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Health Informatics and Chronic Conditions . A View from the Jurassic Coast Andy Hadley, MSc, MHIM, MUKCHIP. Supporting Chronic Conditions. Co-ordinating across health and social care When might the national care record deliver ? Problems introduced by plurality of provision

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Health informatics and chronic conditions l.jpg

Health Informatics and Chronic Conditions

A View from the Jurassic Coast

Andy Hadley, MSc, MHIM, MUKCHIP


Supporting chronic conditions l.jpg
Supporting Chronic Conditions

  • Co-ordinating across health and social care

  • When might the national care record deliver ?

  • Problems introduced by plurality of provision

  • Short term plans for Dorset

  • What happens in year 2013 ?


Strategy l.jpg
Strategy

10 Domains

7 for RIS


How often do we need to access full records l.jpg
How often do we need to access full records ?

GP Referral/Booking

Reason for referral

Signs and Symptoms

Patient History

Current Medications

Alerts and ongoing conditions

Current and Planned Care

Hospital Discharge

Diagnosis and Treatment

Current and Changed Medications

Planned Care by us

Suggestions for follow up



When will the software and systems be up to it l.jpg
When will the software and systems be up to it ?

  • Portability & connectivity

  • Swift login

  • Remembering patient context

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

  • Flexibility to work with personal preferences

    • Portal style

    • Clear summaries when want them, detail if need it

  • Reminders driving the process

    • Pathways, how to guide the uncertain, but not disengage the experts

  • End to end experience – single system for a user


Who gets to share the ncrs sap record l.jpg
Who gets to share the NCRS SAP record ?

The Patient

Hospital Doctor

Hospital Nurse/AHP

General Practice

Spine Summary ?

Accident Department

Ever ?

Release 2

Case Manager

Single

Assessment

Process

Independent sector

Hospitals/care settings

Ever ?

Nurse Practitioner

Mobile

Release 3

Ambulance

Release 3

OTs / Physios

Ambulance & Control

Limited

Integration ?

Health Visitor

Ever ?

Social workers

Home Care

Contracted services

Help at Home

Voluntary sector



Incorporating independent sector reports onto nhs systems in dorset and somerset l.jpg
Incorporating Independent Sector Reports onto NHS Systems in Dorset and Somerset

Multiple GP Systems, or Paper

Poole GP

Interface Box for

East Dorset GPs PMIP

Royal Bournemouth

Clinical Viewer

NHS Number (4 points of ID)

and SnomedCT investigation

Codes

Are vital

Poole

Hospital EPR

East Dorset Interface

Engine (Websphere)

East Dorset Interface

Engine (Websphere)

Electronic

ECG Traces

East Dorset

Community Hospitals

Cerner Millenium Dorset

Community Hospitals R1

Acute Trusts R2

West Dorset Interface

Engine (SeeBeyond)

Indep Sector

Diagnostic

Services

Report

GP Interface Box for

West Dorset GPs PMIP

West Dorset

Hospitals

Electronic

HL7 report

Somerset Interface

Engine (SeeBeyond)

Multiple GP Systems, or Paper

Cerner Millenium

Somerset Trusts R0

“Significant Pathology”

Report within 2 hours

Or

Fast track with report

/images in 24 hours

Indigo Prompt

Somerset

Interface Box GPs

Indigo Prompt

Somerset

Interface Box GPs

Image will need

report and

episode number

to exist on

cluster archive

Multiple GP Systems, or Paper

GE PACS

GE PACS

GE PACS

GE PACS

Southern

Cluster

Archive

Electronic

DICOM

Images

For requests, see

incorporating requests

Royal

Bournemouth

Storrcom PACS

Andy Hadley, SED PCT, Feb 2006

Not yet accessible to view !


Dorset interim approach l.jpg
Dorset Interim Approach Dorset and Somerset

  • Good existing systems – widely used

  • Go for short increments and quick gains

  • Gain consensus where we can

    • Accept that dissenters may have valid reasons

  • Integration engines to give flexibility

  • If NPfIT ever catch up, the learning and experience will have been useful

  • Maintain a healthy scepticism

    • Wessex RISP

    • SW EPR (Shires)

    • NPfIT ?


Copd admission avoidance poole area l.jpg
COPD Admission Avoidance Dorset and Somerset(Poole area)

GP Clinical

Systems

Cardiac

Department

- Muse system

Clinical record

Radiology/Pathology

XDOCS – clinical notes

Discharge Summaries

EMIS x 13

Proposals for

Electronic requesting

in, and reporting out

to EPR

InPractice x 3

Paper

Casenote

Poole EPR

Isoft x 1

Hospital Doctors

PORT Team

Nurses

GPs

Practice Nurses

Cardio-respiratory

staff

Poole CaMIS

Patient Administration

A&E Visits, Outpatients,

Waiting Lists, Inpatients,

feeds Choose and Book

Admin, contracting, MDS


Copd how record l.jpg
COPD (how record ?) Dorset and Somerset

EPR is already

accessible in GP

practices and

Community

hospitals

GP Clinical

Systems

Cardiac

Department

- Muse system

Clinical record

Radiology/Pathology

XDOCS – clinical notes

Discharge Summaries

EMIS x 13

Proposals for

Electronic requesting

in, and reporting out

to EPR

InPractice x 3

Paper

Casenote

Isoft x 1

Poole EPR

GPs

Practice Nurses

Hospital Doctors

PORT Team

Nurses

Cardio-respiratory

staff

PFT Tests

in the practice

PFT Tests

on the ward & OPD

PFT and stress tests

In Cardiology

A&E and MAU

Assessments

Collect audit data

Preparing for COPD NSF

Minimum Dataset (MDS)

FAX – “your patient

has been admitted”

Discharge Summaries (some on EPR)


Copd near future l.jpg
COPD (near future) Dorset and Somerset

Longer term

Clinical record

Radiology/Pathology

XDOCS – clinical notes

Discharge Summaries

PFT Tests - Hospital

PORT information

Building COPD NSF MDS

GP Clinical

Systems

Cardiac

Department

- Muse system

Email or messaging

“your patient

has been admitted,

details are on EPR”

EMIS x 13

Proposals for

Electronic requesting

in, and reporting out

to EPR

InPractice x 3

Paper

Casenote

Isoft x 1

Poole EPR

GPs

Practice Nurses

Hospital Doctors

PORT Team

Nurses

Cardio-respiratory

staff

PFT Tests

in the practice

PFT and stress tests

In Cardiology

Walk-In Centre

Out of Hours

Migration to National Care Record …

Community Hospitals – Release 1 - July 2007

Acute Hospitals – Release 2 – Summer 2008

… at time that this is capable to incorporate

Nurse Practitioner


Frank burns interviewed by sean brennan jan 2002 l.jpg
Frank Burns interviewed by Sean Brennan Jan 2002 Dorset and Somerset

Would you advocate a national EPR solution ?

  • I do get nervous about

    • people far away from reality of implementing

    • Very far away from culture of NHS

    • Who have this notion can simply contract at a national level

  • I personally think it would be a disaster if ever such an approach were attempted

  • Build and roll out as for supermarket checkouts - displays incredible naivety

  • … The higher the level of centralisation, the lower the spec.

  • The NHS IT Project - Radcliffe 2005


Slide15 l.jpg

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 arrangements l.jpg
What are the successor arrangements ? 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.

  • Release 2 – 2008 – start of clinical journey

    • 10 year outsourcing deal to 2013

  • Only 5 years growth, not paperless ?

    • Increasingly complex record

    • Reliance on data for decision support

    • Continuation of other systems to fill gaps

  • Integration with

    • Social Services

    • Independent /private / voluntary sector

    • Foundation Hospitals

    • Patient access, and Care at home