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Current thinking on development of health and social care and integrated informatics Alan Hyslop interim Head of eHealth Scottish Government Health & Social.

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Presentation on theme: "Current thinking on development of health and social care and integrated informatics Alan Hyslop interim Head of eHealth Scottish Government Health & Social."— Presentation transcript:

1 Current thinking on development of health and social care and integrated informatics Alan Hyslop interim Head of eHealth Scottish Government Health & Social Care Health and Social care in the digital age

2 A tale from Cumbernauld

3 So why is IT-enabled information sharing working in some places? Service improvement driven, not IT led Therefore management and practitioner commitment Continual investment in staff support and revising working practices given IT enablement Trust in professional relationships fostered If sharing is in the patient/client interests, mindset = one of good reason not to share. Pragmatic and incremental progress. Not letting the best be the enemy of the good

4 Investing in IT enablement But hang on, hasnt NHS Scotland done big IT in its time? eCare spend IT-relatedOther

5 Emergency Care Summary Patient identity (address, telephone, CHI number, GP) Allergies and Adverse Reactions to medications Medication - Repeat prescriptions in past 12 months - One-off prescriptions in past 30 days Used 3 million times last year, by A&E, GP out-of-hours, NHS24, ambulance, admitting clinicians Major contributor to patient safety National database covering 99.9% of the population that contains…

6 Investing in IT enablement eCare spendECS spend IT-relatedOther

7 Emergency Care Summary – benefits

8 So does that mean our re-freshed approach should be a new improved national IT system, done differently? NO!

9 So what is our current thinking? 1.Re-build relationships – clear signal about working in partnership - refreshed governance on that basis 2.Work collaboratively toward new health & social care information and IT strategy 3.One-size IT does not fit all 4.So clear signal about more flexibility around local solutions, underpinned by common set of standards and protocols.

10 Data Sharing Technologies Board Formed in November 2011 under LA chairmanship Representatives from Local Authorities and Health Boards. Membership will be extended to include other public bodies (eg Police) and Third Sector Transition from national one size fits all approach to a series of locally led initiatives Three strands of business:- –stewardship of the legacy National eCare IT –promote innovative and pragmatic information sharing initiatives that result in better outcomes for service users –develop and oversee the implementation of the Health & Social Care IT Strategy.

11 Policy Relationship with other Strategies and Governance Bodies National ICT Board GIRFEC LA Strategy Board Other eHealth Strategy Board Health and Social Care ICT Strategy Data Sharing Technologies Board Adult Health & Social Care Integration

12 Shared information is vital to improving the outcomes from integrated care services. All relevant information about a persons care should be available electronically to professionals and ultimately to service users. There should be a presumption in favour of information sharing with service users and staff. Personal information should only be shared for the integrated care purposes within the partnerships information sharing protocol. Data Sharing Technologies Board - Principles

13 Service users and staff should be engaged continually in improved use of information to achieve better outcomes. Robust information readily available to operational and strategic decision makers. Initiatives should optimise use of existing assets. Standards based approach to support convergence in line with the McClelland ICT Review.

14 AYRshare NHS A&A South Ayrshire Council SWIS SEEMIS Social Work Education East Ayrshire Council SWIFT SEEMIS Social Work Education North Ayrshire Council CareFirst SEEMIS Social Work Education FACE Child Health The Central Store approach, locally held Lanarkshire and now NHS Ayrshire and Arran and three Ayrshire councils

15 AYRshare NHS A&A South Ayrshire Council Social Workers Teachers East Ayrshire Council North Ayrshire Council Social WorkersSchool Nurses Social Workers Teachers Health Visitors

16 CONCERNS ARE ADDRESSED EARLIER Social Work School Child Health Focus on actions and outcomes Alerts

17 PORTAL Users PORTAL Health Business System A Business System B Business System C Health Business System A Business System B Business System C Local Authority Education Application Social Work Application Integration Engine The Portal Approach NHS GG&C/Renfrewshire Council and NHS Lothian/City of Edinburgh Council re-using existing clinical portal products Integration Engine

18 Other initiatives supported by the DSTB New CHI guidance allowing the CHI number to be used to provide integrated health and care Fife Council and NHS Fife developing the Scottish Accord for the Sharing of Personal Information (SASPI) Health and Social Care IT Strategy –Positioned to support to cover the full breadth of health and social care inter-working –stakeholder consultation over 2013. –Aiming for final endorsement and publication in 2014 –policy context….

19 No shortage of policy drivers… Adult Health and Social Care Integration Bill Children and Young People Bill (GIRFEC) Public Sector Reform (Future Delivery of Public Services – Commission led by Dr Campbell Christie) Government Economic Strategy National Public Sector ICT Strategy and Sectoral Strategies (John McClelland Review of Public Sector ICT Services). Next Generation Broadband (Scotlands Digital Future). Scottish Wide Area Network. NHS Scotland Quality Strategy/20:20 Vision –> eHealth Strategy 2011-17. eHealth Person Centred Strategy.

20 e-form, mostly filled in automatically with information held in GP practice electronic patient record co-created by GP practice with patient targeted for people most likely to need anticipatory/ out- of-hours care available electronically to NHS24, ambulance, community teams, A&E co-created Key Information Summary

21 Section 1 – Special Note –Free text field of 2048 Characters –Expiry Date –Patient, Carer and involved staff details –Other demographics (eg. next of kin) Section 2 – Current Situation –Medical Information and Diagnosis –ACP / Self Management Plan agreement –Home Oxygen KIS contents

22 Section 3 – Care and Support details –Homecare support –Incapacity / Guardianship –Power of Attorney Section 4 – Resuscitation –DNACPR –CYPADM (Children Resuscitation) –Current and Preferred Place of Care –any special instructions Status: all prep work done; roll-out from April; part of GP contract Futures: Patient/carer access via web/ App, with section for self completion? Extensible to other contributors to care?

23 How it works – builds on ECS IT infrastructure ECS Store NHS 24 A&E Ambulance others Audit trail analysis GP consultation

24 Security and confidentiality Alarm at NHS IT breaches 14 February 2013 The BMA in Scotland has expressed disappointment at the number of NHS IT breaches….. Figures published today show that hundreds of NHS staff have been reported for breaching IT guidelines in hospitals over the past three years…. 481 incidents…. At least 15 workers had been sacked or resigned as a result, while some were given counselling…. Scottish Government does indeed take security and confidentiality very seriously…. Comprehensive ranges of improvements, as set out in the NHS Scotland Information Assurance Strategy. But will never be complacent.

25 Final thought: Galls Law A complex system that works is invariably found to have evolved from a simple system that worked. The inverse proposition also appears to be true: A complex system designed from scratch never works and cannot be made to work. You have to start over, beginning with a working simple system. (from John Gall's Systemantics: How systems really work and how they fail)


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