LTC Lunch & Learn: Information sharing for care coordination, 29 April 2015

WELCOME

Wednesday 29 April 2015 Webinar

Information Sharing for Care Coordination

Information Sharing for Care Coordination

Wednesday 29 April 2015

12.30pm – 1.00pm

Adam HatherlySenior Solution Architect, Health & Social Care Information Centre

Christine WikeNHS Improving Quality

&

Beverley MatthewsLTC Programme Lead, NHS Improving Quality

Beverley Matthews

LTC Programme Lead

NHS Improving Quality

[email protected]

www.england.nhs.uk

LTC Year of Care Commissioning

Programme:

4

• 5 Early Implementer sites

• 35 Fast Followers

• Whole Population Datasets

• Implementation Guide

• Simulation Modelling

• Specialist Support Team

www.england.nhs.uk

LTC Framework Improvement

Programme:

5

Organisational &

Clinical

Processes

Informed and

engaged patients

and carers

Health & Care

Professionals

committed to

partnership

working

Commissioning

• Information and

technology

• Case finding & risk

stratification

• Care Planning

• Safety and

Experience

• Guidelines,

evidence and

national audits

• Care Delivery

• Self Management

• Information and

Technology

• Group and Peer

Support

• Care Planning

• Policies for carers

• Voluntary sector

patient & carer

support

• HSC Integration

• Multi Disciplinary

Teams

• Culture

• Workforce

• Technology

• Care Co-

ordination

• Care Planning

• Needs

Assessment and

Planning

• Joint

Commissioning

• Metrics and

Evaluation

• Service User and

Public Involvement

• Contracting and

Procurement

• Care Planning

• Tools and Levers

The table below sets out some of the key components needed to deliver the central

aim for LTC Framework - Person Centred Coordinated Care

Long Term Conditions Dashboardhttp://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html

Long Term Conditions House of Care Toolkithttp://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/long-term-conditions-improvement-programme/house-of-care-toolkit.aspx

Simulation Modelhttp://www.simul8.com/viewer/download.htm

#LTCyearofcare #LTCimprovement @NHSIQ

Tools and Resources:

For registration details, email [email protected]

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….coming soon…

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MRPharmS Director

Monmouth Partners

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Helen Lyndon

Nurse Consultant Older People, Clinical

Lead Frailty, NHS England

27 May 2015

12:30 – 13:30

Primary Care Workforce for the 21 Century

Webinar

Sharon Lee

Primary Care Workforce Facilitator

South Kent Coast CCG

4 June 2015

12.30 – 13.30

Home Checks/Prevention Peter O’Reilly & Geoff Harris

Manchester Fire & Rescue Service

9 June 2015

12 noon – 1pm

Health 1000 Rob Meaker

Barking, Havering & Redbridge

Information Sharing for Care Coordination

• Mapping out your business and technology environment and understanding what information flows you need.

• Understanding the “patterns” of interoperability; selecting patterns and building a sharing roadmap.

• National Systems and Standards which can help.

of Care foundation.

Today’s Learning Outcomes

Information sharing for care coordination

Lunch and Learn WebEx

24th April 2015

Adam Hatherly, Senior Solution Architect, HSCIC

Learning Objectives

• Mapping out your business and technology

environment and understanding what

information flows you need

• Understanding the “patterns” of interoperability:

Selecting patterns and building a sharing

roadmap

• National Systems and Standards which can

help

Definition

• Interoperability:“The ability to safely share and make use of shared information and

services, regardless of the systems in use, and who supplied them”

Presentation Information

Application Technical

Interoperability

e.g. Common

look-and-feel,

standard

headings, etc.

e.g. common

information,

definitions, clinical

coding, etc.

e.g. sharing of

functionality,

common

integration

patterns, etc.

e.g. common

networks, shared

technology

capabilities, etc.

• The Main focus for this session is the Application / Technical aspects for real-time sharing of patient information

Establish your vision and scope

Inter-regional / national

Regional

Institutional

Departmental

• Information sharing typically operates at

different levels of detail (richness) at different

scales

Mapping out the local landscape

• Understanding

where you are

starting from

• Identifying what

can be re-used

or built upon

National

Systems

And

Services

Ambulance Service

CSU

GPs

Community Trust

Hospice

Acute Trust

<<Clinical

Portal>>

<<TIE>><<PAS>>

<<EPR>>

OOH

<<OOH>>

Local Authority

<<Mental Health>>

<<Palliative Care>>

<<Social Care>><<Mental Health>>

<<Data

Warehouse>>

PDS

C&BDBS

SCR

<<Other

Specialties>>

Various Systems

<<Community>>

<<Order

Comms>><<Order Comms>>

Prisons

<<EPR>>

NHS

Mail

<<EPR>>

<<111>>

<<School

Data>>

<<Patient

Portal>>

<<MH Care Plans>>

<<Email>>

EPS

<<GP Comms>>

<<GP

Comms>>

<<CAD>>

<<Data

Warehouse>>

<<MI & Risk

Strat>>

<<Triage>>CMS

DOS

SUS

(PbR)

SCRa

<<Data Warehouse>>

<<A&E>> <<MIU>>

<<Scanning>> <<Scanning>>

<<PAS>>

<<Bed Mgmt>>

MPI

<<Triage>>

<<DW>>

DTS

<<PTS>>

<<ITK>>

<<ITK>>

<<Scanning>>

<<Palliative Care>><<Palliative

Care>>

<<Manual

Processing>>

Voluntary &

Charitable Sector

<<Various Orgs>>

Various

Systems

<<VCS

System>>

<<Reporting>

>

Identify Information Sharing Needs

• There will not be a single “silver bullet” solution.

• Map out the most important information flows.

• This will allow a “roadmap” to be developed to progressively build the sharing capabilities over time.

• Some examples might be:

– Mental Health: Sharing standardised mental health “personal assessments” across integrated teams working in the community trust and the local authority.

– Child Protection: Unscheduled care services (including A&E and the Ambulance Service) want to know if a child who presents for care is subject to a child protection plan. This includes cases where the mother is pregnant, and the unborn child requires protection.

– End of Life Care: Manage the sharing and co-ordination of patient’s end of life care preferences between all services providing end of life care.

• Once you have identified the needs, you can start to discuss specific content to be shared, and approaches for sharing it.

Define and agree new information flows

• Map out how the information sharing process will work, and review with business stakeholders – e.g.:

A COPD patient goes for a regular review of their condition with the case manager in the CREADO

team, and takes along some recent test results, which feed into a discussion as part of reviewing

their care plan. The patient and clinician discuss the results and agree some new and updated

actions/needs, which the clinician updates in the patient’s care plan in the shared COPD record.

2

1

The care plan is

automatically

synchronised with the

clinical systems used

by the GP, community,

OOH and A&E teams.

Care Plan

The patient is given an updated

hard-copy of their self-care plan.

CREADO

Clinician

Shared COPD

Record

Self-

Management

Plan (Paper)

Care Plan SyncATimescale

LONG

In Current Plans?

NO

Interaction

Care Plan SyncA

3

GPCommunity

3

OOH

3

A&E

3

CREADO = Community Respiratory Exacerbation And Discharge Outreach. Focused on preventing readmission

Introducing Patterns

• A “pattern” is a formal way of documenting a solution to a design

problem in a particular field of expertise – this case sharing clinical

information between systems.

• Patterns are not mutually exclusive: many real solutions will use

more than one pattern.

• Solutions may evolve from simpler to more complex patterns over

time.

• Some patterns will be better for specific sharing needs than others –

there is no “one size fits all”.

• Some patterns will scale better to larger populations.

• Some patterns require additional capabilities or services to be in

place.

Summary of Patterns

Sys

A B

Data

A B

Src Con

Con

Src Brk Con

Single Shared

Application

Click-Through

Send point-to

point /

Broadcast

Message

Broker

Src

Rep Con

Con

Portal

Store and

Notify

Shared

Repository

Registry

Repository

Ptl

A

B

N

Do

cu

m

en

t

So

ur

ce

Src Rep Con

ceSrc Rep

Reg Con

http://developer.nhs.uk/library/architecture/integration-patterns/information-sharing-patterns-summary/

Messagin

g

TL

S M

A

System A

System B

Supporting Capabilities

Endpoint

Directory

Organisation

Directory

User Directory

Reference

Data

SSO RBAC

Messaging Standards

Registry

Citizen Identity

Patient Index

DSA

Repository

Relationship

Service

Consent

Service

PKI

Subscription

Service

N3

Inte

rnet

Broker /

Middleware

Building a Roadmap

• It is not realistic to wait for national standards and capabilities before

beginning to address local sharing challenges.

• Equally, once national capabilities and standards are in place, it will

take some time for these to be adopted by system suppliers.

• Local organisations also need to build roadmaps that allow them to

progressively migrate to using more mature patterns, and national

capabilities when they are in place, and it makes sense to do so.

• For example, a locality may build a roadmap for sharing a specific

type of information (e.g. care plans):

Simple notification

and click-through

patterns to provide

access to plans held

in clinical systems

Implement a

shared

repository

and submit

plans to it

Link the repository

with a region-wide

registry to link up

with other

repositories across

a wider region

Link the region-wide

registry into a

national registry to

allow records to be

located nationally.

National Systems and Standards

• National Systems:

– N3: Private Network

– NHSMail: Secure Email

– Smartcards: Authentication and Role Based Access Controls

– PDS: Demographics/NHS Number

– SCR: Summary Care Record

– GP2GP Transfers

– Choose and Book/eReferrals

– Electronic Prescriptions Service

– CPIS: Child Protection Information System

– Secondary Uses Service / Hospital Event Statistics

• National Standards:

– Clinical Coding: READ2,

CTV3, SNOMED CT

– Information Standards:

SCIE (formerly ISB), Data

Dictionary

– Interoperability: Messaging

Specifications (ITK),

Documents (CDA)

– Clinical Safety

– Security

• Emerging Standards:

– HL7 FHIR

Interoperability Toolkit

• The NHS Interoperability Framework (also known as the Interoperability Toolkit or “ITK”) is:

– National standards

– Implementation guides

– Accreditation scheme

• Supports interoperability within local orgs and across local health communities.

• The ITK is not a piece of software

• Moving away from bespoke interfaces

– Reducing complexity and therefore expenditure

• Publishing a series of common specifications

– Policing the deployment through ITK accreditation

– Bring a level of standardisation to the market

NHS England Interoperability Framework

Information GovernanceReferences standards, policies and guidance responsible for ensuring quality,

security and lawful use of information shared between systems.

Identifiers

Used for the unique identification of: patients and service users; NHS and non-NHS

organisations, services, workers and locations; and other physical and non-physical

entities requiring unique identification, e.g. physical products and communication

endpoints.

Codes and TermsUsed to assert the precise meaning of data to enable the consistent recording,

querying and interpretation of information.

Document Headings

Standard headings for organising data for entry and display particularly structuring

free text contents which in turn can convey the clinical and business meaning in a

human readable form.

Data Structures

(logical)

Used to create consistent dataset definitions that can be re-used across different

implementation standards or technologies.

Message Structures (physical)Used to create implementation specifications that define how datasets are realised

by different implementation standards and / or technologies.

Communication PatternsDescribes the re-usable architectural approaches for sharing health and care

information.

Technical Transport

(physical)

Interface mechanism by which data is exchanged between sending and receiving

endpoints.

• Work is ongoing (supported by HSCIC) to produce a range of guidance and resources to support local information sharing.

Questions?