QIPP Digital Technology Team EPa CCS Informatics Advisory

QIPP Digital Technology Team EPa. CCS Informatics Advisory and Support Group 27 th June 2012 V 2

Agenda § Introduction / Objective of Meeting (AH) § Brief review of any comments on the group Terms of Reference (All) § Brief summary of the local approaches for EPa. CCS implementation in local teams (AH) § Review of Candidate “National Enablers” requested by local teams – comments from group (All) § Agree next steps 2

EPa. CCS Informatics Advisory and Support Group § Key Responsibilities of the Group: § Governance for the Development of National Enablers § Details on subsequent slides § Ongoing Implementation Support § Discussing key issues or concerns raised by local teams § Reviewing Update to ISB on Implementation of ISB Standard

Member list as at 20 th June 2012: Team QIPP LTC Workstream LSP (NMEPf. IT, LPf. IT) SHA/PCT Cluster ICT Summary Care Record QIPP Digital Technology GPSo. C Interoperability JGPITC QIPP EOLC Workstream Suppliers Patient Engagement Clinical Teams Name Sharon Lee Richard Mc. Ewan Paul Westerman Julia Riley Stephen Burrows Julian Abel Tracy Davis Alison Chan Adam Cooper Adam Hatherly (Chair) Andrew Williams Mike Curtis Joe Waller Michael Odling-Smee Richard Kavanagh Libby Morris Leo Fogarty Rob Benson Simon Wren Sue Grey Phil Russell Sarah Griffin Chris Pratt Michael Thick James Leeming Simon Fanthorpe Paul Cooper Ian Moody Gemma Daley Jayne Taylor Lesley Boler Julie Mountain Steve Plenderleith Group Members Org/Role LTC National Coach Technical Architect Leeds London Salford South West North East Yorkshire and the Humber Technical Architect Programme Manager Technical Architect Interoperability Development Manager Advanced Health and Care i. Soft EMIS TPP CSE Healthcare Mc. Kesson Graphnet In Practice Systems IMS Maxims PCTI Solutions Clinical Solutions Patient and Public Partnerships Group Director of Nursing and Education Community Matron and Clinical Lead for Long Term Conditions Hampshire (previously Birmingham) Member M M M M TBC TBC M M M M § An invitation to suppliers to join the group has been sent out through Intellect, so there may be more suppliers joining the group in addition to the above

Progress To-Date 27 th June Web. Ex Engagement and Discovery EPa. CCS Survey Evaluate Responses QIPP Digital Technology Initiatives Register Follow-Up Discussions with Local Teams Local Roadmaps (as at 27 th June 2012): § South West: Roadmap Produced § Bedfordshire: Roadmap Produced § Birmingham: Roadmap Produced § South East Essex: Call held § Salford: Call held § London: Roadmap Produced § Leeds: Call held Potential National Enablers Scored and Prioritised Draft High. Level Local “Roadmaps” Prioritised “National Enablers” Development Identify work packages and agree allocation for delivery Work Package Delivery § Candidate enablers identified – outlined in subsequent slides. Enabler Review Published “Enablers” Delivery and Support Identify “First of Type” adopters Support Implementation of Enabler Capture Lessons Learned and Case Study Case Studies / Best Practice

High-Level Local Approaches EPR GP Care Co. Ordination. System A&E EPR EPa. CCS OOH Community EPR Ambulance Palliative Care Record Viewer GP Shared Clinical System EPR Community EPR A&E Record Viewer EPR OOH EPa. CCS Record Viewer Palliative Care EPR Ambulance Dedicated Care Planning System In some cases, local teams have procured a new shared solution specifically for holding end of life care preferences. This is made available to all care settings, who can view/update as per their role in the care planning process. A separate process (often manual) is sometimes used to “flag” within the various clinical systems that a care plan exists in the care planning system, so clinicians know to look there for care preferences. Shared Clinical System In some localities, an existing centrally hosted clinical system is already in place and is used across a number of care settings, giving read-write access to EPa. CCS records. Other care settings can use a record viewer, which provides a readonly view of the record. Updates to other EPRs would be manual, and any updates to EPa. CCS records would need to be fed back to a team with full access to the shared clinical system (this is sometimes handled by a central co-ordination centre).

High-Level Local Approaches (Contd. ) EPR SCR Community EPR A& E EPR GP Summary (inc. EPa. CCS) OO H GP EPR Ambulanc e Palliative Care SCR as EPa. CCS In some cases, local teams who have a good uptake of SCR have used an enhanced GP Summary to provide their EPa. CCS by storing the patient’s end of life care preferences directly in the GP summary. Any changes would need to be fed to the GP to be incorporated into their records, and fed up to the SCR. Other teams could then view the records in the SCR either in their system (if it supports SCR viewing), or using the Summary Care Record Application. Ambulanc e Clinical Portal EPR Clinical Portal G P A& E EPa. CCS EPR EPR Data OO H Communit y EPR Minor Injuries Unit EPR All Clinicians Patient Ambulanc e In some cases, local teams have are developing clinical portals to bring together key information from the various EPRs in clinical systems, and consolidate into a single view. End of Life preferences can then be a combination of data pulled from clinical systems, but can also be augmented directly in the portal if required to additional information not currently held in clinical systems. The level of information exchange between clinical systems and the portal generally varies, with some one-way feeds and other more tightly integrated. In some cases a patient may also have access.

EPa. CCS Candidate National Enablers Requested Enabler Description Interoperability Standards It“Essential would be rather desirable todesirable” allow the EPa. CCS record to be shared than “avoids duplication” electronically with clinical systems, and kept in sync. approaches” This would “Separate message content from synchronisation allow clinicians to use their own systems and avoid re-keying. Standard Templates in Clinical Systems Many local teams have build custom “forms” within their clinical “shares good practice” systems capture end of life care preferences. There would be “there is to too much time spent reinventing the wheel” Guidance on the use of SCR for Eo. LC There is some high level advice the implementation “essential to be using the mostin compatible system” guidance document on the use of SCR, but there is a need to provide “won’t work if controlled by GP system” more detailed guidance to support teams considering this. IG Guidance on Consent for Eo. LC There is a need to be clarify the details of theconsentfor requirements “why would there a need for explicit EPa. CCS? ” “explicit is relating not gained forend other specific registers” and otherconsent IG issues to the of life care co-ordination process. Guidance On Consent for EPa. CCS M Proximity Smartcards The usewith of athe consistent mechanism an important enabler “agree need for. SSO consistent SSO is mechanism” for EPa. CCS. There are concerns over infection control with current smartcard readers. § Provide contacts in identity management team, and give overview of hardware options and timescales for new smartcard functionality L Support for Coding and Cross-Maps To support any readcodes interoperability specifications are “standardised will reduce clinicalthat risk” developed, there is a need to clarify how coded information can “crucial for areas such as Eo. L diagnoses, disabilities, allergies” be conveyed in the messaging across systems safely. Guidance around options for mobile working Standard model for quality and outcome marker capture and modelling benefit in sharing this to avoid re-work in other teams. QIPP DT Team: Potential Work Packages / Comments ITK Spec: Notification with Pointer ITK Spec: EPa. CCS Core Record Click. Through H § Share existing templates on NHS networks site? [Link] M § Build on existing guidance on SCR pages of CFH web site? [Link] M EPa. CCS Diagnosis Subset & Cross-Maps H Many of the teams involved in providing end of life care need to “crucial for DN teams and GP OOH services” be mobile, so there is a need to provide guidance on how EPa. CCS solutions can use mobile technology. § Build on existing guidance in mobile working resource centre? [Link] H Local teamsneeded have built models capturing and tracking “guidance but various local teams willfor have good models” “could be for more sharing teams have done work on this” outcomes patients on from an end of lifewho care pathway, but this could benefit from being standardised. § Not specifically a technology enabler – raise with wider implementation support group? M EPa. CCS Coded Entry Cross-map Guidance

Summary of outputs from the Web. Ex § 19 attendees joined the Web. Ex: Team LSP (NMEPf. IT, LPf. IT) SHA/PCT Cluster ICT Name Richard Mc. Ewan Org/Role Technical Architect Libby Hough London Stephen Burrows Julian Abel Tracy Davis QIPP Digital Technology Adam Hatherly (Chair) Andrew Williams Mike Kelly GPSo. C Mike Curtis Interoperability Joe Waller Richard Kavanagh QIPP EOLC Workstream Rob Benson Suppliers Simon Wren Ewan Jones Susan Kieran Vaughan Paul Cooper Ian Moody Steve Plenderleith Clinical Teams Salford South West North East Technical Architect Programme Manager Technical Architect Interoperability Development Manager QIPP End of Life Digital Lead Advanced Health and Care CSC (i. Soft) TPP IMS Maxims PCTI Solutions Hampshire (previously Birmingham) § No concerns were raised over the group terms of reference. § In general, the group were in agreement with the initial relative priorities of the proposed enablers (previous slide). § One additional enabler was proposed around reporting. § The following slides capture key points raised and actions.

Key Points Raised during Web. Ex Discussion § § There are some quick wins that could be done now: § Guidance on use of SCR. Maybe including a case study from teams using it now. § Sharing of EPa. CCS templates already built and in use in local systems. § Summary of smartcards, SSO and proximity cards. § Sharing of best practice around reporting and outcomes measures. § Share position on consent – debunk some of the myths. § Consent: There is a need for some simple advice on consent to overturn some myths about consent – e. g. That there needs to be a physical signature (this is not required). § Compliance with ISB standard is Dec 2013 – confusion over what this really means. Clarification was that any systems that are in place or new systems created to capture EPa. CCS data need to do so in line with the standard. This does not require that EPa. CCS is in place, or that data is shared electronically. § Challenge is not capturing the data, rather it is the extraction and sharing of it. There is more that is needed beyond the ISB standard. § Concern that people should not use the lack of interoperability as an excuse not to put an EPa. CCS in place, as it can bring real benefits. § Reporting Interoperability § § § Maybe implementing some of the more advanced patterns now (such as the registry/repository pattern) require less work from ITK? Supplier engagement and funding § An important part of understanding what needs to be captured and shared is to understand what reporting, metrics and outcomes information need to be produced by the solution. Would be interesting to hear how many local teams who are asking for this to be developed could support that with funding. § There could be a quick win to share good work already done by local teams who have developed rich reporting solutions. § There is a suggestion that the QIPP should facilitate finding the funding. Even if national team cannot fund it, they could work with multiple local teams to agree joint local or regional funding to fund supplier development against ITK specs. § Work has been done in North East to capture reports and outcomes, and provide comparators across a region. This is also the case in other areas. § Can’t have a full EPa. CCS solution with only one supplier on-board. § § Some suppliers have said that they won’t develop this until it is a “national requirement”. This is essential to allow for continual improvement of end of life care to provide clinicians with data about how well they are doing compared to other areas, and how the work they are doing improves outcomes over time. § Who is hosting the register can also cause issues with how the data is shared. § Developing interoperability requires work from suppliers, which comes at a cost. § Concern is that local health teams do not want to fund this in many cases. § Local solutions and best practice § Would be good to get comparisons of the various local solutions published to help show where solutions do and do not meet requirements. § ITK accreditation is a good way of seeing which solutions provide national interoperability standards. § Rob Benson is maintaining an NHS networks site to share best practice, and the QIPP Digital team have an initiatives register which should be published online soon also. § Rob is also creating a survey to capture a baseline of EPa. CCS activity across the country. § End of Life Diagnoses: What is the likelihood of a subset being defined nationally? § This is on the log for the implementation group, and it is being discussed with the terminology team, so hopefully can be agreed and shared.

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Items for escalation to EPa. CCS Implementation Group