The Digital 2020 Board was formed in 2016 by health and local authority partners across Bradford District and Craven with a vision that appropriate technology could be used across an integrated system to assist in the delivery of health and care services.

The Digital 2020 Board will submit Document “AK” which presents, in Appendix A, information on the Local Digital Roadmap: People Frist – Digital First.  The Roadmap is a 5 year plan and is governed by the Digital 2020 Board.

Recommended –

That the report be noted.

(Cindy Fedell – 01274 364844)

The Digital 2020 Board was formed in 2016 by health and local authority partners across Bradford District and Craven with a vision that appropriate technology could be used across an integrated system to assist in the delivery of health and care services.

The Digital 2020 Board submitted a report, Document “AK” which presented, in Appendix A, information on the Local Digital Roadmap: People First – Digital First.  The Roadmap is a 5 year plan and is governed by the Digital 2020 Board. 

Cindy Feddell, the Co-Chair, Digital 2020 and Chief Digital and Information Officer, Bradford Teaching Hospitals NHS Foundation Trust and Dr Justin Tuggey, Co-Chair, Digital 2020 and Chief Clinical Information Officer, Airedale Hospital Foundation Trust addressed the meeting.

Dr Tuggey provided examples of patient stories where people were accessing various care services at differing locations and the issues they faced with clinicians lacking all their information and patients having to repeat their medical history several times. The examples demonstrated the inefficiency and inaccuracy which could occur. 

Appended to Document “AK” was a Roadmap of an ambitious five year plan through 2020/21 that was aimed primarily at seeing the completion of the strategy to have a fully interoperable electronic health record based on two electronic records – SystmOne from TPP and Millenium from Cerner. The Roadmap was being executed through each of the local partners and was governed by the Digital 2020 (D2020) Board.  D2020 was comprised of all local partners including Bradford Metropolitan District Council.

In addition to the Roadmap all partners had plans in place to ensure that all organisations had digital patient records that were accessible anytime and anywhere. 

The Roadmap also called for progress in the following areas:-

·         Remote care to allow clinicians to care for patients from anywhere, which expedited clinical decisions and treatment.

·         Transfer of care to ensure quick and safe transfer of patient’s care between different care settings, for example, once discharged from a hospital to the care of a GP ensuring the GP had the right information in a timely way.

·         Medicines management and optimisation that intelligently helped clinicians by, for example, alerting clinicians to allergies.

·         Order and results management to expedite the diagnostic process as a critical step in diagnosing the patient and developing a treatment plan.

·         Decision support to assist clinicians, enabled by digital clinical records.

·         Asset and resource optimisation to ensure funding was used as efficiently as possible.

·         Support for the programmes of work locally and for the West Yorkshire & Harrogate Partnership (the integrated care system), the Yorkshire & Humber Shared Care Record, and the National agenda.

In addition Document “AK” provided examples of several areas where progress had moved beyond the road map and included:-

·         A transformational pathway re-design for diabetes that enabled patients to upload wellness and outcome focussed goals using mobile applications including video.

·         Advancing the application of population health analytics via Connected Bradford for example using multiple pieces of data to enable the identification of people who could be frail to support self- management and avoiding harm.

·         Bradford Teaching Hospital, in conjunction with local partners, housing of an Elderly Virtual Ward and Intermediate Care Hub, with over 200 beds, caring for people at home who would otherwise be admitted to hospital.

·         A new Paediatric Ambulatory Care virtual ward (ACE) working with GPs to allow specialist following of paediatric asthmatic patients at home, improving outcomes and avoiding hospital admission.

·         Analysis of population data to provide intelligence that local organisations could action through the Connected Bradford initiative at the Bradford Institute for Health Research.  Findings have concluded, for example, that most deprived communities had the highest air pollution rates.

·         The progression of digital initiatives to ensure solutions help clinicians to better care for patients, in particular for mobile staff, as part of a more efficient use of estate and accommodating flexible working for employees.

·         Continuing to be a forerunner for telemedicine in care homes meaning care homes had video conferring access to clinicians to support treatment and care on site to enable quicker triage, clinical advice and treatment.

A Member who was also an employee of the emergency services acknowledged that fully shared records would prevent inefficiency and would improve patient experience and safety.  The value of systems to enable the monitoring and intervention for patients with diabetes or asthma were also recognised.   The ability to share radiology pictures and prevent repeated medical tests was also welcomed.

The benefits through patients having ownership of their health records and the empowerment that would provide was discussed and it was questioned when the systems could be linked to services for disabled people in the district.  It was explained that work was on-going with a patients communication company based in the district and pilot systems would be trialled shortly.

A view was expressed that working with a company employing people with a disability would enable a better understanding of a disabled persons needs and facilitate the production of more useful systems.  

Members were reassured that D2020 were on the cusp of full integration locally.   SystmOne from TPP used in primary care and Millenium from Cerner used in hospitals did talk to each other.  There was a gap in Adult Social Care which had not yet been launched but the technology was available to do so.  Bradford was in a fortunate position because all GPs were using the same system.  The next phase would be to look at information sharing in Children’s Services.

A Member questioned if there was anything in development to reflect the patient voice in their records and it was confirmed that engagement was on-going with patient groups to investigate that initiative and to consider how that could be supported and the benefits it could bring.  Diabetic residents in the area already were able to input their health status into their records.

The Assistant Director, Transformation and  Change, assured Members that there was an awareness to remain compassionate, empathetic and careful in how technology was deployed to free up clinicians and enhance the way they practised.

A Member referred to incidents where information sharing worked well and patients were moved efficiently through the system.  Concerns were raised, however, that information about abusive patients or those with additional requirements, which other health services were aware of, had not been shared and, subsequently, ambulance crews had been assaulted or specialist equipment had not been provided. 

Contrary to the views of most Members who believed the systems could save lives, one Member expressed his dislike of digital health.  He believed that if patients suffering from mental health issues were asked similar questions at differing times they would not provide the same answers and that could provide a false assessment of their health.   He felt that emotions could not be transmitted via technology and, whilst he acknowledged that information sharing could be beneficial, he questioned the situation if patients were out of the district.

In response it was explained that currently there was no national record sharing system.  Systems across the district did talk and allowed for clinicians to hit the ground running without wasting time gathering background information.

A Member welcomed the interoperability of the systems and acknowledged the benefits of being able to monitor diabetic patients or alert residents to issues such as poor air quality or rises in air temperature which could be detrimental to health.  He acknowledged that people often had a mistrust of technology and questioned and recognised the role that the Council could have in promoting those benefits.  In response the Assistant Director, Transformation and Change, acknowledged the need to be transparent and articulate examples where the technology had been effective.   The Co-Chair of D2020 confirmed that the systems had been discussed with young people and their preference to communicate via technology.

A Member representing people with disabilities believed the technology had exciting possibilities and suggested that other applications including healthy eating and buddy systems could be added and could bring the world into people’s homes. It was agreed that people should be aware of the benefits available through the communication of success stories. 

A view recognising that once size does not fit all and the personal touch should be retained was expressed.

The possibility of record sharing to prevent people having to pay to retrieve medical records for assessment purposes was also suggested.  

Resolved –

That progress on Digital Health and Care in the Bradford District be added to the Committee’s work programme for 2021/2022.

ACTION: Overview and Scrutiny Lead