1. 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

2. Why Digital? A Chief Executives Perspective

3. Some drivers for change
Scotland’s Digital Strategy

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

5. 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
Data intelligence
Agile change
Open standards
New workforce dynamics
User experience
Interoperability
Learning through doing
Rapid product iteration

6. 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

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

8. 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

9. Delivering Care in the Digital Age Long Term Conditions Management

10. 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:
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
For questions about Home and Mobile Health Monitoring please contact:
Michelle Brogan at the Scottish Centre for Telehealth and Telecare

11. Health Intelligence Our Strength in Scotland
Data Saves Lives

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

13. Projected Additional Patients

14. Projected prevalence of Hypertension

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

16. 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
@mahmoodadil

17. 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.  

18. 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. “

19. 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

20. 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

21. 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 :

22. 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.

23. 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

24. 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 “

25. 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.  

26. 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!!

27. 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

28. 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

29.
#FoundFraser

30. Delivering Care in the Digital Age Mental Health Care & Support

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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. Across Europe

40. 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

41. 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

42. 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

43. 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

44. “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”

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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

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

52. 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

53. 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

54. 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

55. 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

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

57. 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;

58. 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.

59. Continue the conversation… Join us for a chat at stand 25 Connect with us on