Area Expected benefit Financial but releasing Public / Societal Joined-up, integrated care delivery Clinicians in different care settings can access the same patient records, saving them time and effort X Patients will experience greater continuity of care and less inconvenience as they are treated in different parts of the care system X Care records can be exposed to clinicians on portable devices, enabling more options for developing patient-centred care provision X Improved efficiency of care provision Bed capacity will be up for hospitals through faster discharge processes X Unplanned hospital readmissions will be reduced as care record sharing enables more effective discharge and step-down planning X Reduction in unnecessary tests and investigations as clinicians can access results from elsewhere X Improved effectiveness of care provision Patients suffer less harm and receive more clinically appropriate care as clinicians are able to access more complete information about allergies, past reactions and risk factors X Patients will receive more care based on their personal preferences X Clinicians will be better equipped to manage complex co-morbidities X Care providers will have clinical improvements (eg hospital mortality, sepsis prevention) recognised by regulators X cash
Hospital clinical improvements recognised by regulators 2 0 0 2 4 3 6 4 8 <etc> - - - - - - - - - Total scores 100 0 38 48 55 Summarise here the relative ranking of the options in terms of qualitative benefits along with a rationale for highlighting any particular option as the preferred choice on quality grounds. Risk assessment Each of the short-listed options will have a certain level of risk attached to them. This is because of biases unwittingly inherent in the appraisal and the risks and uncertainties that materialise during the design, build, and operational phases of the project. This section of the economic case provides high-level analysis of these risks. High-level risk assessment of the short-listed options – example Type Risk description Option 1 Option 4 Option 5 Option 6 Status Quo Federated Central hub £ £ £ £ Business Funding uncertainty Low Med Med High
Business IG challenges Low Med Low Med Business STP priorities change High Med Med Med Service Cost / programme overrun Low Med Low Med Service Complexity of legacy systems High High Med Med Service Data breach or security failure Med High Med Low Service Reputational damage if not fit for purpose Med Med Low Med Service Clinical needs not met High Med Low Low Service Cannot track the benefits High Low Low Low Service Vulnerable patients pressured to share data Low Med Med Med External New breakthrough technology emerges High Med Low Med External Future NHS High Low Low Low Overall risk assessment Med Med Summarise here the relative ranking of the options in terms of risks along with a rationale for highlighting any particular option as the preferred choice. If it is also possible to generate a quantitative financial value of the cost of risk of each option, then include it here.
Sensitivity analysis Use this section of the economic case to subject the preferred option to a sensitivity analysis. In other words, if one or more key financial risks was to materialise, how would this change the economic appraisal of the options. Would it still be the preferred option? By how much would the underlying assumptions need to vary to produce a different ranking of the options? Conclusion - the preferred option Summarise here the preferred interoperability option based the economic case and the rationale for choosing it. This will include an overall assessment of the option against the key service requirements, the spending objectives for the programme and the critical success factors highlighted, along with an analysis of the economic costs, benefits and net present value of the scheme, together with an assessment of the qualitative (non-financial) benefits, risks and sensitivity of the preferred solution. 1 – Interoperability dimensions There are a multitude of potential options available to each interoperability programme based the specific context. To consider these fully, it is important that there is a structured process for considering the long list of potential options and the different dimensions of possible options. Local health communities developing the business case for interoperability are encouraged to combine the knowledge, experience and views of a wide range of stakeholders including – but not limited to – clinicians, managers, technical specialists, patients and commissioners. The following checklist may help when brainstorming potential options for the local interoperability programme: Scope of stakeholder involvement. This will be a function of geography and stakeholder support. While the benefits of interoperability will increase as more stakeholders are involved (because the patient/citizen history will be more complete), the risks of localism, protracted decision making and the costs of delivery also increase Scope of data flows. The more data sources that are included in the interoperability programme, the more complete the patient/citizen history will be and the benefits of clinical and administrative workflow will increase but the costs and risks of information exchange and system interfaces will also increase Incremental or new build strategy. A new interoperability programme could be developed to incrementally build on a mature interoperability site in a neighbouring geography or a decision could be made to start a ‘greenfield’ interoperability site
accessing multiple systems Reduction in unnecessary referrals £395,000 (for 10,000 users) BNSSG Connecting Care Reduction in admissions/ readmissions £1,040,000 (for 10,000 £3.00 per head of population £1.70 per head of population BNSSG Connecting Care Arkansas Lancashire Reduction in delayed discharges £160,000 (for 10,000 users) BNSSG Connecting Care Reduction in unnecessary home visits £70,000 (for 10,000 BNSSG Connecting Care Reduction in duplicate assessment £180,000 (for 10,000 users) BNSSG Connecting Care Reduction in requests for assessment £90,000 (for 10,000 BNSSG Connecting Care Reduction in Length and complexity of Stay £0.94 per head of population £1.00 per head of population Arkansas Lancashire
Pre-delivery – design and build, up to the acceptable delivery of the service and commencement of the payment stream price/costs The service provider(s) are given an incentive to deliver services to time, specification and cost. This element involves a fixed price for the delivery of ‘agreed outputs’ within a fixed timetable, with appropriate remedies in place for delays and cost over-runs. Payment on the delivery of agreed outputs This element links payment to the delivery of key service outputs and does not commence until the contracted services come on stream, as agreed.
The Financial Case The financial case demonstrates that the “preferred option” will result in a fundable and affordable deal. It is concerned with issues of affordability and sources of budget funding and covers the lifetime of the programme and all costs. This section will set out the forecast financial implications of the preferred option for implementing an interoperability solution (as set out in the economic case) and the proposed deal (as described in the commercial case). It should include the anticipated payment stream for the project over its intended life span and how this will be funded. Any requirement for external funding must be supported by clear evidence of commissioner support for the scheme, together with any funding gaps. Introduction The purpose of this section is to ascertain the affordability and funding requirements of the preferred option, in relation to the other short-listed options; and to demonstrate that the recommended deal is affordable. In practice, this involves determining: the financial profile of the short-listed option the impact of the proposed deal – its capital and revenue consequences – on the organisations’ income and expenditure account and balance sheet Methodology and assumptions Provide a description here of: the financial model and the associated methodology any underlying assumptions (for example, interest rates, inflation, taxation, capital charges, depreciation etc) the proposed funding structure Income and expenditure impact The preferred interoperability solution (as identified in the economic case) delivered through the selected procurement route (as determined in the commercial case) will cost a total of £xxx over y years, as set out in the summary below.