John Clark, Lead Clinician CLEFTSiS and Trudie McDonald, Network Manager

1. An electronic patient record for CLEFTSiS – the National Managed Clinical Network for Cleft Services in Scotland John Clark, Lead Clinician CLEFTSiS and Trudie McDonald, Network Manager

2. The CLEFTSiS EPR project A pilot funded by the Scottish Telemedicine Action Forum (STAF) to develop an EPR linking 5 sites; • Perth (Admin Centre for the MCN) • Aberdeen • Edinburgh • Glasgow • Inverness.

3. The CLEFTSiS EPR project Requirement an electronic patient record which includes images (photographs, video, radiographs) and sound recordings. Application to STAF for funding Procurement Undertaken within the framework of EC/WTO rules governing Public Sector procurement under the direction of the Head of the Business Advisory Group of the Information Services Division (ISD). AxSys Technology commissioned to develop the EPR base on their system

4. Background to the UK cleft service Concerns about the quality of care • The Clinical Standards Advisory Group (an independent source of advice to the UK Health Ministers and to the NHS) was asked to investigate the care provide in the UK. • Resources should be concentrated in 8 - 15 UK centres instead of the current 57. There should be one centre in Scotland

5. The Scottish solution Between 70 and 120 live births per year

6. Care extends from birth to 20 years

7. Reorganisation of Scottish services following the CSAG report A Managed Clinical Network (CLEFTSiS) was established in April 2000 to provide and co-ordinate the highest standard of care for patients with cleft lip and/or palate, as far as possible in their own locality, to agreed national standards and guidelines. There would be only one centre – Scotland – with not less than two WTE cleft surgeons vested in three people who undertake surgery according to an agreed common protocol.

8. Combined clinic and treatment sites

9. The Managed Clinical Network

10. HDL (2002) 69 PROMOTING THE DEVELOPMENT OF MANAGED CLINICAL NETWORKS IN NHSSCOTLAND “A key factor in the success of MCNs is the use of integrated clinical information systems that span traditional organisational barriers”

11. A patient record familiar to clinicians.

12. Patient registered

13. Appropriate master protocol attached

14. Cleft lip and palate protocol attached

15. Relevant network personnel assigned to the patient’s Health Board

16. Clinicians reminded to collect audit records

17. Audiology audit form

18. Records collected • Audit forms • Photographs • Study models • Radiographs • Video/sound recordings • Progress notes

19. Record attached to EPR

20. Progress notes

21. Patient review summary

22. Special form activated from review summary

23. Reports

24. HDL (2002) 69 • Provide more accurate ant timely information on the results of patient care and treatment in real time for the multidisciplinary team • Connect patients with their carers for health education, disease prevention / management, and health promotion • Promote professional education and implementation of agreed clinical guidelines • Facilitate the tracking of patients through the healthcare system for the purposes of audit and quality improvement according to criteria defined by SIGN and Quality Insurance Scotland

25. Challenges • Training Network members • NHS Net • Stretched IT resources in Trusts • Difficulty in obtaining funding for additional licences and ongoing support

26. Thank you! to • You, the audience for your attention • STAF for funding the project • CLEFTSiS members for their contribution and on-going support • The staff of AxSys Technology