1. Smartcare - a Foundation for excellent patient care through a strategic approach to IT www.smartcaredevon.co.uk www.smartcaredevon.co.uk Alison Diamond Chief Executive Northern Devon Healthcare NHS Trust

2. A Trust Experience Who and what we are What we wanted to solve Our approach Successes to date Next steps

3. FromToTime (mins) BudeBarnstaple55 BudePlymouth, Exeter, Truro80, 75, 80 IlfracombeBarnstaple25 IlfracombePlymouth, Exeter, Taunton130, 90, 85 IlfracombeAxminster105 Bude

4. North Devon District Hospital in Barnstaple 17 Community Hospitals Integrated health and social care teams Community nursing and therapy services Specialist community services – pan Devon We cover just over half of Devon: Serve 484,000 people (740,000 Devon total) Over 1,700 square miles (2,500 sq m Devon total) Acute: Serve 165,000 people Over 700 square miles Trust profile Turnover 2013/14 £223m

5. Our Integrated Business Plan (IBP)

6. Smartcare – Why? How? What? Why? Why? Patient need only tell their story once and staff will have access to a multi disciplinary records in all settings How? How? An EHR programme that is transformational and clinically lead What? What? EHR across Acute and Community Settings – Interoperability with all other local systems

7. Principles for staff Single Sign On including Tap in and Tap out mobility Fast, reliable and clinically acceptable local IT Easy access to WiFi and safe, secure mobile access Off Line working (Community)

8. Meaningful Use of EHR External Informing Reshaping Internal Informing Optimising Decision Making (Information) _______ Ways Of Working (Technology) Inside the OrganisationOutside the Organisation EHR Managing Clinical Quality Clinical Decision support tools Evidence-base part of care giving process Managing Operational Performance Patients accessing their records Informing to differentiate NDHT Demonstrate we know and care for the populations we serve Helping Commissioners manage demand better Better contracting outcomes for us (coding, revenue per case) Electronic Correspondence Virtual Health Record (through Health Information Exchange**) Clinical Portal EPMA Order Comms Clinical Noting CPOE / CDS

9. EHR Programme Smartcare EHR comprises… – TrakCare (Intersystems) for Hospital Based care – RIO (Servelec) for community / home based care – Ensemble / Healthshare (Intersystems) for interoperability platform In 2015/16 introduce full Digital Observations, Handover, Hospital at Night & EWS Escalations (products: Nervecentre + Welch-Allyn) Adopt clinical noting early on in the programme in what is a ‘clinical foundation’ first phase Retain Winscribe (or similar) for digital dictation and voice recognition to assist with EHR data capture 2-3 year roadmap of transformation

10. Year 1 – Architecture Summary

11. Tele-health in Ophthalmology Routine follow up for patients with glaucoma(wet AMD to follow) Local access to care for patients Remote retinal pressures and photography undertaken by technicians Centrally reported and treatment planned any changes in medication to patient and GP within 5 days

14. Outcomes 20,000 ophthalmology patients, 8000 i.e.40% of patients seen in local community 30% increase in productivity for consultants Opportunities to develop the technician role

15. GP order comms Rolled out to all the practices that use the pathology services at the acute hospital through 2014/15. This was clinically led and clinical pathway based GP/Microbiology. The pilot for the work was to rationalise the requests for urine microscopy and culture to those patients that needed it. Work based on order ‘sets’ The net result now that the implementation is complete stemmed the growth from an annual 3-4% to flat growth This has led to a commissioner QIPP - £300,000 last year £65,000 new business from North Cornwall

16. Complexity and Community Data/PAS Foundation built from collection of CIDS – Mobile devices to over 800 staff – CIDS ++ (through COMPAS in-house App) – Works offline as well – Devices support other new ways of working Developed ‘packages of care’ approach to data collection Refined through pilot in teams with highest levels of completion and accuracy Refined further through shadow monitoring and independent ‘inter-rater’ agreement of complexity for cohorts vs. actual recording in COMPAS Algorithm derived to ascertain community ‘tariff’

17. Outcome Used to demonstrate our increasing demand and acuity of casemix and secure an additional £1.25m on 14/15 contract vs. 13/14. £1.5m on15/16 contract vs. 14/15 Pushing for adoption and move away from block contract High levels of staff adoption demonstrates the value to them and the productivity and service demands they face

18. Next Steps Refine patient pathways to new ‘lean’ models - for ops team and clinicians to design Sign off that EHR fit for purpose Roll out of EHR to hospital sites Contract for EHR for community to be signed and move to implementation phase Review and evaluation to ensure benefits realisation

19. Questions and Comments