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

2. 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

3. 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.

4. 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.

5. 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.

6. Reduce variation and waste. Manage risk
Antimicrobial prescribing
Sepsis
Polypharmacy

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

8. 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.

9. 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.

10. 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

11. 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

12. 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

13. RGH Opportunities cont.
Build workforce capability in using technology.
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%).

14. 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.

15. 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.

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

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

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