Value-Adding Approach to Lot 2B Service Delivery

Together with our technical partners, SCW has significant and credible experience of deploying integrated care record solutions to health and social care providers. From working on successful integrated care record solutions and supporting NHS England to develop national resources on interoperability, we have developed a high level of expertise in developing system-wide architecture. We have experience of, and a strong technical ability to support, current systems and architecture and we can build on the models that individual health and care systems consider to be most appropriate. We deliver solutions collaboratively with highly experienced technology partners: Cerner, Graphnet/System C, and Orion. 

  • Cerner offers solutions that support direct care through interoperability, precision medicine, case finding and care management by connecting disparate sources of information and providing a single view. Cerner’s solution can also support research into building, testing and validating predictive algorithms.
  • Orion provides a range of solutions that support interoperability and population health management. Their solution provides an easy to use shared health and care record that is connected to a clinical portal. Their design is simple for end users to navigate, and uses colour coding to highlight relevant and important data.
  • Graphnet/System C solutions provide real-time access to a single, secure, real-time health record that allows clinicians and care professionals to work across disciplines and organisations.

Together, we design and deliver architectural platforms and sets of services to meet the current and evolving requirements of Local Health and Care Record programmes. Through our own experience of large-scale integration projects and working jointly with our partners, SCW is well placed to support systems with the strategic design that is most appropriate for their system. Whichever solution a health and care system considers most appropriate, SCW provides technical capability to deliver an integrated and holistic ecosystem of technologies, interfaces and data flows based on a flexible open platform model. The breadth of our capability and our supply chain of expert partners allow us to provide a ‘one stop shop’ service for an integrated health and care system, reducing support overheads and simplifying accountability for delivery.

The case study that follows this response describes the wide-ranging transformation support we provide the Frimley health and care system. It shows how we are working at multiple levels in the system, supporting leaders to plan, manage and evaluate change. It shows how, through driving digital integration, we developed a shared care record that is accessible and supports clinicians to provide better person-centred care. 

While we have the ability to produce credible and thought-provoking reports and plans, we invest most energy in actually delivering and embedding change in the fabric of a local health and care system. We are passionate about creating beneficial change at the front line. We take accountability for delivering transformation outcomes, and we optimise sustainability by ensuring that local care teams are fully engaged in the process. We have an appetite for sharing the pain and pressure of change, which helps build commitment, motivation and resilience in the individuals delivering it. This is our definition of partnership working.

Extended Case Study: Connected Care Shared Care Record

SCW has been at the forefront of developing digital solutions with Berkshire East and Berkshire West to implement their vision to support the delivery of safe, effective and collaborative care using a digital shared care record as an enabler for service transformation.

Although there was a broad alignment between providers and commissioners, Berkshire East and Berkshire West had been developing and implementing separate interoperability strategies. Using a number of facilitated workshops and a stakeholder engagement and communications strategy, SCW demonstrated that a single solution could be adopted to meet the needs of both geographic areas. The workshops built relationships between the provider organisations, a common language, cross-organisational requirements and a governance structure that maintained focus and enabled quick decision-making.

Connected Care, which was developed by SCW using Graphnet's CareCentric solution, and is now providing integrated data for 18 health and social care partners across Berkshire. The programme oversaw the design of an interoperability solution that provides unique opportunities for health and social care providers to access whole-system data analytics. Procurement was concluded in three months and the Connected Care solution went live in February 2017. It is currently a read-only shared care record with more than 700 active users, accessing 3,000 to 5,000 records a month. This increases each month as new data feeds go live.

The clinical data repository is the basis for a range of capabilities: 

  • Integrated care record for use by health and social care professionals accessing under role-based access control 
  • Patient and carer portal / Personal Health Record (PHR) 
  • Data for clinical analytics and risk-modelling to support direct patient care, with plans to apply machine learning methods.

“I am the team Leader for Community Children’s Nursing. I have needed to use Connected Care whilst working a shift at the children’s respite centre to clarify a medication dose that had been prescribed by the GP. Without this service it may have meant me making several phone calls and possibly the child not being able to attend respite. When I have approached parents for their consent they have always been willing and think that this is a really good idea.” Specialist Children’s Nurse

The shared care record allows for innovative developments, such as the creation of individualised care plans, creating co-ordinated multi-agency care for individual patients and enabling new ways of delivering services. Patients only need to tell their story once and healthcare professionals will be able to work together, with access to all the key information about a person, to give timely and seamlessly coordinated care. 

The Connected Care programme in Berkshire was shortlisted for the Enhancing Care by Sharing Data and Information category at the 2017 Health Service Journal Awards.

“A call came through for lab results showing a high glucose and that the patient was unwell. No other information was provided. I tried to contact the patient but had no reply. I needed to know if she was a known diabetic, as someone with a blood glucose that high who is not a known diabetic and feels unwell can mean a potentially life-threatening scenario.  I accessed Connected Care and saw that she is not diabetic which helped me decide she needed an ambulance, which I arranged.” Out of Hours GP

Connected Care has established a benefits work stream to monitor and analyse the anticipated clinical, financial and personal benefits of having the relevant information available at the point of care. Some anticipated benefits include:

For citizens: Improved health outcomes; reduction in duplication of recalling information and diagnostic tests; improved discharge experience; key information around preferences regarding end of life wishes and care plans are shared and observed.

For clinicians and carers: collaborative assessment, care planning and safeguarding; immediate access to real-time, accurate, complete patient data to facilitate improved decision-making and prescribing; reduction in time spent looking for information, leaving more time to be spent on caring for patients.

For commissioners: reduced costs associated with more efficient prescribing and treatment and fewer ambulance conveyances; improved system-wide workforce planning; improved discharge planning, leading to a reduction in elective and non-elective excess beds days.

The support which SCW provides has been critical to the development of our Integrated Care System. An example is SCW’s support to the development and delivery of the Connected Care shared care record programme. The development of a shared care record is a central building block to the overall development of our ICS – and to the realisation of our transformation plans for the system - and SCW’s support to us on this programme has been excellent.

Nigel Foster, Director of Finance and IM&T, Frimley Health NHS Foundation Trust

How We Work with Partners in Lot 2B

Specifically for this Lot, we have relationships with a strong set of material sub-contractors (Cerner, Graphnet/System C, Orion, and PA Consulting) who bring extensive technology architecture and solutions capabilities. The breadth of technology partners we bring to this Lot ensures that we can develop an ideal response to the needs of a particular LHACR, taking account of existing infrastructure and systems. According to the needs and interests of a LHACR, we will form the ideal delivery partnership drawing on our available partners and other suppliers in our extensive supply-chain.

SCW works with 3 main providers of LHARC technology: Cerner, Orion and Graphnet/System C. By taking a ‘vendor neutral’ approach and having all three of these expert partners available, SCW is well placed to support differing customer needs with strategic design, covering all aspects of infrastructure development to a great depth. Whatever solution is then considered most appropriate, we provide technical capability to deliver an integrated and holistic ecosystem of technologies, interfaces and data flows based on a flexible open platform model.

 

Case Studies

When supporting a health and care system to design and establish a Local Health and Care Record (LHACR) solution, SCW offers deep strategic and technical expertise, combined with a rigorous programme management methodology, that we have used to develop integrated care records for several major health and care systems. Our teams have been central to the development and deployment of five major integrated care record and interoperability programmes - Connected Care (Berkshire/Frimley), the Hampshire Health Record, Joining up Your Information (Gloucestershire), the Oxfordshire Care Summary, and Connecting Care (Bristol, North Somerset and South Gloucestershire). This covers a total population of more than 5 million. 

“The support which SCW provides has been critical to the development of our Integrated Care System. An example is SCW’s support to the development and delivery of the Connected Care shared care record programme. The development of a shared care record is a central building block to the overall development of our ICS – and to the realisation of our transformation plans for the system – and SCW’s support to us on this programme has been excellent.” Nigel Foster, Director of Finance and IM&T, Frimley Health NHS Foundation Trust

Our approach has been refined based on the extensive learning these programmes have generated. It enables us to provide expert advice and implementation support across the full programme life cycle; from strategy definition and setting the digital vision, stakeholder mapping and engagement, technology design, business case approval, procurement, contract management, information governance, change management and benefits realisation. To provide effective and broad ranging strategic advice, we continually enhance our expertise and insight into the national ‘direction of travel’ by supporting and advising NHS England programmes relating to interoperability, target architecture, personal health records, cancer digital programmes, and local health and care records. This has included preparing the business case analysis for the national LHACR programme.  

Through our work on integrated care records and interoperability, SCW has developed strong relationships with leading technology suppliers who are expert in providing the digital infrastructure services specified in Lot 2B. These partners (including Cerner, Graphnet/SystemC, and Orion) can input to key elements of LHACR strategy and technical design and we introduce them to ICS/STP customers and programmes where they increase value. The Graphnet/SystemC Alliance is a material sub-contractor for LHACR strategy and implementation support, bringing extensive experience of collaborative programme development and delivery with SCW in programmes across the UK, including Hampshire and Berkshire, as well as other UK health and care systems and across related technologies such as child health records systems and acute EPRs. .  PA  Consulting are a further material sub-contractor, bringing extensive expertise in strategies and solutions for digitising healthcare, for example providing essential support on the development of the system-wide architecture model for Hampshire and the Isle of Wight STP.

As well as material co-delivery partners, SCW gives ICS/STP customers rapid access to a broad range of pre-vetted technology suppliers through our dynamic purchasing system. This is convenient for suppliers, SCW and our customers, as it gives us ready access to hundreds of companies who have already been through a qualification process, reducing the time it takes to award contracts. This means we can easily engage co-delivery partners to provide extra capacity and/or specialist skills relating to the requirements of each programme.

An example of good practice in this area is the user adoption of local health and care records within the health and care systems we support. SCW has demonstrated how the adoption and use of this information is dependent on the following elements, which are now designed into our standard approach: 

  • The information that is available; making sure the content in the record is relevant and valuable to users. 
  • The ability to launch the record securely from a user’s source system, without the need to log into another system and remember another user ID and password.
  • The facility to directly access the patient record without the need to search for a patient.
  • User interfaces and work-flow within the shared care record being aligned with and based on user needs.  
  • A sound basis for governance and partnership working across the programme, as user-adoption involves input and engagement with multiple parties. 

In many cases, the integration is so seamless that users are not aware that they are now operating in an external system rather than a module of their line-of-business system (for example a Trust EPR). An example of this in operation is the integration between the community and mental health system in Hampshire and the Isle of Wight (HIOW) and the Hampshire Health Record (HHR), which holds GP, acute hospital, social care and other information about patients. The community provider for Hampshire is Southern Health Foundation Trust (SHFT). Following the success of similar work for other systems, we began integration work with SHFT in December 2016. The work was to introduce a direct link into the main case record in use across the Trust, as can be seen in the screenshot in Figure 21.1. 

SHFT began a pilot in one of their localities in April 2017 and, following an evaluation period, the remaining Trust users went live in September 2107. Access to the HHR gives community and mental health staff immediate access to their patients’ full medical history, enabling clinicians to deliver more holistic, integrated care. 

For example, if a patient presents in the emergency department with shortness of breath and confusion at 3am, clinicians are able to view their GP records to see what their social situation is, whether the patient has recently visited their GP, whether their medication was changed, and which medicines are prescribed for the patient. This enables better care to be provided and can reduce duplication and waste.

Feedback from community staff was very positive. Having a system that is accessible and easy to navigate results in more people using it, and this, in turn results in patients receiving better care. This can be seen in Figure 21.2, which shows the uptake of access to the HHR over the course of 2017. The average use during the period increased by a factor of 10 from around 2,000 documents accessed per month to more than 20,000. 

In Bristol, North Somerset and South Gloucestershire (BNSSG) SCW has worked with Orion, the main system-supplier for the Connecting Care Programme. The integrated digital care record unifies citizen information from across 18 systems into a single view. Connecting Care can now be accessed by 3,628 authorised professionals from a wide range of groups from GPs, nurses, occupational therapists, pharmacists, social workers, care of the elderly and out of hours to pathologists, anaesthetists, homeless health service, community discharge and emergency care staff. The number of records viewed per month is steadily growing, hitting 17,596 in January 2018. The programme is constantly adding new functionality and data sets. Initiatives currently underway include consolidated medication history and a Patient Demographic Service Spine cohorts interface to allow demographic changes to be updated in the Enterprise Master Patient Index more quickly.

“It was amazing having this resource over the long weekend. I was able to access information about a patient’s usual insulin regime when she was severely unwell and not able to communicate with us”. Joanna Latimer, Pharmacist, North Bristol Trust

To encourage wider and continued use of the LHACR, we monitor and share usage information with key programme stakeholders. Together, we can then identify areas of poor uptake and plan how this should be addressed. 

We can also monitor trends, which alert us to areas where, for example, usage was high, but is reducing. This would require a different type of intervention to explore the underlying causes and agree how these obstacles can be overcome. Figure 21.3 is an example of the kind of usage information that we share with the Connecting Care programme board in BNSSG on a monthly basis to highlight usage and uptake across partner organisations.

SCW has worked with a range of technology suppliers on a number of major local care records programmes to integrate data from multiple health and care providers and deliver benefits for patients, care professionals and commissioners. Connected Care in Berkshire / Frimley was built using Graphnet's CareCentric solution, and is now providing integrated data for 18 health and social care partners across Berkshire. The programme oversaw the design of an interoperability solution that provides unique opportunities for health and social care providers to access whole-system data analytics. The Connected Care solution went live in February 2017. It is currently a read-only shared care record with more than 700 active users, accessing 3,000 to 5,000 records a month. This increases each month as new data feeds go live. The clinical data repository is the basis for a range of capabilities: 

  • Integrated care record for use by health and social care professionals accessing under role-based access control 
  • Patient and carer portal / Personal Health Record (PHR) 
  • Data for clinical analytics and risk-modelling to support direct patient care, with plans to apply machine learning methods.

“The support which SCW provides has been critical to the development of our Integrated Care System. An example is SCW’s support to the development and delivery of the Connected Care shared care record programme. The development of a shared care record is a central building block to the overall development of our ICS – and to the realisation of our transformation plans for the system - and SCW’s support to us on this programme has been excellent.” Nigel Foster, Director of Finance and IM&T, Frimley Health NHS Foundation Trust.

SCW provides digital and IT services for more than 1,000 GP Practices (10% of the national total) and many commissioning and provider organisations. Our rigorous security patching policy resulted in minimal exposure and a more limited impact for these customers than for many other NHS organisations during the 2017 ‘Wannacry’ cyber-attack. There were no incidents reported across any of the datacentres that SCW supports. NHS England praised SCW’s response, particularly around how decision-making and regional control of status updates was coordinated centrally, and how local teams were kept suitably informed to enable them to take the necessary mitigating actions. Somerset CCG rated our performance 5 out of 5 and recognised the benefits of our patching service: “I am glad we have been unaffected. I suspect Single Domain has enabled all of our Windows PCs to remain up-to-date with the latest patches.” Rishi Mannan, CCIO, Windsor, Ascot and Maidenhead CCG

Following the Wannacry incident, we developed a report for system stakeholders that identified further actions and recommendations to improve future responses, which have now been implemented by SCW as follows: 

  • Shortening the software patch acceptance testing cycle taking into account the increase in risk that this creates 
  • Removing the ability for staff to indefinitely postpone the application of updates 
  • Standardising management tools across the estate so engineers need only contend with one platform in an emergency
  • Reviewing investments in vulnerability and patch management software to assist operational teams
  • Increasing checks on customer contact details – given challenges in contacting ‘on call’ customer staff
  • Bringing all third party suppliers of IT services to SCW under one set of contractual terms to ensure response and access in the event of a business continuity incident 

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