GP Engagement Events

1
GP Engagement Events

• Progress to date and issues

2
Overview

• What has been achieved?
• What is happening now?
• What is coming?
• Issues on which we want your views

3
What has been achieved?

• QMAS and QoF payments
• N3 the new NHS network 15,500 connections
• NHSMail 200,000 users
• Smart cards issued and used
• Patient Demographic Service

4
Choose and Book

• 10,000 bookings a day
• 61,000 last week
• 25 of first referrals to OPD
• Moved into another phase
• User groups
• End user communications
• Updates

5
ETP

• Over 4 million ETP prescriptions- messaging
  securely 5 of the total volume
• 85 Community registered for smart cards
• 1710 practices enabled and half are actively
  using ETP ie 880 practices

6
GP2GP

• 35 practices now involved across Gateshead and
  Isle of Wight
• Croydon mixed economy due to start in January
  2007
• Attachments flowing with native document
  management systems
• Speeding up roll out end of year

7
IMT Directed Enhanced Service

• 70 million over 2 years
• To encourage engagement with IT developments and
  Data Fit for Sharing
• Provides a contractual framework for the first
  time
• Enhanced services are voluntary
• Support training for all users

8
Data accreditation

• E-audits specification written
• Piloted with 50 practices and their facilitators
• Range of queries
• Guidance available for all Practices and PCTs
  through Primis web portal

9
Personal Demographics Service

• What information is there that you cant find
  elsewhere?
• Existing systems to flag sensitive records
• Not well understood
• Process to ensure that clinicians and patients
  understand clinical significance of being flagged
• Process to flag and unflag

10
What is coming?

• GPSoC
• Summary Care Record
• Detailed Care Record
• Care pathways

11
Understanding the record

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

12
Understanding the record

• Summary Care Record used on first contact and as
  foundation to avoid repetition
• HealthSpace patient access
• Detailed Care Record shared for coordinated care,
  especially pathways of care

13
Ensuring confidentiality and access

• Role Based Access Control (RBAC)
• Legitimate Relationships
• Audit and alerts
• Physical Security

14
Hot issues on which we want your views

• GPSoC
• Summary Care Record
• Explicit or implicit consent
• Validation of summaries
• Detailed Care Records
• Sealed envelopes

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1. GP Systems of Choice (GPSoC)
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GPSoC Maturity Model
Level Minimum Functionality 0 QMAS, RFA99 and
Level 1 IG Compliance 1 QMAS, Choose and Book
and PDS and ETP version 1 2 Level 1 plus ETP
version 2 3 Level 2 plus GP2GP 4 Level 3 plus
fully hosted solution to CfH specification 5 Level
4 plus PSIS, SNOMED CT, Clinical Spine
Applications, the NHS CFH Diagnostic Requests and
Reports (Order Comms) and Provision of Care
6 Level 5 plus fully integrated to the NHS CRS
Level 4 integrated solution
17
GPSoC

• Full Business Case for Department of Health and
  HM Treasury submitted
• The GPSoC Infrastructure Specification which will
  be released for review by the Service soon
• The development of CAP-GP
• the basis on which GPSoC systems will be
  evaluated for compliance
• PCT-Practice agreement
• clearly set out the responsibilities of the PCT
  and the practice in respect of IT service
  delivery
• A data migration specification
• govern the full lifecycle of a GP's data from
  data cleansing, through successful load and,
  subject to DH policy, agreement on the long term
  access to data following a migration

18
GPSoC in Operation

• Exercising choice
• Protection against whims of suppliers
• Improved security of access to data
• System compliance
• Supplier and system performance
• Improvements to infrastructure
• Governance and sanctions

19
System Compliance

• CAP-GP introduced as replacement for RFA 99
  currently being piloted
• Status of existing systems none currently
  higher than GPSoC Level 1
• Greater Transparency through publication of
• Compliance status
• Development roadmaps
• Progress through testing regime

20
1. GP Systems of Choice (GPSoC)

• QUESTIONS
• Does this plan seem reasonable to you?
• Will it allow you to develop your practice IT?

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2. Summary Care Record
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Explicit or Implicit Consent?

• Explicit consent
• no summary care record until the patient has
  checked their summary and agreed
• Supported by BMA/GPC/RCGP
• Significant workload for general practices
• Lag until summaries available
• Was used and abandoned in Alberta, Canada

23
Explicit or Implicit Consent?

• Implicit consent
• Public information campaign
• Then uploading of limited ( scripts, allergies)
  summary care record from all who havent opted
  out
• When patient attends, opportunity to check
  contents and send up clinical problems list
• Still large workload for general practices
• Model used in Hampshire, Wirral and Scotland

24
Consent to View

• In Scotland and Hampshire, a legitimate clinician
  can only see the record after asking the patient
  Consent to View.

25
Explicit or Implicit Consent?

• Current practice
• Time lag
• Consenting process
• Who should consent
• Resourcing
• Difficult to reach patients
• Patient expectations

26
Accurate records

• Joint act of publication
• Data accreditation
• Verification
• Incremental growth in data to shared space
• Automate drugs and allergies
• Summaries of diagnostics opportunity as each
  patient has a transaction

27
PSIS early adopter

• Independent evaluation
• Access controls in vivo
• Human processes
• Patient experience
• Practitioner experience
• Learn from experience

28
2. Summary Care Record

• QUESTIONS
• What are your views on the best way of handling
  patient consent to sharing?
• How can general practice best handle the
  validation of summaries?
• Should we ask for Consent to View?

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3. Detailed Care Record
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Background Problems perceived with original
sealed envelopes

• Single Envelope
• Permission on a named basis
• Complexity
• Risks of breaching due to misuse or non use
• Risks of large numbers of people opting out
  because dont understand how to use

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Some Basic Assumptions

• Clinicians work in teams/work groups
• Confidential information needs to be shared and
  protected within the team
• Secrets not seen by administrative roles unless
  local customisation redefines for particular
  roles and with appropriate training

32
Two levels of sensitivity proposed

• Sensitive level
• Extra sensitive invisible level that is locked
  down and not available outside the clinical
  team/workgroup
• There are potentially significant clinical
  implications to choosing the extra sensitive
  level of which the patient needs to be aware
• The choice will be the patients in discussion
  with their clinician

33
Incremental Confidence Building

• The sealed and locked model gives possibilities
  for how to handle those who want to share very
  little and choose to reveal more as their
  confidence grows. Most (or all )of their records
  could be shielded in this way
• GUM and other special clinics could have the
  default that all their records are sealed and
  locked in this way as a default unless the
  patient chooses to share
• All information in these envelopes can be pulled
  for anonymised SUS since it is present

34
3. Detailed Care Record

• QUESTION
• Does this method for protecting sensitive
  information seem appropriate?

35
REMINDER OF OUR QUESTIONS

• GPSoC
• Does this plan seem reasonable to you?
• Will it allow you to develop your practice IT?
• Summary Care Record
• What are your views on the best way of handling
  patient consent to sharing?
• How can general practice best handle the
  validation of summaries?
• Should we ask for Consent to View?
• Detailed Care Record
• Does the sealed envelopes proposal for protecting
  sensitive information seem appropriate?

36
GP Engagement Events

• Progress to date and issues