Transcript National Information Board Work Stream 1.1: Enable me to make the

NATIONAL
INFORMATION
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Personalised Health and Care 2020
Using Data and Technology to Transform Outcomes for Patients and Citizens
National Information Board Work Stream 1.1: Enable me to make the right
health and care choices
Providing patients and the public with digital access to health and care
information and transactions
In ‘Personalised Health and Care 2020’ we committed that….
Patients will have
access to and write
into their records
We will test use of a
personalised, mobile
care record for parents
of newborns
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Citizens will have a
single point of access
to all transactions
We will link create
digital 111 services
linked to NHS.UK
NHS.UK will be
customisable to
reflect the specific
local needs
We will test use of a
personalised, mobile
care record for
people at ‘end of life’
We will consider the
impact of digital
developments on
inclusion and equity
across the care
system
We will pilot
individual digital care
accounts
In the six months since then we have engaged with a range of organisationsNATIONAL
through
Engagement
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workshops, conversations, literature reviews and surveys
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Through…
- Workshops
- Conversations
- Literature
- Surveys
The research, engagement and literature reviews have told us NATIONAL
the
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problems with the current state..…
 Customer experience – NHS and social care lag behind other industries (2015 Customer Service Satisfaction Index)
 Customer access - the public is confused by the number of access points and phone numbers they can
potentially use to contact NHS and social care services.
 Customer expectation – people expect to be able to contact and transact with health and care like they
can for their shopping, banking, travel and entertainment, and be able to rate their experience.
 Feedback – finding out how we are performing is valuable to us as a public service and enshrined in the
values of the NHS constitution
 Modern Technology – technology-enabled systems and workflows have proven to be more efficient and
cost effective than paper-based working
 Digital inclusion – it is cost effective to invest in giving people basic digital skills so they can use digital
services as they become available
 Security – we need to be sure that the person at the other end of the digital transaction is who they
purport to be
 Across the boundaries between health and care – we need to recognise that much of social care is funded
by the individual so we need to empower carers as well as professionals
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Also, Five Year Forward View and Care Act 2014 have created drivers
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for change that digital services can support …..
 New models of care and the natural move to digital – the personalisation of care, including individual
wellbeing, self-care, personal commissioning; integration of services, particularly across the divides
between family doctors and hospitals, physical and mental health, and clinical and social care; more
effective management of service access, through the provision of alternative sources of information,
supporting self-care and better signposting to direct individuals who need professional care to the
appropriate service.
 Demographic pressures - By 2025 there will be 1.1m more people aged 75-84. The number of older people
with care needs is forecast to increase by over 40% between 2005 and 2020. It is expected that the
number of adults with learning disabilities who require some form of support will increase between 3%
and 8% per year until 2026
 Self-care and empowerment – over 51 million GP consultations are for minor ailments (accounting for 90%
of GP visits and 20% of their avoidable workload) resulting in costs of £1.8 billion, 80% of which is for
consultation time and 20% for prescriptions. If treatment were transferred from GPs to self-care, Pillay
(2010) estimated savings of £1.6 billion could be made.
 Productivity and efficiency – by developing services around the patient’s needs as the starting point, it has
been proven that convenience also costs less.
 Care Act – puts a duty on local authorities to promote wellbeing, prevention and better provision of
information and advice
The evidence has helped us to prioritise which digital services NATIONAL
the
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public prefer …..
1. Multi-channel offer by intent
Customers expect to be able to
contact the NHS through the
channel of their choice including
phone, and digital channels
including web and email, as well as
f2f channels for some groups
2. Consistent and timely
response tailored to contact
scenario
Customers expect the NHS to
engage with their contact in a
consistent, timely manner, tailored
to the contact scenario
3. Personalisation through an
NHS account
Sharing data with the NHS to
create a personalised account was
highly valued, with more value
associated with increasing
functionality
4. Making it easy to self serve
Customers across segments are
ready to self serve. The offer
should include 24/7 access to a
self service option, supported by
access to human support 8am8pm
ATTRIBUTE IMPORTANCE
0%
5%
10%
15%
Contact channel to
the NHS
Timeliness of
response
15.0%
13.9%
Self-service Vs.
Assisted service
11.8%
Remember me /
personalisation
10.5%
No wrong door Vs.
One-front door
10.0%
What type of
information is
available to assist me
Local vs national
contact preference
25%
21.0%
NHS account
Multi – channel – we were told that being
able to contact NHS through channel of
choice is by far the most important
attribute.
20%
9.7%
8.2%
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…..and which digital initiatives provide the highest level of cashINFORMATION
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releasing savings
High cash-releasing benefits
Medium cash-releasing benefits
Lower cash-releasing benefits
1. e-Consultations
8. Pre diagnosis triage
16. Defence Medical Services GP2GP
2. Click and Collect Prescriptions
9. Test Results online
17. Write access to PHRs
3. Electronic referrals
10. Discharge Summaries into PHR
18. Access to PHRs
4. Winter ‘Consent and Switch’ digital
offer
11. Access to test results online
19. Lifelong digital child records
5. Digital 111
12. Upload and Share information to
PHRs
20. Mental Health PHR Access
6. Booking Appointments online
13. Customer Relationship Management
21. Social care Online
7. Online Primary Care registration
Registration
14. Access to records in Care Homes
22. End of Life
15. Telehealth devices
23. Personal Planning and Budgets
24. Care Accounts
25. Widening Digital Participation
So, based on the evidence and the drivers ……..
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We will work with and for citizens to develop health and care digital services, including information and transactions,
which enable people to make the right health and care choices for them.
We will develop services to enable digital channel shift for patients and the public to drive down costs, improve
convenience, satisfaction and quality.
We will support new models of care, developing a citizen, user-focused approach enabled by appropriate digital
technology.
We will support transformation of out-of-hospital care through automation and redesign of primary care transactions,
delivery of digital pharmacy services and provision of digital tools and apps to support self-care (including access to
records, upload of data from wearable devices).
We will support transformation of urgent and emergency care through provision of digital 111 services, digital tools
and apps to support clinical triage and access to detailed patient records.
We will support elective care services through provision of digital offers for patients to support Choice, facilitate
‘consent and switch’ and minimise patient waits.
These commitments translate into 12 prioritised programmes,NATIONAL
some
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of which are underpinning enablers…..
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5.
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11.
12.
NHS.uk platform, including system-wide service directories
Digital Primary Care Services
Citizen Identity, security and consent
Interoperability between local services to allow data sharing
Digital Elective Care Services
Digital Urgent and Emergency Care services
Online medicines management
Patient access to digital health records
Supporting business change and citizen uptake
Supporting a transformation in the design of social care services
Widening access and improving digital skills
Creating a database of demographic, contact and customer
preference information
The programmes
have been
prioritised by a
blend of economic
return, impact on
citizens and wide,
underpinning
enabling impact
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The programmes
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NHS.UK - will act as a single point of access for multiple services
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Provide a single access point
for citizens for information,
advice and transactions
informed by a robust
understanding of user need. It
will not be a ‘single door’, but
an easy to access and navigate
digital hubs for all citizens.
Provide a clinically
profiled directory of
services encompassing
health and social care
services
Digital Primary Care Services
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Provide citizens with a greater choice and flexibility in finding and booking appointments with
the most appropriate service, and with the ability to edit/ cancel/ change appointments.
Expanding this to cover specialist services and nurse led clinics.
Digital interaction and communication channels will become part of the embedded mechanism
to manage demand and signpost to appropriate services
Enable citizens to communicate with their General Practitioner or ‘multi-disciplinary team’ via
online communications at their own convenience
Provide citizens the ability to (following the initial primary care decision to refer) book and
manage their secondary care appointments online, including the ability to cancel and reschedule
appointments after an initial appointment has been made and the ability to switch to an
alternative provider.
Provide the ability for the online registration and facility to change General Practitioner.
Provide free WiFi access for citizens across the NHS and local government estate will be
championed, including working with other Government departments to secure funding and
agree funding models.
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Citizen Identity, Security and Consent
Select who verifies you
I have confidence in the
process for giving me a digital
identity. The process
recognises how sensitive my
care information is.
NHS.UK
Username
Username
Password
One Time pin/Biometric
GP Practice
National components
Matching to NHS Number
Mapping of NHS No <->
ID
I can use a single logon across my health
and care services and
access local and
national services.
Access to Patient
Data
Local Services
National Services
GP Services
Diabetes Information
Test Results
Select NHS
Referrals slot
Online Care
Plans
Order EHIC card
Interoperability
Patient access to summary information (SCR) with
ability to drill down into integrated digital care
records. Ability to access through their Personal
Health Record (PHRs)/NHS Choices
Ability for patients to provide and contribute
information directly /through 3rd party tools (e.g.
wearables/apps). PHRs can combine this information
with that sourced from clinical systems
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The approach is part of the
interoperability strategy developed
through the interoperability
programme.
The strategy purposes straddles
across NIB 1.1 and 2.1 to provide a
coherent approach for professionals
and patients.
It brings together elements from
NIB 1.1.
- GPSOC Interoperability for patientfacing services
- Interoperability platforms for
Personal Health Records to enable
access to all relevant information
(including online care plans and
wearables)
- Care setting specific integration
e.g. Child health.
NIB 2.1
- Local integrated care records and
the summary care record.
- Additional national infrastructure
to locate patient information
across these.
Digital Elective Care
Vision
1. Enabling patients and professionals to manage referrals in
partnership.
2. Providing a single source of information on referrals and bookings
into health and social care services.
3. Providing a standard tool to support the management of health
and social care referrals.
4. Supporting patients in completing referral and booking
transactions online, including provision of assisted digital options.
5. Making data and information readily available to support patient
choice, clinical pathways and health and social care planning.
6. Simplifying the referral process and supporting national standards
of integration and interoperability.
7. Promoting a modern approach to software design and
development.
8. Developing a high-quality solution that delivers significant benefits
and makes the NHS more efficient.
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Digital Urgent and Emergency Care
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Vision
To deliver a safe and effective online
triage and consultation service for
patients with urgent needs. This
service will be fully integrated with
local services so that patients only
have to tell their story once. It will be
delivered nationally as a service for
local use. The service will reside on
the NHS.uk platform allowing
transactions to be conducted
seamlessly by the user based on their
clinically assessed need.
Online Medicines Management
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Digitisation of all prescriptions, and provision of digital data and transactions to patients will allow:
Easy and convenient patient capability to:
• Check information about their
medications, through simple bar codes.
• Automatically pull data from NHS.uk e.g.
to tell them about possible side-effects
• Send an automated request for a repeat
prescription, and track prescribing and
dispensing status.
• Choose to have a prescription sent to their
nominated pharmacy, to an alternative or
have delivered to their home or elsewhere
• Scan a barcode as they enter the
supermarket and pick up on their way out.
• Use apps to help manage their adherence
to taking medications and share this
information with care givers.
• Remove the risk of lost scripts, and
support emergency supply.
Pharmacists, clinicians and other care givers to:
• Prepare more prescriptions in advance, and
increase patient safety through better
validation of prescriptions and medicines.
• See real-time information on the state of
patient prescriptions , and their adherence
and usage.
• Provide better patient care as part of new
medicines reviews, linking prescriptions with
summary care records, checking allergies etc.
• Allow authorised prescribers in other care
settings to send electronic prescriptions, so
patients and service providers have a
consistent service and data set.
• Allow emergency supply of medications in
knowledge of no duplicates, or patient abuse
of system.
The wider system benefits from:
• Ability to analyse data on the overall
usage of medicines, helping achieve
efficiencies and economies.
• Reduce the level of deliberate and
accidental fraud in the system, whether
from patient exemptions or incorrect
claims from pharmacy.
• Support the falsified medicines directive.
• Achieve primary savings of having all
prescriptions electronic, which has
significant efficiencies for prescribers,
dispensers, patients and downstream
processing and payments such as the
BSA.
Patient access to digital medical records
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Citizens will be able to access and download their detailed GP record by 2016. By 2018 this record will
be richer, contributed to by information held in other care settings, including information provided by them
or their carer
We will facilitate digital transmission of test results into a patient’s PHR
Notification to patients when the results are available to view
Providing carer access (with correct permissions) to the PHR of the person they are caring for and
allowing them to contribute information relevant to their ongoing care
Providing residential care homes with access to GP systems and PHRs (with appropriate consents) to
enhance continuity of care between health and social care
Integrating technology wearables and biosensors into PHRs
Providing families the ability to view and contribute to their maternity records digitally at each appointment
(rather than white notes). Upon the birth of the baby, a digital child health record will be created and the
NHS Number will stay with the child into adulthood and throughout their life.
Supporting business change and citizen uptake
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2.
3.
4.
Provide a co-ordinated engagement
approach to professionals, citizens and
carers
Champion IT enabled change and support
the wider health and social care community
Provide insight on why uptake is low and link
into future development
Identify potential test bed for ‘alpha’ and
‘beta’ exploration using established and
emerging relationships
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Reduce burden on NHS by providing support
and a co-ordinated approach to
implementation
More efficient and co-ordinated use of
resources within delivery organisations
Understand reasons for resistance/ low uptake
and opportunity to take action
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Supporting a transformation in the design of social care services
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To support those with a social care need to self-care, to plan and
manage their care and finances, and to connect to carers and
peers.
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Social networks to support citizens and carers and tackle social
isolation
Assisted technology and apps in the home to support self-care,
and prescription of ‘technology’ to empower individuals
Improved online information and advice, effectively curated, to
help people make the right choices
Self assessments, care plans, reviews, feedback all available
online to help improve the citizen experience
Personal budgets and e-marketplaces to help people arrange
the care that suits them and helps meet the outcomes they
want to achieve
Carers’ assessments & support plans to ease the burden on
carers
Care accounts to support financial planning as part 2 of the
Care Act
Why can digital help in social care?
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Rising demand for services - older population set to increase
by over 20% in the next ten years
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Quality and workforce challenges and new models of care are
urgently needed
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Diverse sector, so supporting variation is key - 152 local
authorities, over 25,000 providers, a vibrant voluntary sector,
around 1.5m care workers, and 6m carers
Widening access and improving digital skills
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• Personalised Health and Care 2020 committed to: ensuring that the digital opportunity is inclusive, building better insight into the
barriers to digital inclusion and widening the current programme of digital inclusion with the Tinder Foundation.
• The Five Year Forward View also committed to building the capacity of all citizens to access information and to develop partnerships with
the voluntary sector and industry to support digital inclusion.
Vision
To ensure that the digital
opportunity is inclusive and
nobody is left behind.
Improving digital skills and
capabilities while ensuring
that those who are unable
to transact digitally, due to
disability or literacy, are in
no way disadvantaged.
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Benefits
More patients able to engage digitally with their own health & care
Better patient experience & convenience (including savings in time
& cost) with increased value in interactions with health & care
services
Reduction in inequalities in access to health & care services
Greater engagement of clinicians & professionals in identifying &
supporting patients who would benefit from improving digital skills
Sustainable national and local partnerships which build capacity for
digital inclusion
Creating a database of demographic, contact and customer NATIONAL
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preference information
CRM
Vision
Provide a system that remembers my
previous interactions, outcomes and
special preferences. Provide the
ability to fast track patients within
NHS 111 and Clinical Hubs who have
greater needs. Create personalised
pages for citizens on NHS.uk
Benefits
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Identification of repeat callers for clinical safety
(retirement of the existing repeat caller database)
Enable patients to treated as individuals by
remembering important information about them
such as their preferences
Empower patients to opt-in and define what
information they would like to be held
Extend the service beyond NHS 111 and Urgent
and Emergency Care to provide an holistic realtime view of patient activities