1. A Paperless NHS by 2018 Are patients & clinicians ready for this? Dr Masood Nazir General Practitioner Clinical Informatics Advisor NHS England

2. Patient/Clinician Journey Dr SMr/s D

3. Evolution

4. Paperless Benefits Clinical diagnosis Patient & staff experience Safety. ( prescriptions etc) Reduce burden & improve efficiency ( DNs re typing notes ) 4

5. Summary Care Record National shared medical record containing allergies, adverse reactions and medications Currently being used in acute hospitals across the country Access is based on a legitimate patient relationship Spine based application Access through use of smart card Central Care Record Local shared medical record containing allergies, adverse reactions, medications and diagnostic results Utilised in Birmingham, Sandwell and Solihull only Access will be user specific and based on legitimate patient relationship Content of medical record will be tailored per clinician and organisation Key benefits – quicker for patients, safer care, medication and tests information continuity, safeguarding and supporting vulnerable groups (frail elderly, safeguarding) Care.data NHS England national programme will collect both identifiable and non- identifiable patient information from GP practices Coded data such as symptoms, drugs, diagnoses, lab results to be extracted Information to be managed and anonymised by the Health and Social Care Information Centre (HSIC Utilised for research and planning purposes Opt out code 9NDo or XaXi6 (System One) Opt out code 9ND1 (EMIS Web), 93C1 (LV, INPS), or XaKRw (System One) Opt out codes : For secondary use of data 9Nu0 or XaZ89 (System One) or Disclosure of personal confidential data by HSIC 9Nu4 or XaaVL (System One)

6. Hospital Pharmacists NICE patient safety guidance 1 (Dec 07): ‘The aim of medicines reconciliation on hospital admission is to ensure that medicines prescribed on admission correspond to those that the patient was taking before admission.’ SCR can play a key role in medicines management for patients SCR potential frees up time for both hospital pharmacists and GP surgeries

7. Information Sharing Most people know their own history but...at times of illness, they can forget information e.g. medication. Vulnerable groups require more support: Complex frail elderly Children who need safeguarding English is not first language Better access to information means timely decisions can be made – better for patient care.

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9. The real benefits…. 1.Timely patient care – reducing unnecessary anxiety for patients and families 2.Right information available to support clinical decision making – reducing risk for errors and incidents 3.More investment in real clinical time than administration

10. Compared to other service industries, NHS isn’t easy to do business with 1.Registration 2.Appointments 3.Prescriptions 4.Communications 5.Information access 6.Information sharing 10 And it costs patients and the NHS a great deal in unnecessary visits to GPs, A&E, phone calls, time off work 1.Travel 2.Banking 3.Shopping 4.Blood Donation NHS SERVICESOTHER INDUSTRIES

11. NHS | Presentation to [XXXX Company] | [Type Date]11

12. GP Patient Survey December 2013 Results Appointment Booking And patients tell us they want to do business online…..

13. 22% of people find that it is not easy to get through to their surgery on the telephone 13 Proportion of patients that find it is not easy to get through on the phone Nationally, from 2011-12 to 2012-13, there was a rise of 3 percentage points in the proportion of patients that find it not easy to get through to their GP surgery on the phone. Darker blue indicates better performance Fieldwork dates: 2012-13 GPPS : Jul to Sep 2012 and Jan to Mar 2013; 2011-12 GPPS: Jul to Sep 2011 and Jan to Mar 2012

14. How do you normally book your appointments to see a GP or nurse at your GP surgery? Booking appointments online… the challenge ahead Base: All answering question (in brackets) Source: Ipsos MORI

15. Which of the following methods would you prefer to use to book appointments at your GP surgery? There is an appetite to book online Base: All answering question (in brackets) Source: Ipsos MORI

16. Significant challenges ahead Security Confidentiality East of access and use of services Workload for GP Practices Patient and public awareness Culture – patients and practices Process change for practices Digital divide 16 Trust We are working with professional bodies and with a wide range of stakeholders to ensure the challenges are recognised and addressed appropriately

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19. Virtual meetings and communication : some days I need a TARDIS “ Eat your lunch, sign prescriptions, answer queries from reception staff, get involved, pay attention and contribute!” CCG Chair Solutions (although not quite as good as a TARDIS): Skype Microsoft Office 365 WebEx and many more... i-Engage – Meetings from Planned Care Solutions using Microsoft Office 365. and Microsoft Lync device for virtual meetings

20. Culture Education Technology Barriers to use and adoption

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23. Challenges The two key exceptions for access to information are where it: (Information Commissioner Guidance) is likely to cause serious harm to the physical or mental health, or condition, of the patient or any other person may relate to, or be provided by, a third person who can be identified from the information and has not consented to the disclosure. “It is unnerving to think that patients may see test results before you do” West Midlands General Practitioner

24. Implications

26. Group E Middle income families living in moderate suburban semis Behaviours and attitudes: High users of A&E, out of hours and for minor attendances. Most perplexing of high user groups as access is not an issue and they are more motivated than other groups and happy living with the status quo. Communication strategies: Telephone, internet. Works hard for their money so convenience (GP opening hours) maybe an issue Manual and white collar Married Middle age Children Leafy suburbs Comfortable affordable housing Home improvement Family life Industrious Key Features Hall Green, Bournville, Northfield, Quinton 26

27. 27 “Please test the running of EMIS beforehand” “Thank you for putting on a great event” “Doctors are asked to do too much on stuff that are not related to the care of patients” “There should be consistency in system – similar or same for every patient/practice” “Patients need to have very easy access to the system” “The choice of supplier may lead to confusion amongst patients – we need one portal” “Why is there not one system across GP Practices nationally?” Patient Online Workshop – Crewe – 27 November 2013 General comments/ from graffiti board Online access might not be accessible for patients where English is not first language. GP practices should have in place a toolkit and/or leaflets in appropriate languages which explain what kind of info you can access, how to do it and why.

28. “The overriding problem with failed IT projects in general, and particularly in clinical culture, is lack of attention to the human elements of changing behaviour among professionals” Department of Health. Delivering benefit from the National Programme for Information Technology (NPfIT): A strategy for engaging front line staff and patients

29. Current Pathway PAPERBASED DOCUMENT SCANNING PROCESS LETTER RECEIVED LETTER OPENED LETTER DATE STAMPED LETTER CHECKED TO ASCERTAIN MOST RELEVANT CLINICIAN / REFERRING CLINICIAN – MAINTAIN CONTINUITY OF CARE & MARK ON LETTER CHECK LETTER TO SEE IF IT HAS ALREADY BEEN SCANNED (DUPLICATE) NO YES SCAN LETTER FORWARD TO ………… INTELLISENSE FILE LETTER FILE AS APPROPRIATE WORKFLOW TO CLINICIAN & CODER (9 PROCESSES)

30. What are the benefits of this? No paper, resulting in: No opening of mail No date stamping No scanning No opening, twice daily, of NHS Net account This has already been done for you!

31. Future Pathway EDT / NHS NET DOCUMENT SCANNING PROCESS LETTER IN DOCUMENT VIEWER LETTER CHECKED TO ASCERTAIN MOST RELEVANT CLINICIAN / REFERRING CLINICIAN – MAINTAIN CONTINUITY OF CARE INTELLISENSE SCAN LETTER FILE AS APPROPRIATE WORKFLOW TO CLINICIAN & CODER (5 PROCESSES)

32. The challenge Implementing a Paperless NHS is a challenge, a major project and a substantial change in the way care is delivered But it is achievable, and organisations are starting to achieve it and gained many benefits Once it is in use most health care professionals would not want to go back to paper

33. Thank you Heart of Birmingham Manchester Hampshire More recently: Oxford Staffordshire Cumbria NHS London