NHS Cumbria CCG Governing Body. 4 June

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1 NHS Cumbria CCG Governing Body Agenda Item 4 June Developing an Informatics strategy to support the 2-5 year strategic and operational plan Executive Summary/Purpose of report: The report sets out a number of initiatives being pursued across the Cumbria health and care services in relation to the use of technology to support transformational change. This builds on the CCG Commissioning intentions for Informatics that have been incorporated in contracts with healthcare providers and supported by Cumbria County Council. The report highlights the e-referral and resource management system, (STRATA) which has been recognised as innovative practice by NHS England. Cumbria has been given Rapid Accelerator status, one of only three sites across England, to roll out the software faster across health and social in Cumbria. Also, a number of initiatives that can support the quality of patient care and improve organisational efficiency and effectiveness are highlighted for further development with partner organisations. Key Issues: Use of technology is a key enabler in managing change. The CCG has been successful, working with partner agencies, in obtaining external resource, to develop new initiatives, particularly associated with interoperability across health and care organisations. Greater focus needs to be given by all partners, to utilise the infrastructure and new information systems, if transformational change is to be achieved, for patients, health and care staff and organisations. Too much wasted time and effort is put into the current paper systems used across Cumbrian health and care organisations, which are unsafe, from a patient care / service user perspective, lacks transparency, in terms of care pathways and delivers inefficiencies within and across organisations. Recommendations: Governing Body members views are welcomed on the contents of the report

2 Management Sponsor Clinical Sponsor Presented By Contact Details John Roebuck, Interim Programme Director David Rogers, Medical Director John Roebuck, Interim Programme Director

3 Developing a strategy for the use of technology across Cumbria to support the 2-5 year strategic and operational plan

4 Introduction This report sets out opportunities for the CCG to take forward initiatives associated with the development of Informatics. The CCG has produced commissioning intentions for Informatics for onwards, that highlight the need to build on local agreement across Cumbria health and social care organisations, to deliver, utilise and maximise opportunities in respect of: Community of Interest Network (COIN) infrastructure and its future state i.e. Public Service network (PSN) Medical Interoperability Gateway (MIG) development i.e. ability to share detailed GP Cumbria Care record into relevant provider organisations e.g. A&E, Out of Hours, Primary Care Assessment centres, Outpatients etc E-referral and Resource Management software, (Strata) providing an air traffic control system for patient transitions across Cumbria (see below) Maintain and enhance a single Active Directory for Cumbria, however that may be configured, to facilitate communication and training and access to systems wherever people are based in Cumbria These constitute elements of the Common Platform as set out in the CCG 5 year strategy. The CCG is also working with our health and care providers, across Cumbria, to: Prioritise development of electronic records over the next two years, which are currently paper based / reliant on faxed information and agree timescales for implementation between the respective Chief Clinical Information officers Set out a two year plan to introduce tele consultations in line with CQUIN / Service Delivery and Improvement Plans Agree to rationalise and standardise the range of referral forms that are transmitted between any combination of primary, community, mental health and acute services, with the aim of having single Cumbria wide electronic referrals over an agreed timescale 2

5 E-Referral and Resource management (Strata) The CCG is introducing a unique and innovative project across Cumbria, which has received Rapid Accelerator Status from NHS England. The County wide e-referral and resource management system (STRATA), eradicates paper / fax / telephone transfers /hand over of care, between providers; matches patient needs with the most appropriate services, taken from the directory of services provided by Cumbrian care organisations; enables the CCG, as commissioner, to better understand capacity and demand across Cumbria. Benefits realisation: Standard operating procedures for e-referral and resource management between health and care providers across Cumbria, ensuring patients receive the right service at the right time in the right place Supports optimisation of patient flow Improved data quality of clinical information passing between providers Improved timeliness of transfer of data between providers, speeding up discharge process and reducing likelihood of delayed transfers of care Preventing patients from being lost in the system which occurs with paper / fax referrals etc. To date, the STRATA system has been implemented in full between University Hospitals of Morecambe Bay (UHMB) and Cumbria County Council Adult Social Care, automating the sending, receiving, processing and audit of section 2 and section 5 documents under the Delayed Discharge Act Also, Cumbria Partnership Foundation Trust has introduced the system across each of its six localities for Community and mental health services referrals to Adult Social care. To date around 500 referrals per month are now being made by electronic transfer, which also enables staff to track progress of the referrals and proactively manage blockages in the patient pathway between health and social care. The STRATA system has been fully integrated with Lorenzo, the UHMB Electronic patient record and is in the process of being integrated with Liquid Logic, the County Council Adult Social Care IT system, EMIS Web Community and Realtime for North Cumbria University Hospitals. 3

6 The CCG, and its health and care providers across Cumbria, has a programme of work that will also incorporate Children s services, Continuing Care, Mental Health services, Out of Hours services, Hospices, Specialist Palliative care and Jointly Commissioned Intermediate care beds into the Strata system over the next months. Other Informatics Initiatives In addition to the e-referral and resource management system, the CCG recognises that developments in technology; cost challenges facing commissioners and providers and a greater willingness of patients and carers to utilise technology, offers the opportunity to commission a more transformational approach to service delivery. The investment in the Community of Interest Network (COIN) across Cumbria means that there is a sound technological infrastructure and network on which to develop new services. Four potential areas have been identified for further consideration. Three of these are associated with the provision of clinical services whilst one is related to organisational efficiency. 1. Work with Cumbria County Council to link into the tele-care infrastructure and implement equivalent long terms conditions / chronic disease management monitoring equipment: a. The Council currently has a caseload of 2000 clients using monitoring equipment b. The council contract is due for renewal later in the current year, but there is an expectation that it will be rolled forward for a further 12 month c. The opportunity exists to consider joint development of a specification for tele-care / tele-health monitoring, subject to initial research on: i. the correlation between existing telecare clients and patients on long term conditions registers this can be achieved through comparisons of NHS numbers between social care and primary care, or other manual comparisons ii. Evidence supporting effective interventions for specific long term conditions 4

7 iii. Being clear on specific outcomes to be achieved e.g quality of care; patient experience; cost reductions 2. Assess opportunity to undertake remote consultations e.g: a. GPs to patients b. GPswSI to patient c. Consultants to patients e.g. outpatient follow ups; dermatology; talking therapies d. GP to consultant advice and guidance These could be undertaken across the network, using web ex, video conferencing or equivalent, (Skype) with appropriate training. Again, initial research is being undertaken in relation to: 3. Self help / Prevention: i. Patients and clinicians views ii. Evidence from other organisations using remote consultations iii. Justification for remote consultation e.g. patients distance to travel; cost savings; iv. Nature of services for consideration e.g shortage of dermatology consultants across Cumbria; inability of particular client groups to travel e.g. neuro rehab v. Operational issues associated with provision of remote consultations vi. Clinical / information Governance issues, training needs etc Workington locality were successful with a bid to the Prime Ministers Challenge Fund, associated with longer opening hours for GPs, to implement innovative approaches to the management of patient care, including self-help for patients. Allied to this, the County Council Public Health department are interested in developing initiatives that are technologically driven e.g. health apps that can support self-help for patients. 4. Organisational efficiency: 5

8 The Cumbrian geography means that travelling for meetings is both time consuming and costly. Adoption of Web Ex / Jabber / Video conferencing has the ability to produce a rapid return on investment, both in terms of cost and staff productivity. There is further opportunity to develop home working and rationalise accommodation requirements, or to provide more flexible hot desk working, as a result of the technology infrastructure across Cumbria. Research is being undertaken and demonstrations being arranged, of the potential of the technology, both within the CCG and across health and social care organisations. Recommendations Governing Body members views are requested on the direction of travel being pursued by the CCG and partner organisations across the Cumbria Health and Care Alliance. 6

9 [Page left blank intentionally] 7

10 For more information contact... Name. John Roebuck Address. Lonsdale Unit, Penrith Hospital, Bridge Lane, Penrith, Cumbria Tel

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