What does the electronic health record mean for mental health services Voting

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What does the electronic health record mean for
mental health services?Voting !

• Dr Simon Eccles
• National Clinical Director

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Voting - breakfast

• I had a proper breakfast before coming here this
  morning
• Yes
• Sort of
• Do biscuits count?
• No

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Mayor of London
Ken
Brian
Boris
None of these
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What does the electronic health record mean for
mental health services?A tour of NHS Connecting
for Health and the NHS Care Record Service

• Dr Simon Eccles
• National Clinical Director

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Confidentiality and sharing

• Mental Health services health
• Need for confidentiality
• Desire for better information sharing
• The benchmark for our solutions

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First QUESTION

• How much do you know about the NHS Care Records
  Service?
• A lot
• A little bit
• Not very much
• Nothing

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Some terms

• Client patient service user
• Clinician nurse / hospital doctor / GP /
  community doctor / allied health professional
• PDS Personal Demographics Service
• The summary and detailed care records
• SUS the Secondary Uses Service

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The Effectiveness challenge

• Right patient
• Right time
• Right treatment
• With the minimum effort
• for the patient
• for all staff

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The Connecting for Health Programme aims to join
up all points of care
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Second QUESTION

• How happy are you for your health information to
  be put into the NHS Care Records Service?
• Very happy
• Happy but want to know more
• Somewhat concerned
• Very concerned
• Dont know

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So when its all in

• The health service should become far more user
  friendly
• Your secrets stay secret
• Your basic health details are known to those
  treating you, wherever you are
• The service is easier to access and use
• The service feel more personal and responsive to
  you

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Understanding the record
The clinical encounter record
The clinical encounter record
Detailed Care Record (local)
Detailed Care Record (shared) including
Pathway of Care
Summary Care Record
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Summary record

• Available anywhere
• Starts with medications and allergies, then GP
  summary, then OPD, Inpt and ED discharges
• Later results and care plans

Detailed record
Organisational notes the Electronic Patient
Record or EPR Initially organisation specific
later able to cross local boundaries (primary
care, community and hospital)
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The Summary Record

• Where
• Unscheduled care
• First point of contact
• Where notes are not available
• The Emergency Department
• Out of Hours
• Ambulance

• Why
• Improving patient care
• Providing a common messaging standard
• Allowing doctors to see each others thinking
• Allowing patients to see their records

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Healthspace

• Patient access to the summary record
• Giving patients ownership of their records
• The ultimate accuracy check
• Or is it? (30,000 records)
• Empowering patients in their health and care

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Third QUESTION

• How will the introduction of the NHS Care Records
  Service affect service user confidentiality
• More confidential than existing records
• Less confidential than existing records
• No change
• Dont know

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Fourth QUESTION

• How will NHS Care Records Service affect the
  control people have over their care?
• Not at all
• Give service users less control
• Give service users more control
• Dont know

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Change in practice

• Whose notes are they anyway?
• An end to humour and asides
• 2 screens, 2 keyboards

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Chronic conditions
CPN
Cons
CPN
GP
GP
CPN
NS
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Chronic conditions
GP
GP
CPN
NS
Cons
CPN
CPN
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Chronic conditions
Inpatient
GP
GP
CPN
NS
Cons
AE
CPN
CPN
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Chronic conditions
GP
GP
CPN
NS
Cons
AE
CPN
CPN
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Where are we in secondary care?

• CSC
• iSOFT
• BT
• Fujitsu
• Cerner
• Rio

Bolton
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Infrastructure

• A secure private network for the NHS not www
• Chip and PIN smartcard access
• An electronic bookings service
• A secure e-mail service (with encription)
• Digital x-rays
• Digital prescriptions
• GP2GP notes transfer
• Secondary Uses Service

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Key systems
Blue October 2006 Red October 2007
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Confidentiality data access

• Perceived as our biggest risk.
• Who gets access to patient data?
• What are the controls?

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So what are the protections?
NHS VPN terminal then Chip and PIN access (NHS
Smartcard)
Role based access controls
Legitimate Relationships with audit and alerts
Sealed Envelopes
The Care Record
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System access controls

• Getting in registration, authentication,
  intrusion detection system 6 firewalls

Monitoring who does what audit trails
Alerting potentially inappropriate actions
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Alerts

• What gets alerted?
• Creation of self-claimed legitimate relationships
• Override of patient dissent
• Attempted access to stop noted records
• access to patient sealed envelopes outside
  authors workgroup
• What happens to the alert?
• Goes to organisation of user triggering alert
• Recorded in national alerts database, and
  optionally e-mailed to nominated person(s)
• Authorised users access, review and close their
  own alerts in alerts database
• Each organisation chooses who receives and deals
  with them, Information Guardian expected to have
  oversight
• National guidance expected on how to deal with
  alerts, but not prescriptive

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Role based access

• Porters clerical staff pharmacists doctors
• Different roles different levels of access
• Controlled by your organisation, not CFH, linked
  to the Electronic Staff Record

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Legitimate Relationships

• Access only to your own patients
• Existing and referred (inc. self-referred)
• Self-declared LRs are possible but trigger an
  alert.
• Workgroup based these can be small or larger
• A clinic, a department, a service

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National Summary Care Record
St Elsewheres Trust
Mental Health Services
Anytown Surgery
Abuse