WELCOME Delivering Care in the Digital Age: Embracing Technology and Data Intelligence to Transform Health & Care Chair: Dr Margaret Whoriskey Head of Technology Enabled Care and Digital Healthcare Innovation #nhsscot17

Why Digital? A Chief Executives Perspective

Some drivers for change Scotland’s Digital Strategy

What do we mean by Digital What do we mean by Digital? Liza McLean, Head of eHealth Strategy & Policy, Scottish Government

Digital is… A way of working Putting the person first Any technology that connects people and machines/devices with each other or with information. A way of working http://www.mckinsey.com/industries/high-tech/our-insights/what-digital-really-means Data intelligence Agile change Open standards New workforce dynamics User experience Interoperability Learning through doing Rapid product iteration

In last 5 years healthcare systems in most countries have come under increasing pressure in terms of costs, funding, demand, supply, access and expectations with converging healthcare trends transforming the market Escalating healthcare costs Increasing care complexity A change in patient Expectations Evidence for use of Digital services 50% of the world's population don't have access to the very basic healthcare that they need Yet most have a device that they all carry, on which key aspects of healthcare can be delivered wherever they are Everywhere care This can be an important enabler of self-management for patients with chronic disease and provide vital support for a growing number of carers It is helping shift healthcare delivery, from a traditional paternalistic approach, towards shared ownership Empowered patient sharing ownership Empowered Professional Health tech Empowered Patient

Change will never be this slow again Exponential technology, and the accelerated pace of change

Staff Citizens & Patients Managers & Planners Researchers & Innovators Providing: The right information; At the right place; To the right person; At the right time Managers & Planners Researchers & Innovators

Delivering Care in the Digital Age Long Term Conditions Management

Using Data Intelligence Projected Prevalence of Long Term Conditions Prof Mahmood Adil Medical Director Information Services Division (ISD) NHS National Services Scotland Background/ Context – Chronic disease challenge in Scotland, potential impact on our services.  Importance of good data and intelligence underpinning transformation  and driving further improvements in health and care.   Rationale and summary of the collaborative work carried out by NHS 24 and NSS with respect to LTC projections. Work  represents a compelling case for changing how we deliver care to LTC’s and shift towards prevention and self management. What we did - Overview of key findings Macro trends and other levels of analysis we completed. Significance of this work for Scotland  and where to access this data specific to your Health Board.    This slide deck has been extracted from a report entitled “Anticipating & Planning for Long Term Conditions Service Demand in Scotland”. The report provides a key piece of intelligence to assist local planning for Long Term Conditions in Scotland. The Scottish Government has provided direction to services through its 2020 Vision and, more recently, through A National Clinical Strategy for Scotland 2016, and the Health and Social Care Delivery Plan 2016. These documents call for changes in the ways in which health and care services are delivered in Scotland. These slides, briefings and accompanying actionable data provide a common reference point for local health and care organisations as they plan and deliver the necessary service transformation. Additional documentation can be found at: https://sctt.org.uk/programmes/home-and-mobile-monitoring/long-term-conditions/ We also encourage colleagues to highlight additional areas where production of this kind of intelligence would help to support the work to integrate Health and Care services. For technical questions about the projections and to request additional analyses and actionable intelligence please contact: Richard Dobbie at National Services Scotland, Information Services Division richard.dobbie@nhs.net For questions about Home and Mobile Health Monitoring please contact: Michelle Brogan at the Scottish Centre for Telehealth and Telecare michelle.brogan@nhs24.scot.nhs.uk

Health Intelligence Our Strength in Scotland Data Saves Lives

Projected prevalence of Chronic Disease: Macro Trends (accelerating!)

Projected Additional Patients

Projected prevalence of Hypertension

Disease Trends by Health Boards: Hypertension projections by board and time period

www.sctt.org.uk @mahmoodadil Launching this detailed Report Today Actionable Intelligence to to save lives Scotland’s opportunity to change trends and make history www.sctt.org.uk @mahmoodadil

Home & Mobile Health Monitoring Remote Management of Long Term Conditions: Developing a National service model & optimising spread Michelle Brogan Service Development Manager Scottish Centre for Telehealth & Telecare Definition of HMHM and growing role of digital technology transforming services patients and services.  HMHM does this by managing demand, releasing capacity .  Overview of scale up in Scotland ( 18 month, 6000) citizens across range of services and pathways .  Value proposition of HMHM as we see it nationally so far .  Learning supported development of national service model to develop and support expansion of HMHM – collaboration with partners and IJB’s.  Overview of the national model ( 1 slide) key concepts and areas of expansion . Scale up ambitions with respect to identifying  national “ candidate” services which  can deliver better value and better Care through routine use of HMHM. Introduce NHS Lanarkshire, as an implementation partner who have been leading this work with respect to scaling up of hypertension within primary care.  

What is Home and Mobile Health Monitoring ? “use of digital technologies that enable patients outside healthcare settings to, record and transmit information and their health and well being where, it can be stored, used to inform or guide self management decisions by citizens/or support diagnosis, treatment and care decisions by HCP’s. “

How does it work? Optimises self monitoring and self management Optimises remote decision support DATA Releases capacity - generates efficiencies Assessment & Diagnosis Triage Early Intervention ( Prevention) Treatment & Care Management Service Pathway – Typically LTC’s

6000 new patients benefiting 12 Health and Care Partnerships across Scotland Adoption & Spread of HMHM Integrated over 50 different pathways and services for people living with Long Term Conditions Primary , community and secondary care 6000 new patients benefiting

National Service Model for Home and Mobile Health Monitoring An Introduction to Home and Mobile Health Monitoring The Case for Adoption in Scotland National Service Model Framework – core service principles, generic pathway Essential Actions required to Enabling the Delivery of Home & Mobile Health Monitoring Services at Scale Download : www.sctt.org

Key Enablers “ more about people and change than Technology” National HMHM Community of Practice Sharing Success & creating interest About Impact Evaluation Data Information Address REAL tangible challenges identified Building support TEC champions Services achieve better/fast outcomes Stakeholder Engagement & Leadership From our learning and experiences to date, there are a number of critical enablers which have been identified which have supporting the adoption and service transformation undertaken. These are outlined here. Worked nationally and locally to support these areas – fundamental to our change management approach has been the development of a national community of practice – offers knowledge transfer, supported development of national resources , peer support, sharing best practice and stakeholder engagement.

Benefits -Releasing the value of HMHM Improved Efficiency: Better targeting of Home visits : 25% reduction in travel time and costs Appointments Saved: 40% reduction in GP appointment for hypertension Better Compliance & Adherence to treatment More Patients actively self managing Better Clinical Outcomes e.g. Blood Glucose, BP and delayed exacerbation Improved Outcomes : Timely Patient Care Patient Satisfaction – 94% patients happy to use TEC as part of routine care

Patient – its about me – flexible & person centred “ I have an active role in my healthcare” “Its personal, just for me, just when I need it “ Staff – releasing capacity , improving productivity “ Frees up my time “ “Increased patient and carer compliance” “ Reduced avoidable use of my time “

Home & Mobile Health Monitoring Local Implementation - Lanarkshire Morag Hearty TEC Programme Manager, NHS Lanarkshire Overview of HMHM work in Lanarkshire, focusing on hypertension scale up. What NHSL did , how NHSL worked with staff, service users and citizens to scale up. What was critical to this process.   Overview of outcomes (  summary slides with respect to appointments saved, users feedback and additional efficiencies.  Close with short video of service users and feedback from clinicians on this approach to care.  

Our Experience Staff enthusiastic and willing to try change Positive feedback from patients and staff Flexibility Developing and sharing expertise. Staff confidence increased = time required using system reduced Embedded into key strategic plans Consistency V individuality Wide geographical area Varied level of IT literacy among staff. Varied level of engagement Ensuring supporting communication is effective Enthusiasm V actions!!

18 months of GP Blood pressure monitoring Total recruited : 967 Average text service cost per patient = £6.72 BP monitors: Recycled New procurement contract 40 % of GP practices active 100% clinicians report an aid to clinical decision making 30% shown as “white coat” “couldn’t manage without it” Starting with our rapid improvement study of 5 GP practices just over a year ago we currently have 42 of our 105 GP practices signed up including all the practices within East Kilbride. Our total recruitment of patients has steadily increased and by today we will have over our thousandth patient recruited! We had estimated an average 4-5 practice visits saved per patient ( which can be used for other more urgent use) depending on clinical use e.g. Medication introduction/ adjustments or diagnosis / excluding hypertension diagnosis ( “white coat syndrome” i.e. blood pressure is normal but rises every time they come to the GP or clinic) We recycle our BP monitors where appropriate and are finding patients do return them! We have just arranged a new contract with other boards to obtain a very competitive price. As you can see – an overwhelming positive response from staff and more importantly patients with unexpected outcomes – actually believing they have high blood pressure and taking steps to manage this – reducing their risk of stroke and heart disease. 99% patients found Flo easy to use! 94% would use again! “ I've started taking my medication now!” Estimated clinical contacts avoided: 3,868

Key points Keep it basic to start off –build up slowly Listen to the folk on the ground Keep it basic to start off –build up slowly Look for quick wins/small changes Listen to patients/clients feedback Communication – be inventive! Yes – the folk on the ground – the staff actually using the telehealth system were the ones who drove this forward so massive thanks to them. We are using a “simple” text messaging system – it does not need to be complicated or “over engineered” Even saving one surgery visit can be a massive impact for a patient. We did respond to feedback – and made changes! Communication is everyone's business – raising awareness for staff and public by the use of modern media including twitter, facebook and local radio ads. #TECLanarkshire #FoundFraser

https://vimeo.com/198187123 #FoundFraser

Delivering Care in the Digital Age Mental Health Care & Support

Computerised Cognitive Behavioural Therapy (cCBT) From Local, to National – via Europe Chris Wright Service Development Manager Scottish Centre for Telehealth & Telecare

Depression and Anxiety in Scotland Depression affects as many as 1 in 5 adults 25-30% of all GP consultations involve depression, stress or anxiety Prescription of anti-depressant doubled in 5 years Continual increase of demand on specialist services

A Technical Solution Technology offers large scale, high capacity solution through online therapy cCBT = Computerised Cognitive Behavioural Therapy cCBT is online therapy for the treatment of depression and anxiety For mild to moderate symptoms but evidence shows its effectiveness when used in a blended approach with face-to-face

Progression of cCBT in Scotland DUMFRIES & GALLOWAY BORDERS HIGHLAND WESTERN ISLES AYRSHIRE & ARRAN LOTHIAN ORKNEY GLASGOW & CLYDE GRAMPIAN FIFE LANARKSHIRE SHETLAND 2007: 11% of national population 2015: 44% of national population, funded EU MasterMind Project TAYSIDE FORTH VALLEY 2017: 100% of national population, funded by TEC

About MasterMind MAnagement of mental health diSorders Through advancEd technology and seRvices – telehealth for the MIND Implement at scale computerised Cognitive Behavioural Therapy (cCBT ) MasterMind consortium: 22 members including 14 trials sites in 9 EU member states. Implementation study to identify barriers and facilitators to large scale deployment

Nationally Support Implementation Existing services feed into national expertise and directly into implementing boards Expertise and support offered to Health Boards includes policies, key documentation advice and guidance Implementing Boards in MasterMind able to pass on knowledge and experience to other remaining Health Boards 4 Health Boards

Local Service Model Patients complete treatment in their homes or community locations such as Libraries Co-ordinator arranges access to cCBT treatment program Central Coordination of service from within psychology Co-ordinator supports home and community users All referrals come to one central point using same process Run with minimal clinical input but support is there when needed Referrers maintain clinical responsibility and respond to suicide alerts

This was achieved in month 7 of 24 Success of MasterMind RECRUITMENT NUMBER TARGET +/- Patients 6,107 800 + 5,307 Target of 800 patients commencing treatment was required by MasterMind. This was achieved in month 7 of 24

Across Europe

Referrals BOARDS TOTAL REFERRALS FIRST 12 MONTHS LAST 12 MONTHS REFERRALS PER 1000 NHS Lanarkshire 4,049 1,668 2,381 4 NHS Fife 1,843 788 1,055 3 NHS Grampian 2,671 1,066 1,605 2 NHS Shetland 488 222 266 8 Total So Far 9,051 3,744 5,307 Shetland shows value of cCBT and use of technology to overcome barriers of traditional therapy approaches

Key Element of Implementation Service costs are limited to software licence and administration Multiple referral routes are created across a number of disciplines Selection of the right workforce is vital A strategic approach to marketing High level support, commitment and effort in participating boards

Services becomes more efficient and cost effective with increased use Marketing Works Use increases dramatically and continues to increase inline with marketing activity Average cost per patient = £60 Services becomes more efficient and cost effective with increased use

Evidence shows patient improvement from Session 1 Clinical Outcomes Moderate 1.5 – 1.9 Moderate to Severe 2 – 2.49 Mild 1.0 – 1.49 Low Level 0.6 – 0.9 Healthy 0 – 0.59 Clinical Cut Off Evidence shows patient improvement from Session 1

“I didn't need the talking therapy and I've had my medication reduced” Patient’s Perspective “Few methods of CBT I learned will be invaluable to my progression to better mental health” “Was really easy to use and after only a couple of sessions I started to feel better” “I didn't need the talking therapy and I've had my medication reduced” “I thought the program was excellent, just the right amount of information” “Thanks to the cCBT treatment I have reduced my anti-depressants and have a lot more confidence”

Still Learning The way people engage with technology has changed Self-management of conditions at home is untested so hard to predict Use of cCBT at home requires different approach to patient engagement Need to better manage speed of growth as reduces time and quality of patient support

Key Lessons Plan early and take strategy approach to sustainability Ensure clinical engagement through marketing Right service and implementation model Ensure it is successful and gets noticed

The Impact of Digital Health Pathways in Mental Health Services Ayrshire and Arran Mark Fleming–Nurse Consultant eHealth/Mental Health Kevin Milton – Crisis Service Team Leader Mark

Overview of our Digital Story What Patients/Carers told us. Clinical Leadership/Engagement Matching our Redesigned Integrated Care Pathways with our eHealth systems. Ensuring Quality and Governance. Scope/Impact of the work. Key Messages What next? Mark

From a Patient and Carer Perspective Develop a Care Model and Care Pathways so that patients/carers know what will happen next. Patients are always Involved in the Care Decisions. Easy/Quick access to our Mental Health Services, particularly Out of Hours Staff Access/Appropriate Sharing of our Clinical Information. We don't want to have to keep telling our story! Its often a very painful one. Patient Safety and Quality is Essential Kevin

Matching our Pathways to eHealth Systems Networked eHealth System which is Clinically Focussed. Sharing/Access to Information in all H&SC environments. Mental Health Staff available at Key Access Touchpoints. Adoption of the Healthcare Improvement Scotland Integrated Care Pathway Standards. Consistent Assessment/Risk Assessment and Management. Person Centred Care Planning. Kevin

Quality/Governance Effective Care Governance Person Centred Care Integrated Care Pathways Information Governance Improved/Safer Record Keeping Access Audit and Controls Efficiencies/Informatics Kevin

Scope of Project 2200 System Users CarePartner Support Team All of Mental Health Services Unscheduled Care Areas Child Health Health Visiting School Nursing Child Protection LAAC Children Throughcare CarePartner Support Team Mark

Impact /Achievements Staff have Access to clinical information to support Improved Clinical Decision Making. Streamlining/Integration of services. Bed Numbers Reduction. Improved Care and Information Governance. Reduced burden on patient telling their story too often. Enhanced Person Centred Care Planning. Improved Agile Working. Better Coordination of Care. Improved Structures for and quality of Record Keeping. Mark

Key Messages to Success Clinically Led Clinical Engagement Patient/Carer Engagement Good eHealth Engagement Service Redesign Informatics and Improvement Cycles Staff Skills and Competencies Development Training/Support Essential Mark

What Next? Embed work into the “Excellence in Care Programme” Improved Informatics/Reporting for Managers/Staff Ongoing work re the H&SC Partnerships Integration Agenda Enhancing Police Hubs and Prison work Clinical/Care Portals Developments GIRFEC Developments Patient Safety programme etc Mark

Interactive Panel Discussion Towards Developing a Digital Health & Social Care Strategy for Scotland

Developing our Digital Health & Social Care Strategy Moving from organisational-centred developments and architecture to placing the citizen at the centre; Making better use of data – both health & social care and citizen- generated – for decision support, service delivery, planning and research; Starting to develop digital ecosystems around the individual, home & place; Creating a permissive culture through improved leadership, workforce development and rebalancing our approach to risk;

Developing our Digital Health & Social Care Strategy Fostering a fertile environment for innovation and economic growth; Contributing to social care reform and supporting delivery of health & social care integration; Building on what we have, and spreading what works; Utilising guiding principles such as Citizen-centred; Data-Driven; Flexible; Familiar; Facilitative; Innovative; Safe & Efficient; Open.

Continue the conversation… Join us for a chat at stand 25 Connect with us on twitter @TECScotland or @eHealthScotland