Informatics Implications of Integrated Care

1. Informatics Implications of Integrated Care Adam Drury, GE Healthcare Finnamore 18th June 2014

2. Contents • What is Integrated Care? • Informatics Implications • Questions / Discussion

3. So what is Integrated Care?

4. Who is integrated care for? • Any individuals where gaps in care, or poor care co-ordination, leads to an adverse impact on care experiences and outcomes. • Best suited to frail older people, to those living with long-term chronic and mental health illnesses, and to those with medically complex needs or requiring urgent care. • Most effective when it is population-based and takes into account the holistic needs of patients. Disease-based approaches ultimately lead to new silos of care.

5. Care Coordination and Integration of Organisations • Effective care co-ordination can be achieved without the need for the formal integration of organisations. Within single providers, integrated care can often be weak unless internal silos have been addressed. • Clinical and service integration matters most.

6. What is the evidence for benefits of integrated care? Quantitative evidence base Social care services Community care services Acute care:A&E and UCC Acute care: Emergencies Acute care: Planned LGA value case toolkit BCF 10-15% savings: 10% Limit 15%-35% savings: 15% Limit 20-40% savings: 22% Limit 10-20% savings: 13% Published quantitative case studies CAHS 5% savings CAHS 10% savings CAHS 6% savings 40-70% of gross savings reinvested in social and community care. Savings inferenced from above LES 10%-30% savings: 10% LES 10-30% savings: 12% LES 4-14% savings: 7% Qualitative evidence base A selection of key references used to design and plan new care services.

7. ‘Good practice’ in Implementing Integrated Care • Find common cause • Develop shared narrative • Create persuasive vision • Establish shared leadership • Understand new ways of working • Targeting • Bottom-up & top-down • Pool resources • Innovate in finance and contracting • Recognise ‘no one model’ • Empower users • Shared information and ICT • Workforce and skill-mix changes • Specific measurable objectives • Be realistic, especially costs • Coherent change management strategy

8. ‘Good Practice’ for Shared Information and ICT • Shared electronic records • Information Sharing / Information Governance agreements • Patient consent “Greater use of ICT is an enabler but not a necessary condition for integrating care, and done badly, can be a distraction” Dr. Nick Goodwin, CEO, International Foundation for Integrated Care

9. So who is already sharing care records? plus a number of others.........

10. Informatics Implications of Integrated Care

11. Software and Systems • Systems need to support the care pathway and not the organisations needs –use of Clinical Portals, best of breed solutions, MIG, integration engines etc. • Need for real time data sharing - e.g. sharing lists of patients being treated by community care teams with acute neighbours • Different technical architectures possible: • Building an central EHR type model where data is extracted and consolidated onto a single platform • Providing a portal viewer to aggregate data linked together on different systems – nothing held centrally

12. Hardware and Infrastructure • Connectivity across networks becomes critical – N3, Public Service Network (PSN) and local COINs can support integrated care provision across care pathways • Seamless access to wifi across sites • Mobile devices and access will become increasingly important – mobile devices need to be fit for purpose

13. Data and Information • Business intelligence and big data will help identify where patient challenges are and lead to better commissioning decision making • Predictive algorithms will need to operate at population level on near real time data and then be able to alert and impact care in real time • Integrated care will need more than business intelligence for identifying patient cohorts and their risk, it will need to help manage the clinical outcome objectives set in contracts, attribute value to the provider network, help manage networks of care providers, and deliver the evidence base end to end across clinical pathways

14. Informatics Services • Traditional organisational IT departments will need to change – support needs to be cross-organisational through shared arrangements • Clinical Informatics Leadership will need to be provided across care pathways and not on an organisational basis • CIO role to focus on delivering business value and not on local systems and services • Single sign-on, NHS Number adherence etc become critical • Patient access needs to be through one single portal – standard solutions needed

15. ‘Our survey said......’ • ‘Tension between central control and de-centralisation of the patients information – need to give patient control of their own data and allow staff to access with patient consent • ‘Commissioners to be clearer on the pathways they want to commission – service ethos needed with technical design to follow’ • ‘Financial model is wrong – need to change so that the money follows the patient’ • ‘Can only be solved with the ‘lock down’ – getting people into a room and force them to work together – it is a ‘must do’ • ‘Provider core business under threat – as activity moves to community settings acute sustainability may be questioned’ • ‘Get organisational boundaries out of the way’ • ‘Most solutions are out there somewhere – need to better share ideas and solutions’ • ‘Need to devise the healthcare system to follow the patient not the other way round’ • ‘Put in place positive incentives for change’ • ‘Need an app / plug-in to make it happen!’

16. Summary • Integrated care works best with: • Whole populations rather than care pathways • Appropriately targeted service users • Pooled budgets • Multi-disciplinary teams • Shared care record • Shared care record is an enabler not a necessary condition • Examples of ‘good practice’ shared care records coming to the fore – more will emerge as a result of Tech Fund (1 and 2) • It is not just about systems – people and technology also key to success

17. Adam.Drury@ge.com • 07834 711007