E HEALTH – ENABLING HIGH QUALITY AND CO-ORDINATED CARE FOR PEOPLE LIVING WITH LTC’s

1. E HEALTH – ENABLING HIGH QUALITY AND CO-ORDINATED CARE FOR PEOPLE LIVING WITH LTC’s

2. CONTENT • Some key challenges • Integrating Care – supporting MDT’s • Reshaping delivery of Older People’s Care • E Pharmacy current and future opportunity • The benefits

3. HEALTHCARE DEMAND IS GROWING A new Ninewells Hospital by 2031!

4. ANGUS CHP – PATIENT PROFILE Virtual Wards focusing on Tier 4 , Innovative Step Down Services are key to success! Macro Integrator NHS Tayside and Angus Council 724 2% LTC Population North West 187 North East 191 South 346 LEVEL 4 INTENSE CASE MANAGEMENT VIRTUAL WARD ANTICIPATORY CARE PLANS PATIENT PASSPORTS CASE MANAGEMENT 28% LTC Population 10148 LEVEL 3 CASE MANAGEMENT North West 2631 North East 2673 South 4844 70% LTC Population PRO-ACTIVE CONTACT SUPPORTING SELF CARE LEVEL 2 SUPPORTED SELF CARE 25372 North West 6577 North East 6684 South 12111 PRO-ACTIVE CONTACT SUPPORTING SELF CARE LEVEL 1 HEALTHY COMMUNITIES 66% Overall Population 72487 North West 18790 North East 19096 South 34601 LTC’s Asthma 6101 COPD 2056 CHD 5318 HBP 16423 Diabetes 4698 Obesity 11854

5. ENSURE OUTCOMES ARE DELIVERED…. Project Definition Statement Benefits Statement Project Status Report Is used for: Stating your case for change Current state analysis Evidence / Data Envisaged Change Summarise benefits Is used for: Define benefits in detail Define appropriate measures Summarise enabling changes ( PP&T) Summarise milestone tracking Is used for: Report on delivery progress. Report on Benefits Realisation against plan. Escalate to Project Board or EMT for decision, support etc Multi- disciplinary Project Board, Clinical and Finance essential

6. RESHAPING CARE FOR OLDER PEOPLE – OUTCOMES 1

7. RESHAPING CARE FOR OLDER PEOPLE – OUTCOMES 2

8. User Device Access Applications TECHNOLOGY ENABLING INTEGRATED CARE Security Service Complex Case Management Collaboration Tools Staff ID Virtual Database Case Management Clinical Portal RBAC PMS GP Community Health& Social Pro-active Contact TELEHEALTH PREDICTIVE RISK TELECARE BUSINESS ANALYTICS Prevention Integration Platform

9. IHI CARE CO-ORDINATION MODEL Person Centred For people with multiple needs Personalised Multi-channel interface Family, associated assets Family Carer/s Peer Groups Social Care Voluntary Goals(G) Co-ordination(C) PATIENT IDENTIFICATION OUTCOMES Value Proposition Service Design Service Delivery Supporting with enabling technology CARE CO-ORDINATOR Predictive Risk Tools GP Systems Community Information Systems Telehealth Telecare Business Analytics Performance Management

10. INTEGRATED CARE(VIRTUAL WARDS) - THE CHALLENGE • Emergency admissions and associated bed days not hitting HEAT T12 target.. • Challenge around Health Population Management (HPM) • Lack of effective collaboration between Health and Social Care • Alignment of e Health with key HEAT T6-T12 outcomes • Key improvement areas: • Reduce all age Emergency Beds • More effective HPM • Standard operating procedures • Effective MDT working • Effective medication concurrence

11. ePharmacyProgramme

12. SUPPORTING THE NEW COMMUNITY PHARMACY CONTRACT Acute Medication Service eAMS (& ETP): • eAMS enables the generation and delivery of 1.6M electronic prescription messages per week at all of Scotland’s 1000 GP Practices and used in all 1200 Pharmacies. This improves patient safety through assurance for patient and medication item selection and allows for significant efficiencies to be achieved in payment processing ( £3.2M+ pa in efficiency savings for National Services Scotland.) Chronic Medication Service eCMS • eCMS improves the care of patients with long term conditions through a systematic approach to their care, enables eligible people to register with a community pharmacy of their choice, to have a personalised Pharmaceutical Care Plan record created and monitored and to have ‘serial’ prescriptions to be created to cover up to a years worth of medication. The medication will then be dispensed and monitored in their registered pharmacy. Reduces patient visits to GPs and reduces the number of paper prescriptions plus improves medicines management & reduces the drugs budget. Minor Ailment Service eMAS • eMAS aims to support the provision of direct pharmaceutical care within the NHS by community pharmacists to members of the public with a common self-limiting condition. enables eligible people to register with a community pharmacy of their choice and have their common conditions treated, including prescribing, by their community pharmacist on the NHS without the need to visit a GP and enabled by a revolutionary remuneration process

13. LOOKING FORWARD TO A BETTER FUTURE

14. SOME IDEAS FOR THE FUTURE Telepharmacy Electronic Dispensing and Payment Processing for NHS24, OOH Pharmacy & Pandemics – Trial withUniversity of Aberdeen ECS + PCRs arethe makings of anational patient summary record ECS PCRs Patient Registration Service InformationServicesDivision Remote Electronic Prescribing (iPrescribe) mobile prescribing and pharmacy services – prototype 2011/12 ePharmacy Message Store Payment process PharmacyCareRecord ePay rules engine Scanning and message processing Complianceblister pack technology ??? End to End Medicines & Compliance Management in NHSS – better dispensing and Pharmacy care informationsystems…add secondary care ePrescribing and compliance product to provide a unique medicines management service improving patient care and reducing costs through reducing re-admissions to secondary care and managing the drugs budget Delivering beneficial change and efficiency gains and using innovative ways of sharing, developing and implementing to benefit the full patient journey

15. INTEGRATED CARE(VIRTUAL WARDS) - THE BENEFITS • Test of change demonstrators commenced March 2011 following introduction of PEONY2… • Enabling technology being fully utilised • Aligning with local improvement initiatives eg CMR in Angus, Case Management and ACP’s across Tayside.. • Envisaged benefits across Patient Access, Service Redesign and Patient Experience: • Drive effective attendance at A&E • Reduction in unscheduled bed days • Effective discharge models • Focus on the right patients • Increase value multi-disciplinary team time • Net CRES of £1.5-2.0m per annum.

16. INTEGRATED CARE(VIRTUAL WARDS) - THE APPROACH • Next future state workshop brought together over 70 integrated care professionals and patient groups… • Followed up be local sessions in CHP areas… • NHS Tayside worked with partners to develop new HPM toolset – PEONY2 • Test of Change Demonstrators set up in each CHP • Wider collaboration with Social Care, Voluntary Sector and Social Care • Align outcomes with LDP, HEAT and Reshaping of Older People’s services

17. SUMMARY • A whole system approach is key.. • Identify high impact projects and prioritise resource.. • Fully align with LDP and national outcome requirements • Quality improvement with associated CRES takes priority.. • Early engagement of whole system stakeholders essential.. • Build on best practice evidence and focus on reducing unwarranted variation… • Small steps, quick wins…