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Dr. M G Murphy Clinical Director NWIS Caldicott Guardian for Wales General practitioner Blog sowhatfollows.wordpress.com.

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Presentation on theme: "Dr. M G Murphy Clinical Director NWIS Caldicott Guardian for Wales General practitioner Blog sowhatfollows.wordpress.com."— Presentation transcript:

1 Dr. M G Murphy Clinical Director NWIS Caldicott Guardian for Wales General practitioner Blog sowhatfollows.wordpress.com Transforming Care in Wales Opportunities RSA

2 Structured data Demographic Pathology Radiology Medication IHR WCP – CORE Unstructured data WCRS Shared care record GP System Community Mental health Social care system Community Mental health Social care system Innovation Space Work flow Pathways Existing Hospital Existing Hospital Etc. WCCG WORKING INSIDE OUR WELSH PSBA SECURE NETWORK IDENTIFING STAFF UNIQUELY WITH NADEX CONTROL ACCESS TO WHO SEES WHAT PROACTIVELY AUDIT EVERY ACCESS TO EVERY RECORD MHOL

3 Structured data Demographic Pathology Radiology Medication IHR CORE RECORD Patients Documents WCRS Shared care record GP System Community Mental health Social care system Community Mental health Social care system Innovation Space Work flow Pathways Existing Hospital Existing Hospital Etc. WCCG WORKING INSIDE OUR WELSH PSBA SECURE NETWORK IDENTIFING STAFF UNIQUELY WITH NADEX CONTROL ACCESS TO WHO SEES WHAT PROACTIVELY AUDIT EVERY ACCESS TO EVERY RECORD MHOL National Diabetic system National Diabetic system National Ophthalmology system

4 Current position Modern SOA Architecture Private PSBA, data centers, Active Directory Core services provided provided slowly rolling out Created room for innovation – to use Best of Breed apps All our activity is internally focused – obsessed with communicating with each other

5 So What ? sowhatfollows.wordpress.com

6 ZZZZZZZZZZ….

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8 A short history of the NHS 1947 – but the care process is 150 years old The consultation – based on face to face contact The patient travels to see the doctor / service Institutional and building focus to provision System was designed for episodic & infectious problems Separate health, social and mental health services

9 But We are facing a perfect storm Declining resources Aging population with increasing care needs – social, mental, physical Hospital emergency care has clogged up already with the frail elderly Great difficulty in caring for people in their own home as numbers and frailty increases People die in the wrong place – in hospital

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11 NHS Direct Web Site NHSDW 239k Paid calls Mental health services Police Ambulance 325k calls 500k journeys Outpatients Community pharmacy 70% population use in a year GP OOH 497k Social worker District nurse midwife 14% pop. see DN per year Admissions 343k A & E 714k (4% FU rate) Dentist 3.2M Welsh Citizens 800k LTC GP Practices 5.5M contact s unscheduled (16M total) 84% surgery 10% phone 4% visits 15M new illness episodes (family, friends, voluntary help web etc) 70% population see a dentist In a year 10m 641 k 403k 273k k k 189k k 3k 20k 55% journeys started in each category are stopped 10k 20k (3k) 24k 78k (1k ) 17k 31k 143k 2k 38k 32k 53k 9k 6k 1k Died 343k 48k 66k 10k 126k 10k 18k emergency transfer 392 Nursing Home 19k 12k 7k 7k path Number of call centres, telephones calls

12 Transition in care services 20 th Centaury Care Medical Hospital disease model Episodic reactive (fail and fix) Goal is Prevention of death All Care is provided by the state 21st Century care Holistic Community health and social care model Long term management ( predict and prevent) Goal is maximize quality of life & Good death Coproduction self care

13 Individual at home or usual place of residence 24 hour care usually in hospital Telephone advice or telephone consultation Travel – 99.8% they citizen travel to the services Face to face consultation with professional The Visual Care Cycle The basic risk management process in all care services If the individual or family feel they cannot manage the problem themselves and feel at risk they ring for help If the professional feels they cannot manage the risk without seeing the individual they arrange a face to face assessment If after assessment the professional feels that there is residual risk and they cannot safely be returned home they arrange that the person stays in contact with the service 24 hours a day When the service believes the risk has diminished to an acceptable level the individual return home or to their usual place of residence Individual continues to self care Individual continues to self care ©MGMurphy

14 Dealing with risk Uncertainty = anxiety = risk = cost Its about human contact – not being alone We deal with risk – by keeping a closer eye on the patient i.e. by staying in contact – This is true during a single episode – But it is also true over your lifetime and the reason that 70% of the cost of care is incurred during the last year of life – morbidity compression – At the present time the lack of alternatives means we admit put people in hospital beds Opportunity to use technology to stay in touch – in terms of distance and time

15 The Great Firewall of Wales (PSBA) Public services NHS,LA Social care Mental health The Public The Citizen The carer The third sector

16 Can put the citizen at the Center in our networked world Paradigm shift - we use the technology they have to communicate Third sector Health Citizen Mental health Social care Carer One global network, global services – no outside, no inside Mobile Always on – anytime, any place, anywhere Each of the 15 links can carry voice, video & data The security of each link can change depending on type of communication and citizens requirement for confidentiality

17 Health services Social care Voluntary services MHOL Book appointments Order prescriptions Message GP Access to my GP record MHOL Book appointments Order prescriptions Message GP Access to my GP record Access Knowledge Internet – Ap Cymru Accredited sites Conditions Treatments Performance Directories My global communications Used for Tele Health Video, telephone , Text, IM, HTTPS Secure social networks Instant messaging Communications HUB Tele devices Undertake Tasks GP system Health vault ( Own store) My copies of Care plans Contact details carers Tests Schedule Self monitoring etc Health vault ( Own store) My copies of Care plans Contact details carers Tests Schedule Self monitoring etc Apps to help me manage my health and social problems Self monitoring Point of care Use my record Monitor myself

18 What do we need ? 1.Enable patients to use the technology they have to communicate with the service 2.Enable staff to use the technology the patient has to communicate with patients and with each other But there is a problem with current way our Networks, PSBA, security & Data centers are configured that will get in the way of delivering this change.

19 4 Strategic implications for Wales 1.Separate the care record services from the communications services – they require different approaches to privacy, confidentiality & security 2.Shrink the great firewall back to securing the care record data - the way other information services are delivered 3.Provision of the record data over secured link to mobile devices any where – including hospitals, estate & most importantly all homes in Wales 4.Shift the whole of human communications onto global cloud services available to the citizens

20 Opportunities ? 1.Open Wi-Fi – in public estate and homes 2.Simple reliable cloud VC – internet TVs etc. 3.Mobile working – seamless use of the above 4.Transformation of care – unscheduled care – Long term – Long term condition management Its the right time finally for this revolution because we now have a network that reaches into people homes & the technology has moved beyond public services ability to manage it.

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22 Wakey Wakey...

23 Home Phone First For help Transpor t Assess Face To Face 24 hour Care Individual unwell Family friends Family friends Voluntary sector Web Directory individual Stable at home individual Stable at home 111 call handler 999 call handler Clinical assessment Mental health assessment Social care assessment Clinical assessment Mental health assessment Social care assessment Ambulance Clinic OP appointment OOH visit OOH appointment GP surgery A&E Community Pharmacy Social Worker Specialist advice e.g. Diabetic nurse Signpost Hospital Inpatient Hospital Inpatient 24/7 home Care package 24/7 home Care package Nursing Residential Nursing Residential With access to the IHR, Core H & SC records Care plan (ELP) & Specialist advice for staff on MH, palliative care Acute physicians e Monitoring at home R es id u al Ri sk R es id u al Ri sk Physical & virtual Call center With call location & demographic linkage DN/CPN USC episode Phone(SKYPE) Hot transfer Advice & information Optomatrist Private sector Emergency Respite Safe haven Rapid response Home care Hospital at home Holistic assessment


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