A Paperless NHS by 2018 Are patients

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A Paperless NHS by 2018Are patients clinicians
ready for this?

• Dr Masood Nazir
• General Practitioner
• Clinical Informatics Advisor
• NHS England

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Patient/Clinician Journey
Dr S
Mr/s D
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Evolution
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Paperless Benefits

•  
• Clinical diagnosis
• Patient staff experience
• Safety. ( prescriptions etc)
• Reduce burden improve efficiency ( DNs re
  typing notes )

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• Opt out codes
• For secondary use of data 9Nu0 or XaZ89
  (System One) or
• Disclosure of personal confidential data by
  HSIC 9Nu4 or XaaVL (System One)

Opt out code 9NDo or XaXi6 (System One)
Opt out code 9ND1 (EMIS Web), 93C1 (LV, INPS),
or XaKRw (System One)
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Hospital Pharmacists

• NICE patient safety guidance 1 (Dec 07)
• The aim of medicines reconciliation on hospital
  admission is to ensure that medicines prescribed
  on admission correspond to those that the patient
  was taking before admission.
• SCR can play a key role in medicines management
  for patients
• SCR potential frees up time for both hospital
  pharmacists and GP surgeries

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Information Sharing

• Most people know their own history but...at times
  of illness, they can forget information e.g.
  medication.
• Vulnerable groups require more support
• Complex frail elderly
• Children who need safeguarding
• English is not first language
• Better access to information means timely
  decisions can be made better for patient care.

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The real benefits.1. Timely patient care
reducing unnecessary anxiety for patients and
families2. Right information available to
support clinical decision making reducing
risk for errors and incidents3. More
investment in real clinical time than
administration
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Compared to other service industries, NHS isnt
easy to do business with
NHS SERVICES
OTHER INDUSTRIES

1. Travel
2. Banking
3. Shopping
4. Blood Donation

1. Registration
2. Appointments
3. Prescriptions
4. Communications
5. Information access
6. Information sharing

And it costs patients and the NHS a great deal in
unnecessary visits to GPs, AE, phone calls, time
off work
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GP Patient Survey December 2013 Results
And patients tell us they want to do business
online..

• Appointment Booking

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22 of people find that it is not easy to get
through to their surgery on the telephone

• Nationally, from 2011-12 to 2012-13, there was a
  rise of 3 percentage points in the proportion of
  patients that find it not easy to get through to
  their GP surgery on the phone.

Darker blue indicates better performance
Proportion of patients that find it is not easy
to get through on the phone
Fieldwork dates 2012-13 GPPS Jul to Sep 2012
and Jan to Mar 2013 2011-12 GPPS Jul to Sep
2011 and Jan to Mar 2012
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Booking appointments online the challenge ahead

• How do you normally book your appointments to see
  a GP or nurse at your GP surgery?

• Base All answering question (in brackets)

• Source Ipsos MORI

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There is an appetite to book online

• Which of the following methods would you prefer
  to use to book appointments at your GP surgery?

• Base All answering question (in brackets)

• Source Ipsos MORI

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Significant challenges ahead

• Security
• Confidentiality
• East of access and use of services
• Workload for GP Practices
• Patient and public awareness
• Culture patients and practices
• Process change for practices
• Digital divide

Trust
We are working with professional bodies and with
a wide range of stakeholders to ensure the
challenges are recognised and addressed
appropriately
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Virtual meetings and communication some days I
need a TARDIS

• Solutions (although not quite as
• good as a TARDIS)
• Skype
• Microsoft Office 365
• WebEx
• and many more . . .

i-Engage Meetings from Planned Care Solutions
using Microsoft Office 365. and Microsoft Lync
device for virtual meetings

• Eat your lunch, sign prescriptions, answer
  queries from reception staff, get involved, pay
  attention and contribute!
• CCG Chair

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Barriers to use and adoption

• Culture
• Education
• Technology

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Challenges

• The two key exceptions for access to information
  are where it (Information Commissioner Guidance)
• is likely to cause serious harm to the physical
  or mental health, or condition, of the patient or
  any other person
• may relate to, or be provided by, a third person
  who can be identified from the information and
  has not consented to the disclosure.
• It is unnerving to think that patients may see
  test results before you do
• West Midlands General
  Practitioner

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Implications
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Group E Middle income families living in
moderate suburban semis
Key Features

• Manual and white collar
• Married
• Middle age
• Children
• Leafy suburbs
• Comfortable affordable housing
• Home improvement
• Family life
• Industrious

Hall Green, Bournville, Northfield, Quinton
Behaviours and attitudes High users of AE, out of hours and for minor attendances. Most perplexing of high user groups as access is not an issue and they are more motivated than other groups and happy living with the status quo. Communication strategies Telephone, internet. Works hard for their money so convenience (GP opening hours) maybe an issue
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General comments/ from graffiti board
There should be consistency in system similar
or same for every patient/practice
Patients need to have very easy access to the
system
The choice of supplier may lead to confusion
amongst patients we need one portal
Thank you for putting on a great event
Please test the running of EMIS beforehand
Online access might not be accessible for
patients where English is not first language. GP
practices should have in place a toolkit and/or
leaflets in appropriate languages which explain
what kind of info you can access, how to do it
and why.
Why is there not one system across GP Practices
nationally?
Doctors are asked to do too much on stuff that
are not related to the care of patients
Patient Online Workshop Crewe 27 November 2013
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• The overriding problem with failed IT projects
  in general, and particularly in clinical culture,
  is lack of attention to the human elements of
  changing behaviour among professionals

Department of Health. Delivering benefit
from the National Programme for Information
Technology (NPfIT) A strategy for engaging front
line staff and patients
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Current Pathway
PAPERBASED DOCUMENT SCANNING PROCESS LETTER
RECEIVED LETTER OPENED LETTER DATE
STAMPED LETTER CHECKED TO ASCERTAIN MOST
RELEVANT CLINICIAN / REFERRING CLINICIAN
MAINTAIN CONTINUITY OF CARE MARK ON
LETTER CHECK LETTER TO SEE IF IT HAS ALREADY
BEEN SCANNED (DUPLICATE)
NO YES SCAN
LETTER FORWARD TO
INTELLISENSE FILE LETTER
FILE AS APPROPRIATE WORKFLOW TO
CLINICIAN CODER
(9
PROCESSES)
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What are the benefits of this?

• No paper, resulting in
• No opening of mail
• No date stamping
• No scanning
• No opening, twice daily, of NHS Net account
• This has already been done for you!

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Future Pathway
EDT / NHS NET DOCUMENT SCANNING PROCESS LETTER
IN DOCUMENT VIEWER LETTER CHECKED TO ASCERTAIN
MOST RELEVANT CLINICIAN / REFERRING CLINICIAN
MAINTAIN CONTINUITY OF CARE INTELLISENSE SCAN
LETTER FILE AS APPROPRIATE WORKFLOW TO
CLINICIAN CODER
(5 PROCESSES)
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The challenge

• Implementing a Paperless NHS is a challenge, a
  major project and a substantial change in the way
  care is delivered
• But it is achievable, and organisations are
  starting to achieve it and gained many benefits
• Once it is in use most health care professionals
  would not want to go back to paper

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Heart of Birmingham Manchester Hampshire More
recently Oxford Staffordshire Cumbria NHS
London
Thank you