Suffolk & North East Essex Integrated Care System

Digital

Developing digital capabilities that support people’s health and wellbeing, and enabling the workforce to deliver best care, underpins all elements of our ICS Five Year System Strategic Plan. This section focuses on our system-wide and regional digital strategy and programme, which has seen significant progress in many areas in the last few years working across ever more organisations. Yet we have much more to do to meet the challenges of making it easier for people and practitioners to access information on health and care needs and self-care at the point of care. This reaches beyond our borders across the East of England and further afield. Our digital programme will enable many of the benefits that we want to deliver across the system that will drive better outcomes for people in Suffolk and North East Essex, and will create an environment that:

  • Reduces the burden on clinicians and staff so they can focus on people
  • Enables people to have the tools to access information and services directly
  • Ensures information can be safely accessed, wherever it is needed
  • Aids the improvement of patient safety across the NHS
  • Improves workforce productivity with digital technology

The approach adopted in Suffolk and North East Essex ICS, with local government, NHS and other key partners working together for the benefit of the people in our area, has enabled us to think differently, and work differently.

We are focused on defining and adopting standards and best practice alongside coordinating investment. These include a common information governance framework, standard and shared capability operating models. Local innovation and ideas will continue to be shared as well as standards, core architecture principles (the equipment) and cyber security controls to protect our systems. The digital workforce came together in 2018 to develop our approach to priorities across the east of England, starting with a mutually support and learning network.

To progress this within Suffolk and North East Essex we developed a nationally recognised approach to system leadership and a governance model which we have been putting in place during 2019/20, and will continue to develop further over the coming years. This has already progressed a coordinated approach to investment, has in August 2019 developed into a more robust East Accord Partnership for the region and will create an investment case for our health and care record programme that benefits all partners across the East.

Our digital approach within our ICS and across the east are aligned. It means we can progress collectively – and also recognise that we are working at different paces because of each of our natures and histories – so that:
1. People and practitioners have easy access to relevant information
2. People and practitioners are provided useful information
3. Information provides people, our practitioners and the wider public sector value

We aspire to digital capabilities operating seamlessly across our services and to support people by specifically enabling the following:
• People able to use their health and care records to look after themselves, with good support
• Joining up care more effectively
• More precise intervention
• Better population health management
• Research for development of new treatments and pathways for care

By 2024 we will ensure
• That all health and care professionals involved in a person’s care have secure access in near real-time to a comprehensive care record and care plans,
comprising the relevant individual level information they need to inform their care decisions, when and where they need it, fed from local systems
• That solutions are based on open standards to create a common record for an individual regardless of the source systems1 contributing to that record
• That de-identified information from the records is being used to support the delivery of population health management approaches
• That we demonstrate the ways in which we have engaged and worked with the public
• That people and in particular carers are empowered to manage their own care through having access to their own health and care records as well as coordinated ways for people to look after themselves accessing clinical support and localised signposting information where necessary.

Many of these capabilities exist already in pockets or a few organisations – but none are system-wide at this stage, or sustainable in their current form. We will work with partners to scale existing capabilities wherever appropriate, developing new operating models, and the coordination of investment priorities. We will progress our work, focussing on supporting those who can, to help accelerate partners.

Our four agreed priority outcomes now follow;

Enabler 1: All health and care professionals are easily able to access relevant and timely information at the point of care.

Digital technology can improve workforce productivity, enable services to be better integrated in local areas, and free practitioners to be able to give more time to care. Practitioners need easy access regardless of their location to information digitally held by organisations, so they can review and update the person’s record. This includes requiring fit for purpose IT and easy connectivity (for remote working), as well as all partners to work together to align standards.

The local health and care record will develop over the coming years, supported by the widespread use of national systems such as the Summary Care Record and other systems in use across Suffolk and North East Essex partners.

We will:

  • Develop a digital workforce capacity and capability improvement strategy to support our workforce to develop the digital skills they need to make effective use of new tools and services, creating a secure and capable digitally literate workforce, alongside Information Governance guidance.
  • Mitigate risks introduced by new capabilities, such as multi-agency clinical safety governance, enhanced system-wide cyber security, and an ethics commitment and approach.
  • Encourage local innovation and integration alongside development of standards.
  • Work towards an ICS-wide connected and secured wireless network, with appropriate operating model and common standards, and expansion of Robotic Process Automation, machine learning and augmented intelligence to free up time to care.

Enabler 2: All people in Suffolk and North East Essex are easily able to access key information about their care digitally.

As people have easier access to their own information, and information becomes more accessible to practitioners, new connections will be more straightforward, and we will see systemic progress towards integrated care.

We will:

  • Enable people to have more choice in accessing services and self-care through digital access to their records, care plans, available appointments, medications management, and local services.
  • Support the adoption of new applications and targeted online services to help people manage their health conditions.
  • Adopt or develop and agree standards for care plan and health records connected to NHS App, providing strategic support to our Alliances and Primary care Networks in areas such as end of life, mental health and maternity.

Enabler 3: People involved in health and care can easily access useful information and services digitally.

This stage brings together key existing and some new capabilities to ensure tools and information are easily accessible and useful for practitioners.

We will:

  • Work with people, practitioners and clinicians to improve and adapt digital capabilities within and between organisations in our system.
  • Ensure that coordinated information on patient health records and care plans flows from patients to relevant practitioners, and that useful information follows the patient’s pathway. This will minimise wasteful activity and improve patient experience and care planning.
  • Ensure that digital capability is easy, and useful, and improves workforce productivity.
  • Make existing combined data sets appropriately available to support population health management planning in local areas, progressing towards information being accessible in near real-time.
  • Adopt and adapt best practice and coordinate investment plans that support our alliances to deliver digital access to services, support for people to manage their own health, new and integrated models of primary and community mental health care, easier referrals processes based on best practice models, improved access to tools for integrated care, and health prevention.
  • Introduce core standards to evolve a simple and sustainable operating model that recognises organisational autonomy, alongside the need for collective capability.

Enabler 4: People have better outcomes as a direct result of near-real time insight gathered from easy and useful access to information.

We will:

  • Ensure technologies work for everyone, from the most digitally-literate to the most technology-averse, and reflect the needs of people trying to stay healthy as well as those with complex conditions.
  • Develop interoperable information systems supported by telehealth to enable timely transfer of information between staff, more effective care pathways and improved access to and intensity of rehabilitation for people.
  • Use population health management (PHM) solutions to identifying groups of people who are at risk of adverse health outcomes, predict the health and care interventions most likely to benefit individuals, and identify any gaps in pathways of care to ensure they are filled.
  • Implement data security and monitoring systems across the whole ICS, educate staff, and design systems and services to be resilient and recoverable. We will also promote access for developers to innovate to create new solutions.
  • We will move towards full integration with smart home and wearable devices.
  • Use of de-identified data extracted from local records, in line with information governance safeguards, to enable more sophisticated population health management planning approaches and support world-leading research.

As we progress this work, the definition of a Digital Health and Care system becomes ever more important

“A dynamic network of digitally enabled patients, citizens, clinicians, partner organisations and things interacting with each other to improve outcomes, experience and cost.

The health and care ecosystem enables each participant to easily and cost effectively integrate their capabilities and the capabilities of others to co-ordinate care around the needs of the individuals and society at large”

Digital records are not new in healthcare, but they are generally silo-ed to an organisation, and held on different systems in different ways. Often, only health and care professionals within the same organisation can see this information. This means it can be difficult for them to work together to deliver the best care. When information is made available in a more joined-up way, health and care professionals can provide faster, more effective care for you and your family.

Connecting these records is a challenging and long term programme. Our first step has been to adopt My Care Record, which is an approach to improving care by joining up health and care information, and aligns the processes, the policies and the approach to information sharing between organisations.

To enable stage 1 of the Shared Care Record across Suffolk & North East Essex, the Health Information Exchange HIE at West Suffolk Hospital (the HIE ‘hub’) has been connected with local GP practices, community teams, Hospices, Social Care teams, Urgent Care and local hospitals and mental health trusts. As each connection goes live, staff on the frontline can read relevant information about the person they are treating, that is held by another organisation. This increases safety, enables the most appropriate decision making, increases efficiency and reduces waiting times, as well as the need for the person to repeat their story as their care needs progress. Around 2m records are already connected, and the system is accessed around 40,000 times a month – this number is increasing rapidly. User feedback includes

  • A patient presents with severely reduced renal function, no previously blood test available on our system. Quick review of HIE shows a documented “chronic kidney disease” problem via GP records and a recent blood result from CUH which shows a similar level of renal function indicating this is longstanding and not an acute kidney injury. HIE reduces the need for phone calls to GP surgeries or other sites to obtain this information and reduced chances of admission or onward referral for an acute kidney injury as allow the WSFT result to be put in context of others
  • We admitted a patient with stage 4 ovarian cancer undergoing chemotherapy who was vague about her current treatment and prognosis. We were able to review a very recent scan to expedite her current management and not require a repeat CT scan. It made a big difference to her care and the time required by us to make management plans for her
  • It has been HUGELY helpful and uber appreciated! Enables us to check quickly and accurately before speaking to outside people (without disclosing). Also saves us wasting the ward staff time! One of the best developments yet

Next steps of our Shared Care Records programme include:

  • enabling patients access to their Personal Health Record
  • enabling composite records and cross-organisational care planning
  • enabling the data to be reused securely to better plan care delivery and enable population health management.

We will achieve this by building on and connecting the capabilities we have, and by adopting open standards, common processes and provide support for our workforce in adopting new ways of working

SNEE, Herts & West Essex and the Midlands Accords collaborated to develop a virtual desktop infrastructure that enabled out of hospital staff to be able to access secure systems safely, from a personal laptop, smartphone or tablet device. Faced with a national shortage of laptops in February, this was rapidly enabled in March to ensure that we had a scalable solution to a high number of staff needing to work remotely, securely and flexibly, as well as provide a rapid response to an individual, location specific or more widespread need. As the immediate pressure of the pandemic subsided, and the flow and deployment of laptops was well underway, we enabled the capability to a wide number of different types of staff, working for different organisations, operating in different ways, and using different systems, to understand where this capability enables different ways of working, and wider workforce transformation benefit. We were also able to provide rapid access to systems to staff who had to isolate, and there were insufficient available laptops to provide them with one. It is clear this capability has value for many different types of staff working in a range of ways.

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The ICS Digital team commissioned Healthwatch Suffolk and Healthwatch Essex to understand what peoples experiences were, and what we could learn from that. The approaches were complementary, and enabled the following learning through phone calls and surveys

  • 27% of patients/carers said that they or their relative lacked confidence with using digital technology and 21% said that they/their relative did not know how to use digital to access health or care services. Availability of technology was less of an issue.
  • Responses to the open ended questions were mixed and reflected inconsistencies in how digital technology is being used across the system.
  • Generally people felt moving towards digital services was felt as very positive.
  • Some said that digital technology meant they had to rely on others to access services.
  • Training was a concern and people were not sure where to access positive training.
  • People were concerned about the safety of their data online
  • Professionals were generally confident in their use of digital technology, and felt their digital consultations were effective. They were also satisfied with their access to digital technology and internet connectivity

Recommendations that came out of this was to communicate the latest offers as widely and frequently as possible, to ensure residents are aware of the digital offers and how to access them, including quick guides or details of where to access support.

We have just commissioned Phase 2 which will provide

  • A briefing document of experiences - with a focus on digital exclusion and health inequalities.
  • Co-produced guidance for services to implement digital changes.
  • A group of interested patients and professionals who can be contacted to be involved in further co-production work.
  • Wider communication with the public about access to digital services and our findings
  • Sharing the challenges of a wider demographic in relation to digital literacy, digital poverty and digital exclusion
  • Reporting the challenged and recommendations for digital inclusion along with a series of case studies on the impacts of digital exclusion/inclusion.

The brain child of Ciaron Hoye (Deputy CIO Birmingham & Solihull CCG) and Kate Walker (Suffolk & North East Essex ICS Digital Programme Director and Programme Lead East Accord), the Digital Ethics Charter was created as a set of common principles that digital professionals and those working with "data and technology for public use" can adhere to.

It has been just 13 short months in its journey - for professionals to be able to make a pledge where they would think and work within an ethical code of conduct; promoting the rights of the people and organisations they serve. Continuing to gain support, it now has widespread acknowledgement from digital professionals across England within the public sector to confirm that the proper and correct use of the data they access and use is appropriately maintained.

The use of AI in healthcare is not new with published guidance and professional practice for social care already considered by the Society for innovation, technology and modernisation (Socitm). However, Covid-19 has seen an emergence, adoption and use of such technologies at an accelerated rate and scale where technology, and the science behind it, is being leveraged to inform both clinical interventions and individual (patient) ownership of health management.

AI is changing the landscape of healthcare to incorporate a wider social responsibility outside traditional medical transactions and interactions; as well as treatments and interventions. This medico-tech ecosystem provides qualitative and quantitative data at a pace and form that has the potential to create a much bigger picture of health for all societies and, moreover, to inform and drive decision making for those societies outside the boundaries of health and care.

It might be said that we are on the precipice of health and social advancement - the challenge is how that is managed? Yesteryear ring-fenced data to clinicians and other health and care professionals to inform decision making and treatment options. Today we enter into a realm of AI tools where the level of (personal) granular data is unprecedented and the use of machine learning algorithms and predictive modelling are acceptable practice.

As digital professionals, indeed all technology and data stakeholders, we have a responsibility to preserve the integrity, privacy and utilisation of the data we hold. Let us maintain our ethical practices for today and our future - sign the charter and pledge support for an ethical tomorrow.

We will know we are making a difference because we will see:
  • Records will be shared and available wherever the patient presents, meaning we can provide safer and more efficient care
  • Greater availability and use of range of apps and online advice
  • Higher levels of digital health literacy and tackling digital health exclusion in people from deprived and excluded communities
  • Digital capabilities in place for booking and carrying out online appointments
  • An increase in options for virtual outpatient appointments, identifying which specialities systems to prioritise, working towards removing the need for up to a third of face-to-face visits
  • An increase in uptake of online booking systems, primary care appointments delivered via phone and video consultation, and patients ordering repeat prescriptions online
  • More effective services through reduction and change in case mix of appointments allocated in primary care through the use of care navigation
  • More integrated services
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