Integration of Health Services: How to be Patient Centred

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Learning Lunch
on
Integration of Health Services:
How to be Patient Centred
with
Charlie Elphicke MP
and speakers
Dr. Geraint Lewis, Senior Fellow, Nuffield Trust
Sue Roberts CBE, Clinical Lead, Year of Care Programme
Phil Molyneux, Chief Information Officer, NHS Yorkshire and Humber
at the
Centre for Social Justice
th
17 November 2011, 12.30pm-2.00pm
Key Action Points
Put the patient at the heart of the process:
Inform patients - mail them the information with an explanation, then book an appointment
two weeks later so that when they come in, they are equipped to collaborate in their own
care
Create a space where patients can record their personal health plans/goals so that they can
discuss these with their doctor
Publish data to provide comparative benchmarking between regions/hospitals which will
o force hospitals to compete for the best reputation
o allow patients to make an informed choice about which provider
Facilitate information exchange:
Providers should only be reimbursed when they provide the patient information in a usable
format to support joined up care
Develop common standards for interoperability and information sharing IT systems at a
basic level
Introductory Comments
Broad considerations for the integration of health services:
Integration is the left hand knowing what the right hand is doing
All levels (primary, secondary, etc.) need to work together on a clear path of care
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IT integration means functionally everyone being able to read and write on the same set of
medical records
Clinicians need to drive the change from the bottom up
At the heart of successful integration is a shift in cultural perception towards patient-centred
rather than paternalism
What can be done to promote integration of services?
Lessons from abroad
o A single “cloud”-based open source medical record system such as the one used in
the USA Veteran’s Association can provide nation-wide integration for all levels of
care (e.g. Jordan)
o Telehealth can enable a clinical team to continue to manage a patient after they
have been discharged from hospital, which can prevent readmission (e.g. Toronto,
Canada post-discharge virtual ward)
o “Physician triage” similar to Kaiser Permanente’s 23 hour clinics can reduce hospital
admissions
Lessons from the Year of Care Programme (with respect to diabetes)
o GP visits should be used effectively to provide patients with long term conditions the
information to support self care, which patients are already doing 99% of the time.
o Care planning should be a collaborative exercise between the doctor and the patient
o The patient needs access to and explanation of their own medical information in
order to make informed choices (example: you cannot manage your own finances if
you don’t know what is in your bank account!)
Lessons from the demise of the National Programme for IT
o It is not necessary to institute a single IT system to achieve integration
o It is possible to make better use of the technology that we already have
o There should be a focus on sharing information and developing common standards
for systems at a basic level
o It’s important to look at what the patient needs are when designing an IT system
Discussion
What exactly are we asking for when we talk about integration?
This is difficult to answer as it is different for different sectors.
It should be considered a spectrum, with each sector having different needs for information access.
How do we start the journey?
Each sector tends to be silo’d so it’s a big cultural change, but everyone must get on board.
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It’s possible to just start publishing data on institutions so that people can make informed choices
about which provider.
It’s not necessary to have a complicated IT system - just set a standard so that there can be a basis
for communication.
How can we get patients involved in their own care?
The patient needs access to information to make a choice, not just which provider, but between
actual treatment options, which means knowledge.
We should work towards electronic health records which provide patient access and allow you to
record your personal health plans/goals.
A very effective way to encourage patient self-management is through telehealth.
Do we really need to spend more on IT, and is open source the way forward?
The more you spend on quality IT the more you save in the long run.
Open source provides potential for unlocking ownership over IT and saving money.
It’s all about functionality - the structural issues (open source vs. brand, single system vs. multiple)
are secondary.
IT is not necessarily the solution, or more money – it’s about a shift in our way of thinking.
(Illustration: in Brazil they have “integrated” all major governmental service providers such as water,
power, healthcare and voter registration by physically placing them in the same building – no
complicated IT required).
What are the implications of any qualified provider?
If the incentives are aligned, then everyone will be incentivised to buy in.
Providers should only be paid if they deliver information in the right format to support joined-up care
across organisations.
In the new CCG commissioning system, GPs are unlikely to tolerate any lack of information, and so
will simply not sign off payments if the providers have not given them the information.
What are the key barriers to change?
There needs to be a focus on primary care and clinical leadership.
IT system needs sorting out – the exchange of information is the main aspect of integration.
Consistency and continuity are the most fundamental, and if you get that right, it will enable you to
get the information that you want.
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Differing levels of health literacy may widen social inequality because some people will be able to
make best use of the system but others won’t.
How do we remove these barriers?
There should be comparative benchmarking between regions/hospitals that are made public, which
will force hospitals to compete for the best reputation.
Patients must be educated and empowered to self care.
But to truly make that cultural change, health providers must be educated too.
2020health further thoughts
The Veteran Health Administration in the US provides an excellent model in terms of patient-centred
care, with a universal electronic health record to which patients have access, and a large scale
programme on telehealth based around a care coordination model. This transformation came about
in the mid-1990s when the organisation was challenged to change or be closed down.
Attendees
Charlie Elphicke MP
(Chairman)
Member of Parliament for the
Dover constituency
House of Commons
Dr. Geraint Lewis
(speaker)
Senior Fellow
Nuffield Trust
Sue Roberts CBE
(speaker)
Clinical Lead
Year of Care Programme
Phil Molyneux
(speaker)
Chief Information Officer
NHS Yorkshire and Humber
Sarah Richardson
Director
Edelman
Hannah Cameron
Associate Director
Political Intelligence
Audrey Yvernault
Consultant
Campbell Gentry
Graham Kendall
Chief Executive Officer
Graham Kendall Consulting
Jennifer White
Account Manager
Helen Johnson Consulting
Limited
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Jane Bunnett
Chief Executive Officer
Glencare
Colin Cooper
Editor in Chief, Head of Content
Haymarket Medical Media
Glen Griffiths
Patient eHealth/ Digital
Healthcare specialist
Independent Consultant
Geoff Frew
Managing Director
PharmaTimes
Penny Woods
Chief Executive Officer
Picker Institute Europe
Dr. David Cox
Programme Manager , Integrated
Care and Interventional Public
Health
Imperial College Healthcare
NHS Trust
Matt James
Chief Executive
Private Hospitals Alliance
Jenny Shand
Director of Integrated Care
UCL Partners
Barbara Arzymanow
Director
True Research
Rita Davies
Governor
North East London Foundation
Trust
Janet Kiddle
Founder
Steel Magnolia
Brain Hargreaves
Senior Advisor- Healthcare
3i plc
Jeremy Nettle
Director, Global Client Advisor for
Healthcare
Oracle
Suzi Miller
Consultant
Board Intelligence
John Johnston
Medical Assessor
The Medicines and Healthcare
products Regulatory Agency
Hannah Gagen
Government and public affairs
Boehringer Ingelheim Ltd
James Philips
Director
Glen Care Group
Nick Bason
Head of Policy and Public Affairs
Bowel Cancer UK
James Hewitt
Government Affairs Manager
National Rheumatoid Arthritis
Society
Anita Randon
Director
Capita Group
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Dr. John Chisholm CBE
Director
Concordia Health Limited
Dr. Carole Easton
Deputy Chief Executive
Changing Faces
Angela Single
Clinical SME – Telehealth
BT Global Services
Director
Black Mental Health UK
Professor David
Croisdale-Appleby OBE
Chair,
Honorary professor
NICE Programme Development
Group,
School of Medicine & Health at
Durham University
Laura Clarke
Assistant Policy Adviser
RCN Policy and International
Julia Manning
Chief Executive
2020health.org
Gail Beer
Consultant Director
2020health.org
Dr Jonathan Shapiro
Senior lecturer in health services
research
University of Birmingham
John Cruickshank
Consultant Director
2020health.org
Dr Samantha Gan
Researcher
2020health.org
Gemma McGeachie
Matilda MacAttram