<p>HOW TO WIN THE INTEGRATED CARE PATHWAYS CHALLENGE Whether you are mapping pathways for your CCG, developing your Sustainability and Transformation Plans (STPs), or if you are an accountable care system, Map of Medicine has the solutions to support you to work more effectively. CO-ORDINATE YOUR CARE SERVICES AND SUPPORT YOUR CLINICIANS GET PATIENTS ON THE RIGHT CARE PATHWAY FOR YOUR LOCAL AREA IN ONE POWERFUL, INTEGRATED SOLUTION. Our mission is to help you to develop co-ordinated planned care pathways and to share your local guidance across your health economy to ensure that all healthcare professionals, in all care settings, have a single source of knowledge to support their decision making. 2 3 OVERVIEW Our care pathways experience Let’s define what a care pathway is DESIGNING CARE PATHWAYS Why is it so important to have system-wide care pathways? Designing pathways: who, when and how? Let’s talk timelines for pathway transformation So who should be involved designing the ideal care pathway? SHARING INFORMATION AT THE POINT OF CARE How do you communicate the pathways to the healthcare professionals that need to know them? CASE STUDIES Signposting of local services Bringing together integrated care organisations to develop care pathways Benefit to GPs Care pathway development and rapid uptake .05 .07 .10 .12 .14 .15 .18 .23 .22 .24 .25 H O W T O W IN T H E IN TE G R AT E D C A R E P AT H W AY S C H A LL E N G E C O N T E N T S OVERVIEW SECTION ONE 4 This e-book is designed for anyone interested in improving the way in which care guidance is communicated to clinicians during patient consultations. It will help you understand the benefits of implementing a care pathway programme that unites all aspects of the care community, with patients at the centre.” Jennifer is a Senior Programme Consultant at Map of Medicine. Her expertise is in change management, stakeholder engagement and major change implementations in environments where behaviour and cultural change is required at all levels, to secure implementation success of each project. OUR CARE PATHWAYS EXPERIENCE Jennifer Dennington “I know first-hand the pressures facing healthcare and I’ve seen how great decision support technologies can help our NHS work more efficiently. However, the true power of decision support and other technologies lies within having locally relevant clinical evidence and an adoption strategy that works for your locality. I’ve been working with healthcare organisations across the country to help them drive down unwarranted variations in GP referrals by providing them with a proven structure to do this, and the findings have gone into this e-book. 5 Jeff Dienhart For more than 30 years, Hearst Health International’s solutions have been helping the NHS to deliver actionable evidence into the hands of clinicians. Our care guidance and decision support solutions enable NHS organisations to address both national and local strategic goals, and drive change through their clinical and partner teams. In the last year alone, Map of Medicine and FDB OptimiseRx have been used by vanguard communities and integration pioneer CCGs to support new care models, while FDB Multilex and ZynxOrder are Jeff is the Senior Managing Director for the International businesses of Hearst Health, including Map of Medicine. 6 supporting health care professionals in recently announced digital exemplar trusts. We’ve learnt a lot over the years, and through this e-book hope you will benefit from some of the expertise our teams are sharing with your neighbouring NHS organisations. Hearst Health International are always seeking to improve and innovate our clinical decision solutions to better address the NHS’ evolving care models and outcome priorities. We look forward to hearing of your latest plans and goals, and hopefully having a chance to help you to achieve them. LET’S DEFINE WHAT A CARE PATHWAY IS... 7 A good care pathway should include all aspects of health and social care, not forgetting self-care, and importantly should move the patient towards a defined positive clinical outcome. All of this should be based on the best clinical evidence available, from reputable evidence-based sources, such as NICE, SIGN and the Cochrane Database of Systematic Reviews. A care pathway is the ideal journey of care that a patient should receive within a healthcare community. Visualise the patient journey from presentation to referral Redesign pathways and base discussions on evidence-based best practice Promote self-care and share decision making Introduce a governance structure to maintain local pathways Standardise diagnostic work-up of patients Communicate a standardised clinical approach Highlight red flag clinical features requiring urgent assessment Co-ordinate care and referrals more effectively 8 Map Pathways is the ideal starting point for turning care pathway plans into real resources that clinicians can interact with at the point of care. DESIGNING CARE PATHWAYS SECTION TWO 9 WHY IS IT SO IMPORTANT TO HAVE SYSTEM-WIDE CARE PATHWAYS? The Five Year Forward View and the GP Forward View lay out the need for the NHS to break down barriers between GPs, hospitals, social, physical and mental health care to provide an integrated service that delivers a seamless journey for patients. NHS England stated that for health care to be integrated it must be person-centred, coordinated, and tailored to the needs and preferences of the individual, their carers and family. This means moving away from episodic care to a more holistic approach to health that puts the requirements and experience of patients at the centre of how services are planned and provided. There are significant challenges in making this a reality in everyday practice, not least in managing patient flow through referrals to the most appropriate areas of care. NHS England’s planning guidance asks NHS organisations to proactively develop locally agreed pathways as part of their ‘Local Digital Roadmaps’ and improve the communication of care pathways and decision support using digital technologies by March 2019. Solutions such as those from Map of Medicine can help to enable organisations to go paper-free at the point of care. 10 Map Pathways includes evidence-based pathways on on musculoskeletal conditions, gastroenterology, urology, dermatology, paediatics, eye health and many more. There are also thousands of locally developed care pathways from many organisations across the NHS – so you can share best practice, and learn from peers. Mental health Long term conditions Child health Self care Earlier diagnosis Prevention 11 DESIGNING PATHWAYS: WHO, WHEN AND HOW? We’ve been working with local health economies for more than 10 years and we understand that no two organisations are the same. Location, demographic make-up, rural or urban, make every CCG unique. Local services and provisions also different by CCG, which is why Map of Medicine solutions can be localised to reflect this diversity. No-one knows the local health community and its challenges like the local clinical team, which is why it’s important to bring together clinical champions. This understanding allows commissioners and planned care teams to put in the right measures across their area, which they know will help improve the health outcomes of their patients. 12 Expert care pathway development Point of care Repository of knowledge GPs Planned care Social care Commissioners Community care Clinical governance 13 “As well as improving the technical aspect of disseminating local best practice, Map of Medicine’s care pathway experts can help improve the human side. My team of clinical experts will work with your organisation to develop a clinical pathway strategy, and help define the areas of priority that will deliver the highest value to your organisation. By engaging and training your local teams, Map of Medicine can help to speed up the adoption process and help to ensure your local health community are adhering to your processes.” Gajan is Head of Clinical Strategy at Map of Medicine. His team of clinicians work with hundreds of healthcare professionals and health leaders to advise of clinical strategy for care pathway development. Dr Gajan Srikanthan Use high-quality evidence-based care pathways to agree your local pathways with multidisciplinary stakeholders Transform your guidance into easy to read online care pathways Approve care pathways in line with your local governance structure Connect all the knowledge around the pathway, including a repository of referral guidance and templates GP and healthcare professionals access via clinical system at the point of care LET’S TALK TIMELINES FOR PATHWAY TRANSFORMATION 14 When thinking about a timeframe for implementing a care pathway programme, allow yourself enough time, but set a schedule and stick to it. Research from Map of Medicine shows that without support from Map of Medicine, NHS organisations can spend up to 18 weeks to design just one care pathway. You might be asking yourself why does it take so long? Well, first of all, trying to get the right people in the room is a challenge in itself with many stakeholders requiring many weeks’ notice to attend or take part in a pathway review. It’s also really important to ensure that any pathways developed meet your local clinical governance standards, so allow enough time to include that within your development schedule. y Nurses CCGs 15 SO WHO SHOULD BE INVOLVED DESIGNING THE IDEAL CARE PATHWAY? NHS England say that CGs are expected to coordinate this development process, ensuring Health and Well- being Boards are engaged, as well as acute, community, mental health and local authorities. Healthcare has many key decision makers across many different locations – it’s important to consult with all stakeholders when developing your care pathway programme. To facilitate adoption and collaborative working, it’s really important that you consider the right governance process for your area. GP PATIENTS We recommend that you prepare draft care pathways, and that you invite stakeholders from across your health economy to review and provide feedback. For example, your local provider services, trust, and community care services will be able to provide feedback and information on what happens in those care settings. If it’s not possible to consult with all, then start with those that are engaged and take it from there. CCGS MULTI- DISCIPLINARY TEAMS PRACTICE MANAGERS PHARMACISTS NURSES CLINICIANS 16 Map QuickStart is a professional service from Map of Medicine which includes support in pathway development, implementation and adoption. We also give you access to a range of starter content that you can rapidly localise, known as ‘Summary care maps’. SHARING INFORMATION AT THE POINT OF CARE SECTION THREE 17 HOW DO YOU COMMUNICATE THE PATHWAYS TO THE HEALTHCARE PROFESSIONALS THAT NEED TO KNOW THEM? Now that you’ve agreed your care pathways and referral guidance, and they meet your clinical governance standards, you’ll want to start sharing them with your healthcare professionals. There is increasing pressure within the NHS to get more done in less time. This is a daily struggle across care settings, and, understandably, a problem that most would like a magic wand to help fix. 18 Map Referrals is designed by clinicians for clinicians, and helps to save clinicians time. From instantly sharing referral guidance across your CCG, to one-click auto-populated referral forms, Map Referrals removes excess administration to allow GPs more time to concentrate on patient care and improve efficiency. With a single sign on via EMIS Web, TPP SystmOne and INPS Vision, Map Referrals can be accessed instantly by GPs during a patient consultation. Map Referrals has been designed to be a central repository of localised clinical and administrative guidance that GPs can trust because it is maintained by the CCG. 19 These simple steps, and the tried and tested Map of Medicine methodology for pathway development offer a really easy way to make sure that you are on track to deliver your local care pathway programme. YOUR CHECKLIST FOR CREATING CARE PATHWAYS Understand that a good care pathway should include all aspects of health and social care Design your care pathway from high-quality evidence-based sources such as national clinical guidelines and systematic reviews Keep abreast of changes in the evidence base and update your pathways regularly Work with stakeholders from across your local health economy to agree local pathways, including acute, mental health, community care and other integrated care services Ensure care pathways are available at the point of care, and link with patient records in GP systems so that clinicians can access them at the right time Enable GPs and practice teams to access collection of referral forms that auto-populate with demographic and clinical information Develop an ongoing governance and content improvement structure so ensure that your pathway is up to date It’s a challenge that all healthcare organisations are facing, but with our help it’s a challenge that can be won, and you can transform the way in which care guidance and pathways are developed and communicated to your health economy. 20 CASE STUDIES SECTION FOUR 21 22 Map of Medicine solutions are used in all GP Practices across Sunderland, as part of the All Together Better Vanguard. GPs access a wealth of locally customised care pathways for urgent referrals and 2 week wait, long-term conditions, and guidance on the assessment and initial investigations for patients with abnormal test results. The Vanguard site has linked Map Pathways to their local Individual Funding Request (IFR) platform. This means that when a GP is following the referral guidance within an online Map Pathways care pathway, and determines that the patient meets the criteria for treatment that currently falls outside of care routinely provided by the NHS, the GP can immediately be directed to the platform in a single click to make an IFR. Furthermore, should a referral be required then the referral process can be started instantly with Map Referrals which is integrated with the GPs clinical system. Sunderland GP Alliance (Vanguard) SIGNPOSTING OF LOCAL SERVICES CASE STUDY #1 23 Map Referrals is part of NHS Cumbria CCG’s digital health strategy, which is partly funded by the Safer Hospitals, Safer Wards Technology Fund. Through this strategy, NHS Cumbria aims to transform the way in which referrals are managed across primary care, acute trusts, community and mental health trusts, and to enable commissioners and providers to proactively identify and manage blockages in patient flow. Through a comprehensive development programme with Map of Medicine, a broad range of clinical topics have been created and adapted from best practice evidence. The visual algorithmic care pathways include: guidance on commonly encountered and long-term conditions such as Low back pain and Asthma; localised guidance on 2 week wait referrals; and local referral protocols for procedures of limited clinical value. In total, 75 care pathways and referral templates have been developed and reviewed within 5 months. NHS Cumbria CCG CASE STUDY #2 BRINGING TOGETHER INTEGRATED CARE ORGANISATIONS TO DEVELOP CARE PATHWAYS 24 Within NHS Islington CCG, Map of Medicine is the single source of information for care pathways, referral guidance, and referral form templates. GPs and practice teams can access local information through Map Referrals. The CCG has received positive feedback from Practice Managers and GPs alike, expressing that Map Referrals’ central information repository is useful and supports them with bridging the gap between clinical and administrative workflows. In particular, that using Map Referrals is user-friendly and time-efficient for GPs and Practice Managers as it minimizes the need for healthcare professionals to contact individual provider services for current pathway or referral information. NHS Islington CCG BENEFIT TO GPs CASE STUDY #3 25 In NHS Cannock Chase CCG, 33 local Map Pathways care pathways have been developed, including Anaemia, Back pain, Suspected hearing loss and pathways that depict local processes for procedures of limited clinical value. The CCG’s goal is to carry out evidence-based clinical commissioning as a means of identifying those services or interventions which might be decommissioned on the basis of lack of efficacy or cost-effectiveness. Map Referrals supports the CCG’s goals by supporting GPs and primary care staff to automate referrals in line with the evidence base, and act as a central repository for all referral guidance and referral form templates. More than 17,000 referrals have been made through Map Referrals in a 3 months period alone. NHS Cannock Chase CCG CARE PATHWAY DEVELOPMENT & RAPID UPTAKE CASE STUDY #4 Our solutions include: Evidence-based care pathways to help healthcare organisations communicate best practice at the point of care Seamless solution to standardise referrals across a CCG Professional services to help kick-start local pathway programmes Map of Medicine, FDB (First Databank), Zynx Health and MCG comprise Hearst Health International. Together, we help guide the most important care moments by delivering vital information into the hands of everyone who touches a person’s health journey. With over 100 people based in the UK, our team comprises both depth and diversity of industry knowledge and expertise including medical doctors, registered nurses, pharmacists and healthcare IT specialists, dedicated to serving the NHS. We have more than 30 years’ experience of developing and implementing clinical decision support solutions with around 180 customers across CCGs, secondary care and community trusts, as well as a community pharmacies and mental health trusts. Map of Medicine understand the importance of local health communities being able to define and apply local solutions to the niche challenges affecting their area, whilst applying continually evolving best practice and clinical guidelines to their pathways. Want to find out more? Contact us today for a demonstration 0207 492 6300 </p>