Lorenzo for clinical outcomes transformation? Ben Bridgewater

Lorenzo for clinical outcomes transformation? Ben Bridgewater

Global Trends - Outcomes and Transformation: The Landscape The problems The obstacles The solutions Ageing population and consumerism Increasing costs of healthcare Preventable variation in outcomes Politicians Organisations Professionals Patients The enablers Transparency Financial burning platform Technology Shift away from hospitals Step change in productivity Standardised care Transform delivery subscale payment models Care coordination

Improvement in outcomes Mortality proportion Mortality proportion 0.02 0.04 0.06 0.08 0.10 Observed Expected O:E = 0.73 Actual Overall average Trend O:E = 0.37 2002 2004 2006 2008 2010 Time

The Process Define outcome Set standard for performance Define acceptable (and unacceptable) variance from standard Validate data with units Notify outliers & publish data

So. Have outcomes improved? Does it provide reassurance? Does it feed regulation? Does it support patient choice? Does it drive cultural change?

Effective support structures and IT Individual professionalism Individual concern Liaison with local management Detailed data analysis Structured reflective scrutiny of practice Summary of findings and action plan Organisational and responsible officer buy in Skilled local management

HEALTHCARE GROUP Lorenzo Transformation Offering Update V1.0 1 st July 2016 Internal CSC document not for external communication

The current reality There are many reported benefits from EPR implementations. However EPR deployments in general and Lorenzo implementations specifically have led some healthcare systems to experience the following effects following an implementation: Little or no improvement (or even a decline) in key areas of operational performance An increase in the time it takes for staff to complete their work A rise in their operating expenses A decrease in staff morale These adverse consequences may not be related to the EPR alone, but may be a consequence of complex interaction between the EPR deployment and existing business processes, customs and practices embedded within the hospital and its workforce CSC Proprietary and Confidential September 12, 2016 15

Where do we need to be? A patient-centred, clinically led approach is essential The primary objective for care logistics is to improve patient flow through all pathways simultaneously. A focused process of ongoing improvement to balance patient flow is vital. Removing local measures of optimisation is essential when improving multiple, interacting chains of activity. Deployment should be focused toward supporting improved clinical outcome Shift the pack Drive out variation CSC Proprietary and Confidential September 12, 2016 16

Lorenzo Currently the focus of deployment has been on Care logistics E.g. Bed management admission, transfer, discharge Requesting and reporting Care planning Developing integrated electronic medication prescription and administration Developing integrated theatres Working towards paper-lite/paper free hospitals There are potential benefits to be derived from greater clinical utilisation

Parallel universes? Administrative data Drives financial flow Used for regulatory purposes Drives CQC ratings Not professionally led Not agile Slow change control processes Does not have clinical confidence Well supported infra-structure National clinical audit data Has clinical confidence Professionally led More agile Drives quality improvement Published by Professional societies/hqip/nhs England Not well supported infrastructure

National clinical audits Topics based on NHS outcomes framework Arthritis: Rheumatoid and early inflammatory Cancer: Bowel cancer audit Cancer: Head and neck cancer audit Cancer: Lung Cancer: Oesophago-gastric (stomach) cancer audit Cancer: Prostate COPD: Chronic obstructive pulmonary disease Dementia Diabetes: Adult Diabetes: Paediatric Emergency laparotomy Falls and fragility fractures (includes the Hip Fracture Database) Heart: National adult cardiac surgery audit Heart: Cardiac arrhythmia (or ablation) Heart: Congenital heart disease Heart: Coronary angioplasty (PCI) Heart: Heart failure Heart: Myocardial ischaemia national audit project HIV/STD IBD: Inflammatory bowel disease Intensive and special care: Neonatal Intensive care: Paediatric Joint replacement surgery: the National Joint Registry Kidney: Chronic kidney disease (primary care) Ophthalmology Stroke: Sentinel stroke national audit programme Specialist rehabilitation for patients with complex needs following major injury Vascular: National Vascular Registry

Administration systems For patient level audits Some level of local analysis software Analyses/Dashboard Local data collection National data submission National data collation, curation and analysis National reports and publications Some level of local analysis local data warehouse Governance and KPIs QI QA people process values and behaviors technology

QI Hospital Governance Local publication Local regulation Enhanced coding A better model? Audit reports NHS England publication Pre-op Operative Post-op Pseudonimisation National database (NICOR Lotus notes) Local PAS (Lorenzo) Analytics Risk adjustment Validation Research reports

How will this work? an urology malignancy example Local QA and QI GP diagnosis Urology referral Urology OPD Local audit dataset Pre-op MDT discussion AUDIT DATA Specialist appointment AUDIT DATA Admission AUDIT DATA Radical prostatectomy Discharge AUDIT DATA Post op MDT AUDIT DATA National submission Post op OPD AUDIT DATA Demographics Administrative data RTT etc Lab data Bloods, pathology Prescribing data Clinical data cdc form BAUS PROSTATECTOMY AUDIT NATIONAL PROSTATE CANCE AUDIT

National submission Lorenzo extract to local data warehouse NATIONAL PROSTATE CANCER AUDIT BAUS PROSTATECTOMY AUDIT Grade and stage of tumour Compliance with waiting targets Compliance with best practice process measures Treatment choices Volumes Outcomes Quality of care Efficiency measures

Local business intelligence Quality improvement Governance/Appraisal/revalidation Transparency

How are we progressing this with Trusts? Discovery What audits are done? What systems are used? Interfaces Licences Decision support What documentation exists? What are the processes for? Data collection Data analysis Data usage Data validation Governance QI Coding Procurement and stock control Device registers Implementation Develop cdc forms for audits Auto-populated where possible Specifically populated Co-create with clinical SMEs Embed necessary audit data capture in clinical process enabled work flows Ensure data extraction/reporting/submission processes for: Local use National requirements

How do we move from current state to population health? from Fragmented Care to Coordinated Care to Population Health A Care Co-ordination Centre is the key enabler to Population Health It is the platform for building prevention strategies, improving services, and delivering provider productivity benefits for Health and Social Care

SYSTEMS OF ENGAGEMENT Clinical and Business Transformation SYSTEMS OF INSIGHT SYSTEMS OF RECORD ENABLING PLATFORM INFRASTRUCTURE