The Power of Information: An IGM&T Strategy for Nottinghamshire NHS Clinical Commissioning Groups

Transcription

1 The Power of Information: An for Nottinghamshire NHS Clinical Commissioning Groups

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3 Contents Contents... i Version Control... 1 Executive Summary Introduction Where Are We Now? Upgrading and Modernising Primary Care IT Systems Support the Development of Primary Care Improving Patients Access to Information Integrate Primary Care Systems with Other Health and Social Care Systems Supporting Patients Care through Assistive Technology Use Data Analysis to Inform Clinical Behaviour and Commissioning Decisions How Will We Deliver This Vision? Appendix A: Glossary Appendix B: Prioritisation of Investment Appendix C: Primary Care IT Costs Appendix D: The Information Governance Review Recommendations Appendix E: Caldicott 2 Review - Table of Commitments Page i Version 3.0

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5 Version Control Reference Document Purpose CCG IGMT Strategy v3.0.docx This document lays out the strategic intent of Nottinghamshire CCGs in respect to developments in information governance, information management, information technology and associated services. Version 3.0 Status Approved Title Authors Dr Mike O Neil, NHS Nottingham West CCG Dr Sean Ottey, NHS Rushcliffe CCG Andy Hall, NHS Rushcliffe CCG Jason Mather, Nottingham City CCG Contributors Di Butcher, NHS Newark & Sherwood CCG Dr Ei-Cheng Chui, NHS Newark & Sherwood CCG Dr Carl Davis, NHS Rushcliffe CCG Andy Evans, Connected Nottinghamshire Gina Holmes, NHS Mansfield & Ashfield CCG Approval Date 25 July 2014 Approving Bodies CCG IGM&T Committee Review Date 30 September 2015 Target audience Circulation list Associated documents Public domain Public domain Clinical Commissioning Groups strategy documents; Operating Framework 2014/15; Caldicott 2: To Share or Not To Share; The Power of Information: putting us in control of the health and care information we need; NHS Midlands and East Ambitions. Superseded documents CCG version 2.0 CCG version Page 1 Version 3.0

6 Executive Summary This document describes how Information and Technology will support NHS Nottinghamshire Clinical Commissioning Group s future vision for primary care over the next three years. This document will help to explain the importance of Information Technology within primary care and how IT will best support the links to other primary care contractors and healthcare commissioners which will be essential in delivering a comprehensive service and should be read alongside other key strategic documents. This vision reflects the local requirements driven by improvements in the quality of care, patient health and care outcomes, the reduction of inequalities and increases in productivity and efficiency. With increasingly challenging financial environments and cost saving plans affecting the NHS and Local Authorities, information and technology is a critical tool which primary care will use to deliver the necessary improvements with limited resources available. Information and technology can bring enormous benefits by making the delivery of care more seamless and efficient. It is vital to health and wellbeing, and is pivotal to good quality care. It allows patients to understand how to improve their own health, to know what their care and treatment choices are and to assess for themselves the quality of services available. This IGM&T plan is focused on six essential deliverables: Upgrading and modernising primary care IT systems Supporting the development of Primary Care Improve patients access to information Integrate primary care systems with other health and social care systems Supporting patients care through e-consultation, tele-care and tele-health Use data analysis to inform clinical behaviour and commissioning decisions Page 2 Version 3.0

7 1. Introduction Rapidly advancing technologies have revolutionised the way we interact with each other in everyday life. Industry and the commercial sector have changed profoundly and the available technologies have the ability to enable a similar change in health and healthcare services, shifting the relationships between patient and clinician towards one of shared decision-making; and between commissioner and provider towards one that is more commercially effective. Information is a service in its own right, allowing patients and the public to understand their own health, adopt healthier lifestyles and choose appropriate services; clinicians to identify and act upon variation; and commissioners to respond to changes in health need. The Power of Information was published in May 2012 and sets a ten-year framework for Transforming information for health and care by harnessing the value of information and new technologies, to achieve higher quality care, improve outcomes for patients and service users. There is a focus on information in its broadest sense, including providing the support people need to navigate and understand the information that is available and ensuring that information reduces, not increases, inequalities and benefits all. The main ambitions of the Power of Information are: Information used to drive integrated care across all settings Information regarded as a health service in its own right Nothing about me without me Information recorded once at first contact Electronic care records to become the source for information A culture of transparency An information-led culture This is the second Information, Governance, Management and Technology (IGM&T) Strategy for CCGs across Nottinghamshire, building on the earlier successes of the former commissioning organisations. The interoperability and integration of systems within Nottinghamshire is critical to successful communication between clinical teams and the wider health and social care economy including across GP s, acute hospitals and social services. Information should be recorded once, at first contact and, with patients consent shared securely with those professionals providing care. This three-year vision will show how Information Management and Technologies will support the aims and ambitions of the Nottinghamshire Clinical Commissioning Groups and for Primary Care, however this will depend on the CCGs having an up-to-date and robust IT infrastructure combined with modern optimised systems which provide good quality and relevant information. Technology enables the use of information when and where required for best clinical and operational effect. The key elements to IM&T investment are: Infrastructure (the physical hardware used to interconnect computers, users and services); Systems (the clinical applications that provide staff, managers and clinicians with the tools and information to perform their tasks safely and efficiently); Support (needed for all organisations involved including CCGs; GPs; community, acute and mental health secondary care; and Social Care); Change Management (the management of change and development needed within the primary care organization); Page 3 Version 3.0

8 Transitional Management (necessary in managing an institutional investment and enable the merging of funds and pooled resources); Primary care needs a high standard of technical infrastructure and IT support enabling patient access to health records, health advice and assistive living facilities and technology. Health care requires safe, secure systems in compliance with all relevant Information Governance and Security standards Page 4 Version 3.0

9 2. Where Are We Now? The CCGs has been given, from NHS England, delegated responsibility for GP IT Systems and infrastructure, clinical systems, IT support and maintenance, networking, information governance, software licenses and hardware management. The CCGs hold a Service Level Agreement (SLA) between their informatics service provider and the GP Practices. This SLA identifies and details all the elements necessary to maintain IT services. It provides a framework for the provision of specified services including operational support, desktop support, network support, programme management and business change, training and telecommunications where locally agreed and funded. The CCGs have formalised their strategy for the next 3 years and IT is crucial in helping to provide effective General Practice services to help deliver seamless, accessible care, improve health outcomes, reduce inequalities and improve quality and capacity in primary care. The CCGs have a wide range of IT projects currently being rolled out across the county that will help to support effective General Practice. Core and mandated services include: GP Systems of Choice (GPSoC) provides practices with a choice of systems from GPSoC Framework suppliers in line with the requirements of the GMS contractual agreement. Nottinghamshire has 77 Practices currently live on SystmOne and 14 live on EMIS Web. There are a total of 3 Practices in the process of migrating to one of these two compliant systems with all Practices using or planning to use a GPSoC compliant system. EMIS have recently announced they will withdraw EMIS LV March 31 st CCG Current Proposed EMIS LV EMIS Web SystmOne Undecided EMIS Web SystmOne M&A N&S NNE NW Rush TOTAL Summary Care Records provide healthcare staff treating patients in an emergency or out-ofhours with faster access to key clinical information about their medication and allergies. All CCGs Practices are now live. The Electronic Prescription Service (EPRS Release 2) enables prescribers, such as GPs and practice nurses, to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient's choice. This makes the prescribing and dispensing process more efficient and convenient for patients and staff. Rollout of EPRS R2 is expected to be completed by July Patient access to GP records will allow patients to view their own GP records online. Currently beginning a pilot phase for 6 months in all CCGs before a rollout is agreed Page 5 Version 3.0

10 GP2GP enables patients' electronic health records to be transferred directly and securely between GP practices. It improves patient care as GPs will usually have full and detailed medical records available to them for a new patient's first consultation. GP2GP is currently being piloted in a number of Practices throughout the health community to understand the effectiveness between different clinical systems. edsm is the enhanced data sharing model that has been introduced for TPP SystmOne sites which enables the safe sharing of patient information to support patient care on a consent basis. All practices live with TPP SystmOne have access to the data sharing function however more work is needed to ensure practices follow guidance for best practice when sharing data. GP Access is the system which allows GPs to view certain hospital information including discharge letters from certain NUH services, community physiotherapy, and allows booking of x-rays for Practices not currently using Sunquest ICE (See below). NotIS is an internal NUH system which has been developed to allow GPs to view certain hospital information including discharge summaries. Discretionary Services include: Sunquest ICE provides the ability to request tests electronically, receive results electronically including other results for that patient requested elsewhere. Planned rollout completion expected by October Phase 2 of the ICE deployment will provide additional functionality allowing Practices to receive electronic letters and discharge letters from acute trusts. Medical Interoperability Gateway (MIG) allows access to care data from GP Practices operating either clinical system. This can then be viewed through a number of ways including full integration with the GP system and through a web browser. Connected Nottinghamshire Care Portal is a proposed tool that will give a detailed view of care provided to individuals from multiple care settings in Nottinghamshire to assist in the specific, direct delivery of clinical and social care Page 6 Version 3.0

11 3. Upgrading and Modernising Primary Care IT Systems Summary: Ensuring all of our Practices are equipped with GP Systems of Choice (GPSoC) Level 4 compliant systems will be crucial to helping them deliver good quality care. GPSoC Level 4 systems meet the requirements for the strategic frameworks set out by HSCIC and ensure systems are centrally funded by NHS England. This chapter covers why technology is vital to enable the implementation of services used within primary care. Technologies o Electronic Prescription Service o Sunquest ICE o Virtual Desktop Infrastructure (VDI) o GP2GP o Online appointment booking/prescription ordering o Remote Corresponding with GPs Key References and Publications o General Practice Systems of Choice o Securing excellence in GP IT Services Key Ambitions o Information sharing between organisations o All Nottinghamshire Practices to have access to GPSoC Level 4 systems o Increase efficient ways of working o Drive up productivity by reducing duplication o To enable the provision of IT Service support beyond core hours o Introduce flexible ways of working Overview The current pressures on primary care are increasing, with GPs in short supply, costs on the rise and the increase in care being delivered in the community, this makes transforming primary care imperative and even more challenging. Demand is increasing along with patient expectations of how they access primary care services. The CCGs aim is to free up the GP time to enable them to focus more on managing those patients with Long Term Conditions (LTC). General practice will utilise functions such as the Electronic Prescription Service which enables prescribers, such as GPs and practice nurses, to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient's choice. This makes the prescribing and dispensing process more efficient and convenient for patients and staff. Alongside this GPs will have full access to functions such as Sunquest ICE enabling them to request radiology reports and pathology tests electronically and to receive results electronically, including results for other tests requested by other clinicians for the same patient reducing duplication. The CCGs fully support future developments of this system such as enabling acute trusts to send electronic letters and discharge reports electronically to GP Practices. The CCGs will also support the rollout of other national priorities such as GP2GP. This function will mean that new patients registering or changing their registered GP will be able to do so with the reassurance that their electronic health records will be transferred directly and securely between GP Page 7 Version 3.0

12 Practices, allowing GPs to have full and detailed medical records available to them for a new patient's first consultation as well as releasing time for GP admin staff. Approach To enable primary care access to new innovative systems and programmes to aid the delivery of care, Nottinghamshire CCGs need to invest in GPSoC Level 4 compliant clinical systems such as TPP SystmOne and EMIS Web. The arrangements in the GPSoC framework are geared towards helping Practices get the best out of their GP clinical IT systems. User specified roadmaps and incentives for suppliers to improve the utilisation of national services are aimed at developing an increased focus on good training and continuous improvement of delivered software. The CCGs will work with our informatics system provider to pilot a Virtual Desktop Infrastructure (VDI) which will allow users to access applications and data with little or no software needing to be installed on local machines. As a result, authorised users will access and share information remotely and securely from any location and any device via clinical system apps, key to underpinning more efficient ways of working and delivering the integrated care services that are at the heart of the CCGs reforms. Using these technologies will ensure that Practices that are considering working collaboratively to offer more choice or extended hours access can do so without limitations. The CCGs will ensure all Practices have the option to migrate over to a Level 4 compliant system which will be fundamental to ensuring the effective and safe sharing of patient information through the use of portals and interoperability. CCGs will commission our information provider health informatics services for business critical systems including level 1, 2, 3 support and extended hours help desk cover and support during OOH to support those Practices who are considering being open beyond core hours. Good quality network connections to all our Practices underpin and enable the delivery of new IT systems and services for the NHS. The N3 network provides the essential technical infrastructure through which the benefits to patients and staff from the new systems and services will be fully realised and sustained in the future. The CCG will support improvements and innovations for developments moving towards a single Community Of Interest Network (COIN) joining together multiple trusts and health communities Page 8 Version 3.0

13 4. Support the Development of Primary Care Summary: This chapter describes how the use of technology will support the sustainable provision of high quality Primary Care services. Technologies o Sunquest ICE o Online appointment booking/prescription ordering o Remote corresponding with GPs o Inherent clinical system capability Key References and Publications o General Practice Systems of Choice o Securing excellence in GP IT Services Key Ambitions o Improved ability for individual clinicians to work across organisational boundaries o Provide patients access to specialist skills in primary care o Provide an environment to attract a diminishing pool of available workforce in primary care o Exploitation of the inherent clinical system capabilities between GP Practices and other care sectors o Future proof against organisational changes at an individual Practice level o Maximise the benefits of a duopoly of clinical system suppliers o Where ambition exists, move to a single clinical system across a CCG o Information sharing between organisations o Increase efficient ways of working o Drive up productivity by reducing duplication o To enable the provision of IT Service support beyond core hours o Introduce flexible ways of working Overview Fundamental changes to the organisation and delivery of General Practice and primary care are necessary, including the linking together of Practices in a network or merged partnerships in order to increase a step change in the scale, scope and organisational capacity of General Practice, to deliver and demonstrate measured value. The exact nature of the organisational changes is likely to vary across the county but is likely to be dominated by formal mergers, federations, sharing of back-office functions and informal collaboration. In order to maintain quality, protect the resilience of primary care services and attract a diminishing national workforce the CCGs will need to: Support local relationship based primary care with continuity of care giver where appropriate to needs and preferences of individual Increase investment to increased capacity and capability of General Practice Integrate service delivery outside of hospitals around larger units of General Practice including community care, social care and specialists Build on strengths and develop independent contractor model Page 9 Version 3.0

14 Enhance professionalism and improve quality to patients Improve organisational efficiency and sustainability Approach Practices which have yet to decide on their preferred GPSoC clinical system will have the option to move to one of two systems: TPP SystmOne or EMIS Web. The clinical system landscape in Nottinghamshire has a strong affiliation to these systems and the benefits of restricting choice to only two systems is borne from the inherited operational knowledge of each system, minimisation of wholesale business change required for some system migrations, relationships built with system providers from legacy versions of software, integration with other Practice business systems (e.g. dispensaries), etc. Emerging Practice collaborations (whether formal or informal) will likely result in the use of clinical systems between Practices or an increased mobility of individual clinicians between formal GP units. The outcome of such arrangements is the need for clinicians to be confident of their use of systems, the consistent application of Read Codes and the requirement for appropriate clinical content to be attached to the patient s record. In an ideal environment this would be facilitated through the provision of a single clinical system albeit with multiple instances to maintain medico-legal dissociation where necessary. CCGs will, therefore, individually consider whether they wish to encourage Practices to move to a common clinical system platform. Alternatively CCGs will support a duopoly of SystmOne and EMIS Web instances across their patches. Where this is the case the use of Medical Interoperability Gateway (MIG) and Clinical Record Viewer (CRV) will be implemented to support the sharing and viewing of records across primary and other care settings. Depending on the level of collaboration between Practices consideration will need to be given on the current limitations of MIG, CRV and similar technologies in allowing non-practice clinicians to write back to patients records. Where this is required clinicians may need to be granted permissions to access other clinical system where Information Governance policies allow this to take place. For Practices who have already migrated to GPSoC compliant systems, and who may wish to migrate to a common system in their CCG, support will be given to meet the associated business change and data migration costs. Subject to the outcome of the renegotiation of the Connecting for Health national licensing agreement with clinical system suppliers, the CCGs may also be in a position to support license purchase costs for such installations. Other, well-established, technologies will also be rolled out where there is a supporting business case to do so or where it is deemed to add value to patient experience and the quality of care they receive. An example would be the use of mobile technology to provide visiting clinicians access to patient records in a care home setting. This will provide more accurate access to patient information for the clinician and the ability to instantaneously updating the patient s record with the necessary observations and tasks, potentially eliminating unnecessary delays, referrals to other services and clinical errors Page 10 Version 3.0

15 5. Improving Patients Access to Information Summary: : This chapter covers contractual requirements for Summary Care Records (SCR) and the value of enabling patients to self-manage their own health needs, as well as the utilisation of technology to improve health outcomes through access to information. Technologies o Summary Care Records (SCR) o Patient Access to records o Online appointment booking/prescription ordering o Remote correspondence with GPs o Smart phone Apps Key References and Publications o CCG Primary Care Vision 2014 o The Department of Health s National Mobile Health Worker Project final report published January 2013 Key Ambitions o Seek opportunities to help patients with long term health conditions in managing their own care and treatment o Providing the information for staff to better help and support patients through the development of shared electronic care plans and records that link with key services such as NHS 111, 999 and Out of Hours Overview The GP contract 2014/15 stipulates GP Practices are required to provide an automated upload of their summary information to the Summary Care Record, or have published plans in place to achieve this, by 31 March Practices will need to ensure their Summary Care Records information is up to date ensuring records of medication, allergies and adverse reactions from the patients GP records are recorded onto the national spine. This can then be accessed in the appropriate clinical settings with the appropriate access rights and with patient consent to support clinical care. GP Practices have the option of enabling functions within their clinical system allowing patients to book appointments and order repeat prescriptions online through SystmOnline or EMIS patient access. Currently not all Practices offer this functionality. The Department of Health s National Mobile Health Worker Project - final report, published January 2013, revealed from information collected during the 15-month period of the project, that it is clear the adoption and long-term use of appropriate mobile solutions has the potential to significantly improve productivity, efficiency, safety and assist services to continue to provide good quality care and achieve good outcomes. The reported findings included significant saving in referrals can be achieved (up to 34%) as well as significant savings in admissions. Practices should be able to access electronic information relating to their patients when they are treated in other parts of the health system. This particularly includes discharge and outpatient summaries, pathology, diagnostics and care delivered in community settings. The fast pace of Page 11 Version 3.0

16 evolving technology offers patients greater opportunities to engage with health and care services in ways that are convenient, cost effective and reliable. Furthermore patients themselves should be provided the capabilities to monitor and proactively manage their health care more closely. As well as the appointment and repeat prescription renewal patients will be able to: Send secure messages to their health care team; Conduct e-consultations; Submit requests to update medication and allergy lists; View a summary of their consultation and post- consultation management plan; Access, review and update their personal LTC care plan; Undertake pre-visit reviews; Access information from the record for their child under age 16 or for other family members; View portions of their medical record, including test results, diagnoses, medications and immunisations. Approach Practices will have the option to view Summary Care Records for patients that are not fully registered as part the delivery of care, to do this Practices will ensure they have a privacy officer in place to ensure there is a mechanism for monitoring SCR accesses by that organisation and that those accesses are legitimate. It is essential that our patients feel empowered to self-manage their own health needs and have the necessary information at hand to do this. We will ensure that all practices contain information on how patients are able to direct themselves around the complexities within health and social care with support from the Practice receptionist. CCGs want to encourage patients to take responsibility for their own health and become confident in managing their own health needs as much as possible. Each practice will have the technology to support patients on how to improve the selfmanagement of their own care through the use of smart phone apps, and e-referral. Patients will be able to refer themselves into services that have been commissioned as suitable for self-referral. The CCGs will determine which services are appropriate to accept self-referrals from patients (e.g. physiotherapy, Stop Smoking, counselling services, etc.) and make them visible to patients and giving the patient attending the self-referral appointment the choice to decide whether their GP is notified of the self-referral. The CCGs will support GPs in utilising their existing clinical system functionality to enable patients and carers to access online services. By 2015 patients will be able to access their GP record online including the ability to view test results, book appointments and order repeat prescriptions. All patients regardless of which Practice they are registered with will have access to booking appointments and repeat prescriptions online and work towards patients accessing their health records via the online clinical system used by the Practice. The CCGs will also explore options of how patients can access their GP and how they receive care including telephone consultations, online consultations, audio, visual consultations or face-to-face appointments and telephone triage with their GP allowing Practices to make informed decisions on what would work best for them and their patients. Video conferencing and collaboration tools will offer health and social care providers a whole host of opportunities to provide their services in a Page 12 Version 3.0

17 more efficient and productive manner. By allowing real-time, two-way interaction, using technology to effectively simulate the experience traditionally obtained face-to-face or to obtain clinical input during multi-disciplinary team meetings as and when needed. Video conferencing tools could also provide GPs with the ability to diagnose certain symptoms such as skin disorders without the necessity for patients to attend the Practice with additional support of specialist involvement remotely Page 13 Version 3.0

18 6. Integrate Primary Care Systems with Other Health and Social Care Systems Summary: This chapter outlines plans for integrating health and care systems across all organisations and providers as well as between individual practices. Technologies o Medical Interoperability Gateways o Portal technologies o Use of NHS number as primary identifier o Integrated Care Record Key References and Publications o Everyone Counts: Planning for Patients 2013/14 published December 2012 o Caldicott 2: To Share or Not To Share published April 2013 Key Ambitions o To use the NHS number as primary identifier across all providers by 2013/14 o Set the strategic direction of travel for system integration/interoperability Overview Concerns over security and privacy issues have led to a culture that is sometimes risk averse and reluctant to share information, even where it would improve patient care. An output from the NHS Future Forum work has been the clear message that not sharing information has the potential to do more harm than sharing it. The new Caldicott principle states [the] duty to share information is as important as the ability to protect confidentiality particularly if sharing is in the patients best interest. Information sharing between organisations and across the health and care and support sector is fundamental to an integrated way of working. Information should be recorded once at first contact then shared securely between care providers. Nationally defined standards will allow information to move freely between services and organisations in the local health community with data sharing remaining confidential, safe and secure, promoting public confidence in local services and in the information itself. Nottinghamshire CCGs recognise that the GP clinical system is a strategic component within healthcare. The quality of clinical data held within GP systems has never been more important both internally to support the clinical and business processes within GP practices, and externally to support the delivery of care in the wider context. The CCGs will, as part of its primary care vision, align Practices and community provision to utilise and share resources for patients within a similar demographic area. This will enable CCGs to move towards all teams becoming integrated and tailored to a particular demographic need, whilst working together to utilise and share a limited workforce. Once aligned it is anticipated that some GP Practices will collaborate in GP communities. GP practices working collaboratively may have a requirement for the sharing of patient clinical information, administrative functions, back office functions and workforce Page 14 Version 3.0

19 Approach If a patient has a complex condition, or set of conditions, we will ensure they are appointed a care co-ordinator, to work with multi-disciplinary teams responsible for delivering care. These multidisciplinary teams comprising of community services, primary care services and social care services will have appropriate access to patient information regardless of the clinical system used. The CCGs will adopt national standards to sharing information meaning that systems will be able to connect and join up, rather than every organisation using the same technology or product. GP systems will be connected through Interoperability Gateways and portals allowing patient medical records to be shared to clinicians and staff who have a legitimate relationship with the patient for the purposes of direct care. A fundamental part of this support will be the comprehensive and consistent use of the NHS number across health and social care services, at the point of care with the aspiration of achieving real time NHS number matching as care is delivered. The NHS Number will be used to connect patient records across the whole system as patients move between services. This alongside professionals being able to access relevant records online, simply, securely and in one place will enable more joined-up care. The NHS number will become far more visible to patients themselves, for example, on every letter and appointment. As users of health and care services, and as members of the public, patients should become increasingly aware of their own NHS number and its ability to ensure that they are always correctly identified and how it can help ensure that their care and their records are appropriately reconciled and coordinated. Nottinghamshire CCGs will procure and use innovation and advances in technology that will integrate our clinical systems data with the wider community in order to support our natural communities and the integrated work programme. We will encourage economy-wide joined up patient care through systems integration, interoperability and information sharing across all providers and General Practices encompassing Primary, Community, Secondary, Out of Hours and Social Care service, ensuring information around the frail elderly and comprehensive geriatric assessments are available to all carers and clinicians. The CCG, in agreement with other organisations will support the commissioning of Interoperability Gateways and portals which will allow data from GP Practices operating different clinical system to be viewed by appropriately authorised staff, (which have a legitimate relationship with the patient), in other agencies such as emergency departments, community and social care enabling them to make better, informed decisions about care Page 15 Version 3.0

20 7. Supporting Patients Care through Assistive Technology Summary: This chapter sets out how Tele-care and Tele-health currently support patients, as well as plans to grow Tele-health use and create a single Assistive Technology Service. Technologies o Tele-care o Tele-health o Remote visual Consultations Key Ambitions o Providing alternative methods for patients to access primary care o Keep the population healthy o Promote the benefits of tele-care and tele-health Overview Across Nottinghamshire there is variable uptake on the use of tele-care and tele-health services. Although not universally adopted Flo, a simple tele-health text messaging service, helps patients take a more active role in their health care. Flo can give personalised health tips, provide valuable advice to help them stay on track and send medication reminders. Currently Flo is being used to support patients with: Hypertension Medication Reminders Heart Faliure Diabetes Asthma CCGs will assess the suitability of Flo and similar technologies in order to develop a better quality, more cost-effective service to vulnerable people across health and social care. This will be an integral part of Nottinghamshire s integrated health and social care programme. Alongside the traditional use of tele-medicine applications the CCGs will provide patients with the ability to consult with their GPs using e-consultation capabilities (either video- or tele-consultation). Typically this will be through the use of Skype, FaceTime or other similar technologies. Whilst the CCGs and other organisations in the health and social care community have elected to implement proprietary products, the success of e-consultation facilities will hinge on the flexibility for patients to use their system of choice. It is, therefore, imperative that the infrastructure deployed into GP Practices is sufficiently flexible to communicate seamlessly with a range of products in common use. The longer term aim is to join up the video-conferencing, Flo, tele-care and other tele-health services into a single Assistive Technology Service. This will enable health and social care staff to refer for equipment to support a patient s health or social care needs through a single referral and installation pathway. This new single service plans to be operational during 2015/ Page 16 Version 3.0

21 Approach Nottinghamshire CCGs will commission a strategic review into the most appropriate technologies by which their ambitions can be delivered. Initially this will focus on the implementation of e- consultations in order to rapidly support the introduction of these options for patients and to introduce a mechanism by which demand on primary care can be managed more effectively. It is likely that the introduction of e-consultation capabilities will require hardware enhancements to consultation room IT equipment, since the availability of web cams is not covered under the existing GMS / PMS blue book minimum standards. The added financial pressure of reduced GP IT revenue allocations will mean that consideration may be given to a phased introduction for this capability over a period of up to 3 years. The CCGs will also consider the evidenced benefits of existing and emerging tele-care and tele-health technologies. Where there is clear evidence of positive impacts to quality and patient experience the CCGs will implement such technologies for those patients and / or conditions best suited to realise the projected benefits. It is envisaged this will extend beyond the traditional services designed to support patients with chronic illnesses and could apply to patients with a wide range of conditions and complexities, supported by a wide range of devices used for the gathering of patient information. To help improve the patient s ability to self-manage their own health needs the use of this technology may allow patients to text or their self-taken readings through to the devices taking the readings and asking the patient to answer condition specific questions informing the appropriate clinicians as appropriate. These devices will also support patient education providing the correct advice to allow patients to make informed decisions in order to better self-manage their care reducing continuous unnecessary visits to their GP. The CCGs will also ensure clinicians understand their role in identifying suitable patients. The CCGs along with their member Practices will look at ways we can utilise these technologies to the benefit of General Practice across the primary care landscape. Exploring innovations in technology that will allow secure remote visual consultations to work alongside, for example, teledermatology to help patients gain access to health care that might be otherwise out of reach, lack the means of transportation or have mobility challenges, enabling patient s access to their GP without them leaving their home Page 17 Version 3.0

22 8. Use Data Analysis to Inform Clinical Behaviour and Commissioning Decisions Summary: This chapter identifies how information from clinical systems can be used to improve outcomes and address inequalities in primary care. Technologies o Risk Stratification Tools o Data Warehouses o Referral decision support products Key Ambitions o Encourage the safe sharing of patient clinical information o Utilise the information from clinical systems o An environment in which clinicians are encouraged and empowered to evaluate their decisions against the latest evidence and peer behaviour o Reduction in unwarranted clinical variation Overview Information is not always valued as a key tool to support decision-making and this has a knock-on effect in terms of cultures and behaviour. Information is often seen as the preserve of IT specialists and systems analysts, rather than as an enabler to providing better, more efficient care. Better use of information will enable better care and allow clinicians to compare their own performance and use richer sources of evidence for research, developing new services and innovations which will improve the range and quality of services available to patients. GPs need access to clear information that helps them understand and make informed decisions about the type of care and support that is best suited to individual patients, patient groups and the health economy as a whole. This includes the ability to compare the relative quality and benefits of different pathway options for patients. There is enormous potential from joining up information at the population level. Information on individual patients, when combined securely at a population level, gives the opportunity to have greater confidence in the accuracy and outcome of service changes. This is essential if pathways changes are to be brought into effect quickly and efficiently to improve health. Approach The use of risk stratification and decision support tools will be encouraged to help improve the quality of care whilst increasing efficiency and productivity. The CCGs recognise the enormous potential that these tools can offer but also understands their dependency on high quality primary care data and the importance of enhancing that information through appropriate record sharing. Risk stratification tools will continue to be used to identify those patients who are at greatest risk of hospital admission, enabling appropriate care plans to be in place. It is therefore important that we work with GPs and our IT providers when determining what technologies are best placed to ensure that data is captured both safely and appropriately Page 18 Version 3.0

23 The implementation of the Nottinghamshire data model will enhance our abilities to provide frontline primary care clinicians with this information whilst remaining compliant with the legislative changes withdrawing the ability for NHS commissioners to process patient identifiable data. Within Nottinghamshire considerable progress has been made over many years in the development of information provision. Within the CCGs the existence of a single, common data warehouse accessible through ehealthscope and ROBIN applications has made good inroads into the provision of an online portal bringing together the best of the relevant information allowing practices to access data around their patient population. In some instances CCGs will consider the use of national products to support the referencing of national or locally-defined clinical pathways. Map of Medicine will be considered as a product to deliver this functionality alongside its ability to record details of individual referrals. ehealthscope also provides this functionality so CCGs will consider the use of other functionality and cost when implementing their preferred option. CCGs and local authorities will make better use of the information they have, and move towards collecting and using information based on outcomes and quality, rather than simply the traditional activity and finance. Over time the CCGs will develop capabilities to share information for a wider variety of uses as the source data derives from patient s care records. For GPs and their wider clinical teams this includes making information available on the performance and quality of services, in particular on individual clinical and other care outcomes at a more detailed level. This can include clinical audits down to individual clinician or clinical team, staff feedback and views, and patients and service users opinions, feedback and complaints. To strengthen these capabilities CCGs will continue work with our IT provider to commission data warehouses, creating a central repository of integrated data from disparate clinical sources allowing the data to be analysed helping to identify priorities for investment to improve outcomes and address inequalities. To ensure patients are being managed in the most effective manner, the CCGs will continually work towards enhancing existing systems to: Provide multi-disciplinary teams the ability to assess and stratify the level or risk for patients being readmitted to hospital; The provision of more granular information to support clinicians in examining variations in clinical behaviour through clinical audits; The ability for GP Practices to normalise reported clinical variations by considering differences in working patterns and expertise of individual clinicians and early provision of data sharing across organisations to support Long Term Conditions and End of Life care Page 19 Version 3.0

24 9. How Will We Deliver This Vision? Commissioning NHS England will support CCGs by setting the overall vision and strategy, establishing a single set of standards and maintaining budgetary oversight. This includes maintaining the national infrastructure and managing the GP Systems of Choice contract (GPSoC). Through this arrangement, primary care providers will continue to have a choice of high quality solutions, tailored to local need, underpinned by a commitment from NHS England to support the development of a world-class information and technology infrastructure across health and care. Successful global organisations are underpinned by successful, resilient and well-support IT systems. For the Nottinghamshire CCGs to continue their success they must be supported by high quality, resilient, responsive and cost-effective IT services. The increased reliance on IT, and the probable extension to the hours within which primary care services are accessible to patients, means that the CCGs IT service providers must respond to cover the broader scope and time required and meet rising customer expectations. The CCG, in collaboration with our commissioned IT provider, Connecting Nottinghamshire, the Health & Social Care Information Centre (HSCIC), and our patients, will deliver our primary care objectives through the appropriate sharing of information and the use of technologies. Training Through the revised GPSoC contracts and local arrangements, the CCGs will ensure training is provided to all Nottinghamshire Practices. CCGs recognise the importance of training and its vital contribution towards best and efficient use of clinical systems and IT. Additional training will be provided as and when needed for both beginner and advanced users. Information Governance The vision will be delivered in line with Information Governance requirements including the legislative and regulatory obligations relating to the handling of information. All new system changes and developments will be done so within a framework which ensures necessary safeguards are in place for the appropriate use of personal and sensitive information. Oversight and assurance will be provided to the CCGs IGM&T Committee to manage any risks to confidentiality and or information security. Furthermore, in line with the requirements of DSCNs 14/2009 and 18/2009, the CCGs IM&T Clinical Safety Officer will continue to undertake formal assessments for any local changes to existing software applications or new ones being implemented as part of local developments. Key areas to provide assurance of Information Governance compliance will include: Robust polices, systems and processes are embedded in any project or new development; The rights of patients and service users are respected at all times; Privacy impact assessments will be built into all new processes to ensure any privacy concerns are highlighted at project initiation stage; Page 20 Version 3.0

25 Risk assessments are carried out for all projects which balances identified IG risks against the introduction of any new risks associated with the cessation of existing processes; The confidentiality, integrity and accessibility of data is not compromised; Developments and projects are delivered in accordance with the Information Governance framework and standards as set out in the Information Governance Toolkit (including but not limited to risk assessment processes, access controls and business continuity); The vision is delivered in line with the joint health and social agenda and involvement with wider stakeholder and partners; Compliance with national, regulatory and local best practice and guidance; Close working with the nominated informatics provider. Conclusion Opportunities to utilise these technologies are vast, from providing fast and efficient consultations with difficult to reach services, such as Prison Health Care environments or seeking a remote second opinion from a specialist physician in other areas of the country. We will improve communication across NHS and social care providers by integrating services to reduce duplication and errors and make care more holistic, we will promote the right culture that places the patient at the heart of everything we do, and which will encourage innovation and transformation. Implementation of change must be performed at pace if clinical benefits are to be realised and the improvement in quality and patient experience felt by members of the public. To operate at this pace the CCGs will need to act decisively and in support of their IT services provider alongside those in other parts of the Nottinghamshire health and social care community It is essential that the CCGs engage with all primary care users of information and technology in order to commission the right solutions for the problems that are faced in Nottinghamshire s primary health care community Page 21 Version 3.0