Looking forward, pulling together and pressing on

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Looking forward,pulling togetherand pressing on

• Lewis Ritchie

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SCIMP 2008 Conference BallotInvitation to give
final talk

• Please choose and tick only one of the
  following options-
• I am delighted honoured to accept ?
• I am reluctant have serious misgivings about
  this great responsibility ?
• You have sent this invitation to me by mistake
  ?

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SCIMP 2008 Conference BallotInvitation to give
final talk

• Please choose and tick only one of the
  following options-
• I am delighted honoured to accept ?
• I am reluctant have serious misgivings about
  this great responsibility ?
• You have sent this invitation to me by mistake
  ?

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Small men..cannot handle great events

• General Charles de Gaulle

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Learning from the mistakes of others..
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The task

• To summarise key principles
• and take home messages

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An excellent Conference - packing it all in..
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Not biting off more than we can chew
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A fair sense of proportion. (proportionality)
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Looking forward.

• Values, vision and leadership
• Opportunities and obligations
• Pulling together and pressing on

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What of our values.?
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A rapidly changing and uncertain world..
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Remembering why we are all here
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The importance of the clinician-patient
relationship

• Essential humanity
• Intimacy
• Safety
• Truthfulness
• Mutual understanding
• Workable consent for information sharing

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Key value

• Do unto others as you would have done unto
  yourself..

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A few guiding principles..
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Guiding principles

• Patient centred care patient centred records
• Patient and health professional needs main
  drivers - not available technology
• Imperative of strong clinical leadership and
  professionalism

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Guiding principles

• Universal CHI - key for successful record linkage
  journey of care
• Cultural change and confidentiality concerns
  are the ultimate obstacles - not technological
  constraints
• Incremental, measured progress v big bang

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Prove all thingshold fast to that which is good

• The imperative of evaluation establishing
  resilient models, sharing success and the
  avoidance of duplication of effort

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Our Vision
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but beware the Dubya binocular trap!
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Scotlands Health Challenge

• Ageing population
• Increase in long term conditions
• Unhealthy lifestyles / obesity epidemic
• Leading to
• Growth in emergency hospital admissions
• Pressure on services / waiting times lists
• Compounded by
• Remote and rural dimension
• Deprivation and inequalities
• Increasing public expectations
• Technological advances / cost pressures

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Confronting the Health Care Challenge From Cell
to Community
Scottish Care Networks
Translating Excellence In Life Sciences
eHealth to support world class patient care
New Evidence Clinical Trials
Community
Cell
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Vision

• Traditional boundaries of care demarcated by
  sectors of provision - must give way to
  integrated care, focused on the patient journey
  of care
• Primary and secondary care the language of the
  past?

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A patient centred service the journey of care
In the past organisational and perceptual
barriers have separated primary and secondary care
CH, RGH, DGH
Patient enters hospital
Patient Home
Available as and when required
NHS 24
Specialists 65 Specialties GPwSI
Health information etc
Primary Care
Diagnostics
Sexual Health Services
Mental Health Services
Pharmacy Dentistry Optometry
Emergency Care
Community Care
GPs GPwSI Practice, District Nursing, Health
Visiting, AHPs
Source Carol Black (modified), 2006
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Our Vision for eHealth
exploiting the power of electronic information
to help ensure that patients get the right care,
involving the right clinicians, at the right
time, to deliver the right outcome Better
eHealth Better Care NHS Scotland eHealth
Strategy 2008 www.ehealth.show.scot.nhs.uk
Heather Strachan
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eHealth strategy in the round

• Continuing an incremental and pragmatic approach
  to long-term aim of electronic records
• Focus on
• eHealths contribution to priorities such as 18
  weeks and Shifting the Balance of Care
• Delivering benefits, not systems
• Integration across patient journeys
• Safer, more effective and efficient care
• Promoting patient engagement and self-care

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What it looks like
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Without vision, we perish without values, we
decaywithout leadership, we lose our way
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.and the leadership thing?
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essentialin partnership with technical and
other health professional and administrative
support staff the team
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A defining moment, a new morning, hope for the
future
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Opportunities Obligations
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eHealth supporting the best clinical care and
research environment in the world
AMs four year manifesto opportunity for
change
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• Better Health Better Care
• We are committed to the delivery of high quality
  palliative care
• to everyone in Scotland who needs it,
• on the basis of need not diagnosis,
• and according to established principles of equity
  and personal dignity.
• Extend the use of high quality
• generalist palliative care standards in all
  care settings

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Palliative Care Summary (PCS)

• Macmillan Nurses led initiative
• Palliative Care Forms
• Based on Gold Standards Framework Scotland (GSFS)
• Paper process already in place in many GP
  Practices
• IT Development to assist with key patient group
• Underpinned by new GMS DES

Elizabeth Ireland and Libby Morris
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18 Weeks Referral to Treatment Time
a whole journey waiting time target of 18 weeks
from general practitioner referral to treatment
. by December 2011 Cabinet Secretary for
Health and Wellbeing, Scottish Parliament
Official Report, 28th June 2007.
Tracey Gillies
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Current view of many clinicians
Speed of access
Quality
Key Message Both please! - Imperative of service
redesign and cultural change
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INFORMATION GOVERNANCE
George Fernie
Information Governance ensures necessary
safeguards for, and appropriate use of, patient
and personal information.Key areas are
information policy for health and social care, IG
standards for National Programme for IT systems
and development of guidance for NHS and partner
organisations.
Key message getting confidentiality right for
both patients and professionals
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A proportionality test

• A test of proportionality is the application of
  objective judgement as to whether the benefits
  outweigh the risks, using what some might call
  the test of reasonableness or common sense.
  Proportionality involves making a considered and
  high-quality decision based on the circumstances
  of the case, including the consequence of not
  sharing.

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HealthSpace Development

• Patient portal through which they have a secure
  on line domain for their transactions with health
  service
• Aligned with Choices
• Place to store records access on line
  electronic records-and also from which they can
  send information to their clinician

Gillian Braunold
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Key Messages - HealthSpace

• Considerable potential for real patient
  engagement and supported self care enhancement
• Enhanced consent model possibilities
• Patient audit of care and of professional access
• Universality of eHealth need to learn from
  other systems
• (to avoid the Scots Wha Hae syndrome)

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Information Literacy Cycle
Heather Strachan
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Key Message

• Shared understanding and optimal use of health
  care information key for both patients and health
  professionals

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Data Transfer v Data Migration

• Not synonymous
• Complex and usually incomplete
• Classification of Diseases etc continues to
  evolve
• Transfer of electronic patient records from one
  general practice to another a key milestone in
  primary care computing

Leo Fogarty
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Pulling together and pressing on
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Looking forwarda word of encouragement
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Success is a journey, not a destination!
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Choosing but one ECS a singular success

• ECS connected to 99 of practices
• Accessed by A/E, NHS24 and OOHs
• Palliative Care Summary next development
• Pilots in Grampian for EMIS and INPS
• Next year for GPASS and ASCRIBE

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ECS Accesses
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Much has been achievedthere is much still to
do
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Unless we share information reliably we cant
improve care
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That will require high quality leadership,
professionalism and commitment at all levelsand
were all in this together
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Scary journey but safe outcome!
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We can achieve more provided we are prepared to
give others the credit

• Ronald Regan

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Final thoughts
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America today has a new face as President, so
farewell Dubya!
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Size does matter..
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Thank youfor listening
Thank you for listening!
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and safe home!