Connecting CareOur story so far…

Andy KinnearMarch 2015

Connecting Care is the Bristol, North Somerset and South Gloucestershire [BNSSG] programme, dedicated to using technology to support -• Better information sharing between local

health and social care organisations• Joining up information to ensure care is

focused around the individual and their needs• Improving better, safer and more joined-up

care• Supporting increased efficiency in the delivery

of health and social care services• Ensuring that the people who are providing

care have the information they need, when they need it

• Our first deliverable has been a shared ‘view only’ electronic patient record (using the Orion Health ‘portal’)

what is Connecting Care?

our partnership

project approach

• 2011 Vision• 2012 Procurement • 2013 Staged approach

– First stage (pilot) started in March 2013. Key deliverables:• A working system for 500 users• Evaluation of benefits • Stage one themed on urgent & unplanned care

• 2014 A business case for the second stage .Second stage started Dec 2014 (next 5-7 years)

• 2015 = GROWTHStage two will extend the breadth & depth (10,000 more users, more information sharing)

• Demographics• Laboratory• Radiology• Encounters• Allergies• Diagnosis

Clinical Data RepositoryRhapsody Integration Engine

Orders and Results (CRIS and Ultra) X2

GPs

RiO Extracts

X4

• Authentication• Authorization• Single Sign-On• Patient Privacy & Consent• Relationships• Audit Logs

• Patient Search• Patient Lists• Patient Summary• Timeline• Flowcharts• Secure Messaging• Orion Health Applications• Third Party Applications

Presentation

Integration

Source Systems

Security & Privacy Patient Record

• Medications• Problems • Procedures• Transcribed

Documents

Portal

Connecting Care Clinical Portal

Master Patient Index

MiG

NBT Cerner

PAS

Weston Cerner

PAS

Adastra End Of

Life

SWIFT – North

Somerset

UHB Medway

PAS

Adastra Out Of Hours

Paris Social Care - Bristol

what we’ve delivered…so far…

enabling safer & better care

Community care

• Saves time in triage and assessment • Saves time – reduces the amount of calls to GPs • Saves unnecessary home visits • Supporting risk management and safeguarding

Social care • Supporting referral management• Saves time in triage and assessment• Informs assessments & care planning • Saves installation and equipment costs• Supports risk management and safeguarding

General practice

• Reduces burden on practice administrators • Supports risk management and safeguarding• Increased confidence in better care being provided outside of

the practice• Immediate access to GP records (new registrations)

enabling safer & better care

Out of hours care

• Saves appointments and visits• Saves admissions• Safer prescribing• Improved quality of consultation

Pharmacy • Safer prescribing – provides access to allergy and GP prescribing information

• Saves time – Reduces the amount of time calling GP practices • Safer communication – reduces errors

Hospitals / A&E

• Safer care – patient background, context and medications• Saves time – reduces time trying to find out information• Reduces risks – where patients unable to inform clinicians about

relevant information / fax errors etc

A sample of some possible financial benefits:

Admissions Prevention

10,000 users could see annual saving of £1,036,288 from admissions prevented by using information in Connecting Care

Based on a Department of Health reference cost 2012/13 of £1,436 for a unplanned admission and only the same rate of stated admissions prevented in the pilot

Reducing duplicate assessments

10,000 users could see a annual saving of £179,520 on stopping the duplication of assessments as a result of using information in Connecting Care

Based on cost savings if the same rate of stated admissions prevented during the pilot continues – based on £60 for an average cost of a face to face assessment by a community nurse - Department of Health reference cost 2012/13

potential financial benefits

A sample of some possible financial benefits:

Time savings - calling other organisations

10,000 users could see a annual saving of £155,278 of ‘people time’ as Connecting Care users spend much less time calling other organisations for information

Based on salary cost savings if only one call per week per user is saved where the medium salary between NHS bands 7 to 8 is used.

Reducing home visits

10,000 users could see a annual saving of £68,000 on stopping unnecessary home visits as a result of using information in Connecting Care

Based on cost savings if the same rate of stated home visits prevented during the pilot continues – based on £60 for an average cost of a face to face assessment by a community nurse - Department of Health reference cost 2012/13

potential financial benefits

enabling safer & better care

“Massive difference in time spent accessing information. On average [I can] access the GP record within 30 seconds compared with 15-20 minutes taken via telephone or via fax” Critical Care Pharmacist Manager UHB

“3 cases identified on Connecting Care today that were already allocated to a health practitioner (BCH OT or IMCS OT) so did not require referrals to BCC OT”. Occupational Therapist Bristol City Council

“I now use Connecting Care on almost every case I deal with it (approx. 25 cases per shift). It always makes a difference and adds value. Every shift, acute admissions are avoided.” Doctor (out of hours)

“Have been able to identify trends which have then resulted in swifter [safeguarding] interventions…one case where concerns would not have increased without Connecting Care…”Social Worker Safeguarding team

“Connecting Care is brilliant…I use it to triangulate information from service users, to find out about other services involved so that I can contact them to inform my assessments” Bristol social worker

“it has enabled us to commence discharge planning earlier in the patients stay to help prevent delays later on.”Discharge Nurse

“Unable to obtain a medication history or allergy status from the patient….accurately confirmed through Connecting Care …” Pharmacist, NBT

““Information about the patient’s diagnoses has helped our team decide which type of therapy to offer the patient” UHB

enabling safer & better care

“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

“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

“The extra patient detail is useful when deciding to stop drugs such as anti-platelets and it helps to identify risk factors” Doctor

Having access to accurate, timely,

shared information is no longer a

‘blocker’ to providing high-

quality, effective, efficient care…

“Without Connecting Care today I couldn’t have done my job.” Pharmacist

“Connecting Care has been really helpful tonight. Could not do without it. Particularly in the case of an old lady with XX 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

our next steps

next steps

In 2015 our key projects are In the pipeline…• Children's safeguarding project –

sharing information from our 3 local authorities’ children’s systems

• Document sharing – clinical and social care documents being shared in portal...and ‘sent on’ to other recipients (GPs) ~ initial focus is eDischarge

• Lots of system replacements (2 hospital PAS, 3 community systems, 1 social care system, 2 pathology systems)

• New infrastructure, new data centre hosting, re-write lots of our ‘core config’ to support improved performance

• Rolling out to new users and organisations (e.g. mental health)

• Pharmacy (sharing more – hospital prescribing / community pharmacy)

• Supporting cancer care• Mobile working, patient access • Specialist systems (renal, maternity,

dental etc etc.)• Sharing more information from

within hospitals – e.g. assessments, care plans

• Enable sharing of end of life plans

• Better support for some workflow / pathways

• And lots and lots more!!

5 reasons we have been successful…..

1. Line of business systems that ‘share’

• You cannot share paper data easily• Good electronic ‘line of business’ systems that

share data are critical

2. Integration Partner • Integration is tricky. Find a software partner who ‘gets it’

3. Money…locally owned money!

• Invest locally….seek national money too, but make your local organisations put skin in the game

4. People….local talented people

• Hire really talented project people….we did

5. SPIRIT • Overrides everything else• Stamp on ‘organisationally centric’ thinking at

every single opportunity. • Command the morale high ground that the

patients/citizens best interest occupies

Thank you!