REFERENCE NUMBER Leading the way in e Health 25 th May,2010 E Health Innovation

2 The current challenge?

3 Three key questions… Can we ride the perfect storm? Financial challenge.. People challenge.. Ageing population.. Where should we aim? Point or whole system? How innovative can we be? Disruptive or play safe?

4 9% 24% 41% 61% 84% Calendar year ’07 estimate P Knight Scottish Government A major challenge for Scotland-24% more beds by 2016, 84% by 2031 NHS Tayside +148 beds beds 2031

5 Compelling areas for improvement..T12 Compelling challenge, local variation? Reference: ISD Online National Statistical Information Publication December 2009.

6 Our approach?

7 Steps to Better Healthcare- a whole systems approach.. Improve efficiency for all 36 Outpatient Clinics. Elective Medicine for the Elderly Urgent & Emergency Prescribing Reducing wastes and cost in prescribing Community Care Services Integrated Care (Virtual Ward) Deliver proactive care management via combined model Business Support Unit Mental Health

8 A whole system challenge, typical NHS board.. A&E Inpatients Acute Wards 75,979 55,464 (73%) Discharged 10,631 (14%) IP Admission 9,877 (13%) Acute R/C Admission 38% A&E Attends 26,077 Acute Attends 16,200 GP/other Refer 62% 17,730 (68%) IP Admission 7,800(30%) Discharged Direct Access 44,242 Total U&E IP Admission 15,881 Direct Access (28,361) 547(2%) Other Care Acute Patient Non Elective ~ £86M Virtual Ward savings 3% ~ £2.5m pa 5% ~ £ 4.3m pa 10% ~ £8.6m pa SGHD HEAT T6, T8, T10, T12

9 Doing the right things.. HEAT 1 HEAT 2 Corp 3 HEAT 1 HEAT 2 HEAT 3 Your tactical dashboard Workforce Corporate Objectives LDP HEAT HEAT T6 HEAT T8 HEAT T10 Corp 1 Corp 2 HEAT T12 HEAT There is objective evidence that the Board is able to track progress against key targets and perform well at a tactical level Triple Aim Integrated Resource Framework

10 Who are the whole system stakeholders?

11 Desire Adopt Our Future PrioritiseOutcome based response Tayside Community Today Tayside Community Tomorrow What do you See? What do you Want? What now? Make it real! ‘Test of Change’ Demonstrators Learn AlignBenefits Realisation Art of the probable? Truly needs Based! Impact Assessment We are here 26/05/10 T12 Emergency Bed Days over 65’s T6 Long Term Conditions admissions Patient experience Community team effective patient facing time Medication Concurrence VIRTUAL WARD AIMS TO DELIVER £ M RECURRING SAVINGS Triple Aim – LTC Whole Care Continuum Acute Patient Non Elective ~ £86M Virtual Ward savings 3% ~ £2.5m pa 5% ~ £ 4.3m pa 10% ~ £8.6m pa SGHD HEAT T6, T8, T10, T12

12 Multi-disciplinary stakeholder engagement / outcome Patients Carers Voluntary organisations Care Home representatives Home Care representatives Community/Practice Pharmacists GP’s cross section Practice Managers Specialist Nurses District Nurses Allied Health Professionals E Health Service Improvement Senior Management reps Social Care Telehealth / Telecare reps Mental Health Professionals Secondary Care – Ward Community Hospitals A&E OUTCOMES Agreed Predictive Modelling was key E Health was a key enabler Local stakeholder engagement key Learn from best practice  Local  National  UK/Global wide

13 LEVEL 5 HIGHLY COMPLEX CO-MORBIDITY Macro Integrator NHS Tayside and Councils LEVEL 4 COMPLEX CO-MORBIDITY LEVEL 3 SUPPORTED SELF CARE CO-MORBIDITY LEVEL 2 SUPPORTED SELF CARE SINGLE LTC LEVEL 1 PREVENTION WELLBEING PREDICTED RISK PROFILE LEVEL 4 COMPLEX CO-MORBIDITY LEVEL 3 SUPPORTED SELF CARE CO-MORBIDITY LEVEL 1/2 SUPPORTED SELF CARE SINGLE LTC LEVEL 1 PREVENTION WELLBEING MICRO INTEGRATORS 0 0.5% 5.0% 20.0% 80.0% 100.0% LEVEL 3 SUPPORTED SELF CARE CO-MORBIDITY LEVELS OF CARE Long Term Conditions VIRTUAL WARD ANTICIPATORY CARE PLANS PATIENT PASSPORTS CASE MANAGEMENT Asthma COPD 8795 Diabetes HBP CHD Triple Aim – LTC Whole Care Continuum

14 Initial LTC Referral PEONY Combined Model Unplanned Referral Elective Referral Case Finding e Health infrastructure Receive & Capture Referral Allocate Case Manager Assess Produce Anticipatory Care Plan Patient Passport Diagnostic Intervention Generate Referrals Service Case Finding Urgent Intervention Integrated Care Planned Intervention Integrated Care Review And Assess Identify CasesInitiate Case ManagementCare Assessment & PlanningCare Delivery & Review Typical Integrated Care Model Next Future State Single Point of Access 7*24 Update patient record Update patient record Service Menu Patient, Carer, Professional Info request Update patient Record with ACP/PP SKILLS MIX PLANNING

15 Perth & Kinross Virtual Ward Test of Change’ demonstrator Local Profiles Total Population – 11,123  65+ – 2,525  Under 65 – 8,598 (GRO Scotland 2006)

16 E Health opportunity

17 Integrated Care – information architecture Glue Integration Platform Access Device User Security Service Directory Applications Clinical Portal PMSGP Community Health& Social Virtual Database Service Staff ID RBAC TELEHEALTH TELECARE PREDICTIVE RISK BUSINESS ANALYTICS Virtual Wards Case Management Health Coaching Prevention Collaboration

18 E Health success E Pharmacy E Health success E Pharmacy

19 ePharmacy  Live nationally in June 2006 used by 800,000 patients  All pharmacies able to register patients on national database and issue prescriptions  All reimbursement claims electronic. Minor Ailments Service (eMAS) Acute Medication Service (eAMS) Chronic Medication Service (eCMS) Progress and benefits to patients throughout Scotland > Live nationally in July 2009 used by every person who visits a GP practice or Pharmacy > 900,000 prescriptions per week processed (95% of total) > First full end-to-end UK ETP solution > Increased efficiencies in Prescription processing > Patient Safety benefits (Emergency Care Summary) > All GP Practices, pharmacies and NSS connected > Infrastructure live May 2009, national roll out Q > First GP and Pharmacy sites in early adopter phase – NHS Fife > Allows GPs to issue six or 12 month prescriptions > Reduction in patient visits, reduced costs > Dispensing information back to GP Practice > Medicines management savings

20 ePharmacy Core Infrastructure A A GP (1000) Pharmacy (1200) NSS PSD ~ Atos Origin GP SystemCP System ePharmacy Message Store Information Services Division Payment process Elec msgs via N3 network CHI Forms sent to PSD Patient Registration Service ePay rules engine Scanning and message processing

21 ePharmacy Electronic Transfer of Prescriptions Process Rx Barcoded prescription form(s) produced Barcodes Scanned Electronic message sent & result received ePMS PMR Pharmacy system uses elec datato support ePMS Issue medication and submit claim Paper form Elec Msg Rx Prescription form(s) received at pharmacy Electronic messages sent to ePMS ePMS GP Rx

22 Key focus areas?

23 Key Focus Areas? Collaboration Supporting the whole system Extended health and social care networks D2D business Supporting people living with Long Term Conditions Older People’s Services Scotland’s economy Business Analytics Performance Management Communication HEAT Targets / Quality Strategy in Scotland In England? QIPP ??

Iain Anderson For more information please contact: