Paper K Digital Deep Dive National End of Life Care Programme Board - - PowerPoint PPT Presentation

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Paper K ‘Digital’ Deep Dive

National End of Life Care Programme Board

5th April 2017

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• 1. Background & context
• 2. National solutions
• 3. The London approach
• 4. Questions for the board

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Background & context

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Context & Background

Nationally 2 commitments were made in the government’s response to the Choice Review:

• 100% rollout of EPaCCS by 2020
• Patients able to edit their records and EoLC preferences by

2018 Both these commitments were made in alignment with ambitions of the National Information Board We are aware there are potential opportunities for digital solutions to support End of Life Care from stakeholder workshops and a previous ‘Code4health community’

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EPaCCS background

What: Electronic Palliative Care Co-ordinated Systems (EPaCCS) are shared

electronic records to support end of life care co-ordination

Why: First piloted in 2008 as part of the DH strategy, early evaluation

showed people more likely to have their preferences met and indicated financial savings.

How: Different solutions in place across the country. Footprint of which

services are involved, technical solution chosen and rollout plan all locally

• led. EPaCCS should comply with SCCI 1580 (core set of data items). National

levers – Local Digital Roadmap and NHS Standard Contract.

Issues: Patchy implementation across country. Issues cited include

confusion over information governance, different systems not ‘talking’ to each other, lack of reporting from local solutions, not all enable read/write, some involve double entry, digital maturity a factor

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Outline of delivery

• NHSE EoLC regional leads have a deliverable for 2017-19 to drive

forward EPaCCS implementation locally

• National support to share best practice – events, webinars etc
• Learning from sites where EPaCCS being tested or embedded – case

studies, Vanguards

• NHSE digital colleagues will commission national solutions from NHS

Digital (GP Connect APIs, National Record Locator, Flagging)

• Commissioning guidance will be published – four sections:

1. Introduction/ case for change/ governance/ approach 2. What ‘good’ looks like from technical perspective 3. Implementation examples (London) 4. Outline future national technical developments (GP Connect APIs, National Record Locator, Flagging)

• Continue to promote the Summary Care Record working with NHS

Digital – read only but nationally available and links to GP Contract and frailty requirement

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National solutions

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Basic Needs

• Flag specific patients and their

conditions/preferences to inform clinicians delivering care

• Collect data once
• Index and publish that Information
• Consume it and update it
• Re-publish and share

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Flagging

• London (Coordinate My Care - CMC) and Urgent

Care have asked for an “End of Life” flag – to highlight specific patients and information to call takers

• Flagging patients as End of Life is technically

transferrable for Diabetes, Learning Disabilities, Dementia

• End users have asked for consistency in flagging,

awareness of the potential dangers of “flag fatigue” and for flagging to be centrally coordinated

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Indexing – National Record Locator

• The National Record Locator is a proposed national

index that could be used to provide a pointer to a patient records wherever they are located.

• A need to include indexing capability for specific key

end of life documents e.g. Advance Care Plans, ADRTs, Preferred Priorities of Care

• This indexing capability can be applied to all clinical

systems, to publish key information in standard formats for sharing and consuming

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Information Sharing options

• GP Connect
• Has the potential to publish end of life information

from the GP record

• Care Connect
• Has the potential to publish end of life information

held in the Hospital or Mental Health Record

• SCR
• The Summary Care Record derives from

SCCI1580 information in the GP record and can be shared for Direct Care

• SCR offers a basic level of maturity across the

NHS

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Interoperability

• Lack of interoperability can mean issues with double

input for GP practices

• Much end of life care information is recorded in

community – it may not be recorded in GP systems

• What are the key integration options required?
• See next slide

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31/03/2017

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Consent for sharing End of Life Care information

• Coordinate My Care (CMC) and other local

hubs are working to establish a consent model

• The latest IG advice appears to remove the

need for a consent model for direct care. Patients expect us to share their data for direct care anyway.

• Patients do have concerns about the use of

their data for secondary purposes

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Reporting

• What are the actual reporting requirements?
• For use in Quality improvements of outcomes
• Development of metrics for End of Life Care
• SCR is not for reporting – Its content is derived from

the GP record – which is the prime source for reporting.

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Next Steps & Priorities

• Delivery of GP Connect)
• National Record Locator – PoC complete with Leeds
• SCR continued roll-out
• Flagging capability
• Incentivise continued implementation of EPaCCS

functionality

• Support for place based information sharing

exemplars

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Implementation example - the London approach

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London Digital Programme

Support for care co-ordination in London Beginning with people in the last year of life, the core objectives are:

• To drive up the proportion of people with a shared EoL care plan by enabling

clinicians in different care settings to create, locate and maintain a shared care plan in real time from within their native systems

• To extract ‘summary data’ from these care plans and enable clinicians and carers

involved in urgent care to locate and view this data in real time

• To enable these capabilities using standards based information exchange

between the existing EPaCCS, GP and hospital systems plus new connected apps

• To provide electronic tools that allow patients and data controllers to control the

sharing of this data via these applications Healthy London Partnership

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London Digital Programme

Technical overview – Pan London Exchange View

Online Account Patient Identity Record Locator Service Repositories Workflow Subscribe and Notify Integration Services Consumer API ‘s Integrated Digital Care Services Data Sharing Agreement Citizen and Identity Consent Care Professional Access Directory Services Trust Identity and Consent (IG) Security Authentication Authorisation Secure Communication Audit Presentation Services Applications Services Orchestration Services Connectivity Services Citizens Data Controllers

Care Provider Systems

GP/ Acute/ Mental Health/ Community/ Urgent Care/ Social Care

IHE / Restful FHIR / MESH

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London Digital Programme

High Level Roadmap for End of Life Care Planning Healthy London Partnership

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London Digital Programme

Approach so far

• Spending time with clinicians across primary, acute and community care listening

to their experiences in end of life care planning, exploring current ways of working (process, systems, documents and communications ) to identify common themes

• Completing investigative work to support the creation of a technical test

environment (based on the creation of a test instance of the LHCIE) to enable a basic Fast Healthcare Interoperability Resource (FHIR) standard based ‘exchange’

• f structured EoL care plan data; between selected hospitals, GPs and an EoL care

planning solution

• Learning from the current success of Coordinate My Care (CMC) by removing dual

data entry at the GP level; enabling care plans to be created natively in the GP systems Healthy London Partnership

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London Digital Programme

Key Benefits

• Increasing the availability/ visibility of the end of life care plans to support

decision making by frontline clinicians

• Increased numbers of patients dying in their preferred place of death identified
• n an end of life care plan
• Reduction in duplicate data entry by clinicians across London when creating end
• f life care plans

Healthy London Partnership

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London Digital Programme

Next Steps

• Continue requirements gathering with clinical experts (workflow, rules and

benefits)

• Develop process maps and thematic analysis of end of life care planning ways of

working (current and future)

• Clinical co-design group to meeting and discuss the development of the

information exchange – first meeting planned for the April 27th 2017

• Development and testing of the technical test environment

Healthy London Partnership

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Questions for the Board

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Questions for the Board

• Are board members assured that these plans will deliver our

commitment to enable electronic sharing of EoLC plans by 2020?

• What other contributions can board members make towards

delivery? Are there synergies with any other pieces of work?

• What other opportunities can board members identify where

digital solutions can support delivery of our aims and objectives? Are there examples that can be shared?

• What are Board members thoughts on the likely national reporting

requirements for End of Life Care?

• How can the Board help influence the development of a national

approach on data sharing for secondary purposes?