Draft Deliverables - NHS Networks

Draft Deliverables - NHS Networks

QIPP Digital and Technology Vision work stream Phase 2 Online Personalised Self-Care for Long Term Conditions April 2011 V2 CONTENTS Scope & Vision Business Focus Rationale, Benefits, What is it, Who wants it. Rationale for the Vision Benefits Summary What are the components How is it delivered Stakeholders & supporters Technical Overview Architecture What is provided Nationally Implementation of National Enablers Benefits Case Detail on the benefits case 2 Scope & Vision Online Personalised Self Care for LTC Vision What are the key elements? What should a local digital vision include? Overarching Vision The following vision has been jointly developed by QIPP LTC and DTV workstreams AAfundamental fundamentalshift shiftinincare carefor forpeople peopleliving livingwith

withlong longterm termconditions: conditions: From: Not harnessing and making the most of technology to support people to be more involved in decisions From: Not harnessing and making the most of technology to support people to be more involved in decisions about abouttheir theircare carethrough throughpersonalised personalisedcare careplanning, planning,information informationand andsupported supportedself selfcare. care. To: A locally driven digitally enabled holistic approach to health and wellbeing for patients and their carers, maximising self care To: A locally driven digitally enabled holistic approach to health and wellbeing for patients and their carers, maximising self care and andsupporting supportingthe thesystematic systematictransfer transferofofpower powerand andknowledge knowledgetotopatients. patients.AApatient-centred patient-centredcare careplanning planningapproach approachand and shared management of conditions through the patients channel of choice. shared management of conditions through the patients channel of choice. A locally delivered online digital service for long term conditions to support self care and self management. Each locality should seek to provide: A locally delivered online digital service for long term conditions to support self care and self management. Each locality should seek to provide: access to online medical records (through GP practice website) access to online medical records (through GP practice website)

personalised care planning service (through a local site) that will allow LTC and End of Life patients and carers to be active partners in their care personalised care planning service (through a local site) that will allow LTC and End of Life patients and carers to be active partners in their care sharing of electronic care plans with relevant care givers (subject to patient consent) sharing of electronic care plans with relevant care givers (subject to patient consent) information flows between the medical record and the personalised care plan information flows between the medical record and the personalised care plan connect with digital patient and carer communities and online forums and directory of local services connect with digital patient and carer communities and online forums and directory of local services transact online (book appointments, see test results, online screening etc) transact online (book appointments, see test results, online screening etc) record details and provide reminders for medication record details and provide reminders for medication monitor vital signs through online smartphone applications and link with teleheath/care kit monitor vital signs through online smartphone applications and link with teleheath/care kit digital delivery of targeted information, modular e-learning materials and an online self assessment tool digital delivery of targeted information, modular e-learning materials and an online self assessment tool secure communication with the care team secure communication with the care team provide patient / carer feedback on care and services (this will also inform the commissioning process) provide patient / carer feedback on care and services (this will also inform the commissioning process) Online access to Online access to and ability to and ability to update a update a personalised care personalised care plan by patient / plan by patient / carer / integrated carer / integrated care team (subject care team (subject to patient consent)

to patient consent) Telehealth Telehealth monitoring monitoring & self care & self care tools linking tools linking with care with care plan plan Targeted information, Targeted information, signposting, modular signposting, modular e-learning, self e-learning, self assessment and assessment and service provision service provision based on care plan, based on care plan, patient preferences, patient preferences, behaviour and locality behaviour and locality Secure Secure communication communication with a health with a health professional professional through the through the patients patients channel of channel of choice choice Links to Links to moderated moderated online

online communities, communities, third sector third sector and self and self management management tools/support tools/support Ability to transact Ability to transact online online appointment appointment booking, test booking, test results and results and screening. Linked screening. Linked to care plan and to care plan and medical record medical record Patient feedback and Patient feedback and service monitoring service monitoring information captured. information captured. Supports Supports commissioners to commissioners to improve provision of improve provision of services. Linked to services. Linked to commissioning toolkit commissioning toolkit Online Online access access to to medical medical

records records for for patient / patient / carer carer Online Personalised Self Care for LTC Vision What will be done nationally to support local delivery of the vision? 1.1.Information Informationstandards standards (Minimum (Minimumdata dataset setfor forcare careplanning) planning) 2.2.Interoperability Interoperabilitystandards standards totolink information link informationfrom fromthe theGP GPsystem systeminto intothe thepersonalised personalisedcare careplan plan appointment booking, test results and other GP provided digital services appointment booking, test results and other GP provided digital services link linkwith withtelehealth telehealthsystems systems 3.3.Identity Identityand andAuthentication

Authenticationassured assuredidentity identityofofthe thecitizen citizen 4.4.Ability Abilityto toview viewthe thepersonalised personalisedcare careplan planfrom fromother othersettings settings 5.5.National NationalDirectory Directoryof ofLocal LocalServices Services 6.6.National NationalDirectory Directoryof ofeLearning eLearningResources Resources 7.7.LTC LTCCommissioning Commissioningtoolkit toolkit(developed (developedby bythe theLTC LTCworkstream) workstream) 8.8.Policy Policyguidance guidancefor forinformation informationgovernance governanceand anddata dataownership. ownership. SCOPE SUMMARY A local portal providing an interactive online personalised care plan that could be shared between patients, clinicians and carers. The patient held care plan could be populated or enhanced by information flowing from open interfaces on the local clinical systems. The patient experience would include personalised and targeted information services (such as eLearning modules, local service discovery and signposted content). Patient identity

management would be aligned with the cross-government Identity Assurance approach. Transactional services such as appointment booking could be requested but would still be delivered through local clinical systems. 6 Business Focus Rationale, Benefits, What is it, Who wants it. Rationale for the Proposition Why the focus on LTCs? There are around 15 million people living with a long-term condition in England. These people are the main driver of cost and activity in the NHS as they are disproportionately higher users of health services representing 50% of GP appointments, 60% of outpatient and A&E attendances and 70% of inpatient bed days. This means 30% of the population account for 70% of the total health and care spend. Current trends suggest significant growth in the number of very high intensity high cost users these are often people with multiple conditions or co-morbidities. While the number of people with any long term condition should be relatively stable over the next 10 years, the number with 3 or more conditions will increase by around 60%. Compared to social class I, people in social class V have 60% higher prevalence of long-term conditions and 60% higher severity of conditions, though this varies significantly by condition. Generally prevalence increases with age, though notably asthma is fairly steady at around 4% regardless of age. The average annual cost of someone without a long term condition is around 1,000; which rises to 3,000 for someone with one condition and to 8,000 for people with 3 or more conditions. The additional cost to the NHS and social care for the increase in co-morbidities is likely to be 5 billion in 2018 compared to today. Plans need to be put in place now to address the health and social care issues facing people with multiple long term conditions. The LTC QIPP workstream is working to improve clinical outcomes and experience for patients with long term conditions in England. This digital vision forms part of the workstreams ambition to maximise the use of self care and self management. People with LTCs want to be more involved in decisions about their care, they want access to information to help them make decisions and they want to understand their condition and have more confidence to manage it. They want joined up, seamless care and do not want to be in hospital unless absolutely necessary. The digital service will provide an additional channel rather than be a complete replacement for existing support and management channels, but for those who are able and prepared to make use of it the benefits can be significant. From some informal discussions with GPs and other clinicians it is anticipated that up to 20% of LTC patients could be engaged with this types of online service. Benefits Summary NHS expenditure on LTC is baselined by:

Total number of patients with LTCs 15.4m Percentage of NHS budget spent on LTCs 60% - 70% LTC engagements are estimated from Engagement volumes and unit cost by engagement type (from Channel Shift Data) The percentage of NHS expenditure on LTCs is applied to estimate LTC engagement volumes and total expenditure, by engagement, for LTCs Online adoption of LTC patients managing their conditions on line estimated between 7% and 20% For their transactional consumer services, DVLA have 51% adoption while HMRC has 67% for self assessment The projected financial benefits are: Achievable scenario 298m (20% uptake, improved efficiencies assumed) 9 What is it A locally delivered online personalised care planning service (through a local site) that will allow LTC and End of Life patients to be active partners in their care, working together with their care professionals (health and social care). A digital service that enables information flows between the GP held record and the personalised care plan, the online development of the plan by the patient, and enables the digital delivery of targeted information and learning material based around the plan. This will also allow the patient to: connect with digital patient communities allowing patients to learn from each other through online forums be able to transact online (book appointments, see test results, etc) including securely communicating with their care team to actively record/ provide reminders for their medication and monitor vital signs through online smartphone applications provide feedback on services to be able to inform the commissioning process using online rating services (e.g. DocAdvisor) share their electronic care plan with relevant care

givers (subject to patient consent) Level 3 High Compl exity Case Manag ement Level 2: High Risk Disease/ Care Management Level 1: 70-80% of LTC population self care support/ management Level 0b: At risk population who are likely to move to Level 1 but could be delayed in onset Target Population Level 0a: Healthy population who could be prevented from getting LTCs 10 Central co-ordination to promote use of Digital Technology across QIPP workstreams and local teams: What is it Features (services) of the digital service Prevention Prevention BEST PRACTICE EXISTS BEST PRACTICE EXISTS Online peer support & social community LOCAL BEST PRACTICE EXISTS BEST PRACTICE EXISTS Access/Extraction of Medical Record LOCAL NEEDS WORK

NEEDS WORK Targeted Content & Signposting LOCAL NEEDS WORK NEEDS WORK Online Screening LOCAL Diagnosis Diagnosis & & Assessment Assessment BEST PRACTICE EXISTS BEST PRACTICE EXISTS Personal Health Record LOCAL NEEDS WORK NEEDS WORK Self Management Tools LOCAL BEST PRACTICE EXISTS BEST PRACTICE EXISTS Contact Management & Preferences LOCAL NEEDS WORK NEEDS WORK Identity & Access Management NATIONAL Personalised Personalised Care Care Planning Planning NEEDS WORK NEEDS WORK

Localised Care Pathways LOCAL BEST PRACTICE EXISTS BEST PRACTICE EXISTS Online Care Planning LOCAL Initial Initial Management Management NEEDS WORK NEEDS WORK Online Learning LOCAL NEEDS WORK NEEDS WORK Alerting and Intervention LOCAL BEST PRACTICE EXISTS BEST PRACTICE EXISTS BEST PRACTICE EXISTS BEST PRACTICE EXISTS Commissioning Toolkit (For LTC) Provider Ratings NATIONAL NEEDS NEEDS WORK WORK Directory of local services LOCAL LOCAL

BEST PRACTICE EXISTS BEST PRACTICE EXISTS Online test requesting LOCAL Continuing Continuing Self Self Care Care Support Support & & Management Management BEST PRACTICE EXISTS BEST PRACTICE EXISTS Online appointment booking & repeat prescriptions LOCAL BEST PRACTICE EXISTS BEST PRACTICE EXISTS Online Patient & Clinician Communication LOCAL NEEDS WORK NEEDS WORK Patient Incentivisation LOCAL NEEDS WORK NEEDS WORK Personal Health Budgets LOCAL How is it Delivered The national vision is to deliver a locally driven digitally enabled holistic approach to health and wellbeing for patients and their carers, maximising self care and supporting the systematic transfer of power and knowledge to patients. A patient-centred care planning approach and shared management of conditions through the patients channel of choice.

This locally delivered online service will provide a wealth of self care tools, advice, education, access to medical records and care plans and communication tools. In turn, this will ensure that patients and carers have access to timely, accurate and personalised information so they feel supported and encouraged to be a partner in their own care. [NB: the national vision is not about developing a central electronic care plan] The role for the centre will be to support local development and delivery of this vision through the creation of a number of national levers / enablers. This is primarily through business as usual activities within the Informatics Directorate to develop standards and interoperability specifications. The national LTC workstream will have a key role to play in the delivery. There are a number of national enablers such as the commissioning toolkit for LTCs that they will produce and publish. They will provide a consistent point of engagement with the local LTC teams to align and accelerate the adoption of digital technology to maximise patient self-care. The local NHS will create the primary pull for the service through their commissioning mechanisms and local/regional digital initiatives. Actual delivery will either be by market suppliers or local/regional NHS development. Who wants it Key Stakeholders Who Role Status / Support Sir John Oldham QIPP U/C and LTC Lead Involved in development of the Vision and wants to provide support through the national LTC work-stream. Charlotte Quince PM for LTC QIPP Supports the vision and approach. Wants to continue working with DTV to align and help accelerate use of digital technology to maximise self-care. Rob Benson EOL Digital Lead Supports the vision and approach. Wants to continue working with DTV to create alignment for End of Life care plans.

Sophia Christie EOL & Putting Patients First Supports the vision and approach. Wants to continue working with DTV to create alignment for End of Life care plans. Dr Anne Talbot Urgent Care Work-stream lead for Dashboards Supports the vision. Dr Steven Leitner EofE LTC & Right Care Supports the vision. Julie Yaxley EofE LTC Supports the vision. Looking for support from the national enablers for the patient and workforce portal currently being developed to deliver personalised care planning and other services. Stephen Johnson & Tracy Morton DH LTC Policy Lead Support the vision. Dr Peter Short & Dr Emyr Jones & Rob Pitcher DHID NCLs Provided review and input to development of the vision and approach. Julia Coletta Y&H LTC Lead Supports the vision. Dr Shahid Ali and Dr Richard Pope Y&H Clinical Supports the vision. Looking for support from the national enablers for the patient and

workforce portal currently being developed to deliver personalised care planning and other services. John Thornbury NHS Worcs Supports the vision. Geoff Wedgewood West Mids Supports the vision. Looking for support from the national enablers for the extension of the NHS Local platform to deliver personalised care planning and other services. Dr Amir Hannan NW GP and HICAT Member Seen vision. Thinks that we need to focus on getting patient access to their GP Record and access to Pathways before the other features. 13 Technical Overview How would it work Logical Architecture 15 How would it work - Narrative Market delivered digital patient portal that provides online care planning component which adheres with a national ITK information standard. [National Enabler 1] Patient and GP develop the initial care plan using templates setup in the GP System. The plan document is then pushed to the digital patient portal using an ITK content specification based on the information standard above. [National Enabler 2] The patient is also able to access their GP held medical records through the GP system portal and can manually copy across any key information into their patient held record. The digital patient portal supports the cross-government Identity Assurance standard and enables the patient to securely logon using an existing digital identity. [National Enabler3] Targeted and personalised information is presented to the patient using sources such as a national directory of local business services and a national repository of elearning modules. [National Enabler 5 and National Enabler 6] The digital patient portal provides integration with many personal medical devices such as blood glucose meters and enables information from these to be added to the patient held record and provide analytics and alerting. 16 How would it work - Patient Scenario 1. A newly diagnosed Long Term Condition patient attends an appointment with their GP to discuss their condition and to start developing a personalised care plan. 2. The tool used by the GP adheres with the national information standard and process guidelines for personalised care planning. During

the consultation the GP discusses the benefits to the patient of using an online care plan and personal health record portal. 3. The local GP consortia have recently commissioned such a service to provide better support for their LTC patients. 4. The portal aims to help patients get targeted and personalised information about their condition, provide tailored online learning, and enable self management for the patient of their condition. 5. The patient agrees and the GP requests the practice administrator to create an account for the patient and with the recent development of cross Government services the patient is able to use their existing post office credentials to authenticate with the portal rather than having to create yet another set of username and passwords. 6. The patient receives an email with a link which asks them to authenticate via the post office service to complete the portal account setup. 7. Once the account is setup the GP requests that a copy of the care plan that was drafted in the GP System, together with details of the patients condition and medication information is sent to the patients online care plan. 8. The care plan is extracted from the GP System, by the practice administrator, to a standard format that can be interpreted by any care planning and PHR system that adopts the national standard. The care plan is then attached to a secure message within the portal and sent to the patients inbox. (No direct integration between GP System and Care Planning Portal at this point in time.) 9. The next day the patient receives an email notification to the hotmail account they use on a daily basis telling them that there is a new message in the portal. When they login they can see the new message from the practice and that the attached care plan has already been imported to their PHR and as a result the portal automatically tailors the suggested information and training modules that the patient should consider. 10. The patient decides to register for one of suggested generic online condition management training modules and completes the first module at that time, which is delivered using a mixture of video and CBT. With access to the other targeted information and having completed the first training module the patient realises they have a few question about managing their condition and decides to send a secure message from the portal to the practice asking for advice. The message is picked up by the regular triage process in the practice and one of the nurses is allocated to review the questions. The nurse replies and also requests access to see the care plan and other information held online by the patient so they can provide the best support possible. The patient receives an email notification that a new message is waiting in the portal. They are able to review the nurses response which provides them with the reassurance they need and at the same time approve the request for the nurse to have direct access to the information held by the patient within the portal. 17 Patient perspective a view of the service (care planning) experience Im really worried did not think I had a health problem Theres a lot of info to take in! I am not sure where to look for help. I did not realise that what I eat and being overweight could have such a big impact.

Simplified pathway Diagnosis & Assessment Now Future Initial Diagnosis Condition Information I had never thought about trying to set goals before. I can start a bit at a time to manage what I eat and do more exercise. Develop personalised care plan No access to medical record, pathway or clearly signposted information. Conversation with the clinical team is focused on the medical condition and I dont have the few actions we agreed written down to take away. I have access to the key information from my medical record and good information about the standard

pathway for my condition I can start to think about the actions and goals that will work for me in my own time before seeing the GP. I can document them online My GP really encouraged me and helped to refine my goals and also explain . Review & Agree Plan I was able to share my plan with my spouse who was then able to provide more support to help me achieve the goals Share Plan Tracking my progress using my mobile phone was really easy and I could soon see the benefits Use Plan 18 Patient perspective a view of the service (manage stage) experience Simplified Continuing pathway Self Care

Support & Management Now Future I need to prepare a summary of how I have been managing since the last clinic I need to book my regular clinic visit Book Annual Appointment Attend Clinic My busy working day made it hard to phone the clinic when they are open. I get a letter 3 days later with details of the appointment. I can use the digital service to book my clinic appointment. I opt for an email rather than letter to be sent with details of the appointment. system checks that all information/pr ep in place before the clinic appointment I get a text message reminder the day before the clinic appointment ( From PHR or Clinic ? ) I dont want to

take more timeoff work just to get my test results. Receive Test Results I provide some ad-hoc information about how I feel my condition has been over the last 12 months I need to take more time off work to get the test results which were as expected. I can share my personal care plan which includes the notes and vital signs I have recorded my-self over the last 12 months I get my test results online with comment from my GP who confirms they are within normal tolerance. No need to take any time-off work. I want to provide some feedback about the good treatment I have just had at the clinic

Provide Clinic Feedback I cannot find an easy way to provide any feedback on the clinic. I get a request to provide feedback about the clinic using a simple online form. 19 Delivery How will it be delivered Options Overview A number of delivery options have been considered but when framed in the context of the emerging NHS structure it is clear that the customer/purchaser for an online care planning service will need to locally driven through groups of GP Consortia perhaps supported by their PCT Cluster. In the interim the approach is to work closely with the National QIPP LTC work-stream who is starting to have the conversation with the NCB and Consortia and is also engaged with a large group of local LTC teams. The National LTC work-stream itself does not have the funding (or mandate) to commission such digital services but will have a key role in promoting the digital vision and supporting the local initiatives. A successful digital service in this space will need significant local input to ensure it provides a localised as well as personalised capability making delivery from the centre an unattractive option. It is also recognised that market forces should be allowed to play so that there is some competition between the different digital patient portals that are expected to start emerging later in the year. Therefore the recommended approach is to develop and promote a set of national enablers which will increase the speed of delivery of any local/regional initiatives and which can be used by any portal supplier. The next slides set out these national enablers the rationale for their selection and the proposed implementation plan. 21 Details of the National Enablers National Enabler - National Information standard for "personalised care planning A minimum information standard to enable consistency of data set used in different solutions and flowing between different solutions across the health and social care system. Used to support the health and care planning required jointly between LTC patient and their care team. Foundation for this is examples that already exist from DH LTC Policy and NHS local initiatives. National Enabler - Interoperability standard for information services - to link information from the GP or Departmental system into the digital patient portal

The message specification to enable repeatable/interoperable flow between clinical and Online Care Planning/ PHR Systems. Based on the information standard developed in item 1. Also used to support the transfer of care plans between different PHR Systems. Support multiple transports including a manual export/import. National Enabler - Interoperability standard for information services - to link information/events from the care plan and self management portal back to the clinical systems. The message specification to enable repeatable/interoperable flow between Online Care Planning/PHR Systems and Clinical Systems (e.g. GP, Departmental) Foundation for this is the TeleHealth work on PHMR to enable the flow of vital signs back to GP and other clinical systems. 22 Details of the National Enablers National Enabler Authentication using the cross-government Identity Assurance Standards Simple online mechanism to enable patient to re-use an existing online identity and authentication mechanism such as paypal. Makes use of the National Identity Assurance Scheme (IDA) that is currently in development by the Cabinet Office. Based on SAML standards. National Enabler - NHS Attribute provider including PDS matching for NHS number. Centralises the matching of demographic details to PDS to provide NHS number and other attributes as part of an IDA based authentication process. Required for HealthSpace and potentially as a component of the emerging technology strategy. National Enabler - Consolidated directory of local business services An open access directory to hold information about all commissioned (and other) services. Enabling patient to search for relevant and local services. National Enabler - Consolidated directory of online content, e-learning, and online decision aids An open access directory to hold information about all elearning modules/resources that are available to workforce and to patients. 23 Implementation Approach for National Enablers National Enabler - National Information standard for "personalised care planning Implementation: Creation of draft information standards for usage by local projects within 4 months National Enabler - Interoperability standard for information services - to link information from the GP or Departmental system into the digital patient portal Implementation: Creation of draft interoperability standard based upon information standard within 4 months. National Enabler Authentication using the cross-government Identity Assurance Standards National Enabler - NHS Attribute provider including PDS matching for NHS number. Implementation: Creation of a delivery programme in providing an IdA solution for Health based upon the IdA technical specifications. This would include the delivery of an IdA Hub as well as the NHS Attribute provider. National Enabler - Consolidated directory of local services Implementation: An assessment is proposed on the existing directories of services (Pathways Capacity Management System, NHS Choices, Choose and Book) to agree on the most appropriate directory of business services and the development and transition costs to deliver

a single consolidated national directory. National Enabler - Consolidated directory of online content, e-learning, online decision aids This exists (eLearning Repository) and a national directory is to be recommended through the Technology Enhanced Learning Strategy (DH Workforce). 24 Whats happening currently? Local initiatives East of England Electronic Personal Health Planning In the East of England an innovative approach is being taken to deliver an eHealth portal for patients and healthcare professionals called NHS.info which will be free of charge to the NHS and patient. It incorporates a HealthCare application store which will provide the revenue to sustain the platform. This is planned to go live in Q4 of this year and includes a free personalised care planning application. The portal has 5 main areas: Information; Education/Skills; Tools/Toolkits (under which the electronic PHP will sit); Support; Communication. Yorks and Humber Co-morbidity care planning and e-consultations A dual approach is being taken. Care planning templates for TPP S1 are now in use and being shared across the SHA. The lead clinicians who developed these templates are now looking at how to move this approach to be online and patient-centred this work is wrapped up with Microsoft and a small company called DHS. Their plan is to pilot the new solution at 1 practice in Q2 2011. West Midlands/Worcester NHS Local Plans are being developed to enabled online care planning for a number of regions within the West Midlands. There is an existing digital platform called NHS Local which would be the natural home for such a service. The team have also been talking with DHS/Microsoft and East of England to explore how/if their capabilities could be used to deliver the care planning elements. North West Co-mobility care planning, condition information sign-posting The SHA are looking at options to pilot a care planning service and have been in discussions with a company called In Touch who have developed a care planning solution My Self Care Plan. Other Regions Oxfordshire have just deployed an online tool from InTouch called My Self Care Plan to support developing care plans across the region and are actively working to embed this across their GP practices. Gloucestershire are about to go-live with the call InTouch solution in April and Bristol is also likely for the Summer. Benefits Case Benefits Summary for LTC online service Benefit Theme Area Accessibility The care plan is available through a range of channels both creation and read / update. The patient held record and plan can be shared by the patient with who they choose including family and members of the care team. Availability Creates a permanent copy of the plan and subsequent actions taken by the patient.

Time Patient and Clinical. Removes the need for all interactions between patient and care team to be face to face. Time Clinical. Removal of unnecessary steps in the process e.g. f2f appointment to get test results. Safety Patient captured information can be accessed electronically by the clinician, providing patient authorises the access. Confidence Patient. Self management possible through shared care plan, targeted information and accessible / available support network Experience Service designed around the needs of the user both patient and clinical. In the case of the patient a lifestyle experience delivered by the market. Transactional Reduction in DNAs through better scheduling and access to services, improvement in staff productivity (available time) as a result Quality Ability to probe further for information to expose history and possible undiagnosed conditions Improve online learning and education opportunities to the patient 27 Overall Benefits and Justification for online service Qualitative Financial (National scale, m) Enables patient partnership in care Patient Choice & Portability eLearning Transactions e.g. bookings Convenient access 24x7 Reminders for meds, monitoring Timely Alerted

Responses Personal Care Plan and online development Personalised and targeted Information Improve patient self efficacy Quality & Consistency National Enabler Cost Acute elective diagnostic tests doctor phone call to patie nt electctive daycases elective inpatie nt admissions first outpatie nt appointment followup outpatie nt appointment nurse phone call to patie nt acute emergency A&E type 1 atte ndance A&E type 2/3 atte ndance ambulance (999 & urgent) emergency admissions primary/ community GP appointment GP in hours atte ndance GP out of hours appointment GP phone call to patie nt NHS direct nurse appointment nurse appointment in surgery nurse phone call to patie nt prescription WIC atte ndance Grand Total Sum of LTC Reduced volume emergency Reduced app't Reduced app't (million) (NHS) demand (NHS) DNA (NHS) 55.65 0.54 94.63 26.62 8.26 0 13.01 4.34

4.2 0.54 0 0 3.36 0 15.42 2.57 3.64 0 66.20 11.03 9.94 0 0 2.67 22.05 0 0 6.01 4.2 0 0 0 19.46 105.61 0.00 0.00 9.38 11.68 0 0 2.24 1.98 0 0 4.06 12.06 0 0 3.78 79.89 0 0 826.77 5.26 58.68 7.56 9.8 0 12.94 0 112 0

45.36 7.56 6.3 2.74 0 0 14.7 1.87 0 0 3.92 0.65 0 0 23.8 0 0 0 57.4 0 0 0 7.7 0 0 0 589.4 0 0 0 1.75 0 0.38 0 901.88 111.41 153.31 34.18 NHS Total 131.95 105.61 121.87 298.90 Local evidence West Midlands eLearning and CPD Support for staff - 50m benefit over 5 years ( Market tested ) DH Expert Patient Programme Services demand reduction e.g. (7% in GP consultations ; 10% in outpatient visits ; 16% in A&E attendances ; 9% in physiotherapy use) this is mainly F2F delivery; online would be a significant contributor to achieving these figures

Commentary on estimated input parameters to Benefits Case The key parameters in the LTC Benefits Case and the rationale for the values selected are: Online adoption of LTC patients managing their conditions on line is estimated at 20% Best practice outside Health , but within Public Sector, for transactional consumer services are DVLA who have 51% adoption for online vehicle licensing and HMRC who have 67% online adoption rate for self assessment The number, type and cost of patient engagements is taken from the DH Channel Shift Report, with between 60% and 70% of total costs expended on patients with LTCs The primary financial benefits are associated with efficiency of patient engagements reduced demand, emergency admissions, DNA rate, durations and a booking administration realised through the online channel. The efficiency estimates for online, and the rationale, are as follows: Reduced number of engagements. Currently 33% of patient engagements result in Advice/ Guidance/ No Treatment. Online self management realises a better informed patient, able to receive personalised guidance in lieu of F2F advice. Across the various patient engagements, for those patients managing their LTCs online, we have a range of demand reduction between 0% and 8% (c/f 33% figure) Reduced emergency appointments same logic and efficiency as above, with efficiency improvements ranging from 0% to 8% depending on engagement type Reduced DNA rate NHS data quotes DNA rate of 10%; we have assumed that a reduction in DNA of between 6% and 12.5% (absolute reduction of 0.6% and 1.25%) 29

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  • Olympics management of the construction and commissioning of

    Olympics management of the construction and commissioning of

    Olympic and/or Jacobs should have noticed the discrepancy. Relief Valve RV-1919 No testing under conditions approximating actual operations was conducted prior to start up. Olympic did not discover that RV-1919 was not set correctly until it started operations at Bayview.