1. www.connectingforhealth.nhs.uk/q ipp Telehealth: PHMR Development Review Richard Trusson NHS Technology Office DH Informatics Directorate

2. www.connectingforhealth.nhs.uk/q ipp 2 Agenda Why do we need Interoperability? Previous work: Whole System Demonstrator (WSD) and the 9 use cases Recent work: PHMR Specification Development Lessons learned What’s next? –Draft specifications for others –PHMR early adopters

3. www.connectingforhealth.nhs.uk/q ipp 3 Home Automation Telecare Telehealth Cholesterol Monitor Blood Pressure Cuff Glucose Meter Pedometer Sensor Netw orks Lights, Doo rs, Win dow s, Moti on, etc. Records NHS Housing Social Care Personal Health Elderly Living Independent ly Home Hub Care Profession als Out of H o ur s Carer respo nse servic e Tele-carer Emergency services Friends and Family Limited OfferingsNo integration Increased OfferingsIntegration required Increasing Integration Complexity Service Hub Why Do We Need Interoperability?

4. www.connectingforhealth.nhs.uk/q ipp 4 Why Do We Need Interoperability? Increased Offerings Increasing Integration Complexity Home Automation Telecare Telehealth Cholesterol Monitor Blood Pressure Cuff Glucose Meter Pedometer Sensor Netw orks Lights, Doo rs, Win dow s, Moti on, etc. Records NHS Housing Social Care Personal Health Elderly Living Independent ly Home Hub Care Profession als Out of H o ur s Carer respo nse servic e Tele-carer Emergency services Friends and Family Service Hub

5. www.connectingforhealth.nhs.uk/q ipp 5 Value of Information Integration Business / Service Requirement Information Requirement Cross and Multi-Service Working Effective Sharing of Information High Quality Supporting Information Ease of Access Ease of Consumption and Use Previous work: WSD and the 9 use cases DH wanted investigation into the shared information needs for supporting patient care under telehealth

6. www.connectingforhealth.nhs.uk/q ipp 6 Working with clinicians, GPs, Nurses, etc., patients and the industry we investigated what they needed. This lead to 9 use cases. Previous work: WSD and the 9 use cases Use Case NameDescription UC001Refer Patient for AssessmentThe capability to allow clinicians to electronically refer patients to care managers for telehealth assessment UC002Assess Patient for Telehealth Monitoring The capability to allow clinicians to share telehealth assessment results with other members of the care team UC003Enrol patient on the Telehealth programme The capability to notify care team members that the patient is receiving a live telehealth monitoring service. NOTE: this functionality is thought to be covered in UC009 in which patient status updates are sent to care team members. UC004Install & Commission Telehealth Equipment The capability for a clinician to electronically submit an order for the appropriate telehealth equipment from suppliers (pending installation in the patients home) UC005Create/Update Telehealth Care Plan The capability to allow clinicians to share details of a patient’s care plan with care team members UC006Create Telehealth Patient RecordThe capability to auto-populate patient telehealth records by drawing on existing sources, for example, PDS. UC007Monitor Readings Against Telehealth Care Plan The capability to allow care team members to routinely view a summary of patients’ telehealth data in their local systems. UC008Provide CareThe capability to allow those clinical users whose primary system is a non-telehealth system, to update the telehealth system with details of any patient intervention carried out by them. These updates will then be made available to the other members of the care team either directly through accessing the Telehealth system or through regular updates within the PHMR. UC009Send NotificationThe capability to update care team members as to the status of the patient

7. www.connectingforhealth.nhs.uk/q ipp 7 We also identified user concerns and issues Previous work: WSD and the 9 use cases Right information, right quality Easy to consume & use Easily accessed Volume of data Prioritisation Data overlap Clinician agreeme nt Clarity of purpose Ownership of patient record Clinical autonom y Medication record Speed of access Action accepta nce Speed of comprehensio n Clarity of address ee Linked to relevant clinician Linked to right patient Messaging Assuran ce Import effort Update frequency Professional liability Key Red – most important Blue - important Audit trail of changes/ messages

8. www.connectingforhealth.nhs.uk/q ipp 8 From –Understanding the business needs –Defining the use cases –Identifying the user concerns …the PHMR technical demonstrator message specification was prioritised This sent vital signs information from the telehealth system (Philips Motiva) to the GP system (EMIS Web) and addressed many of the identified user concerns, –right information, known quality, controlled amounts, easily accessed, easy to use. Previous work: WSD and the 9 use cases

9. www.connectingforhealth.nhs.uk/q ipp 9 In early 2012 we ran a workshop at Intellect to revisit and verify the use cases. We identified an additional case – click through Set message priorities. Top three were: –Personal Health Monitoring Report –Clinician Response Message –Referral Message Initiated a program of work to develop the PHMR – as a result of the technical demonstrator this was the most advanced. Recent work: PHMR Specification Development

10. www.connectingforhealth.nhs.uk/q ipp 10 The PHMR sends vital signs information from a telehealth service provider to a system with a legitimate interest – i.e. a GP system. The frequency of updates and range of vital signs reported on can be defined by the receiver. Working with the ITK team a series of WebEx meetings were run to review, verify and update the requirements. A draft message specification was released for comment. In August 2012 this was re-released, with updates, as a Release Candidate message ready for early adopters to start developing against. All work for this is posted on the ITK NHS Networks site. http://www.networks.nhs.uk/nhs-networks/interoperability-toolkit- itk http://www.networks.nhs.uk/nhs-networks/interoperability-toolkit- itk Recent work: PHMR

11. www.connectingforhealth.nhs.uk/q ipp 11 The engagement and development model, overall, worked. –Using WebEx –Using NHS Networks website –Gathering feedback –Reaching agreements Challenges: –Gathering feedback was harder than expected at times –Compressed time lines –Personal emails were better than generic ones Would we do anything differently next time? –Have longer timelines –Publish dates for all meetings at the start, if possible –Look to ‘public’ events for mid term discussion, if possible –Shared development environment Lessons Learned

12. www.connectingforhealth.nhs.uk/q ipp 12 PHMR: Continue to work with NHS and Industry early adopters to support implementation of the PHMR (vital signs) message. To date there are seven organisations, 2 GP system providers and the rest telehealth service providers, signed up. Clinician Response Message and Referral Message: use outputs from the Workshops this afternoon to inform message development and drive towards early adoption in first half of 2013. Work with the NHS, Industry, 3millionlives, dallas and others to support the adoption of telehealth and the implementation of interoperability standards across the board. What’s Next?

13. www.connectingforhealth.nhs.uk/q ipp 13 QUESTIONS? Richard.Trusson@nhs.net