Developing a Single Patient Record

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Developing a Single Patient Record

• Dr Stuart Scott
• Clinical Director ( GP)
• e-Health NHS Grampian

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Scotland Progress to Datepaper for NHS Board
Chief Executives September 2005Stream 1- short
to medium term

• CHI Number
• PACS
• ECS
• SCI Store
• SCI Gateway
• SCI DC Network
• AE System
• New Ways Waiting Time Definitions
• GCS
• Telecommunications
• ePharmacy
• Standards

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Scotland Progress to Datepaper for NHS Board
Chief Executives September 2005Stream 2
Single Record IT Product Set

• NHS HDL(2005) 46

• Exploiting what exists
• Filling the Gaps
• Planning and delivering the Single Record

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Missing from last 2 Slides?

• NHS Contact (NHS Grampian 12 UK user base)
• GP Clinical Systems

• Gpass
• EMIS
• InPS Vision
• iSOFT Synergy
• Protechnic Exeter

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NHS CfH Program Key Deliverables

• NHS Care Record Service
• Choose and Book
• Electronic Transmission of Prescriptions
• New National Network (N3)
• PACS
• NHS-wide e-Mail Service
• GP IT Systems supporting the new GP Contract

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Health Information EnvironmentThe Collaborative
Response to the ONCHIT Request for Information

• Decentralised
• Federated
• Private Secure
• Accurate
• Reliable
• Fast
• Interoperable and built on a Common Framework
• Designed to Respect and Serve Patients
• Flexible

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What the Health Information Environment is NOT

• A Big Bang Undertaking
• A Central Data Repository
• A Significant Financial or Technical Barrier to
  Connectivity
• Proprietary
• The Applications that Rely on It

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Health Information EnvironmentSignificant
Barriers

• Financial
• Technical
• Environmental
• Educational/Attitudinal

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Health Information EnvironmentSignificant
Enablers

• Financial
• Technical
• Environmental
• Educational/Attitudinal

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Recommendations to Stimulate US EHR
AdoptionJournal of the American Medical
Informatics Association Volume 12 Number 1
Jan/Feb 2005

• Expand the Health Care IT Research Agenda
• Financial Incentives to Stimulate EHR Marketplace
• Health Care IT Standard Setting
• Enabling Policy
• Educational, Marketing and Supporting Activities

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Expand the Health Care IT Research Agenda

• Increase funding to evaluate the impact of HIT in
  practice, with a focus on economic outcomes,
  costs and benefits.
• Evaluate the utility of open source or public
  domain software for EHR and implementation and
  maintenance methods for such systems.

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Financial Incentives to Stimulate EHR Marketplace

• Establish financial incentives for the use of EHR
  in practice.
• Capital availability Establish low-interest
  loans or a grant program to facilitate hardware
  and software adoption in health care settings.
• EHR Certification and Accreditation Establish a
  process to certify EHR products as having
  requisite functionality in accordance with
  accepted standards and an accreditation process
  for level of use of EHR in practice.

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Health Care IT Standard Setting

• Coordinate existing efforts to specify essential
  standards for basic EHR functionality, data
  representation, and messaging.
• Specify a minimal clinical data set covering a
  patients demographics, medications, medical
  conditions, allergies, advance directives, and
  selected data pertinent to patient safety and
  health care quality.
• Specify minimal functional standards for HIT
  systems in acute care and inpatient care
  sittings, personal health records, and key
  functional components such as computer-based
  physician order entry.

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Enabling Policy

• Promulgate Medicare Modernisation Act relaxations
• Establish federal policy on clinical data
  ownership and stewardship.
• Establish policy framework for Regional Health
  Care Information Authorities.
• Establish US national licensure in the health
  professions.

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Educational, Marketing and Supporting Activities

• Establish educational and marketing campaign for
  the public Got EHR?
• Establish educational campaign for health
  professionals.
• Establish educational campaign for health care
  management.
• Create a National Health Care Information
  Technology Resource Centre.

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NHS Scotland Single Patient Record The Vision
Where to?
The vision is a single health care record for
each patient jointly managed by patients and
professional NHS staff with in-built security of
access governed by patient consent.
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NHS Scotland Single Patient Record The Vision
Why?
All relevant information will be available to
healthcare professionals and to patients
themselves whenever and wherever they need it.
Built around the record will be features and
facilities to support the healthcare process.
Examples include test requesting, appointment
scheduling, and prescribing.
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NHS Scotland Single Patient Record The Vision
How?
This vision involves many technical, clinical,
organisational and people challenges. As part of
managing these challenges, a high risk big bang
migration to a completely new single IT system
will be avoided. Hence in the short to medium
term we will work toward the vision by building
the single record through linkage of existing
systems and filling gaps where necessary, This
progressive approach means that new initiatives
and implementations are managed coherently as
intermediate steps towards the vision.
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Possibilities

• A single application that is used by everybody
  to do everything.
• A single core application working with specialist
  applications.
• A limited range of best of breed applications,
  used by everyone to do everything in an area
  (e.g. a clinical speciality), with the core
  applications joined together.
• An information hub holding information for a
  patient, everyone uses this information but can
  choose which application they use to do so.
• An information hub as before but this is accessed
  by a limited number of core applications.

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My Choice

• A single core application working with specialist
  applications.
• England are kindly finding the development of 3
  such systems
• NHS Scotland should choose the best fit for our
  needs
• QED