Connecting Care Our story so far – why, what, how, cats etc….

1. Connecting CareOur story so far – why, what, how, cats etc…. Health Insights - BRISTOL 21st May 2014

2. Connecting Care – why? “There needs to be better communication between ‘in-hours’ and out of hours services.” “Adequate and timely information must be shared between services whenever there is a transfer of care between individuals or services.” NOT having access to accurate, timely, shared information is a ‘blocker’ to providing high-quality, effective, efficient care… “The information I have is limited and frequently is missing important elements…” “Services in all settings including health and social care need to improve their communication and handover ” “I don’t have access to some important information electronically…” “If I had better information then it would help me evaluate risks when deciding whether to admit a patient…” “There are delays in getting hold of information that I need…and I spend a lot of time chasing it up…” “Better information would support better safeguarding” *Summarised from feedback from local clinicians & practitioners during workshop events

3. Connecting Care - why? New national announcements strongly support the ‘duty to share’ as being part of ‘duty to care’ • From Integrated Care and Support: Our Shared Commitment (May 2013) “In order to deliver person-centred coordinated care, data relating to individual’s risk factors, identified needs, care plans and status should be shared at the following levels within appropriate time frames: • Between patients, people who use services and care providers such as clinicians, to enable self-management and build independence • Between front line workers, to enable coordination and continuity of care at transitions between services throughout the care pathway” • From The Information Governance review March 2013 (‘Caldicott 2’) “People using health and social care services are entitled to expect that their personal information will remain confidential… However, people also expect professionals to share information with other members of the care team, who need to co-operate to provide a seamless, integrated service. So good sharing of information, when sharing is appropriate, is as important as maintaining confidentiality.

4. Connecting Care – why? Clinicians told us that NOT having access to accurate, timely, shared information wastes time and is a ‘blocker’ to providing high-quality, effective, efficient care… Connecting Care is our response to the call from practitioners and clinicians across BNSSG for better, more joined-up information to support local care and local pathways. Connecting Care will deliver a detailed, local shared patient record that pulls together health and social care information - providing a unified view that can be used to facilitate improved care provision and decision-making

5. Connecting Care - what is it? • Connecting Care is a clinical system interoperabilityprogramme……aka a new way of safely sharinghealth & care information. • Authorisedprofessionals see a single electronic view of specific, up-to-date, clinical information • Initial focus on the ‘clinical portal’ • Connecting Care is a partnership between NHS organisations and Local Authorities • Connecting Care is the ‘brand’ we use to encompass our complex portfolio of interoperability projects • Delivered with our partner andestablished expert supplier ‘Orion Health’

6. Connecting Care – staged approach Connecting Care’s first year is a pilot year themed on urgent and unplanned care. The aims of the first year are to – • Test the concept • Test the technology – can we do it / does it work? • Understand what we would need to do to make it more ‘mainstream’ • Understand the benefits – to patients, organisations, the local health and social care economy, to clinicians and practitioners • Build the costs for a business case • Establish if we can work together and if we (collectively) want to take this further Connecting Care is a partnership between – • CCGs - South Gloucestershire, Bristol and North Somerset CCGs • Acutes - UH Bristol, North Bristol Trust and Weston • LAs - Bristol City Council, North Somerset Council, South Gloucestershire Council* • Community providers - South Gloucestershire, Bristol and North Somerset • Out of Hours provider (Brisdoc) • CSU - South West Commissioning Support • AHSN – West of England • Mental health - AWPT* • Ambulance - South West Ambulance * Some partners are actively taking part in the first year pilot and are contributing resource, direct funding and active support. Other partners are Board members* but are not taking an active part yet

7. Connecting Care – Timeline

8. Presentation Connecting Care Clinical Portal Notifications Security & Privacy Patient Record Portal Secure Inbox • Patient Search • Patient Lists • Patient Summary • Timeline • Flowcharts • Secure Messaging • Orion Health Applications • Third Party Applications • Authentication • Authorization • Single Sign-On • Patient Privacy & Consent • Relationships • Audit Logs • Demographics • Laboratory • Radiology • Encounters • Allergies • Diagnosis • Medications • Problems • Procedures • Transcribed Documents E-Mail Mobile Integration MiG Rhapsody Integration Engine Clinical Data Repository Master Patient Index GPs Source Systems SWIFT – North Somerset NBT Cerner PAS Weston Cerner PAS Paris Social Care - Bristol UHB Medway PAS Adastra Out Of Hours Orders and Results (CRIS and Ultra) Adastra End Of Life RiO Extracts

9. Connecting Care – whatinformation?

10. Connecting Care – Project Information • General • Taking a staged approach – first stage is for 12 months. • Key deliverables • A working system • A Business Case for the second stage • Second stage contract will be for 5 years (plus extension) • Clinical / care ‘theme’ • Stage one has focussed on urgent & unplanned care • Stage two will be for wider use (long term conditions, other pathways, ‘patient portals’…40+ projects in the stage 2 pipeline) • Numbers of users • Stage one c.300+ • Stage two – 10,000+

11. Connecting Care – Benefits “Without Connecting Care today I couldn’t have done my job.” Pharmacist “On Monday I managed to obtain details for 22 patients on Connecting Care, I saved a huge amount of time as I didn’t need to phone the GPs and wait for the faxes to arrive” Acute Pharmacist Having access to accurate, timely, shared information is no longer a ‘blocker’ to providing high-quality, effective, efficient care… “I used Connecting Care to find vital information for the diabetes nurses . The information logged by district nurses is a goldmine of information. We saved 20 minutes on the telephone and managed to find the reason for patients insulin being discontinued” Discharge Nurse “In cases where we are dealing with a person who is being supported by Rapid Response and the district nurses, Connecting care comes in to its own. All the notes from visits are documented and it can save at least 30-40 minutes on duty cases of this nature” Social Worker “Connecting Care has been really helpful tonight. Could not do without it. Particularly in the case of an old lady with serum toponins who I could not reach on the phone. Without Connecting Care this would have resulted in a visit and probably her door being broken down. But with CC I was able to work out that all that should of been done, had been done.” OOH Doctor “The extra patient detail is useful when deciding to stop drugs such as anti-platelets and it helps to identify risk factors” Doctor “over the weekend I was able to find out drugs that a patient was taking (very useful). This enabled a management plan to be put in place immediately-I stopped his antihypertensives” Acute Consultant

12. Connecting Care – Project Information • Profile • Connecting Care has been announced of one of three ‘NATIONAL EXEMPLAR’ sites for clinical system interoperability • Attracting national and international attention • Is helping other work in the BNSSG health community through increased profile as we use technology to support care Sir Bruce Keogh, NHS Medical Director visiting Frenchay Hospital in March 2014 to view the Connecting Care portal

13. Connecting Care – Behaviours The ‘herding cats’ challenge – Connecting Care characterised by: • Multiple organisations with multiple agenda • Multiple clinician professions with multiple priorities • Multiple system suppliers with multiple commercial interests But there is only ONE patient

14. Connecting Care – Behaviours The ‘herding cats’ challenge – Recognise and work on the different elements – • Political dimension • Personal dimension • Human behaviours • Organisational behaviours • Interests, motivations and blockers • Time and timing Leadership, vision, direction, blah blah blah….. But ‘BEHAVIOURS’ are all critical to success

15. Connecting Care – Behaviours • Work at it - it doesn’t happen by accident • Acceptsteady progress - it is going to take time to deliver • Create ‘independent brokerage’ • Recognise vested interests - pander to them where necessary • Encourage ‘friendship’ - like each other & be happy • Appeal to the greater good – stifle organisationally centric thinking early • Bring dissenters inside the tent • Deal with key stakeholders individually - formally and informally – be flexible in your approach • Be trustworthy, honest and open- but leave room for clandestine thinking now and then!

16. Connecting Care – behaviours It takes time to build a partnership

17. Connecting Care Any Questions?