Health Informatics and Health Informatics and Chronic Conditions Chronic Conditions

A View from the Jurassic CoastA View from the Jurassic CoastAndy Hadley, MSc, MHIM, MUKCHIPAndy Hadley, MSc, MHIM, MUKCHIP

Supporting Chronic Supporting Chronic ConditionsConditions

Co-ordinating across health and social Co-ordinating across health and social carecare

When might the national care record When might the national care record deliver ?deliver ?

Problems introduced by plurality of Problems introduced by plurality of provisionprovision

Short term plans for DorsetShort term plans for Dorset What happens in year 2013 ?What happens in year 2013 ?

StrategyStrategy

10 Domains7 for RIS

How often do we need to How often do we need to access full records ?access full records ?

GP Referral/Booking

Reason for referralSigns and SymptomsPatient HistoryCurrent MedicationsAlerts and ongoing conditionsCurrent and Planned Care

Hospital Discharge

Diagnosis and TreatmentCurrent and Changed MedicationsPlanned Care by usSuggestions for follow up

Have we got time for a shared Have we got time for a shared record ?record ?

When will the software and When will the software and systems be up to it ?systems be up to it ?

Portability & connectivityPortability & connectivity Swift loginSwift login Remembering patient contextRemembering patient context

Mix of diary, what was I doing last, what’s next Mix of diary, what was I doing last, what’s next prioritypriority

Flexibility to work with personal preferencesFlexibility to work with personal preferences Portal stylePortal style Clear summaries when want them, detail if need itClear summaries when want them, detail if need it

Reminders driving the processReminders driving the process Pathways, how to guide the uncertain, but not Pathways, how to guide the uncertain, but not

disengage the expertsdisengage the experts End to end experience – single system for a userEnd to end experience – single system for a user

Who gets to share the NCRS SAP Who gets to share the NCRS SAP record ?record ?

Single Assessment

Process

General Practice

Nurse Practitioner

Health Visitor

Hospital Doctor

Accident Department

Ambulance & Control

Social workers

Help at Home Voluntary sector

Home CareContracted services

Case Manager

Mobile Release 3

Release 2

AmbulanceRelease 3

Ever ?

Ever ?

Limited Integration ?

OTs / Physios

Independent sector Hospitals/care settings

Ever ?

The Patient

Spine Summary ?Hospital Nurse/AHP

Cluster Proposed Interim Cluster Proposed Interim Architecture for SAPArchitecture for SAP

synchronization

HealthcareApplications

Local Govtusers

MillenniumAcute

GPGP

OthersCommunity,

Mental Health

NHS users

Social CareSocial Care

Local Govt Applications

HousingHousing

VoluntaryEducation

HUB

SharedRepository

Shared Form Definitions

/ View

Frameworkenvironment

Interim or “non-aligned”users – e.g. voluntary sector

synchronization

HealthcareApplications

Local Govtusers

MillenniumAcute

GPGP

OthersCommunity,

Mental Health

MillenniumAcuteMillenniumAcute

GPGP GPGP

OthersCommunity,

Mental HealthOthersCommunity,

Mental Health

NHS users

Social CareSocial CareSocial CareSocial Care

Local Govt Applications

HousingHousingHousingHousing

VoluntaryEducationVoluntaryEducation

HUB

SharedRepository

Shared Form Definitions

/ View

HUB

SharedRepository

Shared Form Definitions

/ View

Frameworkenvironment

Interim or “non-aligned”users – e.g. voluntary sector

Incorporating Independent Sector Incorporating Independent Sector Reports onto NHS Systems in Dorset Reports onto NHS Systems in Dorset

and Somersetand Somerset

NHS Number (4 points of ID)and SnomedCT investigationCodesAre vital

Indep Sector DiagnosticServicesReport

Royal Bournemouth Clinical Viewer

Poole Hospital EPR

East Dorset Community Hospitals

Electronic HL7 report

Multiple GP Systems, or Paper

Poole GP Interface Box for

East Dorset GPs PMIP

East Dorset Interface Engine (Websphere)

Electronic DICOM Images

GE PACS

Royal Bournemouth

Storrcom PACS

SouthernCluster Archive

Not yet accessible to view !

Electronic ECG Traces

Cerner MilleniumSomerset Trusts R0

For requests, see incorporating requests

“Significant Pathology”Report within 2 hoursOr Fast track with report /images in 24 hours GE PACSGE PACSGE PACS

Indigo Prompt Somerset

Interface Box GPs

Indigo Prompt Somerset

Interface Box GPs

Somerset Interface Engine (SeeBeyond)

Cerner Millenium Dorset Community Hospitals R1

Acute Trusts R2

East Dorset Interface Engine (Websphere)

West Dorset Interface Engine (SeeBeyond)

Andy Hadley, SED PCT, Feb 2006

Multiple GP Systems, or Paper

West DorsetHospitals

GP Interface Box for West Dorset GPs PMIP

Multiple GP Systems, or Paper

Image will need report and episode number to exist on cluster archive

Dorset Interim ApproachDorset Interim Approach Good existing systems – widely usedGood existing systems – widely used Go for short increments and quick gainsGo for short increments and quick gains Gain consensus where we canGain consensus where we can

Accept that dissenters may have valid reasonsAccept that dissenters may have valid reasons Integration engines to give flexibilityIntegration engines to give flexibility If NPfIT ever catch up, the learning and If NPfIT ever catch up, the learning and

experience will have been usefulexperience will have been useful Maintain a healthy scepticismMaintain a healthy scepticism

Wessex RISPWessex RISP SW EPR (Shires)SW EPR (Shires) NPfIT ?NPfIT ?

Cardio-respiratorystaff

COPD Admission Avoidance COPD Admission Avoidance

(Poole area)(Poole area)GP Clinical Systems

EMIS x 13

InPractice x 3

Isoft x 1 Poole EPR

Poole CaMIS

Clinical recordRadiology/PathologyXDOCS – clinical notesDischarge Summaries

Patient AdministrationA&E Visits, Outpatients, Waiting Lists, Inpatients, feeds Choose and Book

GPsPractice Nurses

Hospital DoctorsPORT TeamNurses

Cardiac Department- Muse system

Proposals for Electronic requesting in, and reporting out to EPRPaper

Casenote

Admin, contracting, MDS

COPD (how record ?)COPD (how record ?)GP Clinical Systems

EMIS x 13

InPractice x 3

Isoft x 1

Poole EPR

Clinical recordRadiology/PathologyXDOCS – clinical notesDischarge Summaries

EPR is alreadyaccessible in GP practices and Community hospitals

GPsPractice Nurses

Hospital DoctorsPORT TeamNurses

Cardiac Department- Muse system

Proposals for Electronic requesting in, and reporting out to EPRPaper

Casenote

PFT Testsin the practice

PFT Testson the ward & OPD

A&E and MAU AssessmentsFAX – “your patient

has been admitted” Discharge Summaries (some on EPR)

PFT and stress testsIn Cardiology

Collect audit dataPreparing for COPD NSF Minimum Dataset (MDS)

Cardio-respiratorystaff

COPD (near future)COPD (near future)GP Clinical Systems

EMIS x 13

InPractice x 3

Isoft x 1Poole EPR

Clinical recordRadiology/PathologyXDOCS – clinical notesDischarge SummariesPFT Tests - HospitalPORT informationBuilding COPD NSF MDS

GPsPractice Nurses

Hospital DoctorsPORT TeamNurses

Cardiac Department- Muse system

Proposals for Electronic requesting in, and reporting out to EPRPaper

Casenote

PFT Testsin the practice

Email or messaging “your patient has been admitted, details are on EPR”

PFT and stress testsIn Cardiology

Migration to National Care Record …Community Hospitals – Release 1 - July 2007Acute Hospitals – Release 2 – Summer 2008… at time that this is capable to incorporate

Cardio-respiratorystaff

Longer term

Walk-In Centre

Out of Hours

Nurse Practitioner

Frank Burns Frank Burns interviewed by Sean interviewed by Sean Brennan Jan 2002Brennan Jan 2002Would you advocate a national EPR Would you advocate a national EPR

solution ?solution ? I do get nervous about I do get nervous about

people far away from reality of implementingpeople far away from reality of implementing Very far away from culture of NHSVery far away from culture of NHS Who have this notion can simply contract at a Who have this notion can simply contract at a

national levelnational level I personally think it would be a disaster if I personally think it would be a disaster if

ever such an approach were attemptedever such an approach were attempted Build and roll out as for supermarket Build and roll out as for supermarket

checkouts - displays incredible naivetycheckouts - displays incredible naivety … … The higher the level of centralisation, The higher the level of centralisation,

the lower the spec.the lower the spec. The NHS IT Project - Radcliffe 2005The NHS IT Project - Radcliffe 2005

Punt says many blue-chips rushed headlong into long-term outsourcing contracts, with the result that many IT leaders failed to clarify the relationship between supplier and customer. 'Once you get beyond the deal, they're not sure what they want,' he says.'The vendor can manage the contract. As businesses change, so do third-party relationships. Provision will inevitably become more fluid and there will be a change in how such services are delivered.'Insourcing is of interest because people are acknowledging that deals are not providing benefits.'

What are the successor What are the successor arrangements ?arrangements ?

Release 2 – 2008 – start of clinical journeyRelease 2 – 2008 – start of clinical journey 10 year outsourcing deal to 201310 year outsourcing deal to 2013

Only 5 years growth, not paperless ?Only 5 years growth, not paperless ? Increasingly complex recordIncreasingly complex record Reliance on data for decision supportReliance on data for decision support Continuation of other systems to fill gapsContinuation of other systems to fill gaps

Integration with Integration with Social ServicesSocial Services Independent /private / voluntary sectorIndependent /private / voluntary sector Foundation Hospitals Foundation Hospitals Patient access, and Care at homePatient access, and Care at home