Digital Child Health and Maternity Update Briefing 15 May PDF Free Download

Digital Child Health and Maternity Update Briefing 15 May 2017

Agenda 14:00 14:30 Digital Child Health overview 14:30 15:15 Child Health Information Standard and Events Catalogue 15:15 15:30 Break 15:30 16:00 Alpha phase 16:00 16:30 Maternity 16:30 17:00 Questions

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Digital Child Health National overview Presented by Thomas Burnett Digital Child Health Programme Manager

Background to programmes Healthy Children: Transforming Child Health Information, a strategy commissioned by NHS England September 2015, delivered July 2016, published November 2016. NHS Digital work began July 2016 (Discovery) Maternity Transformation Programme, formed on the back of the National Maternity Review (Feb 2016). 9 Workstreams, 2 dedicated to information services and technology. NHS Digital handed remit for a Discovery period for Workstream 7: Harnessing Digital Technology in September 2016.

Healthy Children strategy vision Knowing where every child is and how healthy they are Appropriate access to information for all involved in the care of children

A number of current challenges National Personal Child Health Record (PCHR) still on paper Limited capability to manage children unregistered to GPs and offer them preventative services Deficiencies in managing local populations highlighted by National Incident Team report, children at risk of missing out on preventative services Healthcare professionals don t have access to a core summary of child health information, records are fragmented across systems Services still very paper driven and manually intensive

Personal Health Professional Health NIPE Bloodspot Hearing New Baby Review 6-8 Week Exam 8/12/16 wk Imms 12 mth Review 12/13 mth Imms 2/2.5 yr Integ Review 3yr 4mth Imms 4-5yr eyesight check School Entry Chk Year 6 Check Year 8 HPV Booster Imms Public Health Public Health England Commissioners Research & Policy Directors of Public Health & Children s Services National Audit Emergency & Acute Services Neonatal Services CYP Dataset Mental Health Services Community Services GPES Voluntary Services Social Services Maternity Dataset CAMHs Dataset Education Services Justice Services Delivery of all other care services (Some Children) Midwifery Maternity Information Systems Health Visiting Screening Information Systems Primary Care Primary Care Systems School Nursing SCR Delivery of Healthy Child Programme (All Children) CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD 90 CHRDs PCHR 0d 5d 8d 11d 7w 9w 12m 13m 24m 40m 4y 5y

Healthy Children where do we start? With the basic building blocks: A first layer of essential child health information for exchange A first phase of systems exchanging that information - Maternity, Child Health GP systems and Personal Child Health Records A roadmap for growing the scope and sophistication of the information exchange Adding in new services as they become available, for example, national Failsafe for Healthy Child Programme

How it works Other New Services National Failsafe Management Service National Events Management Service Citizen Identity Relationship Management epchr National Screening Services Hub Registration Authority Events Design Authority Public Health Primary Care Child Health Records Maternity School Nursing 5-19 Health Visitors 0-5

Regional support National Failsafe Management Service National Events Management Service Citizen Identity Relationship Management Local ep(c)hr Hub Registration Authority Events Design Authority epchr Integrated Digital care Record Local Events Management Service Local Failsafe Management Service Public Health National Screening Services Primary Care Child Health Records Maternity School Nursing 5-19 Health Visitors 0-5

Timeline touch points Programme Business Case approved by TDIB NEMS and FPM Alpha complete NEMS & FPM Business Case Development Complete Events Catalogue published by PRSB NEMS and FPM Beta complete NFMS Business Case Development Complete NEMS and FPM pilot complete NEMS used by the first organisations to share data from the events catalogue NFMS used by the first organisations to get failsafe alerts Key Event Go Live date NFMS pilot complete Events Catalogue development complete ISN Interoperabi lity and FPM Published NFMS Alpha complete NFMS Beta complete ISN for Failsafe Published epchr available to first Parents/Carers/ Children with national health record access 2017/18 2018/19 2019/20

Implementing the Strategy Philip M.J. Graham Health Informatics Programme Director Blackpool Teaching Hospitals

Where were we?

Tech UK Dec 2016

Health National Partner Personal National Screening Systems Registration SCR/PDS Local IDCR / Interface Maternity Systems Local failsafe management Local Access Management GP Systems Community Systems CHIS

Where are we now?

STP Programme Mandate (Events Model)

What next?

What next? Governance Build on the infrastructure Implement the phases In partnership To implement the Strategy

Health National Partner Personal National events hub National Screening Systems Local Authority Systems Registration SCR/PDS Commissioning Failsafe Management Population Management Local events hub Local IDCR ephr Maternity Systems LPRES Education Systems Access Management GP Systems Community Systems CHIS

Current Strategy Supported phases Design Governance Care Pathway

Events Catalogue Presented by Silas Collinge Lead Business Analyst

We will cover Event definition Event content Professional Records Standards Body (PRSB) consultation Timelines

Where did it all start? The strategy: Parents, families and carers will have an online record of their child s health and development Professionals will have access to a core view of child health information at the point of care But where do you start? How do you define a Core View? Maternity Dataset v1.0 and Children and Young Persons PCHR (Personal Child Health Record) OBS 2015 NHS Digital created the starting point around the events that should be exchanged for Professional, Personal and Public Health

Digital Child Health approach to events Something happens in the life of a child It may or may not be in the Healthy Child Programme or recorded in the Red Book We call this a clinical intervention or occurrence A visit to the GP Newborn Infant Physical Examination Birth Writing a comment in the child s epchr MMR immunisation

Digital Child Health approach to events Once this clinical intervention or occurrence has happened any number of events are produced These are published to the National Events Management Service (NEMS) A Newborn physical examination is performed this is the clinical intervention After the clinical intervention a series of events may be triggered HCP Clinical Intervention: Newborn Physical Examination Referral Measurement Physical Examination:NIPE

Digital Child Health approach to events Professional, Personal and Public Health will be able to see the events in the events catalogue A GP may want to see to all events relating to all children under their care Public Health may only want to see certain events such as measurements or immunisations Parents may want to see all events relating to their child

Example event contents Measurements Birth Details

What is an events catalogue? One document containing all events based on the Healthy Child Programme and the scope of the PCHR Gives enough information for all involved in the care of children to understand the strategic direction, the current ways of working and data flows Contains all clinical and non clinical data items broken down into each event In future will allow public, professionals and personal health to decide which events they want to send/share/publish and what events they want to ingest/view/subscribe to The document will be iterative and future work will continue into the Maternity and National Failsafe work

PRSB consultation Scope split down into 3 packages to be consulted upon covering all elements of the PCHR and Healthy Child Programme 3 large consultations planned with health professionals, parents, public health and suppliers with over 70 people attending NHS Digital provided the starting point of what information should be exchanged Gain agreement on what clinical data items should be shared across professional, personal and public health PRSB to gain sign off from Academy of Royal Colleges for a Community Child Health Record structure and where each data item sits within the record

PRSB consultation

Timelines Draft FHIR resources for Package 1 online now (feedback welcome!) Alpha design phase has begun on NEMS (collaboration welcome!) Package 2 and 3 consultation in June and July Events catalogue to be finalised by October and shared via GitHub alongside draft FHIR resources ISN to be released in February 2018

FHIR profiles Presented by Dave Barnet Interoperability Lead

Interoperability uses

Resources http://hl7.org/fhir/dstu2/resourcelist.html

Resources Observation Diagnostic Patient Report Practitioner

Profiles Profiles are resources that have been constrained for a use case Cardinality Optionality Terminology Extension

Birth details Location Observation Procedure Related person Conditions Referral Observations

Bundle example DCH-BirthDetailsEvent-Bundle-1 This 'DCH-BirthDetailsEvent-Bundle-1' Bundle resource profile is used as a container to collect a combination of the following resources, as ordered below, to fulfil the information requirements of a Birth Details Event: DCH-BirthDetailsEvent-MessageHeader-1 CareConnect-DCH-BirthOccurrence-Encounter-1 CareConnect-Organization-1 CareConnect-DCH-Baby-Patient-1 CareConnect-DCH-LengthOfPregnancy-Observation-1 CareConnect-DCH-NumberOfFetusesInConfinement-Observation-1 CareConnect-DCH-ActualDeliveryPlace-Organization-1 CareConnect-DCH-ProblemsInBirth-Condition-1 CareConnect-DCH-AbnormalitiesDetected-Condition-1 CareConnect-DCH-ProblemsInPregnancy-Condition-1 CareConnect-DCH-TypeOfDelivery-Procedure-1 CareConnect-DCH-Delivery-Encounter-1 CareConnect-DCH-Mother-Patient-1 DCH-MotherAndBaby-RelatedPerson-1 CareConnect-Location-1

Bundle example MessageHeader Encounter Location Patient Healthcare Professional Service Provider Responsible Organisation Observation (Length of pregnancy) Observation (Foetuses in confinement) Related Person Procedure (Type of delivery) Mother

Bundle example

Alpha ways of working

Break

Alpha works overview Presented by David Nevill Senior Project Manager, Digital Child Health

Alpha scope Who s here What we ve done so far What next? What are the risks / dependencies? How can you engage?

What we ve done so far When Early 2017 April What Ongoing Strategic Alignment Architecture / conceptual exploration Project Scope clarification Through the DDC Front Door, tactical alignment, planning Defining a manageable Alpha scope Approach to requirements management Defining ways of working as part of the Digital Interoperability Platform agenda Delivery Alignment Verifying the Use Cases Strategic Alignment Alpha Scope Definition

Realigning the Alpha scope National Events Management Service (NEMS) National Failsafe Management Service (NFMS) Limited short term scope: child population tracking of contact with health services: Child Health Record Department Health Visiting Service Primary Care Service (GP) School Nursing Service Longer term scope Full failsafe management

dfd Vitamin K DFD Midwife Additional Vitamin K doses dfd Vitamin K DFD Midwife Additional Vitamin K doses dfd Birth Notification DFD Vitamin K administered Administration Details Flimsy CHRD Administration Details Administration Details GP Health Visitor Vitamin K administered Administration Details Flimsy CHRD Administration Details Birth Details Administration Details Midwife Enter Birth Details Administration Details Vitamin K consent Administration Details GP Link Mother to Baby Health Visitor Birth Details Administration Details Vitamin K consent Administration Details Search for Mother Child's NHS Number Child's NHS Number Mother's Details Create Child's NHS Number Administration Details Administration Details Administration Details Maternity System Vitamin K Admin Child's NHS Notified of additional doses Number Maternity System (Non PDS) Notified of additional doses Maternity System Mother's Details Birth Details Notified of additional doses Notified of additional doses Administration Details Administration Details Administration Details Maternity System Vitamin K Admin Birth Details Birth Details Mother's Details Mother's NHS Number Mother's Details Further Doses (Oral) Find Mother's NHS Number Child's NHS Number Mother's NHS Number Birth Notification Application Health Visiting System GP PCHR Administration Details CHIS Further Doses (Oral) Mother's Details Mother's NHS Number Child's NHS Number Health Visiting System PCHR Administration Details GP CHIS Birth Notification Send Child's NHS Number PDS Child's NHS Number Submit Birth Notification Birth Details Birth Notification Birth Notification Birth Notification Birth Notification CHIS Registrars Online ONS National Screening Store Verifying and elaborating use cases Ensuring NEMS / NFMS requirements align with events Data flows (publishers and subscribers) for events in scope elaborated Building a solution as agnostic as we can of the Business system / organisational model to make it more sustainable

Alpha timeline what next? When May June What Requirement Elaboration Resource Allocation and prep for Sprint #1 Development Ongoing Requirement Elaboration User Research / Service Design (in parallel / collaboration) July Sept Iterating the above October Refinement / consolidation November Alpha Closure checkpoint Prepare for Beta ONGOING Engage Users Engage Suppliers Manage Expectation Articulate the direction Get feedback Strategic Alignment Transparency

What next - Healthy Child events in early scope Original Alpha Scope Birth Notification Possible Updated Approach Pattern 1 Bloodspot 8-week immunisations HPV Population failsafe? Pattern 2 Pattern 3 Pattern 4 Pattern 5 Failsafe

Alpha ways of working Following the Government Service Design Manual. Where applications are stood up to explore an issue, these will be made available for experimentation, with test data.

Alpha ways of working All latest developments available through GitHub All discussions, communications and points of view contributed by suppliers and users will be openly available online

Alpha outputs One or more prototype(s) Documented evaluations of the prototypes from business and technical viewpoints A recommendation of which approach is the best, viable option to progress to beta phase Documented design of the best viable option, in sufficient detail to support approvals by architecture governance

What are our risks and dependencies? It s part of a wider Digital Interoperability Platform The strategy encourages local equivalents (still aligning to national standards) Ongoing feasibility and viability Citizen Identity dependency (and wider P2020 agenda)

Invitation for involvement in Alpha Opportunity for supplier and user communities to become involved to both influence and learn Seeking different levels of involvement Open to the all supplier and user communities No financial support to suppliers or users to become involved in Alpha If a future procurement is authorised a notice will be published advising all strategic suppliers that a procurement has commenced. Consequently there will be no impact resulting from participation in the Alpha

Levels of involvement in Alpha Doers - suppliers and users who are willing to get their hands dirty trying out aspects of the Alpha work Thinkers suppliers and users who are willing to publically offer views, advice or critiques Watchers suppliers and users who just want to follow progress

Request for user involvement GPs Health Visitors School Nurses Other interested Health professionals Supplier user groups dch@nhs.net

For more information Email: dch@nhs.net GitHub: https://github.com/digitalchildhealth/discovery-alpha Health Developer Network: https://developer.nhs.uk/downloads-data/digital-child-health-fhir/

Supporting women, helping professionals Harnessing digital technology in maternity transformation Presented by Helen Harger Senior Clinical Product Manager

What are we trying to help with? Numbers of births are increasing A changing profile in users of maternity services Changes in service usage and access Increasing demand for personalisation of care Wide variation in maternity pathways and their effectiveness Recognition of a lack of access to mental health services Missed opportunities relating to still birth and appropriate interventions

Digital challenge Cultural reliance on paper notes, digital often used only for booking and hospital care around birth and the early post-natal period Few building blocks for digital innovation, e.g. legacy maternity systems, limited mobile working, variance in digital maturity Lack of reliable information reflecting national UK care provision and consistency of access to national guidance on birth and care choices for women No standards or core dataset for interoperable maternity systems Women-held maternity notes still on paper Time to administrate paper/technology interface is impacting time to care

Three things Digital tool Standards & interoperability Digital maturity > > > Initially, an app to improve personalisation and choice by enabling access to unbiased, evidence based and locally specific information about their own circumstances, choices available and their own personal care plans Behind the scenes machinery. Replacing paper processes with point-of-care accessible electronic maternity records. The enabler for consistent capture and movement of maternity pathway information between and within local maternity systems, professionals and with women Making life easier through appropriate adoption and uptake of technology. Create a supportive framework for growing digital maturity and capability in maternity services

Problems and priorities for professionals National Maternity Transformation Stakeholder Survey for WS 7 - Oct-Feb 73

Getting it right for women What are the 3 biggest complaints you hear from women receiving your care? Poor Support/Communication Lack of continuity of care Delayed Care National Maternity Transformation Stakeholder Survey for WS 7 - Oct-Feb Not enough time with HCPs Lack of consistent advice/info Having to repeat their history Poor Accessibility Too much Admin Other Technology should never be the entire solution but can play a huge part

A record: standards and interoperability Standards needed to bring together the multitude of supplier systems in use across and within local maternity systems Create a safe continuity of care and continuity of carer approach whilst maintaining choice Improved choice for women: example Provider 1: antenatal Provider 2: intrapartum Provider 3: postnatal Enabling capture once, re-use many

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