Decision Support and a Technology-Enabled Workforce Rural General Hospitals Conference 27th September 2016 Dr Ann Wales, Specialist Lead, Scottish Government eHealth Ann.wales@gov.scot

Overview Challenges How Decision Support tools are addressing these challenges. What are the opportunities for RGHs? Tools and techniques Building confidence and competence in using technology

Challenges Clinical Strategy Increasing demand/diminishing resource Unwarranted variation and waste Ageing population Increasing complexity of care Knowledge base 17 year gap between research and practice Doubling time for published healthcare knowledge will be 73 days by 2030.

RGH Challenges Isolation Distance Limited access to specialists Dealing with low volume high acuity cases Building confidence in decision-making top priority in 2016 RGH VC education survey.

Decision Support Roadmap Part of national eHealth Strategy Role in Clinical Strategy - supporting Realistic Medicine Reduce harm and waste Reduce unnecessary variation Informed management of risk Personalised approach to care Shared decision-making Improve processes in hospitals Build capacity in community and primary care.

Reduce variation and waste. Manage risk Antimicrobial prescribing Sepsis Polypharmacy

Improve processes in hospitals Clicking on Evidence link leads to evidence sources.

Patient-Specific Decision Support Patient-specific prompts based on SIGN integrated into SCI-Diabetes. Patients 3-4 times more likely to be referred for screening in line with guidance. Small but significant improvement in glycaemic control.

Shared decision-making Proposals in hand: Decision aid to support patient-clinician conversations about insertion of grommets. Mobile app to monitor maternal risk throughout pregnancy; facilitate clinician -patient conversations.

RGH Opportunities Development of Mobile Decision Support Handbook for RGHs. Adapt and augment Lothian Adult Emergency Care Handbook. “Top 20” Priorities for RGHs – e.g: Sepsis Deteriorating patient Chest pain Abdominal pain Acute respiratory infection Asthma Dementia Intoxication

Use templates and localize RGH Opportunities Handbooks Editorial Platform Handbook Handbook Template Lothian Handbook RGH 1 Deliver to web & mobile Use templates and localize Handbook RGH 2 Handbook RGH 3

RGH Opportunities cont. Proposal for mobile app suite for community nurses and Advanced Nurse Practitioners in community hospitals – extend to RGHs? Examples of topics: Sepsis Wound care Continence care Palliative care

RGH Opportunities cont. Build workforce capability in using technology. 2014-15 survey of technology skills needs (N=12,879) Main value of technology is to support decision-making (78%) Many already confident in using technology (68%) Top priorities for further skills development: Using technology for shared decision-making with patients (48%) Using technology for clinical decision-making (42%) Using teleheathcare and assistive technologies (41%).

RGH Opportunities cont. How to use survey recommendations in your learning and development plans? Survey highlighted 4 capability domains: Generic digital literacy – Internet, MS Office, Information governance, social media Technology for health literacy and shared decision-making Using telehealthcare solutions Leadership and facilitation in using technology as an integral part of care.

RGH Opportunities cont. Get involved…. Workforce development to support Technology-Enabled Care Programme. Mapping learning needs and existing learning resources for TEC in health and care partnerships. Facilitating spread of skills and change in attitudes to TEC across partnerships.

RGH Opportunities cont. Board Learning and Development Leads NES Scottish Centre for Telehealth and Telecare Building a Technology-Enabled Workforce Priority in 2020 Workforce Implementation Plan Collaboration and coordination National collection of online learning resources for technology capabilities ??? Higher Education TEC programme SSSC

Discussion How can you make best use of the opportunities to use decision support tools and to build workforce capability in using technology?

Decision Support and a Technology-Enabled Workforce Rural General Hospitals Conference 27th September 2016 Dr Ann Wales, Specialist Lead, Scottish Government eHealth Ann.wales@gov.scot