Emergency Care Summary

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Emergency Care Summary

• Dunblane
• November hb2008

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NHS in Scotland

• 14 Health Boards
• Primary and Secondary Care
• 1030 Practices
• GPASS, InPS, EMIS, Ascribe
• 1 National Ambulance Board
• Scottish Government Health Department

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Agreed Dataset

• Patient demographics (address, telephone, CHI
  number)
• Allergies and Adverse Reactions to medications
• Medication history
• - Repeat prescriptions in past 12 months
• - Acute prescriptions in past 30 days
• Consent Flag
• Patient opt out status

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Progress to Date

• ECS Service pilot started in 2004
• National ECS launched in Sept 2006
• 98.5 of Scottish GP Practices connected
• Full Integration and rollout
• NHS24
• OOH
• ECS available in AE for 12 out of 14 Health
  Boards
• National Cross Border Access across all Health
  Boards in Scotland

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Progress to Date

• Over 5.2 Million Patient Records extracted
• 1400 patients have opted out of practices
  connected
• Represents 0.02 of all patients
• Over 1.5 million accesses to date and increasing
  trend in use
• Expected increase in use as new developments are
  available

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Users of ECS

• Over 5000 registered users (not including GP,
  Administrators or Audit)
• Access controlled through Local System
  Administrators in each Health Board
• System to system integration in place for
• Adastra and Taycare OOH
• NHS24
• AE Integration due in 2008
• Web access for Audit
• AE, OOH Admin, System admin (per NHS Board)

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Consent Model

• Implicit consent to extract / send the data
• Regular extract and update of information
• Explicit Consent to view ECS record
• Patients can Opt Out / In at any time
• Simple flag on GP Practice System
• ECS information is read only
• Only available to Emergency Care Clinicians

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ECS Security and Audit

• Access and security controls with passwords and
  log on for all clinicians
• Patients must give permission for the clinician
  to view their records
• Practices can check who has accessed their
  patients records
• Audit controls in place for
• Practice Reporting
• Health Board Audit
• Cross Border Audit
• National Audit

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ECS Security and Audit

• National Audit checks include
• Unsuccessful log in attempts
• Casual Browsing / suspicious behaviour
• Long periods worked (trap sharing of passwords)
• Check on practice files structure
• National Access Protocols
• Refresh of training information for Local System
  Administrators

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ECS Access Report
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Palliative Care Summary

• Macmillan Nurses led initiative
• Palliative Care Forms
• Based on Gold Standards Framework Scotland (GSFS)
• Paper process already in place in many GP
  Practices
• IT Development to assist with key patient group

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GSFS Solution

• Extension to ECS dataset to include more detailed
  information to send to OOH for Palliative Care
  patients (known as PCS)
• Move from paper to electronic information
• Reduction in faxes from GP Practices to OOH
  Centres
• Consent Model
• ECS Implied to send, Explicit to view
• PCS Explicit to send, Implied to view

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Future Developments

• Integration with National AE System
• Scottish Ambulance Service
• Preparation of Business Case
• Patient Access
• Extension of Users
• Extension of Data Set
• NO DEVELOPMENT WITHOUT CONSULTATION

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Future Developments

• Patient Access
• Extension of Users
• Other hospital departments
• Dentists
• Community pharmacists

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Future Developments

• Extension of Data Set
• Immunisations
• Special notes
• Past medical history
• Recent Consultations

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Summary

• Good progress with use of ECS
• Security built in with fully integrated solutions
• Audit at all levels with focus on inter Health
  Board Access
• Palliative Care Summary next development
• Consultation and communications in planning for
  next stage

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Questions?

• Dr Libby Morris (libby.morris_at_nhs.net)
• Jonathan Cameron (jcameron2_at_nhs.net)