#NIECR Better,safer,fastercare

Whatsingleunheraldedchangehasmadethemostdifferenceinyourfieldinyourlifetime?“The Electronic CareRecord:there'snoneedtoworryaboutlettersnotinthechart,andmostofourhospitalspecialitiesnowusethis,soitsavesalotoftimeand

effort.DNAtestingissecond.”

ProfPatrickMorrison

ConsultantclinicalgeneticistBCH

BMJ2015;350:h2304(pub:6th May2015)

NorthernIrelandElectronicCareRecord

IntegrationinhealthandsocialcareGARYLOUGHRAN

HEADOFEHEALTH PROGRAMME(BSO)

•Whoweare

•Whyweneededtochange

•Whatwedid

•Wherearewenow

• Thebenefits

#NIECR Better,safer,fastercare

#NIECR Better,safer,fastercare#NIECR Better,safer,fastercare

80*100Miles

5HealthandSocialCareTrusts 20Acute

Hospitals

350GeneralPractices

(~1500GPs) TotalWorkforce54,000(WTE)

609,000AdmissionsAvg LOS6

days

~£4Billion(50%ofTotal

Budget)

OurOrganisation

#NIECR Better,safer,fastercare#NIECR Better,safer,fastercare

Adayinthelife• 1,000peoplearetransportedbyambulance

• 2,400childrenarelookedafterinsomeformofcare

• 5,000peopleareinhospitalbeds

• 12,000peoplearereceivinganursinghomeorresidentialcarepackage

• 24,000peoplearereceivingacarepackageintheirhome

• 28,000peopleseeafamilydoctororpracticenurse

• 84,000peopleareprescribedmedication

• 1000soflocalpeoplereceivinghelpandsupportfromcharitiesandcommunitygroupsintheirownlocalities

StrategicVision20152005DHSSPSNIStrategyidentified2keyintertwinedstrands:

ElectronicCareCommunicationsand

ElectronicCareRecords

#NIECR Better,safer,fastercare

#NIECR Better,safer,fastercare

InfrastructureNetworks

DataCentresGPModernisation

RegionalUniquePatientIdentifier

(HCN– PopulatedontoallRegionalSystems)

RegionalSolutionsNIPACS

ElectronicCareRecord

Whatwedidnext- buildstrongfoundations

WhyweneededanElectronicCareRecordMostPatientsthoughtthatinformationabouttheircondition,treatmentorservicecapturedinonepartoftheHSCisavailabletootherpartsoftheHSC!

UntiltheyhavesignificantinteractionwithHSCwhentheyfindout!

• Informationdoesnotmovebetweenorganizations

• Informationdoesnotmovebetweenfunctions

• Thesameinformationisaskedforoverandoveragain

• Serviceisnotjoinedupbutoperatesinsilos

#NIECR Better,safer,fastercare

#NIECR Better,safer,fastercare

#NIECR Better,safer,fastercare

NIECR

8 PAS9 EDM

14 EDs

5 OOH

6Laboratorysystems3

RadiologyRIS

3RadiologyPACS

5DiabetesCardiology

3Social–Community

CareSystems

350GPsystems

1 HealthandCareNumberIndex

• MultipleSiloed Systems

• Multiplepasswords

• FragmentedPatientRecords

PAS HCN’s1 7426222 6779463 5460094 2355155 48736

InformationGovernanceDatasharingprinciples• UseofNIECRisfordirectpatient/serviceusercareonly;

• Informationisaccessedwhenthereisaclinical/caring relationshipwiththepatient/serviceuser;

• AccessinNIECRmodelledontheaccessstaffgroupscurrentlyhavetosourcesystemsandpaperrecordsandwhatisappropriatetotheirroleinthecareteam,ona‘needtoknow’basis;SimpleRBACModel

• Aninformationcampaignto• makethepublicawareoftheproposeduseoftheirdata• consenttoviewshouldbeobtainedfromthepatient/serviceuseratthepointofcontact;

• DataSharingAgreement– DataControllerinCommonModel

#NIECR Better,safer,fastercare

#NIECR Better,safer,fastercare

KeyFactssinceJuly2013• 1,098,315 UniquePatients’RecordsAccessed~57%ofNIPopulation• 17M AccessestoPatientRecords• 10.8M UniqueUserLogins >15KuniqueloginsduringSeptember16• 27M Patient CentreDocumentsAccessed• 32K Drug AccessesperWeek• 1.5M Print Requests• 4.6M RadiologyReports Viewed• 47M+CumulatedLaboratoryResultsPresented• 17000 eReferrals viewed per Week• 10500OutofHoursReportsviewed perweek

TotalresultsviewedonNIECR– 72.7Million

#NIECR Better,safer,fastercare

NIECRActivity

#NIECR Better,safer,fastercare

ActiveUsers17,314ActiveAccounts

DoonceforNI– SystemicallyandFunctionality

Ouraim– tocreatearichlongitudinalpatientrecordavailableacrosstrusts,publichealth,andsocialcare.Asolutionthatbreaksdownthetraditionalboundariesbetweencareproviders,patientsandservices– “rightinformation,rightperson,righttime”.

NIECRavailability• >95%GPWorkforce• AccessedNIECR350,000timessinceOct15• OOHProvidersAccessedNIECR351,000sinceFeb15• >98%MedicalWorkforceusingNIECR• SurpassedBusinessUserNumbersof10,000Registeredusersin8months

#NIECR Better,safer,fastercare

StrategicVision2016“ThrougheHealth,wewillempowerpeopletobemoreactiveintheirowncareandsupporthealthandsocial.carestaffindeliveringthebestpossiblehealthandwellbeingforeveryone.”

HSCeHealthStrategy(March16)

RisingDemandcoupledwithconstrainedresources• Adoptbestpractices• Reducewasteandduplicationofeffort

SupportReform• Mobileworking• Integratedservicedesign• Modernwaysforpatientsclientsandcarerstointeractwithserviceandobtainadvice

Usedigitalsolutionstoimproveefficient,patientsafetyandqualityoutcomes• Avoidinappropriatecare• Reduceunwarrantedvariations(systemsandprocesses)

Investmentinthetechnologiesneededtounderpinandsupporthealthcaredelivery

#NIECR Better,safer,fastercare

• eReferralsTriageManagement

• CardiologyMDMReferrals

• SingleClinicalOrderingPlatform

• CommonResultsAcknowledgement

• CarePathwaysforspecificworkflowsDiabetespathway

• RegionalMortalityandMorbidityReviewSystem

#NIECR Better,safer,fastercare

DoonceforNI– innovateatscale

#NIECR Better,safer,fastercare

Yesterday• GPSendseReferral viaCCG• AutomaticallyRegisteredonPASand

immediatelyavailabletoSpecialityviaNIECR

• ConsultantTriagesonNIECR• AutomaticallyreturnedtoBooking

OfficeinNIECR

• BookingOfficeNotechangesonPAS• BookingOfficearrangeappointment

Today

InnovateatscaleeReferralstriage

E-Referralstriagebenefit• Fullypaperlessprocess• ReferralTriagecanbeperformedanywherewhenconnectedto

HSCNInetwork• AtHome• Fromofficeifworkingacrosssites• Virtuallyfromanylocation

• ReducestimefromreferraltocompletiononPAS• >60%ofeReferrals registeredautomaticallyonPAS• ~30%eReferrals Registeredonsameday• Reducedtimetowaitinglist• Betterinformeddecisions– increaseddischarges

#NIECR Better,safer,fastercare

#NIECR Better,safer,fastercare

InnovationatscaleCardiologyMDMreferrals• RegionalDistributedCardiologyGroups• General,ACHD,TAVI,ICC,PCI,Paediatric• Higherparticipation• OpeninformedDiscussions• TransparentMovementonlists• SinceNov2014

• 3,758patientsreferredanddiscussedby• Cardiologists:128• CardiologySurgeons:24• CardiologyTAVI:18

• Frameworkre-usedforneuro-oncologyMDMs

#NIECR Better,safer,fastercare

CardiologyMDMReferralsfeedback“I just want to say that to my view, the cardiology/cardiac surgeryMDMmodule is working unbelievably well in its first few months.To me the overall reaction has been huge positivity and it hasintegrated seamlessly into clinical practice.Once again, the NIECR team should be proud of what you havedone.”ClinicalDirectorCardiology– BelfastTrust“On behalf of the TAVI MDT, I will like to thank you and your NIECRteam for helping develop our TAVI programme further. I can saythis with confidence that we are miles ahead of the gamecompared to any other TAVI unit in the UK.”SeniorCardiacSurgeon

#NIECR Better,safer,fastercare

• LiveSeptember2015

• 1369UsersPlacingOrdersinallHSCNITrusts

• 15%ofallRadiologyRequestsnowonNIECR

• AvailabletoGeneralPractice

InnovationatScaleRadiologyinvestigationrequests

Carepathwayprinciples• Build upon NIECR foundation of clinically rich

information• Update once - immediately available to all NIECR

users• Create Common Components• Ensure Components are reusable across care

pathways & plans• Minimise Specificity• Diabetes Pathway has over 3,500 registered patients

#NIECR Better,safer,fastercare

Diabetes care plan

Pathway/Plan 3 tasks

Pathway/Plan 4 tasks

Common tasks

Diabetes

Astham

Path. 3

Path. 4

Common

Paediatric Asthma care plan

UseCommonBuildingBlocks

#NIECR Better,safer,fastercare

Diabetes care plan

Pathway/Plan 3 tasks

Pathway/Plan 4 tasks

Common tasks

Diabetes

Resp.

Path. 3

Path. 4

Common

Paediatric Asthma care plan

IncreaseCommonality

#NIECR Better,safer,fastercare

#NIECR Better,safer,fastercare

InnovationatscaleRegionalmortalityandmorbidityreviewsystem• Department of Health Death Certification reform Initiative• Accuracy of Death Certificate• Quality – Peer Review• Assurance – Learning, openness and transparency

• Record, Review, Monitor and Analyse all Hospital Deaths

• NIECR bid and won contract to deliver solution

• Go-Live Imminent

#NIECR Better,safer,fastercare

InnovationatscaleRegionalmortalityandmorbidityreviewsystem• Over 100 M&M teams established throughout HSCNI

• Every Patient Death will be offered for review at an M&MMeeting

• Forms Created on Pathway• Initial record of Death – filled out on death• Consultant Review of Death• M&M Team Review• Lessons Learned

#NIECR Better,safer,fastercare

InnovationatscaleRegionalmortalityandmorbidityreviewsystem

#NIECR Better,safer,fastercare

Medicines• MedicinesReviewandReconciliation• PrepopulateeDischarge LetterPotential

Future 2017-19

Problem List• DirectEntry• Alerts,Adversereactionsand

Diagnoses

Clinical Intelligence• PlatformforAnalytics• PopulationHealthAnalysis• ClinicalDataArchtypes and

Domains

Patient Portal• Appointments• CircleofCare• ResultsFilter• Add&ViewMedications• CommunicatewithCareProviders

ContinuetoAlignGrowthandOpportunitywithKeyStrategicThemes

NIECRFuture&Potential

ü Buildonmaturetechnologicalplatformsü Reusabledesignpatternsü Componentapproachü Centralised,SharedRecordü DoOnce,DoRight!ü VendorandHSCexpertise

ü Singledeliveryorganization(BSO)ü Developmodernmanagers

ü IT,PM,Service,Strategicallyü Proofofconceptcriticalü Iterative;developasolidplatformand

build

ü Nurtureclinicalchampionsü Fundclinicalinputü Wideclinicalengagementü Buildevidenceü Showbenefitsü Usersgreatestadvocates

ü Strongexecutivesupportü Buildsharedbusinesscaseü Incorporatehardandsoftbenefitsü Requirescalculatedriskü Seniorlevelsupportofinnovation

#NIECR Better,safer,fastercare

Technology Users

BusinesscaseProject

LessonsLearned1Langer’sLotteryTickets

The importance of positive engagement

Whenweareinvitedtobecomeinvolvedinadecision,wearemorepositivelycommittedtotheoutcome

HighReturnonInvestment

#NIECR Better,safer,fastercare

#NIECR Better,safer,fastercare

LessonsLearned2• StrongGovernance

• SRO• Information• Clinical

• EmbedclinicalleadershipintheGovernanceStructure• Regional&LocalProjectBoards• AllnewProjectTeams• Indeliveryteam

• KnowYourself– OrganisationalStrengthsandCapability• Putthepatientnottheinstitutionatthecentreofdecisions• KeepMovingForward– Don’twaitonperfect

#NIECR Better,safer,fastercare

BenefitsEvaluationOutpatientauditfindings(April2014)

• 5 Trusts, 68 Clinics, 604 Appointments, range of medical and surgicalspecialties

• Avoidance of Laboratory tests in 27% of patients

• Avoidance of Imaging tests in 8% of patients

• Improved management or experience of the patient in 37% of patients

• Reduced need for a Review appointment in 3% of patients

#NIECR Better,safer,fastercare

BenefitsevaluationOutpatientauditfindingsIfthepercentagereductioninappointmentsseenintheoutpatientclinicauditwasextrapolatedtoallreviewappointmentsintheHSCNIthenanassociatedbenefitof£2,963,397 couldbebaselined forthisactivity.

Theachievementofafurther25%reductioninreviewappointmentasaresultofcapitalinvestmentinNIECRcouldpotentiallysave£ 246,950

#NIECR Better,safer,fastercare

BenefitsevaluationNIECRUserSurvey(Feb2015)• 95.13% StatedNIECRsavedthemtime• 10%EstimatedNIECRsavedover2hoursperday• 31.5% EstimatedNIECRsavedbetween30minutesand1

hour• 56.5% ThoughtthatNIECRallowedtheusertomakea

betterdecisionaroundadmission/discharge• 56% ThoughtNIECRwashelpfulinpreventinga

duplicatediagnosticrequestorinvestigation• 79.6% StatedthatNIECRimprovedthequalityofpatient

care

#NIECR Better,safer,fastercare

ThankYou