IT integration – Many Challenges, One Answer?

1. IT integration – Many Challenges, One Answer?

2. IT Integration Challenges Professor Derek Bell Solution Information integration Information utilisation

3. Past Present Future ‘If i have seen further it is by standing on the shoulders of giants'. SirIsaac Newton Master of the Royal Mint (1699-1727)Today's achievements would not be possible without the discoveries of the past,

4. The technology existsIT will make an efficient business more efficient ; IT will make an inefficient business more inefficient” Bill Gates Are we utilising it Culture Scotland has a unique position

5. “Some boards use data simply for reassurance, rather than the forensic, sometimes uncomfortable, pursuit of improvement.” Professor Sir Bruce Keogh Review into the quality of care and treatment provided by 14 hospital trusts in England 16th July 2013

7. Technology as an enabler • Improve individual care - longitudinal • Improve population health and wellbeing • Inform planning – organisational, regional, unit • Research • Focus • Participation • Coordinate education • Inform policy and ‘commissioning’

8. The third health revolution Citizens Information Knowledge Technology

9. Where can IT add value (patient outcome x patient experience) - Harm Value = Resources Cash Releasing Non-Cash Releasing But it must facilitate dialogue

10. The CLAHRC approach • From evidence based medicine • To evidence based practice • Via evidence based implementation

11. Why do we need a clinical portal? Health

15. Patients perception of use of e-health recordsself - healthcare - research – policyN= 5000

16. Ah but! • 78% would worry about the security of their health record if this was part of a national electronic records system. • 71% do not think that the NHS is presently able to make EHRs secure. • 46% believe that a national EHR system would be less secure in comparison to the way their health record was held at the time the survey was completed.

18. General patient information Clinical letters Diagnostic test results Clinical notes and assessments Lists and templates Performance indicators Knowledge support CPD Audit Appraisal E health survey questions

20. Clinician-centred information • Clinical performance indicators useful but not important • Information to support appraisal and CPD activities not thought to be important to deliver through clinical portal • Clinicians happy to use alternative sources to access these types of information • More important to focus on delivering patient centred information

21. Past medical history Current problem list Current medication Allergies Alerts Hospital discharge letters Outpatient clinic letters Referral letters Laboratory results Radiology results Radiology images Diagnostic text results Local clinical guidelines National clinical guidelines eBNF Agreed information priorities

23. Current Environment • NHS Boards are at different stages of readiness to implement a clinical portal • Majority of NHS Boards wish to implement this within the next two years • The data items exist across a wide range of clinical systems within and across the NHS Boards • Varying levels of access to key data items that are required for inclusion in the portal • Key challenges will be • Developing interfaces • Data cleansing • Information governance agreements

24. Population data Hyper-local data

27. DesignedRespiratory servicePaediatric ServiceMaternityMental healthComplex needs ……….. With and for the patients and population

28. GP Primary Care (Consul-tations) Outpatient Attendances Self Care 230m 14 4 2 2 1.4billion Elective Day Cases Emergency admissions Elective admissions Health Incident 2 billion (99-00)) Flow to Repeat Outpatients Self to A&E 31m 2 = A&E Attendances 3 13 999 6 A&E GP 9 HOSPITAL CARE SECTOR Fast Access Primary Care (NHS 111 and Walk in Centres) In Hospital Intermediate Care 340m Residential & Nursing Home Care Home Care Health Incidents Pharmacy Health and Social Care Whole System: Overview of Patient Flows(Figures in parentheses are in millions of cases per year) 10

35. 35.7%

38. Simplified Secondary Care ExampleBigger picture

39. Collaborative Care Solution - HIE • It ensure all clinical staff have access to relevant, up-to-date and accurate patient information – regardless of where that care is provided or the clinician is located • It is tailored to the needs of clinical users, enabling them to customize their experience and access unified patient data through a Clinical Portal, or exchange documents directly with their existing EMR system. • It supports global interoperability standards, works with best of breed partners, and can flexibly integrate with existing IT infrastructure to provide an open enterprise architecture that saves resources today and allows future system migrations to tie in seamlessly.

40. Collaborative Care Solution - HIE • The collaborative care solution supports a robust patient consent model to ensure strict patient confidentiality • It supports ‘connect all’ and not ‘replace all’ facilitating interoperability across all care settings • Adds value to existing infrastructures and investments, such as Quality Improvement Tracking Tools and Data Warehouses • Facilitates Patient Consent to make data available for research can be facilitated through Patient Portal • Orion Health development platform supports innovation by exposing RESTful APIs to third parties for customised API development

41. Key Benefits • Improved Patient outcomes – A single view of a patient record supports better clinical decision making and risk analysis, particularly where allergy, medication and co-morbidity information is available. • Improved care coordination - Enhanced levels of clinical communication will allow UCLP to rapidly respond to changes, deliver new clinical work-flows and collaborate with other healthcare providers on care for shared patients. Increased access to timely and up to date patient information through a role-based portal by any authorized person from any location, results in enhanced clinical collaboration on patient data and heightened delivery of care.

42. Key Benefits • Saves time – In-depth presentation of all information that is readily available, reduces the amount of time a caregiver spends searching for relevant patient data and enables treatment to begin immediately. • Reduces costs – Efficiencies are delivered through the reduction and elimination of duplicate or unnecessary tests and procedures. The provision of more coordinated care, gives the ability to avoid expensive, unplanned or unnecessary hospital admissions.

43. Key Capabilities • Complete View of Patient InformationHIE provides secure online access to patient records for all healthcare providers within the region via the Clinical Portal, offering providers without access to an EMR system a shared view of patient information. • Security and PrivacyHIE is highly configurable and supports either an opt-in or an opt-out model. It provides highly configurable rules, location, and roles-based access via information and patient access policies. These rules comply with local privacy and consent laws concerning minors, sexual health, and mental health. The solution has been deployed in over nine countries, proving its configurability and adaptability. • Intuitive User InterfaceA streamlined and clear user interface that provides effective visual integration to clinical content such as lab results, simplifies the patient record for clinicians.

44. Key Capabilities • User Subscribed NotificationsNotifications supports alerting and delivery of information when and where the user wants to see it, whether in the Portal or in an EMR. Users are in control and can subscribe to events that alert them to the availability of information in a variety of configurable ways. This helps to minimize information overload. Notifications can be altered to suit the circumstance, such as email, Phone, and iPad alerts for new information in the HIE, and SMS/pager alerts for a patient admission, and push of laboratory or CCD documents to an EMR at patient discharge. • Standards Based and Designed for Healthcare SettingsInformation exchanged between HIE systems uses HL7 and IHE based standards. Orion Health includes a full-featured technology set with extensive ability to integrate existing systems from hospital registration systems, to laboratory systems, to PACS viewers. • Continuity of Care Document (CCD) ExchangeBidirectional support for the Continuity of Care Document (HITSP C/32 v2.5) including the ability to receive, view, or print CCDs shared from external systems, and the ability to generate a CCD based upon information available in the patient’s record and view, print, or send it to an EMR system. The Orion Health Clinical Portal parses the CCD’s to provide a unified view of the patient data .

45. Key Capabilities • Semantic Interoperability Provides the ability to normalize the vocabulary sets used to describe laboratory results, problems, allergies, medications, and other clinical content so that information can be reliably grouped, trended, analyzed and exchanged even if it originates from different systems. Core support for standard terminology including SNOMED-CT, IC9-CM, ICD-10, CPT-4, LOINC, and RxNorm. • Web Based AccessThe Orion Health HIE/EHR can be accessed from any secure, web-enabled workspace now including the Apple iPad, improving mobility and remote access for the user. • External System IntegrationConnectivity to a wide variety of external systems via SSO, Web Services, and standards-based messaging in CCD or HL7 format.

46. Key Capabilities • Flexible Open ArchitectureProvides a flexible architecture tailored to the needs of the organization, supporting integration of many different clinical systems, and minimizing or eliminating the need to rip-and-replace previously implemented systems. • Flexible, Extensible PlatformGrow and extend the HIE/EHR in response to changing business needs with the installation of a range of add-on options including “EMR Lite”, Patient Portal, Reporting & Analytics, Case Management, Orders, Problem List, Enterprise Image Viewing, Electronic Prescribing,

47. NHS Glasgow NHS Glasgow NHS Greater Glasgow and Clyde Health Board are using Orion Health technologies to deliver a single best patient record, providing access for the providers regardless of where the patient lives or where the clinician is located while feeding lab results and other clinical documents into its existing central data repository to reduce costs and improve patient care. • 25,000 users • Employs 44,000 staff • Population of 1.2 million • Covers 14 acute hospitals, 35 major hospitals, 10 specialized units and 50 health centers and clinics The largest NHS organization in Scotland and one of the largest in the Western Europe The Clinical Portal in Glasgow has delivered the following benefits: • Reduced Lab Tests carried out across city (2,600 fewer per week) by avoiding unnecessary lab tests • >1m results viewed per week via the portal • Avoided costs of £15m alone from not having to move paper around the city • Remote access for GPs and community-based providers • Reduced time spent searching for information • Appropriate access to data backed by auditing for transparency and accountability • Streamlined workflow and data sharing • Lower reliance on paper based processes

48. NHS Camden NHS Camden • The first CCG to roll out a ‘single-view’ of the patient record • NHS Camden’s Integrated Care project aims to identify and proactively manage the 5% of patients who account for 50% of health expenditure, the goal being to keep them out of hospital where the majority of the costs are incurred. By shifting the emphasis from unplanned care to planned care, costs can be controlled and appropriate interventions provided earlier • At early stages of the deployment, no measuring of benefits have been undertaken