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Information Sharing for Care Coordination
Wednesday 29 April 2015
12.30pm – 1.00pm
Adam HatherlySenior Solution Architect, Health & Social Care Information Centre
Christine WikeNHS Improving Quality
&
Beverley MatthewsLTC Programme Lead, NHS Improving Quality
Beverley Matthews
LTC Programme Lead
NHS Improving Quality
www.england.nhs.uk
LTC Year of Care Commissioning
Programme:
4
• 5 Early Implementer sites
• 35 Fast Followers
• Whole Population Datasets
• Implementation Guide
• Simulation Modelling
• Specialist Support Team
www.england.nhs.uk
LTC Framework Improvement
Programme:
5
Organisational &
Clinical
Processes
Informed and
engaged patients
and carers
Health & Care
Professionals
committed to
partnership
working
Commissioning
• Information and
technology
• Case finding & risk
stratification
• Care Planning
• Safety and
Experience
• Guidelines,
evidence and
national audits
• Care Delivery
• Self Management
• Information and
Technology
• Group and Peer
Support
• Care Planning
• Policies for carers
• Voluntary sector
patient & carer
support
• HSC Integration
• Multi Disciplinary
Teams
• Culture
• Workforce
• Technology
• Care Co-
ordination
• Care Planning
• Needs
Assessment and
Planning
• Joint
Commissioning
• Metrics and
Evaluation
• Service User and
Public Involvement
• Contracting and
Procurement
• Care Planning
• Tools and Levers
The table below sets out some of the key components needed to deliver the central
aim for LTC Framework - Person Centred Coordinated Care
Long Term Conditions Dashboardhttp://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html
Long Term Conditions House of Care Toolkithttp://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/long-term-conditions-improvement-programme/house-of-care-toolkit.aspx
Simulation Modelhttp://www.simul8.com/viewer/download.htm
#LTCyearofcare #LTCimprovement @NHSIQ
Tools and Resources:
For registration details, email [email protected]
LTC Lunch & Learn Series
….coming soon…
Date Webinar Hosted by Bev Matthews &
1 May 2015
12:30 – 13:30
Information as a Therapy Mark Duman
MRPharmS Director
Monmouth Partners
6 May 2015
12:30 – 13:30
Prevention & Effective Interventions in
Frailty
Helen Lyndon
Nurse Consultant Older People, Clinical
Lead Frailty, NHS England
27 May 2015
12:30 – 13:30
Primary Care Workforce for the 21 Century
Webinar
Sharon Lee
Primary Care Workforce Facilitator
South Kent Coast CCG
4 June 2015
12.30 – 13.30
Home Checks/Prevention Peter O’Reilly & Geoff Harris
Manchester Fire & Rescue Service
9 June 2015
12 noon – 1pm
Health 1000 Rob Meaker
Barking, Havering & Redbridge
Information Sharing for Care Coordination
• Mapping out your business and technology environment and understanding what information flows you need.
• Understanding the “patterns” of interoperability; selecting patterns and building a sharing roadmap.
• National Systems and Standards which can help.
of Care foundation.
Today’s Learning Outcomes
Information sharing for care coordination
Lunch and Learn WebEx
24th April 2015
Adam Hatherly, Senior Solution Architect, HSCIC
Learning Objectives
• Mapping out your business and technology
environment and understanding what
information flows you need
• Understanding the “patterns” of interoperability:
Selecting patterns and building a sharing
roadmap
• National Systems and Standards which can
help
Definition
• Interoperability:“The ability to safely share and make use of shared information and
services, regardless of the systems in use, and who supplied them”
Presentation Information
Application Technical
Interoperability
e.g. Common
look-and-feel,
standard
headings, etc.
e.g. common
information,
definitions, clinical
coding, etc.
e.g. sharing of
functionality,
common
integration
patterns, etc.
e.g. common
networks, shared
technology
capabilities, etc.
• The Main focus for this session is the Application / Technical aspects for real-time sharing of patient information
Establish your vision and scope
Inter-regional / national
Regional
Institutional
Departmental
• Information sharing typically operates at
different levels of detail (richness) at different
scales
Mapping out the local landscape
• Understanding
where you are
starting from
• Identifying what
can be re-used
or built upon
National
Systems
And
Services
Ambulance Service
CSU
GPs
Community Trust
Hospice
Acute Trust
<<Clinical
Portal>>
<<TIE>><<PAS>>
<<EPR>>
OOH
<<OOH>>
Local Authority
<<Mental Health>>
<<Palliative Care>>
<<Social Care>><<Mental Health>>
<<Data
Warehouse>>
PDS
C&BDBS
SCR
<<Other
Specialties>>
Various Systems
<<Community>>
<<Order
Comms>><<Order Comms>>
Prisons
<<EPR>>
NHS
<<EPR>>
<<111>>
<<School
Data>>
<<Patient
Portal>>
<<MH Care Plans>>
<<Email>>
EPS
<<GP Comms>>
<<GP
Comms>>
<<CAD>>
<<Data
Warehouse>>
<<MI & Risk
Strat>>
<<Triage>>CMS
DOS
SUS
(PbR)
SCRa
<<Data Warehouse>>
<<A&E>> <<MIU>>
<<Scanning>> <<Scanning>>
<<PAS>>
<<Bed Mgmt>>
MPI
<<Triage>>
<<DW>>
DTS
<<PTS>>
<<ITK>>
<<ITK>>
<<Scanning>>
<<Palliative Care>><<Palliative
Care>>
<<Manual
Processing>>
Voluntary &
Charitable Sector
<<Various Orgs>>
Various
Systems
<<VCS
System>>
<<Reporting>
>
Identify Information Sharing Needs
• There will not be a single “silver bullet” solution.
• Map out the most important information flows.
• This will allow a “roadmap” to be developed to progressively build the sharing capabilities over time.
• Some examples might be:
– Mental Health: Sharing standardised mental health “personal assessments” across integrated teams working in the community trust and the local authority.
– Child Protection: Unscheduled care services (including A&E and the Ambulance Service) want to know if a child who presents for care is subject to a child protection plan. This includes cases where the mother is pregnant, and the unborn child requires protection.
– End of Life Care: Manage the sharing and co-ordination of patient’s end of life care preferences between all services providing end of life care.
• Once you have identified the needs, you can start to discuss specific content to be shared, and approaches for sharing it.
Define and agree new information flows
• Map out how the information sharing process will work, and review with business stakeholders – e.g.:
A COPD patient goes for a regular review of their condition with the case manager in the CREADO
team, and takes along some recent test results, which feed into a discussion as part of reviewing
their care plan. The patient and clinician discuss the results and agree some new and updated
actions/needs, which the clinician updates in the patient’s care plan in the shared COPD record.
2
1
The care plan is
automatically
synchronised with the
clinical systems used
by the GP, community,
OOH and A&E teams.
Care Plan
The patient is given an updated
hard-copy of their self-care plan.
CREADO
Clinician
Shared COPD
Record
Self-
Management
Plan (Paper)
Care Plan SyncATimescale
LONG
In Current Plans?
NO
Interaction
Care Plan SyncA
3
GPCommunity
3
OOH
3
A&E
3
CREADO = Community Respiratory Exacerbation And Discharge Outreach. Focused on preventing readmission
Introducing Patterns
• A “pattern” is a formal way of documenting a solution to a design
problem in a particular field of expertise – this case sharing clinical
information between systems.
• Patterns are not mutually exclusive: many real solutions will use
more than one pattern.
• Solutions may evolve from simpler to more complex patterns over
time.
• Some patterns will be better for specific sharing needs than others –
there is no “one size fits all”.
• Some patterns will scale better to larger populations.
• Some patterns require additional capabilities or services to be in
place.
Summary of Patterns
Sys
A B
Data
A B
Src Con
Con
Src Brk Con
Single Shared
Application
Click-Through
Send point-to
point /
Broadcast
Message
Broker
Src
Rep Con
Con
Portal
Store and
Notify
Shared
Repository
Registry
Repository
Ptl
A
B
N
Do
cu
m
en
t
So
ur
ce
Src Rep Con
ceSrc Rep
Reg Con
http://developer.nhs.uk/library/architecture/integration-patterns/information-sharing-patterns-summary/
Messagin
g
TL
S M
A
System A
System B
Supporting Capabilities
Endpoint
Directory
Organisation
Directory
User Directory
Reference
Data
SSO RBAC
Messaging Standards
Registry
Citizen Identity
Patient Index
DSA
Repository
Relationship
Service
Consent
Service
PKI
Subscription
Service
N3
Inte
rnet
Broker /
Middleware
Building a Roadmap
• It is not realistic to wait for national standards and capabilities before
beginning to address local sharing challenges.
• Equally, once national capabilities and standards are in place, it will
take some time for these to be adopted by system suppliers.
• Local organisations also need to build roadmaps that allow them to
progressively migrate to using more mature patterns, and national
capabilities when they are in place, and it makes sense to do so.
• For example, a locality may build a roadmap for sharing a specific
type of information (e.g. care plans):
Simple notification
and click-through
patterns to provide
access to plans held
in clinical systems
Implement a
shared
repository
and submit
plans to it
Link the repository
with a region-wide
registry to link up
with other
repositories across
a wider region
Link the region-wide
registry into a
national registry to
allow records to be
located nationally.
National Systems and Standards
• National Systems:
– N3: Private Network
– NHSMail: Secure Email
– Smartcards: Authentication and Role Based Access Controls
– PDS: Demographics/NHS Number
– SCR: Summary Care Record
– GP2GP Transfers
– Choose and Book/eReferrals
– Electronic Prescriptions Service
– CPIS: Child Protection Information System
– Secondary Uses Service / Hospital Event Statistics
• National Standards:
– Clinical Coding: READ2,
CTV3, SNOMED CT
– Information Standards:
SCIE (formerly ISB), Data
Dictionary
– Interoperability: Messaging
Specifications (ITK),
Documents (CDA)
– Clinical Safety
– Security
• Emerging Standards:
– HL7 FHIR
Interoperability Toolkit
• The NHS Interoperability Framework (also known as the Interoperability Toolkit or “ITK”) is:
– National standards
– Implementation guides
– Accreditation scheme
• Supports interoperability within local orgs and across local health communities.
• The ITK is not a piece of software
• Moving away from bespoke interfaces
– Reducing complexity and therefore expenditure
• Publishing a series of common specifications
– Policing the deployment through ITK accreditation
– Bring a level of standardisation to the market
NHS England Interoperability Framework
Information GovernanceReferences standards, policies and guidance responsible for ensuring quality,
security and lawful use of information shared between systems.
Identifiers
Used for the unique identification of: patients and service users; NHS and non-NHS
organisations, services, workers and locations; and other physical and non-physical
entities requiring unique identification, e.g. physical products and communication
endpoints.
Codes and TermsUsed to assert the precise meaning of data to enable the consistent recording,
querying and interpretation of information.
Document Headings
Standard headings for organising data for entry and display particularly structuring
free text contents which in turn can convey the clinical and business meaning in a
human readable form.
Data Structures
(logical)
Used to create consistent dataset definitions that can be re-used across different
implementation standards or technologies.
Message Structures (physical)Used to create implementation specifications that define how datasets are realised
by different implementation standards and / or technologies.
Communication PatternsDescribes the re-usable architectural approaches for sharing health and care
information.
Technical Transport
(physical)
Interface mechanism by which data is exchanged between sending and receiving
endpoints.
• Work is ongoing (supported by HSCIC) to produce a range of guidance and resources to support local information sharing.