Telehealth PHMR Development Review Richard Trusson NHS Technology

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

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 2 www. connectingforhealth. nhs. uk/q ipp

Telehealth Cholesterol Monitor Telecare Glucose Meter Home Automation Why Do We Need Interoperability? Sensor Netwo rks Records • NHS • Housing • Social Care • Personal Health Care Profession als Blood Pressure Cuff Out of H ou rs Service Hub Pedometer Lights, Doo rs, Win dow s, Moti on, etc. Tele-carer Home Hub Elderly Living Independent ly Limited Offerings Increased Offerings Friends and Family Emergency services Carer respo nse servic e Increasing No integration Integration required 3 Complexity www. connectingforhealth. nhs. uk/q ipp

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

Previous work: WSD and the 9 use cases • Working with clinicians, GPs, Nurses, etc. , patients and the industry we investigated what they needed. This lead to 9 use cases. Use Case Name Description UC 001 Refer Patient for Assessment UC 002 Assess Patient for Telehealth Monitoring Enrol patient on the Telehealth programme The capability to allow clinicians to electronically refer patients to care managers for telehealth assessment The capability to allow clinicians to share telehealth assessment results with other members of the care team The capability to notify care team members that the patient is receiving a live telehealth monitoring service. UC 004 Install & Commission Telehealth Equipment NOTE: this functionality is thought to be covered in UC 009 in which patient status updates are sent to care team members. The capability for a clinician to electronically submit an order for the appropriate telehealth equipment from suppliers (pending installation in the patients home) UC 005 Create/Update Telehealth Care Plan Create Telehealth Patient Record UC 003 UC 006 The capability to allow clinicians to share details of a patient’s care plan with care team members The capability to auto-populate patient telehealth records by drawing on existing sources, for example, PDS. The capability to allow care team members to routinely view a summary of patients’ telehealth data in their local systems. UC 007 Monitor Readings Against Telehealth Care Plan UC 008 Provide Care The 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. UC 009 Send Notification The capability to update care team members as to the status of the patient 6 www. connectingforhealth. nhs. uk/q ipp

Previous work: WSD and the 9 use cases • We also identified user concerns and issues Data overlap Professional liability Audit trail of changes/ messages Key Red – most important Blue - important Volume of data Linked to relevant clinician Medication record Ownership of patient record Prioritisation Speed of comprehensio n Easily accessed Clinical autonom y Clarity of address ee Import effort to e m sy Ea nsu co use & Messaging Assuran ce Action accepta nce Ri gh rig t inf ht or qu ma al tio ity n , Clarity of purpose Clinician agreeme nt Speed of access Linked to right patient Update frequency 7 www. connectingforhealth. nhs. uk/q ipp

Previous work: WSD and the 9 use cases • 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. 8 www. connectingforhealth. nhs. uk/q ipp

Recent work: PHMR Specification Development • 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. 9 www. connectingforhealth. nhs. uk/q ipp

Recent work: PHMR 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 Web. Ex 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-toolkititk 10 www. connectingforhealth. nhs. uk/q ipp

Lessons Learned • The engagement and development model, overall, worked. – Using Web. Ex – 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 11 www. connectingforhealth. nhs. uk/q ipp

What’s Next? • 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, 3 millionlives, dallas and others to support the adoption of telehealth and the implementation of interoperability standards across the board. 12 www. connectingforhealth. nhs. uk/q ipp

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