Delivered by Lincolnshire Health and Care Day Two, Pop-up University 4, 13.00

1. The reality of an integrated digital care record
Liz Jones Project Manager IMT, Lincolnshire Health and Care Programme
Tracey Thrift Assistant Director ICT Programmes, United Lincolnshire Hospital Trust
Adam Lavington Head of Primary Care Systems Enablement, NHS Arden and Greater East
Midlands Commissioning Support Unit
Ian Baldam Deputy Director of Informatics, Lincolnshire Partnership Foundation Trust

2. Lincolnshire Health & Care - Care Portal

3. Lincolnshire Health & Care Economy
• 5921 sq.km
• 775,213 population
• 1242K health economy
• 4 CCGs
• 1 main acute provider with 3 main sites
• 1 community services provider
• 1 mental health services provider
• 1 Ambulance services provider
• 101 GP practices
• 1 upper tier local authority
• 7 x lower tier local authorities

4. • Rural: 57% population in LECCG
• Dispersed: 88 people per km2 in LECCG
• Poor road infrastructure (51 minutes
lowest drive time between acute sites)
• Poor telecommunications infrastructure

5. • Rural: 57% population in LECCG
• Dispersed: 88 people per km2 in LECCG
• Poor road infrastructure (51 minutes
lowest drive time between acute sites)
• Poor telecommunications infrastructure
(But it is very beautiful, with great
history and heritage, safe, with
good schools, and very attractive
property prices)

6. • The population age structure is older than
England as a whole.
• 15.8% of the population are aged 0-14
years compared with 17.3% in England,
whereas 9.9% are aged 75 years or over,
compared with 7.8% in England.
• Population structures also vary within the
STP area. Lincolnshire East has a higher
proportion of older people (11.0%).
• 14.2% of the population live in the most
deprived areas of England as defined by the
Index of Multiple Deprivation (2015)

7. Quality:
Keogh Review
Fragmented services
Population profile:
Ageing population
Long term conditions
Rising expectations from patients
Financial pressures:
Deficit over £250m by 2020
Requirement from NHSE to balance books (STP)
Workforce issues:
Recruitment and retention
Agency costs
Viability of services due to staff shortages
The Challenges

8. • Strategic change programme involving all commissioners and providers
• Commenced 2014
• Six work streams: Planned Care, Urgent Care, Proactive Care, Women
& Children’s Care, Primary Care, Mental Health
• Seven enablers: Workforce, Estates, Transport, IM&T, Contracting &
Commissioning, Finance
• Now meshed with the Sustainability & Transformation Plan (STP)

9. LHAC Vision
Quality, safety and sustainability for health and care services
Improved joint working of health and care professionals –
an integrated service for patients
Providing the right care at the right time closer to patients’ homes
7 day a week services for local people through community 'neighbourhood' teams,
supported by urgent care centres across the county
Hospitals ‘freed up’ to provide specialist or genuine
emergency trauma and time critical services

11. IM&T Enabler Group (IMTEG)
• All providers and commissioners
• Commenced with an infrastructure stocktake
• Developed a system architecture
• Conducted a requirements analysis with all LHAC work
streams

12. Care design Groups
•Planned Care
•Urgent Care
•Proactive Care
•Mental Health & LD
•Women & Children
•Primary Care
Service Ambitions
•Self Care
•Integrated Care
•Care Navigation
•Proactive Care
•Care in the right place
•Capacity optimised
Digital Enablers
•Integrated health records
•On-line and remote patient
processes
•Capacity Management
•Integrated Communications
•Networking and mobile
•Collaboration services
•Directories of services
•Decision support technologies

14. Why deploy a Care Portal?
• No.1 enabler (from Care Design Groups)
• Reduces risk and improves decision
making
• Reduces duplication and waste
• Delivers Patient Online
• Analysis of portal data can provide rich
insights
Key policy drivers are ‘The Power of Information’
(2012), ‘Personalised Health & Care 2020’ (2014), and
the National Information Board Interoperability
Strategy:
• Digital roadmaps
• 2016: Child Protection Information Sharing (CP-IS)
• 2018 : primary, urgent and emergency care should be
operating without the use of paper records
• 2018: individuals should be able to record their own
comments and preferences on their care records
• 2020: all care records should be digital, real-time
and interoperable

15. Lincolnshire Care Portal History
• Project started about 3 years ago
• Initial bid to the tech fund
• £3m matched bid for integrated care portal including
patient portal
• Got through to the interview stage
• Failed at last hurdle

16. Lincolnshire Care Portal History – Lessons Learned
• Too much of an IT led programme
• Lack of buy-in for “the vision”
• Failed to reach a “tipping point”
• Too expensive
• Heavy on infrastructure
• Governance not worked through

17. Specification and Procurement
• Market research
• Reference sites, in particular Scotland, Northern Ireland, and Sweden
• Engagement with care design groups on requirements analysis and design
sessions
• Involvement of 32 stakeholders from a variety of organisations and disciplines
• Proof of concept integrating 5 existing systems
• NHS Infrastructure bid £1M
• Framework procurement - InterSystems

18. SystemOne
/TPP GP
Social Care System
MOSAIC
TeleHealth/TeleCare
Monitoring Platform
Summary
Care Record
Clinician Social Care Worker Patient
Electronic
Master
Patient
Index
EMISWeb
GP
Community
Health
Mental Health EPR
Acute
Departmental
Systems
Anonymised
Clinical Data
Repository
Note: the systems detailed
are for illustration and can
easily be expanded.
Authentication Security Audit Logs
Complete
Record
Charts Document
Viewer
Professional View
Authentication Security Audit Logs
Appointments Messages
Patient View
Complete
Record
Health
Links
Integrated Care Record
Aggregated on demand
Consent Management
Real Time Analytics
Population Health
Research
Reporting
Care Plans
End of Life
Long Term Conditions
Now
Future
Notifications
Ambulance

19. Benefits
• Improved clinical decision making
• Improved patient management though the use of portal
information to alert and case find
• Improved quality of care
• Improved patient experience
• Improved cost effectiveness through reduced duplication
• Increased time to care through reduction in administrative
burden

20. Risks
• The system is immature or dogged by deployment problems
• Organisations fail to engage and share records
• Suppliers refuse to cooperate
• Information governance issues compromise the project or slow it
down
• We fail to realise the benefits and the business case does not deliver

21. Care Portal
Governance
Structure
STP/LHAC Governance
IMTEG
Care Portal Project
Board
Clinical
Reference
Group
User
Group
Informatics Sub
Group
Information
Governance
Group
Technical Design
Authority
Work
Packages/Sit
Rep calls with
ISC
Caldicott
Guardians
Clinical
Safety
Officers

22. First phase of systems to be surfaced in Care Portal
Sector Systems
Acute System C Medway PAS
HSS CRIS radiology results
WebV lab results
Mental Health Silverlink PCS PAS
Mayden IAPTus (IAPT)
Primary Care Summary Care Record
Mini Spine Services

23. Systems in Scope for future phases
Sector Systems
Acute Electronic Discharge Documents, Outpatient letter, E-Obs & Charting
End of Life Care EPaCCS
Local Authority Adult Social Care - MOSAIC
Primary Care TPP SystmOne & EMIS
Community WebV lab results & TPP SystmOne Community
Radiology Images EMRAD
Tertiary Sites North Lincs & Goole/Peterborough and Stamford + others
Independent Providers Test results/images

24. What’s happening now?
• Opt-out consent model agreed
• Two GP practice early adopters to test comms materials
• Preparing for public awareness campaign to commence late September
• Preparing for system testing
• User registration
• Preparing for technical and user training
• Service Desk
• Go Live end of October 2016
• Scoping systems to connect for next phase

25. What does
it look like?

26. http://lincolnshirehealthandcare.org/care-portal/
lhac@lincolnshireeastccg.nhs.uk
01522 718051