Transcript Alan Hyslop`s presentation (ppt 11MB)

Health and Social care in the digital age
Current thinking on development of health
and social care and integrated informatics
Alan Hyslop
interim Head of eHealth
Scottish Government Health & Social Care
A tale from Cumbernauld
So why is IT-enabled information sharing
working in some places?
Service improvement driven, not IT led
Therefore management and practitioner commitment
Continual investment in staff support and revising working
practices given IT enablement
Trust in professional relationships fostered
If sharing is in the patient/client interests, mindset = one of
good reason not to share.
Pragmatic and incremental progress. Not letting the best be
the enemy of the good
Investing in IT enablement
eCare spend
IT-related
Other
But hang on, hasn’t
NHS Scotland done big
IT in its time?
Emergency Care Summary
National database covering 99.9% of the population that
contains…
• Patient identity (address, telephone, CHI number, GP)
• Allergies and Adverse Reactions to medications
• Medication
- Repeat prescriptions in past 12 months
- One-off prescriptions in past 30 days
Used 3 million times last year, by A&E, GP out-of-hours,
NHS24, ambulance, admitting clinicians
Major contributor to patient safety
Investing in IT enablement
eCare spend
IT-related
ECS spend
Other
Emergency Care Summary
– benefits
7.000.000
6.000.000
5.000.000
4.000.000
₤
3.000.000
2.000.000
1.000.000
0
2002
2003
2004
2005
2006
Present value of total annual costs
2007
2008
2009
2010
Present value of annual benefits
So does that mean our re-freshed approach
should be a new improved national IT
system, done differently?
NO!
So what is our current thinking?
1. Re-build relationships – clear signal about
working in partnership - refreshed governance
on that basis
2. Work collaboratively toward new health & social
care information and IT strategy
3. One-size IT does not fit all
4. So clear signal about more flexibility around
local solutions, underpinned by common set of
standards and protocols.
Data Sharing Technologies Board
•
Formed in November 2011 under LA chairmanship
•
Representatives from Local Authorities and Health
Boards. Membership will be extended to include other
public bodies (eg Police) and Third Sector
•
Transition from national “one size fits all” approach to a
series of locally led initiatives
•
Three strands of business:–
–
–
stewardship of the legacy National eCare IT
promote innovative and pragmatic information sharing
initiatives that result in better outcomes for service users
develop and oversee the implementation of the Health &
Social Care IT Strategy.
Relationship with other Strategies and
Governance Bodies
National
ICT
Board
Policy
Other
eHealth
Strategy
Board
LA
Strategy
Board
GIRFEC
Health and Social Care ICT Strategy
Data Sharing
Technologies
Board
Adult Health &
Social Care
Integration
Data Sharing Technologies Board Principles
• Shared information is vital to improving the outcomes
from integrated care services.
• All relevant information about a person’s care should be
available electronically to professionals and ultimately to
service users.
• There should be a presumption in favour of information
sharing with service users and staff.
• Personal information should only be shared for the
integrated care purposes within the partnership’s
information sharing protocol.
Data Sharing Technologies Board Principles
• Service users and staff should be engaged continually in
improved use of information to achieve better outcomes.
• Robust information readily available to operational and
strategic decision makers.
• Initiatives should optimise use of existing assets.
• Standards based approach to support convergence in
line with the McClelland ICT Review.
South Ayrshire Council
SWIS
Social Work
SEEMIS
Education
East Ayrshire Council
SWIFT
Social Work
SEEMIS
Education
The Central Store
approach, locally
held
AYRshare
FACE
Child Health
NHS A&A
North Ayrshire Council
CareFirst
SEEMIS
Social Work
Education
Lanarkshire and now NHS
Ayrshire and Arran and three
Ayrshire councils
South Ayrshire Council
Social Workers
Teachers
East Ayrshire Council
AYRshare
Health
Visitors
Social Workers School Nurses
NHS A&A
North Ayrshire Council
Social Workers
Teachers
CONCERNS ARE ADDRESSED EARLIER
Social
Work
Child
Health
School
Focus on actions and
outcomes
Alerts
The Portal Approach
NHS GG&C/Renfrewshire Council and NHS Lothian/City of Edinburgh
Council re-using existing clinical portal products
Business System B
Business System C
User’s
PORTAL
PORTAL
Integration Engine
Business System A
Local Authority
Integration Engine
Health
Education Application
Social Work Application
Other initiatives
supported by the DSTB
• New CHI guidance allowing the CHI number to be used
to provide integrated health and care
• Fife Council and NHS Fife developing the Scottish
Accord for the Sharing of Personal Information (SASPI)
• Health and Social Care IT Strategy
– Positioned to support to cover the full breadth of
health and social care inter-working
– stakeholder consultation over 2013.
– Aiming for final endorsement and publication in
2014
– policy context….
No shortage of policy drivers…
•
•
•
•
•
•
•
•
•
Adult Health and Social Care Integration Bill
Children and Young People Bill (GIRFEC)
Public Sector Reform (Future Delivery of Public
Services – Commission led by Dr Campbell Christie)
Government Economic Strategy
National Public Sector ICT Strategy and Sectoral
Strategies (John McClelland Review of Public Sector
ICT Services).
Next Generation Broadband (Scotland’s Digital Future).
Scottish Wide Area Network.
NHS Scotland Quality Strategy/20:20 Vision –> eHealth
Strategy 2011-17.
eHealth Person Centred Strategy.
co-created Key Information Summary
• e-form, mostly filled in automatically with information
held in GP practice electronic patient record
• co-created by GP practice with patient
• targeted for people most likely to need anticipatory/ outof-hours care
• available electronically to NHS24, ambulance,
community teams, A&E
KIS contents
Section 1 – “Special Note”
– Free text field of 2048 Characters
– Expiry Date
– Patient, Carer and involved staff details
– Other demographics (eg. next of kin)
Section 2 – Current Situation
– Medical Information and Diagnosis
– ACP / Self Management Plan agreement
– Home Oxygen
Section 3 – Care and Support details
– Homecare support
– Incapacity / Guardianship
– Power of Attorney
Section 4 – Resuscitation
– DNACPR
– CYPADM (Children Resuscitation)
– Current and Preferred Place of Care
– any special instructions
Status: all prep work done; roll-out from April; part of GP contract
Futures:
• Patient/carer access via web/ App, with section for self completion?
• Extensible to other contributors to care?
How it works – builds on ECS IT
infrastructure
NHS
24
GP consultation
A&E
Ambulance
ECS
Store
analysis
Audit
trail
others
Security and confidentiality
Alarm at NHS IT breaches
14 February 2013
The BMA in Scotland has expressed disappointment at the number of
NHS IT breaches….. Figures published today show that hundreds of
NHS staff have been reported for breaching IT guidelines in hospitals
over the past three years…. 481 incidents…. At least 15 workers had
been sacked or resigned as a result, while some were given
counselling….
Scottish Government does indeed take security and
confidentiality very seriously….
Comprehensive ranges of improvements, as set out in
the NHS Scotland Information Assurance Strategy. But
will never be complacent.
Final thought: Gall’s Law
A complex system that works is invariably found
to have evolved from a simple system that
worked.
The inverse proposition also appears to be true:
A complex system designed from scratch never
works and cannot be made to work. You have to
start over, beginning with a working simple
system.
(from John Gall's “Systemantics: How
systems really work and how they fail)