Technology supported transformation in Health Visiting Services Coleen Milligan #cciolip

Technology Supported Transformation in Health Visiting Services Coleen Milligan National Clinical Implementation Lead

What Will Success Look Like? Parents will have access to their childs health records electronically; Families will be able to access electronic advice, education and support; Health Visitors will have mobile technology to improve access, quality and productivity; Mobile technology will enable information to be available at the point of service delivery and electronic capture of information will be the norm; Once recorded, data will be available for numerous purposes e.g. commissioning including contracting and performance, reducing double entry and transcription errors; Information collected will also support delivery of QIPP, education, research, public health interventions, clinical audit and demonstration of clinical outcomes.; and Robust sharing of information arrangements will be in place between agencies to facilitate joined up services for families at all levels of the service model

The Future – Opportunities and Challenges

Building virtual communities On line communities national e.g. Net mums Personal and family health records Electronic Care Record (>10 million Summary Care Records) Health Space – NHS Portal to navigate services and access service - >173HealthSpace Accounts Digital / electronic Red Book 2016 Online services Access to online services (NHS Choices >1000,000 visits per year) Health visiting direct Electronic repeat prescriptions Choose and book / electronic booking of appointments Tele health Tele medicine Apps for medical symptoms / self care The Potential – Supporting The Service Model

Information on line NHS Local/Public Health Information on line Digital Advice Service for Families 2012 (>2 million messages sent per month via NHS mail to remind patients of appointments) Digital Babies 2012 Information sharing Sharing information through NHS e mail Information sharing NHS mail – nhs.net, Local Government -.gcsx.gov.uk, Police National Network -.police.uk, or pnn.police.uk, orscn.gov.uk, or cjsm.net Productivity Mobile working

What Would Good Look Like: Antenatal Visit The antenatal visit had been scheduled using a rostering tool, booked electronically with parents and a text reminder sent. In the home the Health Visitor accesses the maternity record and birth plan using laptop, and discusses with the parents. They discuss mothers intention to breast feed and HV identifies local breast feeding support groups for parents. The HV demonstrates to parents validated information web sites for parenting advice and information and introduces virtual community sites such as Netmums/Mumsnet etc The Health Visitor shows the parents the local HV service offer on local website and talks about what will happen once midwife discharges mother (using the electronic professional pathway). She leaves contact details including an address for parents to contact for further questions and advice Information about the antenatal visit, including information on outcomes is recorded electronically in the clinical family record. Information from the clinical record is available to the organisation to report on activity and performance.

Health visiting team has been alerted to review due by routine reporting from Systmone via the waiting list function linked to HV team availability via Outlook. Once an appointment had been identified an invitation letter was ed/texted to the family and a reminder text was sent just before the appointment. This helps keep the DNA rates down and makes better use of clinical time. As local services are working towards integrated health and foundation years review at 2 the family are seen at the Childrens Centre. The childs record is be accessed via a mobile device and information from the review entered directly into the clinical record at the point of service delivery. This information is only entered once but then is shared as appropriate When the child and parent/carer come for their appointment, the review is carried out using the electronic Ages and Stages assessment. Online resources Websites, apps. teaching videos are used during the review to assist parents where necessary. Information for the parent is recorded in the Electronic Red Book. E customer feedback is encouraged which is recorded once and available for instant analysis. In addition to the clinical information the time it took to do the review, travel time, any referrals required etc is also entered. This allows reports to be created from the rich information in the clinical information system. The final task is to remove the child from the 2.5 year list and place him/her on the appropriate list for the next review What Would Good Look Like: 2 – 2half Year Review

What Would Good Look Like: Health Visiting Healthy Child Programme Service Planning And Delivery The Health Visiting team have contributed to the JSNA. They are now using this and other public health data and local community information to identify priorities for action to improve health outcomes/reduce inequalities in the local community The identifies one local estate as an outlier for high incidence and admission for childhood home accidents. This is confirmed by the paediatric liaison service A health improvement group is formed within the local community with representatives from the health service, childrens centre,, fire service and schools and all information available is pooled and shared electronically. This enables a shared action plan to be agreed which includes Virtual home tour to identify where safety equipment is needed /text address is created for families to loan or purchase equipment Information regarding fire safety / free smoke alarm is made available on a app for mobile phones App for first aid in the home is developed and made freely available Families informed of local child care programmes by text reminders Joint outcomes for the action plan agreed with the community and monitored

Benefits For Staff Agile working Reduction in travel Increased productivity Electronic diary Access to decision making support tools Instant messaging to colleagues and GPs Secure transfer of information (NHS Mail) Real time action – sent a change of new born babys name to Child Health Team during consultation with mum Access and use of standardised care plans e.g. Nursery Nurses using a standard template for behaviour management Ability to access real time information and run reports On line access to organisation policies and procedures

Benefits For Staff Will Lead To : Improved satisfaction / morale due to improved efficiency Ability to be flexible in where they start and finish the working day Once only data entry Ability to make referrals and appointments at point of service delivery More effective use of clinical time Ability to use on line educational tools and programmes Ability to promote self care with use of on line information Ability to share information appropriately and effectively Providing Health Visitors with the technology at work which they probably use and feel comfortable with in their social lives

What Needs To Happen To Make The Possible The Norm? Up front investment Wide scale deployment of mobile technology to Health Visitors Wide scale deployment of an electronic clinical application which can be used in a connected and disconnected modes Clinical Information Knowledge Management and Decision Support software BNF on line Clear measures to demonstrate benefits and return on investment / QIPP and productivity gains Demonstration of information on line from national / local educational sources Cultural change within the profession Cultural change and across agencies especially in regard to sharing information Clear benefit realisation measures

What Local Services Need To Do To Make This Happen Undertake assessment of information and technology requirements – tool available Complete state of readiness for mobile working – tool available Prioritise investment for the deployment of mobile technology Have a robust implementation plan Provide business change support at a local team level Provide project management for implementation Provide responsive and timely IT support Measurement benefits to demonstrate on going improvements and increased family satisfaction with services Rapid replication of what we know works

What The National Health Visiting Programme Could Do To Make This Happen? Production of Options Appraisal of approaches to implementation (Incremental approach v big bang) Development of Return on Investment tool for mobile working and pilot of the use of emerging technologies to provide evidence for future use and benefits to local families and Health Visiting Development of standard scorecard for the measurement and assessment of the impact of Health Visiting and development of a performance scorecard to capture all performance and outcome measures Identification of improvements in robustness of connectivity, disconnected clinical applications, intra operability between systems and national information sharing protocols (in partnership with Informatics Directorate) Commencement of discussion with industry and educational organisations to develop Clinical Information Knowledge Management and Decision Support software Development of core templates to ensure clinical applications capture all HV information requirements Provision and promotion of National Clinical Leadership – Cultural change / Use of technology / Change Management Skills Creation of a couple of whole scale demonstrator sites to provide the NHS with the evidence on the benefits possible

What The National Task Force Could Do To Make This Happen? Supporting and communicating the vision for information and technology in Health Visiting Leading cultural change in the professions/ organisations and across agencies Contributing views from service users on technology supported services Making case for investment within organisational networks Supporting and driving information sharing across agencies Publishing information from national studies and educational resources Influencing training and education for staff to be competent and confident in using mobile technology -Inclusion of informatics in HV training, training when deploying technology and on going support post implementation

This is technically and culturally possible – so lets do it ! Can we afford not to? Thank you for your attention