eHealth in Scotland The Single Medical Record The Case for and the Journey to

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eHealth in ScotlandThe Single Medical RecordThe
Case for and the Journey to

• Kenneth Robertson

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Response to Kerr Report
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Delivering for Health

• Patients will have access to their own Electronic
  Health Record and so will all the clinical staff
  who treat them

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Delivering for Health

• Patients will have access to their own Electronic
  Health Record and so will all the clinical staff
  who treat them
• Strengthen health care in remote and rural areas
  by establishing the Scottish Centre for
  Telehealth

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Delivering for Health

• Patients will have access to their own Electronic
  Health Record and so will all the clinical staff
  who treat them
• Strengthen health care in remote and rural areas
  by establishing the Scottish Centre for
  Telehealth
• We now need to sharpen the focus on delivery.and
  that real health improvement is demonstrated

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Health Improvement Health Inequalities
Public Health
Waiting Times
Investment in Health
Access to Healthcare
Smokefree Scotland
Scotlands Health
Efficient Government
Service Redesign
Tarrifs
CHPs
Quality in Healthcare
Efficiency in Healthcare
Kerr Report
Healthcare framework
Clinical Standards
Benchmarking
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The Big Four

• The NHS as local as possible
• Systematic support for people with long-term
  conditions
• Reducing the inequalities gap
• Actively managing hospital admissions

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The Big Four

• The NHS as local as possible
• Systematic support for people with long-term
  conditions
• Reducing the inequalities gap
• Actively managing hospital admissions

Underpinned by quality information
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Whats Single Record All About?

• Patient centred single record available
  wherever care is delivered
• Patient access improved data quality and
  consent management
• Governance/Management information as a by-product
  of care
• Shared functionality across NHSScotland

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Patient involvement especially chronic disease
Prevention/Early intervention
Co-ordinationwith secondary care
Surveillance
Planning
Not sensible to have separate records(including
in Primary Care) when policy is to extend and
enhance localhealth services
Extended role practitioners
Diverse models of local provision(CHP Driven)
Peripatetic professionals
Multi-agency working
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Game Plan

• (a) Exploiting what exists
• (b) Filling the gaps
• (c) Preparing for the future

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(a) Exploiting What Exists

• Universal CHI by 6/6/6
• Clinical letters in SCI Store
• Haematology/Biochemistry results in GP record by
  March 2006
• 90 of GP referrals via Gateway by end March 2006
• Use of Gateway for discharges including AE
• ECS in OOH by June 2006
• AE June 2006

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Exploiting what exists
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(b) Filling the Gaps

• National PACS rolled out by end 2007
• Identity and Authentication service planning
• Standard desktop
• National contract for Managed Technical Services
• Use of GCS

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Filling the Gaps
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and

• More support for Community Nursing and Allied
  Health Professionals
• Infrastructure improvements
• Order communications and results reporting
• Preparation for HEPMA
• Systems rationalisation

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Generic Clinical System
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Generic Clinical System

• AxSys
• Early implementers
• Cancer
• Mental Health
• Then what?

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Emergency Care Summary

• Extract from GP systems onto dedicated national
  instance of SCI Store
• Initially Drugs, Allergies
• Later PMH and Events
• Accessible to OOH services at first Primary
  Care/NHS 24 but soon AE, Ambulance Service
• AND patients!

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Accident Emergency

• National system
• ..unless exceptional circumstances
• 11 Boards already signed up
• Vital to support Unscheduled Care Collaborative
  and Performance Review

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Why are (a) and (b) so important?

• Culture change
• Use of information standards
• Sharing of information
• Comfort with security/confidentiality
• Public education/acceptance
• Improved infrastructure
• Iterative approach to governance arrangements

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Why the emphasis on Store and Gateway?

• Big bang too dangerous
• Incremental approach to sharing information
• Vital to avoid planning blight
• Need to support the service in evolution as we
  prepare for single record working

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Useful progress
Labs
SCI Store
Letters
Generic Clinical
Emergency CareSummary
PACS
Radiology
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What do we mean by Single Record?

• Recognition that 90 of of patients interactions
  with the NHS start and end in primary care
• Therefore need GPs inside the tent

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Some core principles

• Patient-centric record
• Consent and confidentiality
• Reliable and robust networks and remote access
• Sharing based upon need/relationship

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Planning and Delivering Single Record

• What is it?
• Service Oriented Architecture
• Scenarios
• Traditional specification
• Evaluation criteria
• Engagement with the service

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Timetable

• Continuing work on Exploiting What Exists and Gap
  Filling with timetable published for many of the
  elements
• Preparing documentation in relation to single
  record procurement
• Planning/options development
• Office of Government Commerce Gateway Process
• Implementation complete by 2010

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Service Oriented Architecture

• Less procurement disease/speciality silos
• Break down working practices into functions
• Use tools to deliver requirements

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What might be the core functions?

• Identification services
• Patients
• Staff
• Authentication
• Scheduling
• Requesting
• Reporting
• Medication management

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What about Laboratories?

• We will have one way of doing things throughout
  Scotland
• Requirements analysis will begin very soon
• Laboratory staff will involved heavily in setting
  requirements, establishing evaluation criteria
  and in the decision making

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Why isnt a Single Record Good Enough?
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Scheduling Image capture
Requesting Reporting
Clinical information capture
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Clinical Scenarios

• A day in the life of..

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A District Nurses Tale - extract
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eHealth Design Approval Authority

• Scrutiny
• Rigour
• Transparency
• Context
• Expenditure
• Benefits/Risks
• Exit strategy / Migration strategy
• eHealth Register

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Acknowledgements

• Alan Hyslop
• Martin Irving
• Charlie Knox

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