC Boscombe Cobalt Gloucester Marie Stopes BPS Palliative care Palliative care Open bore MRI Scanner Large bore MRI Scanner Contraception and abortion Contraception and abortion Crosscare, links to Dorset county hospital 15. Glossary AHSN Academic Health Science Network CCG Clinical Commissioning Group CoIN- Community of Interest Network DIG Dorset Informatics Group DISC Dorset Information Sharing Charter - Wessex AHSN is one of 15 nationally - NHS Dorset CCG, purchases healthcare - secured network for an organisation or area - multiagency group to oversee Dorset Informatics - agreement between organisations in Dorset HSCIC Health and Social Care Information Centre national body, recently relabelled NHS Digital HSCN Health and Social Care network NIB National Information Board N3 NHS Wide Area Network - the next generation wide area network - oversees strategy nationally - private network for the NHS, also see HSCN PISA - Personal Information Sharing Agreement - describes individual reasons and methods to share PF@POC Paper-free at point of care - ambition of national 5-year plan - achieve by 2020 PPEG Patient and Public Engagement Group STP Sustainability and Transformation Plan - engagement group facilitated by NHS Dorset CCG - community service redesign strategy 16. Annex A: Sample person centred journeys We have held workshops with clinicians, practitioners, technical staff and with patient representatives to consider how interactions with health and care community services will change over the next 5 years and how these will be enhanced through use of Digital technology. Our service transformation programme is aiming to provide more care closer to home, and to coordinate between agencies working with people, and remote access to expert opinions through use of digital technology. 45 P a g e O c t o b e r

46 a. Long Term condition Joan s story b. Planned Care Hip Operation Eva s story The second example is an elective case, it highlights the carer/family impacts of uncertainty, and the readiness for some citizens to make use of digital channels in pre-operative planning, and aftercare. 46 P a g e O c t o b e r

47 47 P a g e O c t o b e r

48 c. Acute Hospital Journeys These two patient journeys highlight how adoption of improved technology across our networked Acute care settings will transform and underpin care in an Aute setting for the unwell patient. John Brown, a 42-year-old man with is brought to the Emergency Department (ED) via an ambulance, having collapsed as home with central chest pain. During the ambulance journey the paramedics access the national Summary Care Record (SCR) and obtain important information (about drug allergies and intolerances) to stabilise John appropriately and they discover that he is a diabetic on insulin and allergic to penicillin. The paramedics are able to transmit electronically, to the ED staff, his ECG heart tracing, their working diagnosis of a possible myocardial infarction together and details of treatments given. The ED staff confirmed that the cardiac intervention unit will pre warned in case they are needed. The ED staff are fully prepared for John when he arrives. The clinical team are able to access John s past medical history from the hospital s electronic patient information systems in use (as John is already known to the service) and the primary care systems (including SCR). The ED registration process is virtually complete (pending a data quality check on arrival). A bar-coded bracelet and blood sample labels are created so that John s process through the trust is safe. A repeat ECG is performed and is sent wirelessly to the ECG archive on the electronic patient records (EPR). The clinical team compare it with previous ECGs and confirm an acute myocardial infarction. John is transferred to the cardiac intervention unit for primary angioplasty to open up the blocked artery in his heart. A record of the procedure is stored on the EPR and a copy of this report is sent directly to his GP, before he has left for the Coronary Care ward. Throughout John s episode in ED, Coronary Care and Inpatient wards any activity/observations/assessments and plans are fed into the EPR via host departmental system (e.g. Cardiology, Endoscopy) so that any clinician subsequently delivering care will see what has happened and the trends over time. A modern clinical system will calculate an Early Warning Score for John to alert clinical staff if his condition deteriorates. Free text entry to the EPR will be kept to a minimum to keep the data entry swift and an easier retrieval of key facts, e.g. an electronic ward round template will enable ward recording easier. John s GP is kept informed of his progress and Estimated Date of Discharge via electronic messages directly to the GP system at critical points of his journey and is able to provide input to John s care as necessary. If clinically indicated, John s care will form part of a predetermined (evidence based) clinical pathway, which, carried by the EPR, will provide prompts and reminders to clinical staff to enable the most effective recovery. In John s case this involved alerting the diabetic nurse specialist to review his insulin treatment. 48 P a g e O c t o b e r

49 Investigations will be requested electronically and results will be flagged up on the EPR requiring acknowledgement. Certain test results will be paged automatically to the medical firm who will carry suitable handheld devices allowing them to view EPR from wherever they are in the Trust. Throughout the journey John s prescribed drugs will be recorded on an Electronic Prescribing and Medicines Administration system (which in turn feeds a data set to the EPR) with automatic cross referencing for drug interactions allergies and intolerances and other prompts as indicated by the clinical pathway or care bundle. The rota for all clinical staff will be visible electronically, which will help ward staff access relevant peripatetic staff more efficiently. When John has recovered sufficiently, the clinical staff will create the discharge summary directly from the EPR system, which will enable the booking of suitable OP appointments. The discharge summary will be automatically sent electronically to the relevant GP. The structured and standardised nature of the data captured about John s stay allows all aspects to be accurate coded and audited against the expected care pathway for discussion at the regular departmental audit meetings. The details of John s episode of care captured on EPR will be accessible to appropriate health and social care professionals in the community to support seamless management of John s on going care needs. For example, if John spends some time at a community hospital perhaps undergoing a course of rehabilitation, the EPR will be available to that clinical team to enable a smooth handover of his care. John will have the choice of services and locations for follow up treatment and may review some data on the national NHS Choices web site to guide him. If he chooses the Trust s specialist cardiology outpatient clinic for this aspect of his care, there would be no paper records to retrieve as all of his inpatient care was captured electronically. Clinical staff in outpatients continue to add to John s electronic record during the consultation by a mixture of handwriting (that is converted to a digital input to the EPR directly after the consultation), digital forms, transcribed voice recording files and direct keyboard entry. At the point of discharge from Outpatients, a summary of John s care is sent electronically to the GP and to John himself, who will be able to securely access his record on CV online for future reference. A copy of all the electronic records captured during the episode will be made available to John for him to upload to one of a range of trusted repositories of Personal Health Records and to present to a future provider of healthcare. Jane is John s 17-year-old daughter. She is seen to have a fit by friends whilst on a school trip. One of her friends happened to capture the fit on a video that she was making to record the trip. Jane is taken to the emergency department but recovers within a few hours and is sent home for outpatient follow-up. Her GP refers her to the first-seizure service where she is seen a few days later. She is sent an electronic reminder of her appointment the day before along with a link to information 49 P a g e O c t o b e r

50 about how to find the outpatient department where she is to be seen and transport options. She is also given details of what to expect and about what would be helpful for her to bring to clinic and a questionnaire to fill in and return via a secure patient portal. Jane and her parents have previously found the large hospital campus confusing to navigate and car parking difficult which made her late and stressed for a previous appointment. On this occasion the patient portal has recently been upgraded to include a way finding application which interacts with her smart phone s GPS to direct her to a vacant car park space and then the quickest walking route to the outpatient reception she needs. As such she arrives in the outpatient department without stress and then checks in electronically, further reducing wasted time spent on queuing. The nurse comes to find her a few minutes later and records her routine observations and an ECG. She then sees the consultant neurologist who has already reviewed her questionnaire and the clip of the fit taken by her friend which she has uploaded to the patient portal. During the consultation Jane mentions that there have been a number of episodes of feeling odd with word-finding difficulties in the last year or two. The history and examination details are recorded electronically on Jane s electronic patient record and with her consent the video is also uploaded to her record. The consultant explains what investigations are needed and offers possible appointments for MRI & EEG, including later the same day. Jane elects to have tests done the same day and a further appointment to see the consultant later the same day is arranged to feedback results. The consultant enters the outcome details from the consultation into the EPR including coding information and a natural language letter is generated from the entries. Jane is sent details electronically of where to go for the MRI scan & EEG. The investigations are completed and Jane is seen later the same afternoon by the consultant who explains that there is an area of abnormality on the left side of her brain which is the likely cause for her seizure and may have caused her previous briefer episodes. He explains what further investigations and treatment may be needed and the medical options. He provides advice covering first aid, safety and other relevant advice to Jane and her parents as well as contact details for the telephone and advice line, with additional electronic copies for Jane and leaflets for her parents. Jane reviews some videos of the treatment options available to her which the clinicians have found and posted to her portal page and links in to patients on the community website (e.g. patients like me.com) to discuss the options with her peers. After which Jane decides that she wants to start on medication and is given the initial prescription from clinic with a detailed description of how to build it up with reminders sent to her mobile phone s electronic diary via the patient portal. Copies of all the letters and information are sent securely to her patient portal. A further appointment is arranged for after her next MRI scan. Jane remains well and seizure free on medication, and interval scans show no change in the appearance of the area of abnormality on her scan, which is thought to be a form of tumour. She continues with interval imaging and as she grows older, her clinic reviews are conducted by videoconferencing as this fits in better with her work. Her details are provided to her and uploaded to her patient portal which she is able to use when she needs information for insurance or work purposes. 13 years later Jane is 38 weeks pregnant with her 1 st child when she has a further seizure. She has been counselled about epilepsy and pregnancy and has been kept under close review. Eclampsia is 50 P a g e O c t o b e r

51 excluded and a further MRI is arranged. Her healthy baby is delivered just before term. Throughout her admission she and her baby are provided with patient identification labels with RFID technology which allows ward staff to let her doctors and family to know where she is. The same technology automatically informs portering staff when she is ready to be brought back from the MRI department and for her consultant to know that she is back on the ward to discuss her scan results. Her consultant sees her on the maternity ward and discusses the repeat imaging which shows that there has been progression of the tumour. Jane s consultant shows her the scans and discusses the options. Jane s case is discussed in the MDT with the regional neuro-oncology & epilepsy surgery centre by video link and surgery is recommended following additional assessment. This is then discussed with Jane and she decides to be assessed for surgery. Her local scans and records are sent to the regional unit in preparation for surgery. Jane undergoes assessment and surgery at the regional epilepsy surgery centre, where they are able to remove most of the area of abnormality without causing any permanent deficit. However, as the area is near speech areas, not all of the embryological tumour could be removed and Jane is told that she will need long-term follow-up. The scans and clinical information from the surgery are copied to Jane s local hospital and she is followed up locally with interval imaging. She remains seizure free on adjusted medication following surgery and returns to work after the end of her maternity leave. 51 P a g e O c t o b e r

52 17. Annex B: Capability trajectory for Dorset The NHS Provider Digital Capability Matrix for organisations in Dorset was completed as a baseline in February We have since undertaken a review with partners of their ambition to achieve the capabilities in the plan over the next 3 years, and this is summarised in section 9. Category scores by Trust as follows; All the Trusts are making good progress, from a variable base. There are enormous programmes of work to undertake to achieve fully paperless records. The main NHS organisations have made good progress on sending discharge summaries, and are working towards other key areas of communication. There is some uncertainty on the means to automatically incorporate referrals into digital workflows, which will be dependent on national work. 52 P a g e O c t o b e r

53 There is significant variation in current progress on orders and results. Because Dorset Healthcare is dependent on others, and with a highly mobile workforce, progress is likely to be slower. For Medicines management, Dorset County have already widely implemented. The other two Acute organisations have selected the same supplier and are working towards integrating their solution. Dorset Healthcare have to select their forward plan on this. 53 P a g e O c t o b e r

54 Decision support is heavily dependent on structured information being available, and therefore dependent on progress with records. SWAST have entirely digital records, and use NHS Pathways. Dorset HealthCare have moved furthest on updating digital records at point of care, enabling them to progress digital alerting and workflow soonest. There are a number of small projects around the community supporting aspects of Remote Care. The use of online tools for virtual and remote consultations is a key strand in the STP plans for Dorset, but the detail is yet to be formulated. 54 P a g e O c t o b e r

55 The Asset and Resource Optimisation measure includes patient flow tracking, asset tracking, and automated interfaces for monitoring devices. Not all Trusts have plans for these as yet. All the Acute trusts intend to implement the AoMRC standards for transfers of care. There is less certainty in plans about adopting the SnomedCT standards in secondary care, and the GS1 barcode standards. 55 P a g e O c t o b e r

56 Infrastructure largely in place, with continuous improvement planned. Providing public Wi-Fi is a major new piece of work for all organisations, reciprocal seamless access for staff, and single sign-on across multiple clinical and operational systems continues to be a challenge. Social Care organisations were invited to complete a similar baseline survey for both Adults and Children s services. This was voluntary, collated by SOCITM. Dorset County Council did make a submission highlighting that the core social care record is stored digitally for both adults and children s services and NHS Numbers are fully deployed in Adult Care. There is work underway for children s services, to enable staff to access relevant information from point of care, and to access relevant information from other health and care providers. We plan to work with the three authorities on developing their trajectories. With Case Management systems under implementation in all of them, and our shared care record work, a step change in interoperability is anticipated, and in particular, all are engaged in work on the Universal Capabilities for Social Care notifications from hospitals, and for propagating Child Protetion information to appropriate urgent care settings. 56 P a g e O c t o b e r

57 18. Annex C: Overview of significant shared projects 57 P a g e O c t o b e r

58 19. Annex D : Digitally Enabled Portfolio Costs Capital and revenue costs over the 5 year plan period. Digitally Enabled Dorset Portfolio 5 year total 2016/ / / / /21 Capital Revenue Capital Revenue Capital Revenue Capital Revenue Capital Revenue Capital Revenue Shared Care Record 8,496,213 5,364,116 3,259, ,100 3,316, ,700 1,480,188 1,123, ,200 1,267,675-1,639,876 Intelligent working 2,050, , , ,000 1,537,500 30,000-30, Self Care 435, , ,500 50, , , , , ,000 Independent Living 264, ,000 64, , , ,000-63,000-63,000-3,000 Digital Shared Service 880,000-80, , Enabling Technologies 7,250,000 29,870,000 2,425,000 1,670,000 3,625,000 7,800,000 1,200,000 6,800,000-6,800,000-6,800,000 19,375,713 36,622,236 6,476,528 2,965,100 9,778,797 8,706,820 2,680,188 8,136, ,200 8,250,675-8,562, P a g e O c t o b e r

59 20. Annex E : Universal capabilities templates Instructions for Completion Please indicate your Local Digital Roadmap Footprint above Complete questions A to E in the subsequent pages the same structure is used for each of the 10 universal capabilities For further guidance, refer to: o Sections 6.24 to 6.30 of the Developing Local Digital Roadmaps o The Universal Capabilities Information and Resources document This template and the documents referenced above can be downloaded from the LDR page on the NHS England website A. Baseline Please summarise the current baseline across your local health and care system. The data may encompass deployment penetration (e.g. deployed in 80% of practices), volumetrics (e.g. accessed 2500 times in Q3) and take-up (e.g. accessed for 95% of prescriptions). B. Ambition With reference to the defined aims set out above, please set out your ambition in the grid below. Remember that clear momentum is expected in 16/17 and substantive delivery in 17/18. Also note that you can go further than the defined aims examples are provided in the Universal Capabilities Information and Resources document. C. Activities Please detail the activities you propose to undertake, by quarter, in the grid below. Separate activities should be separated out as separate bullet points. At the time of submission on 30 June 2016, any activities for 16/17 Q1 should be complete. D. National Services / Infrastructure / Standards In progressing the universal capabilities, if you are proposing to use alternative solutions to the national services, infrastructure and standards, please provide a rationale in the box below. E. Evidencing Progress Please set out your proposals below for evidencing progress towards the defined aims for the universal capability, as set above. Your response should be informed by any national metrics available, as described in the Universal Capabilities Information and Resources document. 59 P a g e O c t o b e r

60 Universal Capability: Capability Group: a. Professionals across care settings can access GPheld information on GP-prescribed medications, patient allergies and adverse reactions Records, assessments and plans Defined Aims: Information accessed for every patient presenting in an A&E, ambulance or 111 setting where this information may inform clinical decisions (including for out-of-area patients) Information accessed in community pharmacy and acute pharmacy where it could inform clinical decisions A. Baseline All GP practice systems in Dorset are capable of feeding SCR. 97% of patients in Dorset have a Summary Care Record. 11,500 of these are enriched to enable sharing of additional information. Community staff using SystmOne can access the GP records for patients from the 68/96 SystmOne practices where the individual records have been shared, and permission granted. Hospital Pharmacy staff can access drug information for patients from all 96 local practices and for visitors registered with a connected English practice via Summary Care Record, and this is in widespread use for drugs reconciliation. Emergency Departments do have access, but this is not so frequently used. Dorset Healthcare have implemented a SCR link for their community services using SystmOne, this includes the Urgent Care Centre in Weymouth, and Minor Injuries units in the county. The Dorset Out of hours/111 provider uses Adastra, which can launch straight to Summary Care Record for an identified patient, and is well used. We have commenced rollout of SCR to Community Pharmacies. B. Ambition Year Ambition 16/17 Access to enhanced Summary Care Record in urgent care settings 60 P a g e O c t o b e r

61 SystmOne EPR Core in Acute hospitals to simplify good access to GP records Mini-spine services for Community teams Rollout of web access to SCR to Crisis teams in Mental Health Rollout of SCR to Community Pharmacies around county 17/18 Dorset Care Record will incorporate summary primary care information alongside other information about a patient to provide a universal capability C. Activities Quarter Activities 16/17 Q1 16/17 Q2 Rollout EPRCore Poole / Dorchester Communication programme to encourage increased use of enhanced SCR by U&EC settings. 16/17 Q3 Rollout EPRCore RBH Continued promotion and increased access for community pharmacists to SCR 16/17 Q4 Mental Health Crisis team SCR online 17/18 Q1 17/18 Q2 Initial deployment of Dorset Care Record including Admission avoidance and early discharge from A&E based on better access to shared records 17/18 Q3 17/18 Q4 Continued promotion and rollout of access for appropriate staff D. National Services / Infrastructure / Standards We will use SCR but also link to more comprehensive record sharing, including updates from all parties, via Dorset Care Record, including on caseload for social care and mental health. E. Evidencing Progress National SCR usage statistics available monthly Agreement from GP practices to share records User logs on Dorset Care Record NHS Digital Map highlighting pharmacies with access to SCR K3DTj7gWKcb3tx6e4QjRPjfA 61 P a g e O c t o b e r

62 FIGURE 14 : PHARMACIES IN DORSET WITH ACCESS TO SCR - OCT P a g e O c t o b e r

63 Universal Capability: Capability Group: b. Clinicians in U&EC settings can access key GP-held information for those patients previously identified by GPs as most likely to present in U&EC Records, assessments and plans Defined Aims: Information available for all patients identified by GPs as most likely to present, subject to patient consent, encompassing reason for medication, significant medical history, anticipatory care information and immunisations Information accessed for every applicable patient presenting in an A&E, ambulance or 111 setting (including for out-of-area patients) A. Baseline Advanced Care Plans (ACPs) are ed or printed and faxed to the UCS by individual practices. A special message is created on Adastra to log that an ACP has been received. A note on the 999 despatch system advises that someone at the address has an ACP. These are not easily available and well accessed by SWAST staff. Enhanced Summary Care records are being created to share ACP and EoLC information. At Apr 2016, 7,000 records were marked for explicit consent to share escr. Dr Mark Spring at Sandford Surgery, and GP Out of Hours in Dorset is a national Case Study of the benefits of use. B. Ambition Year Ambition 16/17 Rollout of using Enhanced Summary Care Record to share ACP contents. Campaign to enrich the records for long-term condition patients. Target 16,000 most at risk patients with enriched SCR by end of Mar /18 Dorset Care Record will provide a more comprehensive record for these people with complex care needs, including an up to date picture on recent interactions, and which H&SC teams are engaged with them. 63 P a g e O c t o b e r

64 C. Activities Quarter Activities 16/17 Q1 Pilot 8 practices for use of new Anticipatory Care Plan (ACP) clinical template automatically feeding into SCR enriched records once patient consent is gained. 16/17 Q2 Roll out new ACP clinical template to the 68 SystmOne practices Communication programme to encourage GPs to set Consent for additional information on SCRs for the top 2% of at risk patients 16/17 Q3 Roll out new ACP clinical template to remaining practices on EMIS Web 16/17 Q4 Communication programme to encourage GPs to update Mental Health patients for SCR enriched records 17/18 Q1 17/18 Q2 escr access via Ambulance Control System, and potentially to paramedics at scene 17/18 Q3 Work to ensure that Dorset Care Record will become the point of reference for staff in urgent care settings to get an overview of existing arrangements across Health &Social Care D. National Services / Infrastructure / Standards We will use SCR, but also more comprehensive record sharing via Dorset Care Record, including on caseload for social care and mental health. E. Evidencing Progress Locally run queries on the Read code marking enabled for enhanced SCR. 64 P a g e O c t o b e r

65 Universal Capability: Capability Group: c. Patients can access their GP record Records, assessments and plans Defined Aims: Access to detailed coded GP records actively offered to patients who would benefit the most and where it supports their active management of a long term or complex condition Patients who request it are given access to their detailed coded GP record A. Baseline All GP systems in Dorset are capable of allowing access for patients, and the feature has been enabled in all but one, which is being migrated. February 2016 POMI dataset POMI statistics show only 50% of practices in Dorset having been enabled for access to records, with 6754 records (0.7%) marked for viewing test results o Highest enabled 53% Stalbridge, 27% Puddletown 3450 records (0.4%) marked for viewing letters 2070 records (0.3%) marked as enabled access to full coded records, over half of these are at one practice. (Puddletown) The data appears incomplete for some suppliers, which we have been pursuing with NHS Digital and the suppliers. B. Ambition 65 P a g e O c t o b e r

66 Year Ambition 16/17 To support all practices to enable online access to Detailed Coded patient records by end Dec 2016 Communication and training programme to encourage active promotion of online access by GP Practices Public campaign to inform Dorset residents of the facility. 17/18 Consolidation and support for practices and the public. C. Activities Quarter Activities 16/17 Q1 Contacted all practices to ensure access to Detailed Coded record is available (all but 2 sites in Dorset are compliant, and these are migrating) 16/17 Q2 16/17 Q3 Communication programme to encourage uptake of patient access to online records Training delivered via Locality meetings and clinical system user groups 16/17 Q4 17/18 Q1 17/18 Q2 Communications programme for the remainder 17/18 Q3 Identify exemplar practices and share experience D. National Services / Infrastructure / Standards Initially plan to use GP supplier patient portals. Ambition for Dorset Care Record within 5 year plan to enable citizen access to the shared record, to aid data quality, co-production, and a unified view of interactions across all H&SC partners. Also working with neighbouring communities and patient choice of Personal Health Records E. Evidencing Progress Please set out your proposals below for evidencing progress towards the defined aims for the universal capability, as set above. Your response should be informed by any national metrics available, as described in the Universal Capabilities Information and Resources document. POMI datasets 66 P a g e O c t o b e r

67 Universal Capability: Capability Group: d. GPs can refer electronically to secondary care Transfers of care Defined Aims: Every referral created and transferred electronically Every patient presented with information to support their choice of provider Every initial outpatient appointment booked for a date and time of the patient s choosing (subject to availability) [By Sep 17 80% of elective referrals made electronically] A. Baseline All Dorset Practices use ereferrals, and it is already used for booking the majority (81% March 2016) of first Outpatient Appointments. This includes 1688 for 2 week wait appointments, 527 assessments, and 641 GPSI/other appointments. The main area affecting ability of practices/patients to book appointments is shortage of appointments being displayed for booking by providers. (local acute service providers range from 20% to 51% of patients being unable to book an appointment as of July 2016) B. Ambition Year Ambition 16/17 Maintain 80% performance on use of ereferrals 17/18 Work with providers to manage capacity and enhance referral rates C. Activities Quarter Activities 16/17 Q1 Using direct communications through Dorset CCG s dedicated e-referral Helpdesk to update practices on specific services available, in particular locally services. Contacting practices that would benefit from additional / refresher training from the Dorset CCG ERS dedicated expert team that trains, advises and guides practices in referral pathways via the e-referral system (ongoing) 67 P a g e O c t o b e r

68 16/17 Q2 16/17 Q3 Revising and promoting our E-referral intranet page to include key training documentation/links, key referral pathways. Working with our Business Intelligence team to develop a tool to easily identify and work with any outlying practices from the Daily Booking Report Info 16/17 Q4 Implementation of revised Wessex 2WW forms to work with practices that are still faxing 2WWs and therefore increase ERS rates. Work with providers regarding slot availability issues to develop SDIPs (Service Development Improvement Plans) slot unavailability is a disincentive to GPs and patients as unable to book / choose appointment. 17/18 Q1 17/18 Q2 Identify through Business Intelligence and discussions with providers the most pressurised services and work with providers to manage services in order to provide more appointments. This is centred on driving down inappropriate referrals being received by the clinical teams to reduce rejected referrals being returned to practices. D. National Services / Infrastructure / Standards A number of our 2 week wait urgent referral pathways are tied to diagnostic testing, and we are exploring the use of ICE to speed the referral process E. Evidencing Progress Dorset Provider performance - July 2016 Published OP services Total DBS No of bookings July 2016 OP DBS Booking OP % DBS Organisation Last Month(July 16) - 21 working days DORSET COUNTY HOSPITAL % POOLE HOSPITAL % DORSET HEALTHCARE % ROYAL BOURNEMOUTH AND CHRISTCHURCH % 68 P a g e O c t o b e r

69 Appointment Slot issues (ASIs) by Dorset provider July 2016 Provider No Slots Slot Unavailable System Unavailable Total ASIs DBS Bookings ASIs Per DBS Booking DORSET COUNTY HOSPITAL % POOLE HOSPITAL % DORSET HEALTHCARE % ROYAL BOURNEMOUTH AND CHRISTCHURCH % Universal Capability: Capability Group: e. GPs receive timely electronic discharge summaries from secondary care Transfers of care Defined Aims: All discharge summaries sent electronically from all acute providers to the GP within 24 hours All discharge summaries shared in the form of structured electronic documents All discharge documentation aligned with Academy of Medical Royal Colleges headings A. Baseline As at end March 2016, all Acute providers in Dorset, plus the main community/mental health provider, are sending discharge summaries electronically via Mesh. Parallel paper flows scheduled to stop June These are not yet structured or using the full AoMRC headings. Additionally outpatient clinic letters are flowing in some cases, and MIU notifications for all. B. Ambition Year Ambition 16/17 Migrate unstructured MESH to ITK CDA structured messages. 69 P a g e O c t o b e r

70 Ensure all specialist department letters are sent this way. Stop sending paper copies. Adopt the AoMRC standards for discharge letters Meet target for A&E letters within 24 hours of discharge Aim to send all outpatient letters via electronic messages. Confirm significant out of county and independent sector feeds Migrate 111 MESH to CDA ITK 111 Messages 17/18 Target other correspondence Post Event Messages from paramedic records to GPs where patients not conveyed. C. Activities Quarter Activities 16/17 Q1 Poole Hospital to cease paper copies May /17 Q2 Dorchester implementing AoMRC Headings July /17 Q3 All discharge documents to AoMRC Headings format 16/17 Q4 Dorchester Cardiology Structured document transfer All ED documents flowing electronically Migrate SWAST 111 PEM to ITK CDA 17/18 Q1 Audit GP practices on continuing paper flows and issues 17/18 Q2 SWAST paramedic PEM to GP where patient not conveyed 17/18 Q3 Resolve issues raised by practices 17/18 Q4 D. National Services / Infrastructure / Standards Using national standards methods Kettering on Mesh moving to ITK CDA E. Evidencing Progress Reporting from providers, MOLES reporting on transactions, monitoring and auditing experience of GP practices on move to paperless. 70 P a g e O c t o b e r

71 Universal Capability: Capability Group: f. Social care receive timely electronic Assessment, Discharge and Withdrawal Notices from acute care Transfers of care Defined Aims: All Care Act 2014 compliant Assessment, Discharge and associated Withdrawal Notices sent electronically from the acute provider to local authority social care within the timescales specified in the Act A. Baseline The information is mostly not currently gathered in an electronic system, and is set by each NHS Provider, and accepted by the 3 local authorities. Royal Bournemouth paper Poole Hospital - EPR template, needs updating Dorchester paper and spreadsheet Dorset HealthCare - Community Hospitals - SystmOne template - Mental Health units - a form on RiO Our three Local Authorities are in the process of changing their case management systems, and we have highlighted the ITK CDA H&SC standard as a requirement during their procurement. We are investigating methods for our immediate neighbours Yeovil Hospital (East Somerset) Currently implementing Trackcare, Salisbury Hospital (South Wiltshire) - Currently implementing Lorenzo B. Ambition Year Ambition 16/17 Standardise the information and ensure it meets latest care act standards. Hospitals to develop templates for online capture of information, and the means to send to Local Authorities 17/18 Assessment, discharge and withdrawal notifications to flow from hospital settings to local authorities. Admissions notifications to social care or care providers 71 P a g e O c t o b e r

72 C. Activities Quarter Activities 16/17 Q2 Establish current practice across NHS and LA organisations 16/17 Q3 Develop means to digitally capture notice events on hospital wards with each provider 16/17 Q4 Ensure Trusts are using a new shared format notification 17/18 Q1 Electronic notification messages developed by providers 17/18 Q2 Mechanism tested to send notices to social care 17/18 Q3 Social care CMS readiness tested for receipt of messages 17/18 Q4 Live use of electronic notifications and acknowledgement across the three authorities from all local NHS providers D. National Services / Infrastructure / Standards Plan to use ITK CDA H&SC messaging E. Evidencing Progress Local validation with Social Care Departments, and NHS Digital MESH reporting. 72 P a g e O c t o b e r

73 Universal Capability: Capability Group: g. Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly Decision support Defined Aims: Child protection information checked for every child or pregnant mother presenting in an unscheduled care setting with a potential indicator of the child being at risk (including for out-of-area children) Indication of child protection plan, looked after child or unborn child protection plan (where they exist) flagged to clinician, along with social care contact details The social worker of a child on a child protection plan, looked after or on an unborn child protection plan receives a notification when that child presents at an unscheduled care setting and the clinician accesses the child protection alert in their record A. Baseline Please summarise the current baseline across your local health and care system. The data may encompass deployment penetration (e.g. deployed in 80% of practices), volumetrics (e.g. accessed 2500 times in Q3) and take-up (e.g. accessed for 95% of prescriptions). All three local authorities are using Raise from CareWorks, which was not enabled by the supplier for uploading CPIS. NHS providers are therefore not able to access information in this way. A project has been undertaken in the three LAs to ensure that NHS Numbers are recorded against all clients (Adults and Children). Procurement of new case management systems has recently been undertaken, and implementation is underway. These systems are able to interoperate with CPIS will be able to feed and receive CPIS information. We are already promoting use of Enriched SCR for other purposes, which will assist with rollout. B. Ambition Year Ambition 73 P a g e O c t o b e r

74 16/17 Expand use of SCR in Urgent care settings for other purposes. Ensure that the new Case Management systems implement CPIS features, and that NHS Numbers are recorded for all children 17/18 As Local authorities change their Children s systems, CPIS information will be made available. The relevant A&E departments, Minor Injuries and Out of hours services will be notified of the capability and encouraged to adopt as part of their standard operating procedures for safeguarding. C. Activities Quarter Activities 16/17 Q2 Promotion of use of escr in unplanned care 16/17 Q3 Assurance of use of NHS Number in Childrens systems 16/17 Q4 17/18 Q1 17/18 Q2 17/18 Q3 CPIS enabled in Dorset and Bournemouth Councils CPIS enabled in Borough of Poole 17/18 Q4 Promoting access to CPIS information in unplanned care D. National Services / Infrastructure / Standards Planning to use the national facilities of CPIS alongside SCR E. Evidencing Progress Local validation with Social Care Departments, ED, MIU and OOH care settings NHS Numbers on Social Care systems (current clients, not whole database Oct 2016) Adults Children Bournemouth 83 % 68 % Dorset 94 % 80 % Poole The main reasons given for why NHS Numbers are not available are; Dealing with Travellers, forces staff, and how names are stored (nicknames etc.) 74 P a g e O c t o b e r

75 Universal Capability: Capability Group: h. Professionals across care settings made aware of end-of-life preferences Decision support Defined Aims: All patients at end-of-life able to express (and change) their preferences to their GP and know that this will be available to those involved in their care All professionals from local providers involved in end-of-life care of patients (who are under the direct care of a GP) access recorded preference information where end-of-life status is flagged, known or suspected A. Baseline Currently enriching SCR for patients with an EoLC plan. GPs are therefore able to record and share the preference as given at the practice. Across Dorset, 8,050 patients in April 2016, rising to 11,500 in Sept 2016 have an enhanced SCR record (for any purpose, mostly Anticapatory Care Plans and End of Life care plans). Patients do change their preferences when in contact with other care givers, and this currently needs to be passed back to the practice to update the record, we have raised this nationally. Enrichment in primary care, and access to escr in urgent care settings is not universal. B. Ambition Year Ambition 16/17 Rollout using Enhanced Summary Care Record to share EoLC contents. Campaign to enrich the records for patients with an EoLC plan. Incorporate EoLC decisions in ACP clinical template across Dorset. 17/18 Dorset Care Record will provide a more comprehensive record for these people with complex care needs, including an up to date picture on recent interactions, and where plans and preferences change, to record and share this information. We will explore this. C. Activities 75 P a g e O c t o b e r

76 Quarter Activities 16/17 Q1 Pilot 8 practices for use of new Anticipatory Care Plan (ACP) clinical template incorporating EoLC decisions automatically feeding into SCR enriched records 16/17 Q2 Roll out new ACP clinical template to the 68 SystmOne practices Communication programme to encourage GPs to set Consent for additional information on SCRs for all EoLC patients Working with main Community Service and clinical system provider to ensure SCR information can be automatically updated from Community settings such as Community Matrons and District Nurses (subject to sharing agreements being set) 16/17 Q3 Communication programme to encourage GPs to update Mental Health patients for SCR enriched records Roll out new ACP clinical template to remaining practices on EMIS Web 16/17 Q4 Agree common coding used in clinical templates across Primary and Community settings for ACP and EoLC We are using escr, but have been very keen to progress the ability to update in other care settings. The rollout of Dorset Care Record will provide an opportunity to share changing EoLC intent discussions where this changes as people pass through relevant agencies. E. Evidencing Progress We are able to run a Trust level query on all TPP practices, and separately on all EMIS practices for the codes for escr consent. This does not differentiate the reason for enhancing the records. We have been monitoring this, as we have promoted the principle of using escr to disseminate ACPs. 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Dorset enriched SCR records 76 P a g e O c t o b e r

77 Universal Capability: Capability Group: i. GPs and community pharmacists can utilise electronic prescriptions Medicines management and optimisation Defined Aims: All permitted prescriptions electronic All prescriptions electronic for patients with and without nominations - for the latter, the majority of tokens electronic Repeat dispensing done electronically for all appropriate patients By end 16/17 60% of repeat prescriptions to be transmitted electronically By end 17/18 80% of repeat prescriptions to be transmitted electronically A. Baseline EPS has been deployed to 85 out of 98 practices. We have about 20 dispensing practices in the rural parts of the county, for whom this is not yet developed. (Aug practices now live). In April 2016, for 20 practices, over 75% of prescriptions were sent and claimed via EPS2. Practices handling EPS April 2016 Aug 2016 Over 75% of scripts % to 75% of scripts Over 5% of scripts P a g e O c t o b e r

78 For Repeat Dispensing, in April 2016 Over 5% of scripts 11 practices Over 0% of scripts processed 17 practice Current erd prescriptions rate at 2% of total scripts 78 P a g e O c t o b e r

79 Across Dorset, 39% of patients have nominated a pharmacy (Aug 2016) Dorset Practices - % of patients nominated for EPS Aug B. Ambition Year Ambition 16/17 Deployed EPS to 89 practices by end Mar 17 Increase EPS use to 60% of scripts in all practices Increase erd use to 15% 17/18 Increase EPS use to 80% Increase erd use to 25% We would also like to feed accurate current medication into Acute Hospitals to feed the Electronic Prescribing Medicines Administration (EPMA) systems, and support accurate recording of medications and drug interaction warnings C. Activities Quarter Activities 16/17 Q1 16/17 Q2 Communications for practices on benefits of EPS to them and their patients 16/17 Q3 Rollout EPS to 2 more practices Programme of 10 locality based training courses for GP and Pharmacy staff in the use of erd 16/17 Q4 Rollout EPS to 2 more practices Continuation of training courses for GP and Pharmacy staff in the use of erd 17/18 Q1 17/18 Q2 Subject to availability of EPS for dispensing practices, rollout 79 P a g e O c t o b e r

80 Quarter Activities EPS to remaining 8 practices 17/18 Q3 17/18 Q4 Aim to feed primary care medications into Acute EPMA systems via GP Connect FHIR messages or alternative D. National Services / Infrastructure / Standards We do have a high proportion of rural dispensing practices in the county (20%) which are not yet served by the electronic prescription service. We have also been discussing Outpatient scripts in the Acute hospitals E. Evidencing Progress National EPS and erd monthly statistics produced by HSCIC, currently sent to us by . This includes rate of EPS scripts, Repeat medications, and % of patients with nominations of a preferred pharmacy. Universal Capability: Capability Group: j. Patients can book appointments and order repeat prescriptions from their GP practice Remote care Defined Aims: [By end 16/17 10% of patients registered for one or more online services (repeat prescriptions, appointment booking or access to record)] All patients registered for these online services use them above alternative channels A. Baseline All GP systems in Dorset are capable of allowing access for patients, and the feature has been enabled in all but one, which is being migrated soon. March 2016 POMI dataset 14.5% of patients across the county are enabled to book appointments and allow repeat scripts, 14,004 appointments were made online, 33,358 repeat scripts requested in March P a g e O c t o b e r

81 7,886 Patients (24%) enabled at Adam practice, 79% at Sandford surgery B. Ambition Year Ambition 16/17 25% of patients across the county to be able to electronically book appointments or repeat scripts (12/100 have achieved this) 17/18 50% able to electronically book appointments or repeat scripts (2/100 practices have already achieved this). C. Activities Quarter Activities 16/17 Q1 16/17 Q2 Share progress towards the target 16/17 Q3 Support practices in implementing access to online services 16/17 Q4 17/18 Q1 Showcase practices that are seeing benefits 17/18 Q2 Support practices in implementing access to online services D. National Services / Infrastructure / Standards Using national services E. Evidencing Progress POMI datasets 81 P a g e O c t o b e r

82 21. Annex F : Information Sharing Approach 82 P a g e O c t o b e r