Delivering a Paperless NHS by Dr Masood Nazir General Practitioner Clinical Informatics Advisor NHS England

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1 Delivering a Paperless NHS by 2018 Dr Masood Nazir General Practitioner Clinical Informatics Advisor NHS England

2 About us The NHS Commissioning Board (NHS CB): was established as a special health authority on 31 October 2011 and as an executive non-departmental public body on 1 October 2012; plays a key role in the Government s vision to modernise the NHS and secure the best possible outcomes for patients. Renamed to NHS England 1 st April

3 3 Clinical Informatics Team Professor Jonathan Kay Chief Informatics Officer Multidisciplinary clinical leads Anne Cooper - Nurse David Davis Paramedic / AHP lead David Low Consultant Paediatrician Masood Nazir GP / CCG lead Network support team - Head of Informatics, Network support manager, project support Recognition that clinical input and networks are essential to deliver our goals

4 Every citizen should feel confident that information about their health is securely safeguarded and shared appropriately when that is in their interest. Everyone working in the health and social care system should see information governance as part of their responsibility. There is therefore a balance to be struck between protecting information and sharing it appropriately, legally and with proper safeguards. I know that this is something that can feel worrying for people, not just patients but also the professionals that care for them who simply want to be sure that they are doing the right thing. Dame Fiona Caldicott, Review Chair, April 2013

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6 Patient Online Vision Patients are enabled to take greater control of their own health and wellbeing supported by their General Practice offering a range of digital services......everyone who wishes to has online access to services at their convenience. General Practice teams are confident to offer Patient Online digital services to enhance the quality of patient care......especially for patients that General Practice teams know will benefit the most from Patient Online.

7 Drivers for change Unleashing the power of people - by using data and technology to drive efficiency, effectiveness and quality improvement The Spending Gap: It is estimated that there will be a shortfall of around 30bn in NHS finances within 5 years, as demand and costs rise. Yet there is unlikely to be a similar increase in public expenditure. Data and technology, through transforming productivity and enabling patients to do more for themselves, can play a major role in filling that gap. The Quality Gap: There continues to be widespread variation in the quality of health and care services, and in the offer to support citizens to manage their health and Wellbeing more effectively. Strategies of transparency, data sharing, and service personalisation are key to reducing variation. In the medium term, data and technology are essential prerequisites to the transformation in patient outcomes and healthcare costs The effective collection, analysis and dissemination of relevant information is essential for swift identification and prevention of substandard services; facilitating accountability; provision of accessible and relevant information to the public; and supporting patient choice of treatment. Robert Francis QC Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry

8 BMJ 29 th June 2013 Preventable Diabetes 8

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11 Domain 1 - Preventing people from dying prematurely Mike Richards

12 Domain 2 - Enhancing the quality of life for people with long term conditions Martin McShane

13 Domain 3 - Helping people to recover from episodes of ill health or following injury Keith Willett

14 Domain 4 - Ensuring that people have a positive experience of care Neil Churchill

15 Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm Mike Durkin

16 Birmingham CrossCity CCG current configuration Population: 730,000 patients Number of practices: 117 practices across 125 sites Formed from 3 PCTs across the city and Six former groups: Equity, UBC, SBIC, Sparkfield, BICC, NEB Made up of ten area based clinical networks

17 A complex 2 nd city 8 provider organisations: University Hospital Birmingham FT Queen Elizabeth Hospital Birmingham Heart of England FT Good Hope, Heartlands and Solihull Hospitals Sandwell & West Birmingham FT City, Sandwell Hospitals Birmingham Children s Hospital Birmingham Women s Hospital Royal Orthopaedic Hospital Birmingham Community Healthcare NHS Trust Birmingham and Solihull Mental Health Trust Birmingham City Council, Sandwell MBC and Solihull MBC WMAS (West Midlands Ambulance Service)

18 Patient/Clinician Journey Dr S Mr/s D

19 A simple, yet quite ambitious aim To create one record available to different Health and Social Care Services across the City Patients think we already do this The record will be: held centrally in a data warehouse accessed only with the expressed consent of the patient

20 Most people know their own history but... More vulnerable groups may not Complex frail elderly Children who need safeguarding Better access to information means better decisions can be made

21 What information is to be shared Not everything has to be shared but enough to join things up Child is subject to Child protection plan Should we share? Domestic Violence Notifications? History of Mental Health issues? Drug or alcohol misuse?

22 Zero harm NHS Following mid Staffs, need a zero harm culture Unaware of a patient s history, complications arise in surgeries, diagnostic tests are repeated and patients find themselves repeating their medical history over and over again, sometimes several times on the same day. National Urgent Care Review 2013 Information critical to my care, is made available to all those treating me

23 Benefits Practice Savings and Efficiency Reduction in medical tests carried out Reduction in duplication of medications prescribed Reduction in admin time for medicines reconciliation requests Avoidance of emergency admissions Avoided costs of data extraction Quicker discharge from hospital Improvement in patient s health and social care outcomes Reducing the incidence of medication errors causing serious harm Improving the healthcare experience for mental health/eol/ltc Increase in patient self care and care ownership Improve Management of risks Improved multi-agency safeguarding as a result of alerts

24 Community Health summary Medical tests and results Alerts - domestic violence Medication problems and reason for changes Soc serv / Com Health care plans Referral details MH/Soc serv/com Health care plan GP visits Ambulance trust Ambulance activity MH/Soc serv/com Health care plan Medical tests and results Alerts domestic violence / child protection / high volume user Medication problems Advanced decision Adult Social Services (ASS) Referral details Alerts dom viol / adult protection Best interest decisions Acute provider summary Medical tests and results Medication problems and reasons for change A&E / IP / OP attendances Alerts - domestic violence / child protection Referral details MH / Social services / Community Healthcare care and visit plans GP visits Core summary Demographic details Agencies involved (contact) Carer / NOK details Medication history Allergies Alerts A&E / IP / OP attendances End of Life care plan Medical discharge summary Children s Social Services GP visits Family social care history GP summary Medical tests and results Medication problems and reasons for change MH / Social services / Community Healthcare care plans Ambulance activity Social Services care plan Child protection alerts Mental Health Medical tests and results MH/Soc serv/com Health care plan Medication problems and reasons for change Alerts domestic violence / child protection GP visits Referral details ASS (hospital based) MH / Soc serv/com Health care plan

25 CCR Phase 1 Primary Care Record Data items to be delivered based on primary care dataset only Demographic details Medication history Diagnoses Allergies End of Life Status Medical tests and results (those recorded in GP patient record only) Alerts present in GP patient record

26 Clinician benefits There are many occasions where patients have gone into A&E for an urgent problem, didn't know what their medication was and they've ended up staying a few days, just for the hospital to find out what medication they were on before they could make the changes Improved appropriateness of clinical care Faster recognition of critical clinical need An end to "flying blind" with access to medication history for confused or non-verbalising patients

27 Hospital Pharmacists NICE patient safety guidance 1 (Dec 07): The aim of medicines reconciliation on hospital admission is to ensure that medicines prescribed on admission correspond to those that the patient was taking before admission. SCR can play a key role in medicines management for patients SCR potential frees up time for both hospital pharmacists and GP surgeries

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29 29 The Technology Fund

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33 The challenge Implementing electronic health records is a challenge, a major project and a substantial change in the way care is delivered But it is achievable, and others have achieved it and gained many benefits Once it is in use most health care professionals would not want to go back to paper

34 Give me a kick when it s all sorted Masood Nazir: masood.nazir@nhs.net