Transcript Presentation heading

A Paperless NHS by 2018
Are patients & clinicians ready for this?
Dr Masood Nazir
General Practitioner
Clinical Informatics Advisor
NHS England
Patient/Clinician Journey
Dr S
Mr/s D
Evolution
Paperless Benefits
• Clinical diagnosis
• Patient & staff experience
• Safety. ( prescriptions etc)
• Reduce burden & improve efficiency ( DNs re
typing notes )
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Summary
Care Record
• National shared medical
record containing
allergies, adverse
reactions and medications
• Currently being used in
acute hospitals across
the country
• Access is based on a
legitimate patient
relationship
• Spine based application
• Access through use of
smart card
Opt out code
9NDo or XaXi6 (System One)
Central Care
Record
• Local shared medical
record containing
allergies, adverse
reactions, medications
and diagnostic results
• Utilised in Birmingham,
Sandwell and Solihull
only
• Access will be user
specific and based on
legitimate patient
relationship
• Content of medical
record will be tailored
per clinician and
organisation
• Key benefits – quicker
for patients, safer care,
medication and tests
information continuity,
safeguarding and
supporting vulnerable
groups (frail elderly,
safeguarding)
Opt out code
9ND1 (EMIS Web), 93C1 (LV,
INPS), or XaKRw (System One)
Care.data
• NHS England national
programme
• will collect both
identifiable and nonidentifiable patient
information from GP
practices
• Coded data such as
symptoms, drugs,
diagnoses, lab results to
be extracted
• Information to be
managed and
anonymised by the
Health and Social Care
Information Centre (HSIC
• Utilised for research and
planning purposes
Opt out codes :
• For secondary use of data
9Nu0 or XaZ89 (System One) or
• Disclosure of personal
confidential data by HSIC
9Nu4 or XaaVL (System One)
Hospital Pharmacists
•NICE patient safety guidance 1 (Dec 07):
‘The aim of medicines reconciliation on
hospital admission is to ensure that
medicines prescribed on admission
correspond to those that the patient was
taking before admission.’
•SCR can play a key role in medicines
management for patients
•SCR potential frees up time for both hospital
pharmacists and GP surgeries
Information Sharing
Most people know their own history
but...at times of illness, they can
forget information e.g. medication.
Vulnerable groups require more
support:
• Complex frail elderly
• Children who need safeguarding
• English is not first language
Better access to information
means timely decisions can be
made – better for patient care.
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The real benefits….
1.
Timely patient care – reducing
unnecessary anxiety for patients and
families
2.
Right information available to support
clinical decision making – reducing risk
for errors and incidents
3.
More investment in real clinical time
than administration
Compared to other service industries, NHS
isn’t easy to do business with
OTHER INDUSTRIES
NHS SERVICES
1.
Travel
1.
Registration
2.
Banking
2.
Appointments
3.
Shopping
3.
Prescriptions
4.
Communications
5.
Information access
6.
Information sharing
4.
Blood Donation
And it costs patients and the NHS a great deal in unnecessary visits to
GPs, A&E, phone calls, time off work
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11 NHS | Presentation to [XXXX Company] | [Type Date]
And patients tell us they want to do business
online…..
GP Patient Survey December 2013 Results
Appointment Booking
22% of people find that it is not easy to get
through to their surgery on the telephone
Nationally, from 2011-12 to 2012-13, there
was a rise of 3 percentage points in the
proportion of patients that find it not easy
to get through to their GP surgery on the
phone.
Darker blue
indicates better
performance
Proportion of
patients that
find it is not
easy to get
through on the
phone
Fieldwork dates: 2012-13 GPPS : Jul to Sep 2012 and Jan to Mar 2013;
2011-12 GPPS: Jul to Sep 2011 and Jan to Mar 2012
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Booking appointments online… the challenge ahead
How do you normally book your appointments to see a GP or nurse at your GP
surgery?
100
90%
90
90%
December 2013…
80
December 2012…
70
60
50
40
31%
30
30%
20
10
4%
3%
0
In person
Base: All answering question (in brackets)
By phone
By fax machine
Online
Source: Ipsos MORI
There is an appetite to book online
Which of the following methods would you prefer to use to book appointments
at your GP surgery?
100
90
80%
80
80%
December 2013
(935,598)
December 2012
(973,503)
70
60
50
40
32%
33%
31%
30
30%
20
10
0
In person
Base: All answering question (in brackets)
By phone
By fax machine
Online
Source: Ipsos MORI
Significant challenges ahead
• Security
• Confidentiality
Trust
• East of access and use of services
• Workload for GP Practices
• Patient and public awareness
• Culture – patients and practices
• Process change for practices
• Digital divide
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We are working with professional bodies and with a wide range of
stakeholders to ensure the challenges are recognised and addressed
appropriately
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Virtual meetings and communication:
some days I need a TARDIS
Solutions (although not quite as
good as a TARDIS):
• Skype
• Microsoft Office 365
• WebEx
and many more . . .
i-Engage – Meetings from Planned Care Solutions using Microsoft Office 365. and Microsoft
Lync device for virtual meetings
“Eat your lunch, sign prescriptions, answer queries from reception staff, get involved, pay attention and
contribute!”
CCG Chair
Barriers to use and adoption
• Culture
• Education
• Technology
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Challenges
The two key exceptions for access to information are where it:
(Information Commissioner Guidance)
• is likely to cause serious harm to the physical or mental health, or
condition, of the patient or any other person
• may relate to, or be provided by, a third person who can be identified
from the information and has not consented to the disclosure.
“It is unnerving to think that patients may see test results before you
do”
West Midlands General Practitioner
Implications
Group E
Middle income families living in moderate suburban semis
Key Features
• Manual and white collar
• Married
• Middle age
• Children
• Leafy suburbs
• Comfortable affordable
housing
• Home improvement
• Family life
• Industrious
•
•
Hall Green, Bournville, Northfield, Quinton
Behaviours and attitudes: High users of A&E, out of hours and for minor attendances. Most perplexing of
high user groups as access is not an issue and they are more motivated than other groups and happy living
with the status quo.
Communication strategies: Telephone, internet. Works hard for their money so convenience (GP opening
hours) maybe an issue
26
General comments/ from
graffiti board
“Thank
you for
putting
on a
great
event”
“Why is there not
one system across
GP Practices
nationally?”
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“The choice of
supplier may lead to
confusion amongst
patients – we need
one portal”
“Patients need to
have very easy
access to the
system”
Online access might not be
accessible for patients where
English is not first language. GP
practices should have in place a
toolkit and/or leaflets in
appropriate languages which
explain what kind of info you can
access, how to do it and why.
“There should be
consistency in system
– similar or same for
every
patient/practice”
“Please test
the running of
EMIS
beforehand”
“Doctors are asked to
do too much on stuff
that are not related to
the care of patients”
Patient Online Workshop – Crewe – 27 November 2013
Current Pathway
PAPERBASED DOCUMENT SCANNING PROCESS
LETTER RECEIVED
LETTER OPENED
LETTER DATE STAMPED
LETTER CHECKED TO ASCERTAIN MOST RELEVANT CLINICIAN / REFERRING CLINICIAN –
MAINTAIN CONTINUITY OF CARE & MARK ON LETTER
CHECK LETTER TO SEE IF IT HAS ALREADY BEEN SCANNED (DUPLICATE)
NO
SCAN LETTER
YES
FORWARD TO …………
INTELLISENSE FILE LETTER
FILE AS APPROPRIATE
WORKFLOW TO CLINICIAN & CODER
(9 PROCESSES)
What are the benefits of this?
• No paper, resulting in:
• No opening of mail
• No date stamping
• No scanning
• No opening, twice daily, of NHS Net account
This has already been done for you!
Future Pathway
EDT / NHS NET DOCUMENT SCANNING PROCESS
LETTER IN DOCUMENT VIEWER
LETTER CHECKED TO ASCERTAIN MOST RELEVANT CLINICIAN / REFERRING CLINICIAN –
MAINTAIN CONTINUITY OF CARE
INTELLISENSE SCAN LETTER
FILE AS APPROPRIATE
WORKFLOW TO CLINICIAN & CODER
(5 PROCESSES)
The challenge
• Implementing a Paperless NHS is a challenge, a
major project and a substantial change in the way
care is delivered
• But it is achievable, and organisations are starting
to achieve it and gained many benefits
• Once it is in use most health care professionals
would not want to go back to paper
Heart of Birmingham
Manchester
Hampshire
More recently:
Oxford
Staffordshire
Cumbria
NHS London
Thank you