The Value Proposition Dylan Roberts Tech Stream lead
The Value Proposition Dylan Roberts Tech Stream lead Robert Hickingbotham Tech Stream Partner & guests June 2019
Agenda • Why we are doing the LHCRE • What is an open platform approach and why are we adopting it • What does each organisation have to do to plug in • How are we going to help Leeds City Digital Partnerships Team
Why we are doing LHCRE • Change the way we deliver care – Prevention and Earlier Intervention – Self care – Integrated teams working in localities (e. g. PCNs) – Integrated teams working across regions (e. g. cancer) – Data driven decisions for better commissioning Leeds City Digital Partnerships Team – Data driven decisions into early interventions – Data driven research • To help you (if you want it) to deliver digital capabilities faster and cheaper
Why we are doing LHCRE : The bigger Y&H AMBITION Health and Wellbeing Strategies Raising the base line ICS/STP Strategies & Plans Data driven decisions Industrial Strategy Challenges Leeds City Digital Partnerships Team Improving the lives of the poorest the fastest Enabling PCNs – new models of care The Left Shift – Primary Care Home Model
Our target : a vendor neutral future THE NEW WORLD is a componentised model allowing different mixes of solutions for individual citizens or the professionals. The data is to a common open standard which opens it up to a new competitive market place of innovators and data scientists. CORE SYSTEMS OF RECORD are traditional and sequential, emphasizing safety, accuracy and are generally composite applications. Yorkshire & Humber Care Record and Data Ark Leeds City Digital Partnerships Team The move to new world enabled by easier access to data in a standard form whilst maximising the investment of the existing systems
What do we mean by open platform • Open data standards • Open requirements and business cases • Open APIs • Open information governance • Open source components provided by YHCR • Open citizen engagement kits Leeds City Digital Partnerships Team YHCR will provide capabilities (that will be continually improved) that can be reused by ICS, localities and organisations to enable and accelerate integrated care.
Following National guidelines and design principles Leeds City Digital Partnerships Team
How are we doing it?
Systems of Systems May 2019 Regional FHIR Store Regional FHIR Aggregator Identity and Access Management FHIR Proxy Doncaster Acute FHIR Proxy Humber Mental Health & Community FHIR Proxy Leeds Acute Rotherham Acute & Community FHIR Proxy Yorkshire Ambulance Service
DEMO VIDEO
Population Health Management Sep 2019 BI users have a variety of tools to perform analyses Dataset required for a ‘problem space’ is defined via the Query Builder UI Community Based Analytics Platform Query Builder Initial data and streaming updates supplied by the System of Systems Data Collector Analytics Repository Returned data will be pseudonymised or anonymised before loading into analytics repository System of Systems National De. Id Service (Privitar) National Data Opt-Out Service BI Tools Multiple platforms can be easily instantiated for different communities and/or regional use Only data for patients that have not opted out of data sharing will be released
What does each organisation have to do to plug in?
On site FHIR Proxy
On site FHIR Proxy
Install the FHIR Proxy The FHIR Proxy is your on-site link into System of Systems It is open source software which wraps the FHIR APIs and provides features such as validation, caching, queuing, mapping… (see published specification for details) There are two ready-to-install versions of the FHIR Proxy now available Both are open-source, fully supported, and will be further enhanced as new features evolve 1. FHIR Proxy based on Qewd. JS 2. FHIR Proxy based on Intersystems Ensemble It is licence FREE! Entirely self-contained, open source, and free FHIR Proxy code is open source and free, but assumes licenses purchased for Ensemble. Did we mention… it is Licence FREE!
Prepare your data * You’d have to do this anyway! Data validation – ensuring data accuracy and completeness Data structure mapping – mapping data from existing fields to the standard FHIR schemas Data Coding – providing a mapping to standard coding schemes NHS Number is key – and is the key An intimate familiarity with the source systems will be necessary, including analysis of real data Important user engagement from now- working closely with Health and Social Care professionals to understand their day-to-day challenges and improve data quality at source Not all data problems have a technical solution! Working closely with users is vital As a data provider you have a vital role in providing high quality data to the wider System of Systems. Others will directly use the data which you provide.
How are we going to help? Digital Team
Onboarding We are in process of defining a comprehensive onboarding package to support new organisations connecting to System of Systems. This will build on lessonslearned from the pilots so far. Contacts Workshop s Training Checklists / FAQ The onboarding process will be initiated once you enter the pipeline of YHCR Pilots
Internal Operating Model (“Intelligent Client”) We are procuring partners to help LOT 1: Product Design, Development and Support Services Procurement started, contract award circa September 2019 LOT 2: Discovery and Change Services BI Platform, Skills Development, Data Ark, Cloud Hosting. Procurement complete and partners appointed
Documentation – available from https: //yhcr. org/downloads/ # Title 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 019 021 020 021 022 023 024 025 026 A Unified Distributed Data Model for FHIR Data Availability Service Conceptual Design for a FHIR Proxy Server Patient Identity Exchange (PIX/MPI) Identity and Access Management (IAM) Service Reliable Messaging Infrastructure Subscriptions Infrastructure* Data Access and Consent Management* Auditing FHIR Aggregator Service Interfaces with the Personal Demographic Service (PDS) Interfaces with the Electronic Staff Record (ESR) Interfaces with the Organisational Data Service (ODS) Governance for Data Providers* Governance for Data Consumers* Securing the YHCR Data Quality Reporting* Regional FHIR Store Document Management Non-Functional Requirements for Regional Infrastructure Onboarding Data Providers* Onboarding Data Consumers* YHCR FHIR Resource Profiles* The YHCR Maturity Model* FHIR and the Co-ordination of Care* Support for Inter-LHCR Data Exchange* Data Normalisation Publishe d 07/01/19 24/01/19 09/02/19 26/05/29 22/02/19 16/03/19 10/04/19 28/04/19 23/06/19 26/05/19 30/06/19 09/06/19 25 Architecture documents and guides – Architecture Group are reviewing and agreeing
Use Cases It is still early days, but see below for a sample of use cases being demonstrated by the initial pilots. North Yorkshire County Council: Care home discharge summaries (Transfer of care) Provide hospital discharge message to the care home Humber: ED attendances for “frequent flyers” Provide notifications that an ED encounter has started directly from the secondary care service’s system Rotherham: Ambulance transfer of care Provide both the transfer of care document and its composite parts directly from the YAS EPR software to the Rotherham Teaching Hospital North Yorkshire County Council: Social care support plan visibility in ED Provide support plan information from local authority social care case management system to hospital EPR system Yorkshire Ambulance Service: Secondary care ED discharge disposition outcomes YAS to receive finished ED encounter directly from the secondary care service’s system Leeds: Cancer summary care record - cancer referrals Sharing of the cancer IPTs/Summary Care Record amongst the YHCR cancer service providers We have ambition to do much more! What is your use-case?
What was it like for you?
Fin
Appendixes
Appendix A: Yorkshire and Humber Digital Team and Collaboration Partners
Pilot Sites First Phase – February – May 2019 • Yorkshire Ambulance Services • Leeds Teaching Hospital Foundation Trust • North Yorkshire County Council • Rotherham NHS Foundation Trust (with CCG oversight) • Doncaster & Bassetlaw Teaching Hospital NHS Foundation Trust (with CCG oversight) • Humber Teaching NHS Foundation Trust (with CCG oversight) Second Phase – June – Sept 2019 • Bradford Teaching Hospital NHS Foundation Trust • Barnsley Hospital NHS Foundation Trust • North Lincolnshire and Goole NHS Foundation Trust • Rotherham MDC • York NHS Foundation Trust • Harrogate NHS Foundation Trust
YHCR Architecture Forum Dylan Roberts Dave Maidment (YHCR Tech Commissioner) Martin Waugh (LTHT) Kevin Woodcock (East Riding) Kevin Beatson (York NHS FT) Toby Page (Leeds City Team) Stephen Stewart (Sheffield Teaching Hospital) Martin Matthews (Sheffield Health&Social Care) Ken Anderson (Doncaster & Bassetlaw NHS FT) Jonathan Booker (Wakefield CCG) Robert Hickingbotham (Synanetics) Yunus. Mayat (Mid York NHS FT) Jim Brayshaw (LTHT) Alison Clare (YHCR Programme Manager) John Aldhous (Doncaster & Bassetlaw NHS FT) Tom Amos (THIS) George Hope (NHS DIGITAL)
Appendix B: Architecture Diagrams
A Component Based Architecture
Appendix C: Maturity Model
Maturity Levels Level 1: Basic Facts Data Providers Read and search access broadly aligned with GP Connect specification Regional Infrastructure Data Consumer FHIR aggregation of structured resources across data providers. Deduplication of physical concepts. A regional summary care record which details key facts about the patent is available at the point of care. Regional encounter database. A care professional is able to view a timeline of contact with a patient across all care providers in the region. Level 2: Clinical History Data Providers Read and search access to care plans, procedures undertaken, test results, diagnoses and other clinical data using local coding systems. Regional Infrastructure Capture of patient contributed data with representation as FHIR resources. Data Consumer A clinically rich medical record can be viewed at the point of care. The clinical record is Regionally consent policies accessible for secondary defined, and consent use purposes subject to wishes recordable. patient consent.
Maturity Levels Level 3: Pseudonymisation Data Providers FHIR resources related to pseudonymised patients using local coding systems. Regional Infrastructure Data Consumer Regional pseudonymisation Pseudonymised data is service. available to centres of analytics. Level 4: Cross-Organisational Working Data Providers Regional Infrastructure Read and search access to Creation and management appointments and of regional care plans, team associated resources. definitions, questionnaires, and other resources. Manage referral process through the creation and management of appointments. Data Consumer Teams of carers from different care settings can work jointly for benefit of a patient. Services can be accessed electronically regardless of the care provider from whom they are offered.
Maturity Levels Level 5: Care Automation Data Providers Production of agreed compositions (FHIR documents) to regional standards and registration with regional document registry. Regional Infrastructure Data Consumer Regional document registry Transfer of care and other with XDS mappings. documents sharable across care settings. Support for subscriptions against regional data Regional alerting systems inform care professionals of significant events. Support for subscriptions. Event driven care systems automate some administrative tasks. Level 6: Population Health Management En-mass Data Providers Pseudonymised FHIR resources coded to SNOMED-CT. Regional Infrastructure Terminology translations services available. Data Consumer Regional outcome correlations and population health indicators are used Regional semantic analysis to too improve wellbeing tooling. and access to services.
FHIR MATURITY Foundation Conformance Base Security Documents Provenance Audit. Event Consent Patient Practitioner. Role Organization Healthcare. Service Endpoint Encounter Episode. Of. Care Flag Related. Person Group Summary Allergy. Intolerance Adverse. Event Location Substance Device. Component Diagnostics Device. Metric Observation Diagnostic. Report List Care Provision Care. Plan Care. Team Condition Procedure Specimen Body. Site Task Appointment. Respons e Schedule Slot Process. Request Process. Response Medications Medication. Request Medication. Administration Medication. Dispense Medication-Statement Family. Member. History Clinical. Impression Detected. Issue Imaging. Study Medication Procedure. Request Req & Resp Communication. Request Device. Use. Statement Supply. Request Imaging. Manifest Questionnaire. Response Sequence Questionnaire Immunization. Recommendation Nutrition. Order Vision. Prescription Supply. Delivery Risk. Assessment Request. Group Entities Workflow Composition Document. Manifest Document. Reference Other Code. System Value. Set Concept. Map Expansion. Profile Naming. System Individuals Clinical Terminology Capability. Statement Structure. Definition Implementation. Guide Search. Parameter Message. Definition Operation. Definition Compartment. Definition Structure. Map Graph. Definition Data. Element Management Goal Referral. Request Basic Binary Bundle Linkage Media Message. Header Operation. Outcome Parameters Subscription Maturity Index 1 2 3 4 5 No Plans
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