Taking forward Information SharingHealth Insights June – July 2106David WallerInteroperability Engagement Lead, NHS England

Strategic context

Breaking down “interoperability”

What this means for professionals and citizens

Current priorities

Working in conjunction with localities and the market

The development of an open environment for information sharing supporting emerging models of care based on open interfaces and open standards.

Open APIsOpen interfaces to enable information to flow across a care pathway and to be accessed across geographies

Local shared care records that link health and social care as main approach for delivering local information sharing needs

Tight standards for key transfers of care

Local IDCRs Professional

Through my system I can directly access and contribute to summary and detailed care information

Citizen

Using my PHR I can access care information about myself and contribute information

PHR

Patient Record IndexAbility to locate patient record information that can then be accessed through open APIs

Open interfaces from national systems such as SCR to simplify access and contribution.

Expansion of SCR for access by additional care settings and additional critical information.

Summary Care Record

• Breaking down “Interoperability”

• Key priorities - NHS Number, Transfers of Care

• Focus on opening up key systems (Open structured APIs) for key clinical priorities based upon industry standards - FHIR

• Working directly with localities and clinicians on needs and market on solutions – the “Community”

• Not seen as national organisations in an ivory tower

• Supporting localities to be more “informed customer” in implementing information sharing approaches

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97% Of localities using NHS Number as primary identifier when sharing information

66%Of localities sharing discharge summaries electronically

StandardsLevers Incentives Service change Technical Capability

Professional endorsed standards

• Developed initially by the Royal College of Physicians (RCP) and published in July 2013

• Signed off as fit for purpose by

50 organisations that give professional leadership to the medical, nursing and clinical professions

• Adopted by the Professional Records Standards Body (PRSB)

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Discharge summaries

Nov 2015

March ‘16

National Information Board

Interoperability Strategy published

Over 95% of hospitals using NHS Number in

clinical correspondence

Launch Interoperability Community bringing together localities,

vendors and national organisations

Over 70% of hospitals sharing discharges

electronically

Use of FHIR APIs for

workflow and accessing

record starts

Discharges shared using professionally endorsed

clinical structure

Key APIs Transfers of CarePrimary IdentifierFocus on key priorities

Change the dynamic

Nov‘15

Jan‘15

Nov‘14

Sept‘16

Dec‘16

End of life care prompting key preferences

Vaccinations andimmunisations history

Visual comparison of medicationsPrescribing alertsEncounter timelines

Long term conditions(trending and recall)

Pre-populationof pre-operative assessment

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Clinical Scenario Drivers/Benefits

Why Structured and Real-time

Elements on GP Record Needed Supplier Capability

1.Visual Comparison of Medications

Drivers: • Medication errors are the third most prevalent source of reported patient

safety incidents in England• Prescribing errors are the most important cause of medication errorsBenefits: • Reduction of safety issues on manual transcription• Medication errors reduced as have up to date medication list• Time taken to have to compare across tabs/systems

Cannot create a consolidated list from sets of information that are in different read-only views.

Have up to date medication information.

• Medications EPRs systems e.g. Cerner, Orion, Allscripts and shared records already able to provide functionality

2.Prescribing Alerts

Drivers: • Medication errors are the third most prevalent source of reported patient

safety incidents in England• Prescribing errors are the most important cause of medication errorsBenefits: • Reduction in safety incidents due to lack of contra-indications

Cannot proactive prompt from information that is in a read-only view.

Have latest allergy, problem information

• Medications • Allergies• Diagnosis• Problems

EPRs/shared record systems e.g. Allscripts, Connecting Care are already able to provide functionality

3.Long-term condition patients(trending and recall)

Drivers:• Reduction in avoidable cost for long term condition management e.g. an

estimated 80% of the costs of diabetes come from the management and treatment of avoidable diabetes-related complications

• Recalling people safely on time – e.g. repeat obs/testBenefits:• Proactive intervention in long term condition management• Avoiding unnecessary drug administration• Avoiding safety incidents where drugs administered incorrectly as have

real-time access to latest trend information

Cannot proactive prompt from information that is in a read-only view.

Have access to latest readings and their trend to manage intervention.

• Medications• Diagnosis• Problems• Investigations• Observations

Some EPRs/shared records already able to provide trending and recall functionality

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Clinical Scenario Drivers/BenefitsWhy Structured and Real-time

Elements on GP Record Needed Supplier Capability

4.Prompting on key preferences

Drivers: • NICE guidance on improving end of life for people in their last days• Improved efficiency in care provision – 111 workflowBenefits: • Enables patients to die in accordance with their patient preferences

e.g. in their preferred place of death. • Efficient and appropriate use of services in co-ordinating care for the

patient e.g. sending ambulance to admit into hospital when patient wishes to die at home.

Cannot proactive prompt from information that is in a read-only view.

Have latest information on key preferences e.g. preferred place of death.

Specific preferences/flags • DNR• Preferred place

of death

111 service EPACCS systems (e.g. Adastra, Graphnet)

5. Encounter Timeline

Drivers: • Safeguarding • Improved efficiency in care provisionBenefits: • Ensuring appropriate intervention based upon having holistic view on

patient’s touchpoints with the service.

Cannot create a timeline from information spread across a set of different read-only views.

Need to have latest view on all touchpoints in crisis period.

Encounter (including care setting, encounter type, clinician type and associated clinical information)

EPRs/IDCR Portal already able to provide this e.g. Connecting Care portal

6. Vaccinations and Immunisations History

Drivers:• Avoid duplicate immunisations/vaccinations • Aid recall system for children• Aid frail and elderly who are immuno-surpresed Benefits:• Enables correct intervention based upon accurate history – important for

Digital Children's strategy

Cannot proactive prompt from information that is in a read-only view.

Have latest vaccination information e.g. child health.

• Immunisations• Medication• Allergies

EPRs systems e.g. Cerner, Orion, Allscripts already able to provide functionality

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Clinical Scenario Drivers/BenefitsWhy Structured and Real-time

Elements on GP Record Needed Supplier Capability

7.Pre-population of Pre-operative Assessment

Drivers: • Improved patient experience of not having to repeat same information or

attend unnecessary appointments• Improved efficiency in care provisionBenefits: Reduction in administration burden leading to:• Improved patient experience• Improved productivity of clinicians

Cannot pre-populate forms from a read-only view.

Have access to latest record information to go onto the form.

• Medications• Allergies• Diagnosis• Problems• Investigations• Observations

Hospital PAS systems

Example of alerting against allergies when prescribing Example of encounter timeline

AppointmentsManage appointments in order to co-

ordinate access to care

Access RecordAccess a patient’s care record for the

purpose of direct care

Tasks Manage tasks in order to work effectively

across care settings

eDischargeDischarges from inpatient care back to

the general practitioner

A&E eDischargeInformation sent to the general

practitioner from an A&E attendance

Ambulance

Social Care

Referrals

Emerging needs

Creating a common and open set of APIs to support information sharing across health and care

Defining the key clinical information sharing needs.

Prioritising the key APIs.

Group members e.g. CCIOs, CIOs, Vanguard, Pioneers, PMCFs, NHS England.

Outlining the accreditation approach for APIs.

Group members e.g. TechUK, CIOs, suppliers, HSCIC.

Defining the key underpinning components and policies, e.g. security and authentication.

Group members e.g. HSCIC, suppliers, CIOs, TechUK, NHS England.

Establishing and creating the required APIs based on clinical information sharing needs.

Group members e.g. suppliers, innovators, CCIOs, CIOs, NHS England, HSCIC.

Made up of the above organisations, the Project Boardis responsible for the assurance and governance process.

Links to existing communities and

signposts tools and products.

• The board will be made up of representation from across the stakeholder community:

• Builds on models from other geographies e.g. Commonwell.

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