SCOTTISH CLINICAL

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WELCOME
SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel
2
SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel
3
NPfIT - Developments in Primary Care

• Dr Gillian Braunold
• Joint National Clinical Lead for GP in
• NHS Connecting for Health

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The vision for NHS IT

• To develop a system for health information that
  is
• Patient focused
• Improves patient outcomes
• Improves choice and control for patients
• Helps clinicians to make better decisions
• Reduces errors
• Is practicable/usable/effective

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The vision for NHS IT

• All sites linked
• GP2GP
• Electronic prescribing
• Choose and book
• Electronic communications
• Patient care linked through the Care Record
• Summary available 24/7
• Confidentiality and security

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The benefits for patient care

• Safety
• Records always available
• Decision support and warnings
• Increased confidentiality
• Consistency
• Support for guidelines, NSFs, pathways of care
  etc
• Choice

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The challenges in primary care

• System choice
• Getting improvement while the rest catches up
• The content of the Care Record
• Implementing GP2GP and ETP
• Ensuring we and our patients are confident about
  confidentiality and security

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The National Clinical LeadsLinkages with the
programme
Contracting And Programme management
Service Implementation And Clinical Engagement
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The roles of the NCLs

• To listen to what you and your patients want and
  to feed that back into the Programme
• To review the programme deliveries and ensure
  they are fit for purpose
• To tell you what the Programme is up to and,
  where appropriate, emphasise the positive
• To link with representative bodies

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The Reason for the NHS Care Record

• Patient safety and quality of care
• Accurate information available when needed
• Checking of prescriptions for allergies and
  interactions
• Enabling best care
• Communication between health workers
• Informing patients and facilitating choice
• Efficiency (ETP, GP2GP, less paper)

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The NHS Care Record Service

• We recommend that conceptually and functionally
  there are two records
• The Detailed Care Record
• The organisation record
• Important information from other records
• The Summary Care Record
• Extracts of key information for first contact care

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The Detailed Care Record

• The records of individual clinicians recording
  their episodes of care
• Key aspects of that record placed in Detailed
  Care Record to be shared with others
• Health professionals see their own records and
  can see key information in the records of others
  as their role allows
• Patients can choose to limit their participation

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The Summary Care Record

• A summary record for first line care
• Available to clinicians with a legitimate
  relationship to the patient
• Initially populated with key historical data from
  GP systems
• Updated as significant problems or prescriptions
  occur
• People can choose to limit their participation

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Confidentiality

• Access controls
• Role- and group-based security
• Legitimate relationships
• Audit and policing

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Limiting Participation

• Most patients will take part in all aspects
• Some may limit their participation by
• Choosing not to place some or all summary data in
  the Summary Care Record
• Not allowing access to their Detailed Care Record
  to some or all of those caring for them

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A Step on the Journey
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Principles behind the approach

• Incremental implementation of new tools
• Growth in confidence in both clinicians and
  patients
• Testing of access controls in limited controlled
  settings
• Effective piloting of plans

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Summary Record Development

• 2006B messaging facility
• Accredited practices can upload data excluding
  sensitive diagnoses to spine
• Information campaign specifically giving detailed
  information to patients of those practices
• Patients encouraged to view their summaries and
  enable sharing of their sensitive data at their
  surgeries

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Summary Record

• Initial upload
• Summary refreshed after new significant diagnoses
  recorded
• New summary is the only summary able to be viewed
  
• Old summaries hidden from view
• Present for medico legal reasons

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Limiting Participation

• Patients can ask for their data not to be
  uploaded
• Their summary message will not upload but a flag
  will be sent to note their informed dissent
• Patients can change their minds over data that
  was sent by refreshing the summary

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2006B messaging

• The rest of the service will increasingly be able
  to send electronic messages of discharge and
  other summary information to the GP
• GP will maintain the summary with key data from
  the information received

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What will a GP practice have to do?

• Electronic summaries of their patients data
• Standards of data to be accredited
• Information Governance understanding increased as
  core competency
• Caldicott Guardians
• Explain and discuss consent with patients

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PATIENT CHOICE
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NPfIT - Developments in Primary Care

• Dr Gillian Braunold
• Joint National Clinical Lead for GP in
• NHS Connecting for Health

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SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel
26
Developing a Single Patient Record

• Dr Stuart Scott
• Clinical Director ( GP)
• e-Health NHS Grampian

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Scotland Progress to Datepaper for NHS Board
Chief Executives September 2005Stream 1- short
to medium term

• CHI Number
• PACS
• ECS
• SCI Store
• SCI Gateway
• SCI DC Network
• AE System
• New Ways Waiting Time Definitions
• GCS
• Telecommunications
• ePharmacy
• Standards

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Scotland Progress to Datepaper for NHS Board
Chief Executives September 2005Stream 2
Single Record IT Product Set

• NHS HDL(2005) 46

• Exploiting what exists
• Filling the Gaps
• Planning and delivering the Single Record

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Missing from last 2 Slides?

• NHS Contact (NHS Grampian 12 UK user base)
• GP Clinical Systems

• Gpass
• EMIS
• InPS Vision
• iSOFT Synergy
• Protechnic Exeter

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NHS CfH Program Key Deliverables

• NHS Care Record Service
• Choose and Book
• Electronic Transmission of Prescriptions
• New National Network (N3)
• PACS
• NHS-wide e-Mail Service
• GP IT Systems supporting the new GP Contract

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Health Information EnvironmentThe Collaborative
Response to the ONCHIT Request for Information

• Decentralised
• Federated
• Private Secure
• Accurate
• Reliable
• Fast
• Interoperable and built on a Common Framework
• Designed to Respect and Serve Patients
• Flexible

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What the Health Information Environment is NOT

• A Big Bang Undertaking
• A Central Data Repository
• A Significant Financial or Technical Barrier to
  Connectivity
• Proprietary
• The Applications that Rely on It

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Health Information EnvironmentSignificant
Barriers

• Financial
• Technical
• Environmental
• Educational/Attitudinal

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Health Information EnvironmentSignificant
Enablers

• Financial
• Technical
• Environmental
• Educational/Attitudinal

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Recommendations to Stimulate US EHR
AdoptionJournal of the American Medical
Informatics Association Volume 12 Number 1
Jan/Feb 2005

• Expand the Health Care IT Research Agenda
• Financial Incentives to Stimulate EHR Marketplace
• Health Care IT Standard Setting
• Enabling Policy
• Educational, Marketing and Supporting Activities

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Expand the Health Care IT Research Agenda

• Increase funding to evaluate the impact of HIT in
  practice, with a focus on economic outcomes,
  costs and benefits.
• Evaluate the utility of open source or public
  domain software for EHR and implementation and
  maintenance methods for such systems.

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Financial Incentives to Stimulate EHR Marketplace

• Establish financial incentives for the use of EHR
  in practice.
• Capital availability Establish low-interest
  loans or a grant program to facilitate hardware
  and software adoption in health care settings.
• EHR Certification and Accreditation Establish a
  process to certify EHR products as having
  requisite functionality in accordance with
  accepted standards and an accreditation process
  for level of use of EHR in practice.

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Health Care IT Standard Setting

• Coordinate existing efforts to specify essential
  standards for basic EHR functionality, data
  representation, and messaging.
• Specify a minimal clinical data set covering a
  patients demographics, medications, medical
  conditions, allergies, advance directives, and
  selected data pertinent to patient safety and
  health care quality.
• Specify minimal functional standards for HIT
  systems in acute care and inpatient care
  sittings, personal health records, and key
  functional components such as computer-based
  physician order entry.

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Enabling Policy

• Promulgate Medicare Modernisation Act relaxations
• Establish federal policy on clinical data
  ownership and stewardship.
• Establish policy framework for Regional Health
  Care Information Authorities.
• Establish US national licensure in the health
  professions.

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Educational, Marketing and Supporting Activities

• Establish educational and marketing campaign for
  the public Got EHR?
• Establish educational campaign for health
  professionals.
• Establish educational campaign for health care
  management.
• Create a National Health Care Information
  Technology Resource Centre.

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NHS Scotland Single Patient Record The Vision
Where to?
The vision is a single health care record for
each patient jointly managed by patients and
professional NHS staff with in-built security of
access governed by patient consent.
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NHS Scotland Single Patient Record The Vision
Why?
All relevant information will be available to
healthcare professionals and to patients
themselves whenever and wherever they need it.
Built around the record will be features and
facilities to support the healthcare process.
Examples include test requesting, appointment
scheduling, and prescribing.
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NHS Scotland Single Patient Record The Vision
How?
This vision involves many technical, clinical,
organisational and people challenges. As part of
managing these challenges, a high risk big bang
migration to a completely new single IT system
will be avoided. Hence in the short to medium
term we will work toward the vision by building
the single record through linkage of existing
systems and filling gaps where necessary, This
progressive approach means that new initiatives
and implementations are managed coherently as
intermediate steps towards the vision.
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Possibilities

• A single application that is used by everybody
  to do everything.
• A single core application working with specialist
  applications.
• A limited range of best of breed applications,
  used by everyone to do everything in an area
  (e.g. a clinical speciality), with the core
  applications joined together.
• An information hub holding information for a
  patient, everyone uses this information but can
  choose which application they use to do so.
• An information hub as before but this is accessed
  by a limited number of core applications.

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My Choice

• A single core application working with specialist
  applications.
• England are kindly finding the development of 3
  such systems
• NHS Scotland should choose the best fit for our
  needs
• QED

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SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel
47
SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel
48
NI

• Information Needs in Nursing
• SCIMP
• 2nd November 2005

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NI
Overview and Challenges Part One
What information do nurses need?
When and Where do nurses need information?
Why do nurses need information?
How do nurses obtain that information?
Kathy Dallest Part Two
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NI

• What information do
• nurses need?
• Raw data, concept representation, data elements
  and minimum data sets.
• Nursing care elements nursing diagnosis,
  interventions, outcomes and intensity.
• Patient demographics PIN, DOB, sex, ethnicity.
• Service elements encounter/admission date,
  discharge/termination date.

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NI

• Challenges Value
• Defining outcomes
• Role of the nurse
• Advances in healthcare delivery
• Expectations
• Governance agenda

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NI

• When and Where?
• Information Seeking behaviour routine, task
  oriented or triggered by patient need
• Information Sources patients carers,
  colleagues, guidelines, other information systems
• Information Characteristics accurate, relevant,
  succinct, readily available

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NI

• Challenges Wealth of Information and growth
  in knowledge
• 25 time collecting and using information (Audit
  Commission 1995)
• 50 knowledge acquired during training is
  obsolete (McCormic 1984)
• Nursing Outcomes

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NI

• Why to nurses
• Need information?
• Clinical decision making
• Co-ordination of care
• Communication
• Planning

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NI

• Challenges the right information, right time,
  right person, right decision.
• Using information
• Involving patients
• Patient safety
• Sharing information

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NI

• How can nursing
• information needs
• be met?
• Technology
• Knowledge management
• Whole system approach
• Redesign

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NI

• Challenges managing complexity and change
• Involving Users
• Information skills
• Resources
• Culture

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SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel
60
Information Needs in Nursing

• SCIMP Conference
• 2 November 2005

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• What the current situation is
• Why this cannot continue
• What we are doing about it
• Moving Forward

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Kerr Report

• Integration of services
• Common information and Communications technology
  system

The need for a common information system and
communications technology (ICT) system that
provides the glue for an integrated NHS seems
to be a universally accepted requirement
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Single Healthcare Record
Some summary some detail
Community Nursing, HVs, AHPs
The Information Sharing Model
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Framework for NMAHP eHealth

• Leadership and Engagement
• Standardisation for clinical recording
• Learning and Personal Development
• Access to ICT and IM
• Best Practice (eHealth)
• Implementation
• Improving Service Level Information

In the context of Single Record Strategy
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• National NMAHP eHealth lead
• NMAHP eHealth leads in Boards
• National event Feb/March 2006
• Managed Knowledge Network e-library
• NMAHP eHealth Strategic Group
• Strong NMAHP perspective

• Leadership engagement
• Standardisation for clinical recording
• Learning and personal development
• Access to ICT and IM
• Best Practice in eHealth
• Implementation
• Improving service level information

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• National Clinical Dataset Development Programme
  (ISD)
• National Library of electronic Clinical Templates
  (eCHIP Feasibility)
• AHP Census Project (ISD)

• Leadership engagement
• Standardisation for clinical recording
• Learning and personal development
• Access to ICT and IM
• Best Practice in eHealth
• Implementation
• Improving service level information

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• eHealth Knowledge and Skills Framework
• Educational requirements

• Leadership engagement
• Standardisation for clinical recording
• Learning and personal development
• Access to ICT and IM
• Best Practice in eHealth
• Implementation
• Improving service level information

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• Identification of the gap
• Filling the gap

• Leadership engagement
• Standardisation for clinical recording
• Learning and personal development
• Access to ICT and IM
• Best Practice in eHealth
• Implementation
• Improving service level information

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• Show where NMAHP involvement is making a
  difference
• Positive impact on better patient care and
  service delivery

• Leadership engagement
• Standardisation for clinical recording
• Learning and personal development
• Access to ICT and IM
• Best Practice in eHealth
• Implementation
• Improving service level information

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• Identification of solutions within Single Record
  Programmes
• Infrastructure Programme Board is commissioning
  an option appraisal

• Leadership engagement
• Standardisation for clinical recording
• Learning and personal development
• Access to ICT and IM
• Best Practice in eHealth
• Implementation
• Improving service level information

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• Filling the data gap (ISD)
• Group-based Health improvement activity
• Standardised datasets for service level
  requirements (ISD)
• Practice Team Information (PTI)
• Workforce/Workload information

• Leadership engagement
• Standardisation for clinical recording
• Learning and personal development
• Access to ICT and IM
• Best Practice in eHealth
• Implementation
• Improving service level information

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Moving Forward

• Collaboration
• Communication
• Consider patient need
• Equity in support for reference groups
• Recognition of similarities and differences
  

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SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel
77
SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel
78
SCOTTISH CLINICAL INFORMATION MANAGEMENT
IN PRACTICE (SCIMP) CONFERENCE
PUTTING IT INTO PRACTICE 1st 2nd November
2005 Dunblane Hydro Hotel