DEVELOPING THE DURHAM TRE. LESSONS LEARNED FOR THE REGIONAL ARC Dr Ian Briggs
Great Northern Care Record in 2020 Service improvement planning & commissioning Front line care GNCR 2020 Whole person Whole system Whole region Research innovation & development Open systems Assured data sharing ISG People focus Continuous improvement Access, Choice & selfmanagement
WHAT WE WILL NEED GOING FORWARD INTEGRATED CARE Cohorts of common need; nuanced complex cohorts & predictive need DATA ACCESS Extract and process data from a range of sources to improve planning OPERATIONAL EFFICIENCY A&E utilisation. LOS, home / res care. MDTs PREDICTIVE WHOLE SYSTEM MODELLING AND EVALUATION PERFORMANCE MGT SUPPORT KPI and performance monitoring benefits mapping accountability support QUALITY & PATIENT EXPERIENCE Real time quality and event prediction; risk of falls / dementia CLINICAL OUTCOME MODELLING Real time prediction of LOS, pressure ulcers, MRSA, risk of readmission
The Durham pathway dilemma + + = Unlimited opportunities for improvement Unlimited problems to solve Limited Resources
County Durham and Darlington CHC proposal Infrastructure development Unplanned care prediction Planned care and HNT Pathway analysis N3 connectivity for academia IG framework and gateway Collaboration agreements Analytics network Development plan A&E predictive flow model development Cross site surge scenarios Bed & staffing risk models On site Operation mgmt. And activity model Primary care and NEAS impact HNT planned care scenarios, activity and risk modelling Base lining & evaluation Commissioning and integrated planning support Workforce planning Predictive analysis on two pathways: dementia and hard-to-reach groups Cohort identification and risk identification Self-management support Analytical support infrastructure and evaluation Improved access and risk planning Integrated planning and evaluation Improved care and Pathway mgmt.
Durham TRE requirements Secure Interoperable access to health, care and environment data sources Link to telehealth \care self mgt data Pseudonymisation TRE. Core data mgt Analytics capability and collaboration platform Consent IG & data sharing
Third Party Data Centre NHS N3 Network NHS Data Analyst Is able to access virtual analysts workstations to test analytical models. N3 Facing Live Data Area Virtual Analyst Workstations and Data Storage to allow the live running of models Sandbox Area Virtual Analyst Workstations to allow the testing of models using anonymised data PSN Facing Live Data Area Virtual Analyst Workstations and Data Storage to allow the live running of models Sandbox Area Virtual Analyst Workstations to allow the testing of models using anonymised data PSN Local Authority Data Analyst Is able to virtual analyst workstations. NHS Data Provider Is able to upload data to a secure server on the N3 network. N3 Data Provisioning and Storage (File server and SFTP) Database PSN Data Provisiong and Storage (File server and SFTP) Local Authority Data Provider Is able to upload data to a secure server on the PSN network. ETL RBAC Data Storage VPN Access to N3 for researchers Upload of local data sets SFTP Virtual Analyst Workstations External Data API Proxy External Data Sources (e.g. weather) VPN Connection University Researcher Launches a remote desktop session on virtual analyst workstation to allow analysis of data. Data never leaves the workstation virtual environment. Durham University Partner Universities
Third Party Data Centre N3 Facing NHS N3 Network NHS Data Provider Is able to upload data to a secure server on the N3 network. N3 Data Provisioning and Storage (File server and SFTP) Data Storage Upload of local data sets SFTP Virtual Analyst Workstations External Data API Proxy External Data Sources (e.g. weather) VPN Connection Local Authority Data Provider Sends info to DU University Researcher Launches a remote desktop session on virtual analyst workstation to allow analysis of data. Data never leaves the workstation virtual environment. Durham University
Draft Schematic of ISA s for Durham Univ TRE Collaboration agreement Durham University Collaboration agreement Collaboration agreement Durham univ AIMES 'Technical ISA & Contract Aimes TRE Technical ISA owned by Durham univ covering:- Data provider 1 Data provider 2 Aggregator service*will need to be NHSD approved Research partner TRE Project 1 A&E TRE 1 Bespoke Data analytics 'process ISA, Format as per A&E, HNT ISAs Should reference 'technical ISA NB data providers remain data controllers Of their data TRE Project 2 HNT Bespoke data analytics process ISA Should reference 'technical ISA NB data providers remain data controllers Of their data TRE Project 3 EWS Bespoke data analytics process ISA Should reference 'technical ISA NB data providers remain data controllers Of their data Standards Compliance Data flows Back up TRE data mgt Accountabilities etc.
The iceberg of knowledge on infrastructure issues 4% Problems \ issues known to those making strategic decisions 100% Problems known to those managing the work 96% of potential issues unknown to strategic leaders Source: Forum Corporation
New contracting and procurement challenges with. G cloud New collaboration agreements within the region and with north west Developing joint working with local authority & primary care Front line and back office Managing the procedural differences in Academia and nhs / LA Developing Shared learning & communications opportunities to enhance Regional capability The less obvious parts of infrastructure Iceberg Developing sustainability plans next phase research bids Pathfinder work with NECS on pseudonymisation Developing Linkages with STPs and FT R&D teams to focus \ align priorities Collaborative work with FTs / private sector to look at tele health and direct feed data options
Learning from the PAST Managing the Creating the FUTURE PRESENT Common sense common knowledge common practice
Planning and service improvement Frontline care Research& evaluation the challenge for the whole system arc. Enabling safe data access in the three traditional usage areas and Managing the complexity at the interfaces
Ark requires integrated socio-technical approach Technical system Building & Physical layout Steps in the core work process Task analysis Work methods and procedures Work instructions Quality mgt system Technology Equipment, materials Common problems or variances Cycle time/value added Business strategy & organisation vision Technical system Joint optimisation Stakeholder requirements Social system Social system Benefits & Performance measures Planning Engagement and consent Governance Roles, responsibilities and reporting relationships Management structure & style Accountability culture Outsourcing, procurement and partnering Decision making practices Information sharing Pay appraisal and other personnel practices Training needs Culture and values Job attitudes and expectations
Learning from the TRE - Critical success factors Senior organisational leadership alignment with active local care organisation commitment Outcome not initiative driven - Clear business case and case for change based on regional needs Measurable health economy focussed objectives Careful change planning and preparation with adequate resourcing and implementation mgt process to get from flip chart to reality Go at the speed of the innovators High involvement of key stakeholders from the beginning e.g. IG as part of team Information sharing. Benefits identified, Concerns directly addressed New skills developed and supported in social, partnering and technical areas. If we don't have the core skills. Be prepared to outsource or learn from elsewhere recognise the costs in all partners Early demonstrable wins
Learning from TRE - potential failure factors Support commitment in words but not deeds & resource Unclear objectives No time because of short-term operational pressures Thinking this is just an analytics\ informatics development this is a system and culture change Procurement and market protection / development behaviours Lack of a regional analytics strategy People & Culture change aspects underestimated Linking this to Too many unconnected initiatives stay focused Expecting training\ one off workshop sessions to work miracles Lack of early wins leading to withdrawal of support Lack of planning, Inadequate & part time resources
Draft Schematic of next step Prototype TRE Sealed project Sealed project Sealed project Data provider 1 Data provider 2 Aggregator service*will need to be NHSD approved Research partner TRE Project 1 A&E TRE 1 Research team of duly authorized researchers \ analysts TRE Project 2 HNT TRE Project 3 EWS Teesside Sunderland Newcastle Northumbria Cumbria TRE projects? 1