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

1. A Paperless NHS by 2018Are patients & clinicians ready for this? Dr Masood Nazir General Practitioner Clinical Informatics Advisor NHS England

2. Patient/Clinician Journey Dr S Mr/s D

3. Evolution

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

5. 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)

6. 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

7. 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.

9. 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

10. Compared to other service industries, NHS isn’t easy to do business with OTHER INDUSTRIES NHS SERVICES Travel Banking Shopping Blood Donation • Registration • Appointments • Prescriptions • Communications • Information access • Information sharing And it costs patients and the NHS a great deal in unnecessary visits to GPs, A&E, phone calls, time off work

11. NHS | Presentation to [XXXX Company] | [Type Date]

12. And patients tell us they want to do business online….. GP Patient Survey December 2013 Results Appointment Booking

13. 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. 22% of people find that it is not easy to get through to their surgery on the telephone 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

14. 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 Booking appointments online… the challenge ahead

15. 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 There is an appetite to book online

16. Significant challenges ahead Trust • 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 We are working with professional bodies and with a wide range of stakeholders to ensure the challenges are recognised and addressed appropriately

19. 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

20. Barriers to use and adoption • Culture • Education • Technology

23. 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

24. Implications

26. 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

27. General comments/ from graffiti board “There should be consistency in system – similar or same for every patient/practice” “The choice of supplier may lead to confusion amongst patients – we need one portal” “Patients need to have very easy access to the system” “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

28. 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)

29. 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!

30. 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)

31. 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

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