Collaborative e-care: health information exchange for ...

Collaborative e-care: health information exchange for

enhanced care

Wednesday, March 2, 2016 Charles Gutteridge MD

Barts Health NHS Trust UK

Conflict of Interest

Charles Gutteridge MD

Has no real or apparent conflicts of interest to report.

Agenda

•Health economy of East London

•Commissioning for value

•Collaborative e-working in East London

•How are we doing?

•Lessons learnt

Learning Objectives

• Identify lessons learnt in delivering integrated

care across traditional healthcare boundaries

• Distinguish how best to use health information

exchange to support clinical and business

objectives in health delivery systems

• Describe the key steps towards building self

care delivery platforms

1.2 M people US 1.6B budget

3 core elements to our programme

•A people’s health data movement

•Empowering clinicians with point of care information and outcomes data

•Developing data for population health

Enhanced service aims

1. Increase practice availability to patients

2. Identify patients at high risk of emergency admissions

3. Improve hospital discharge processes and coordinate care

4. Internal provider reviews of emergency admissions and ED attendances

5. Patients satisfaction surveys

3 key interventions

•Linking electronic health records

•Health information exchange

•Outcomes tracking

Ris

k s

trat

ific

atio

n

Co

-ord

inat

ed c

are

Reduce

emergency

attendances

Reduce

emergency

admissions

Improve

outcomes QAdmission® algorithm

(Consent)

(Enrol)

East London Integrated Care Programme

High

Moderate

Low

Very low

Very high

Clinical case.

Julia Hippisley-Cox, and Carol Coupland BMJ Open

2013;3:e003482

©2013 by British Medical Journal Publishing Group

Reasons for attending the ED

Pain

Shortness of breath

Generally Unwell

Fall

Chest Pain

Confusion

Chest infection

LRTI

UTI

Gastroenteritis

IHD

COPD

Heart failure

Superficial injury

Fracture

Electrolyte imbalance

Unspecified chest pain

Unspecified fall / collapse

Unspecified abdominal pain

Unspecified MSK pain

Primary diagnosis at discharge (ICD-10)

Target population for community-based intervention

510

3,024 7,074

≥ 1 ED attendance

≥ 4 ED attendances

Current algorithm • Dependent on structured data in primary care record

• Focuses on medical problems

• Social history and functional status not included

Hypothesis • Point of care narrative information = most accurate

• May indicate factors increasing risk of attendance

ED clerkings • Barts Health ED: 7 years of electronic

documents

NLP

& ML

The answer is in the data…?

• Mathematical modelling and visualisation

3 different community approaches

Community matrons

Face to face

Community matrons

Face to face

Health analytics

Rapid response team

Telephone consent

GP EMIS web EMIS community

8 networks Care navigators

Telephone consent

Feedback from hospital systems Cerner Millennium HIE Cerner-EMIS

Waltham Forest Newham Tower Hamlets

GP EMIS web EMIS community

In 2011 systematic programme – guideline, IT decision support and recall,

Flu vaccination 1st and 2nd best in London. In 2011/12 Newham 18/31 THamlets 9/31

CCG Variation in high cost - low benefit medicines

Jan 2014

June 2015

City and

Hackney

60.8% 88.2%

Tower Hamlets 54.3% 78.8%

Newham 35.9% 72.6%

% Age 65 yrs or more: Pulse Check

in 5 yrs

Questions

Thank you

•[email protected]

•@gutteridgec