eHealth Update

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eHealth Update
Heather Strachan NMAHP eHealth Lead eHealth
Division, Scottish Executive
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eHealth Update - Overview

• Policy Context
• Vision
• Cornerstones
• The Gaps
• The Future
• The How

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Delivering the Big

• NHS Scotland is committee to delivering the
  Electronic
• Health Record. It will become a reality with use
  of common
• information and communications technology
  systems, data
• standards and appropriate safeguards. This will
  support the
• big 4.
• The NHS as local as possible
• Systematic support for people with long-term
  conditions
• Reducing the inequalities gap
• Actively managing hospital admissions

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Modernism
In everything else machinery is used, why not in
medicine? So the public drops its penny and
receives its prescription. It is not difficult
to foresee the time when the prescribing chemist
will be a thing of the past. There will, in
fact, be no need for him, his shop will be
crowded with penny-in-the-slop machines, by the
use of which the patients weight will be taken,
his eyesight tested, his urine examined, his
vital capacity ascertained, his muscle power
measured, his knee-jerks recorded, his pulse
trace taken, and ultimately his prescription
written plainly by a typewriter, so that it can
be made up by and assistant at a mere living
wage, while the chemist, free from all
responsibility will take the fee and flourish
exceedingly.
BMJ 1895 (Source Reiser SJ. Medicine and the
Reign of Technology)
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Delivering for Health

• eHealth Programme Outcomes
• improve patient and carer involvement
• and experience.
• support evidence-based and safe care.
• support professional development.
• improve integration of health and social care.
• support community-based care.
• support scheduled care.
• support unscheduled care.
• improve information intelligence.
• support effective resource management.
• improve information governance.
• advance eHealth.

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Cornerstones

• CHI Number
• SCI Programme
• Accident and Emergency
• Emergency Care Summary
• PACS and RIS
• Data Standards

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CHI number Implementation
Universal use of CHI number by 6/6/6
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Scottish Care Information Programme

• SCI Store
• One in each Board acts as the Local Electronic
  Health Record
• Information repository, fed by CHI index, local
  specialty electronic patient records eg labs, GP
  systems.
• Provides on line access to lab results, clinical
  letters and summaries of care contributions
• Ongoing programme for clinical letters
• SCI Gateway
• Over 2,500 communications per day
• Many protocol based, agreed best practice by MCNs
  and provide decision support
• Cross Border flow
• Target 90 referrals from GPs to hospital by end
  2006 currently 70
• Plans to increase referrals from other
  disciplines
• Other SCI products
• SCI outpatients, SCI discharge, SCI
  prescriptions, SCI DC (diabetes) SCI Index

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AE

• National solution
• No new procurements
• 5 Boards completed conformance testing
• Completion scheduled for end of 2006

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Emergency Care Summary

• Extract from GP Systems
• Demographics and CHI
• Allergies
• Current and active repeat medication
• 4.3 m patient records
• Access by Out of Hours Services with patients
  explicit consent
• 54 patients have opted out
• Pilots for access by NHS24 and AE
• National Leaflet drop September 06

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Picture Archiving and Computer System and
Radiology Information System

• PACS and RIS contract awarded to Kodak
• Target for completion of implementation of PACS
  April 2008
• Glasgows Southern General went live Sept 2006
• Data standards agreed by Royal College of
  Radiologists SNOMED-CT.

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Data Standards

• 32 Data standards approved
• More than 2800 data items with clinical and
  technical definitions
• Over 300 clinicians involved in development
• Many in use in systems

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Integrating Clinical Knowledge, Data Standards
and eHealth to enable Clinicians to Care, Share
and Compare
Improving Performance
Improving Patient Safety
Improving Patient experience
SHARE SCI/eCare Stores
CARE Health Systems
COMPARE Secondary Uses
eHealth
Referrals
Assessment
Data Standards
Forms Library
Health/Social Care Data Dictionary
Pathways
Informing Knowledge
Experts
Evidence
Best Practice
Clinical Knowledge
Managed Knowledge/ Clinical Networks
eLibrary
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Gap Filling

• Generic Clinical System
• Decision support
• Staff Identification and Authentication
• New Procurements
• De-Militarised Zone

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Generic Clinical System

• Contract awarded to AxSys technology
• First phase of development work complete
• Early Implementations in 3 Cancers and Mental
  Health Cancer Waiting Times
• Developer training underway
• Rules of engagement to be agreed

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Chart designer may be used to create clinical
charts for a variety of requirements
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Quickly capture coded information following
surgery and let Excelicare create the operation
note
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(No Transcript)
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Create complete care protocols with automatic
reminders
Colour coded flags are set to show the status of
interactions with the patient
Stages in a protocol clearly displayed with
coloured buttons providing links to other forms
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MDT Process
(2) Establish the Conference template
(3) Manage and run the conference
(1) Define the Managed Clinical Network
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Decision Support

• Multi-layered
• Access to evidence www.elib.scot.nhs.uk
• SCI Gateway protocols
• Library of Clinical Templates Feasibility Study
  Community Nursing
• Decision support at front of test requests

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Staff Identification Authentication

• Dependency of many projects especially HEPMA
• Procurement and implementation very high priority
• Big Issue
• Who is person? ID
• What can they do? Role
• What have they done?

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Procurements Under Development or Proposed

• Theatres
• Sexual health
• HEPMA
• Community Systems including child health
• Chemotherapy Prescribing
• Community Dental Services
• PAS

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ePharmacy Programme

• Support for new community pharmacist contracts
• N3 broadband connections rolled out to pharmacies
• Development of e-system for minor ailments
  service (MAS) complete. Service live from July
  2006.
• Chronic medication service (CMS) planning
  underway to go live from April 2007.

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Hospital Electronic Prescribing and Medicines
Administration

• Requirements (Standards, evaluation)
• Want single solution
• Want unified training
• Need prescriber identification authentication
• Will procure
• Part of suite?
• Separate?

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Data Sharing

• De-militarised Zone
• Shared multi-agency stores in each Board
• Pass agreed data for viewing only
• Systems remain separate
• Health and social care data standards
• Require appropriate access controls and
  governance arrangements

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A year in the life of eHealth Strategy

• Settling down now, and being taken seriously
• funds
• top level commitment
• incremental convergence, not rip-and-replace
• exploit what exists
• fill gaps where necessary, approached nationally
• But with ambition comes aversion to failure So
  management of eHealth set to radically change
• Some changes to be structural, e.g. strengthened
  programme team in SEHD

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Programme Executive Team
Director eHealth
Head of Change and Benefits
Head of Strategy
Head of Design Authority
Head of Programmes
Project Commissioning
Service Redesign and eHealth Reqts.
Market Intelligence, Research Evaluation
Information Standards Confidentiality Governance
eHealth Staff Skills, Resource Management
Career Development
Benefits Identification Delivery
Strategy Maintenance and Delivery Roadmap
Security Authentication
Programme Management Office
Communications
Definition of Project Brief Initial Agreement
Applications Standards Architecture
National Projects
User Skills Development
Technical Standards Architecture
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Overall
Chief Executives Group
Minister
SEHD Departmental Board
NHS Board
eHealth Strategy Board
National eHealth Programme Board
Clinical Change Board
Heads of eHealth (NHS Boards)
Local eHealth Programme Board
National Clinical Reference Group
Patient Care Services Sub-Programme Board
Infrastructure Business Systems Sub-Programme
Board
Optional Sub- Programme level
National Project Board
National Project Board
Specify and commission work (in partnership with
Head of Programmes)
National Project Board
etc
National Project Board
Local Project Board
National Project Board
Local Project Board
Local Project Board
National Project Board
National Project Board
NSS
Other Suppliers
Local Project Team
National Project Team
Local Project Team
National Project Team
Local Project Team
Provide expertise, staffing resource and line
management
National Project Team
National Project Team
Local
National
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The future

• Autonomy to Convergence
• Individual to Collective
• Responsibility
• Free text to defined data
• Primary purpose to
• secondary uses

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How this will be delivered?

• Migration
• Ensure Good Governance
• Management of Change
• Strategic procurements
• Focus on delivering benefit
• Information Governance
• National models for finance, support and ongoing
  management