Information Architecture Review
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DSTB
Health and Social Care Data Sharing
Information Architecture Review
Final Issue on 10 April 2013
Information Architecture Review
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To
Johan Nolan, Eddie Turnbull, Ann Martin, Murdoch Carberry, Robin Wright, Stephen Pratt,
Stephen Duffy, Mark Daroch, DSTB Members
Document History
Version Date Update Origin Written by Verified by
Interim 00 29/11/2012 Draft for limited stakeholder review Phil Young Cheryl Trigg
John Bailey
Interim 01 7/12/2012 Updated as a result of:
Feedback from SG eHealth area
Information on Western Isles solution
Discussion with Stephen Pratt
Phil Young
Interim 02 16/1/2013 Updated as a result of:
Feedback from Finlay Stewart (Tayside)
Feedback from Stephen Duffy (Ayrshire)
Information from Allan Small on GIRFEC
Information on Borders proposals
Phil Young
Interim 03 21/1/2013 Updated as a result of:
Feedback from from Allan Small on GIRFEC
Minor changes to Borders detailed notes
Information on D&G approach
Phil Young
Final 10/4/2013 Updated as a result of information on Fife, Orkney and Forth Valley approaches
Phil Young
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Summary
1. Introduction 5
2. Key Messages 6
3. Terms of Reference 7
4. Approach Taken 7
5. Summary of Information Shared 10
5.1. Summary Table 10
5.2. Common Locally Shared Information 11
5.2.1. Service User Demographics and Linked Professional Details 11
5.2.2. Assessments and Plans 11
5.2.3. Child Protection Alerts and Messages 12
5.2.4. GIRFEC Chronologies 13
5.3. Other Locally Shared Information 13
5.4. National Information Sharing 13
5.5. Status of Solutions 14
6. Approaches Taken 15
6.1. Stand-alone Central Store 16
6.1.1. Key Features 16
6.1.2. Planned Implementations 16
6.2. Integrated Central Store 16
6.2.1. Key Features 17
6.2.2. Operational and Planned Implementations 18
6.3. Portal 18
6.3.1. Key Features 18
6.3.2. Operational and Planned Implementations 19
6.4. Central Messaging Hub 19
6.4.1. Key Features 20
6.4.2. Planned Implementations 20
6.5. Single Shared System 20
6.5.1. Key Features 20
6.5.2. Operational Implementations 20
7. Common Features 20
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8. Commercial Packages 22
9. Strategic Options 23
9.1. Spectrum of Solutions 23
9.2. Central Assistance and Coordination 23
9.3. National Child Protection Alerts 24
10. Short Term Actions 25
11. Maturity Model 25
11.1. Functions and Data 26
11.1.1. Service User Demographics 26
11.1.2. Professional Details and Consents 26
11.1.3. Assessments and Plans 26
11.1.4. Child and Adult Protection 27
11.1.5. GIRFEC Support 27
11.1.6. Access Control 28
11.1.7. Data Matching 29
11.1.8. Auditing 29
11.1.9. Reporting 29
11.1.10. General 29
11.1.11. Other Possible Data 30
11.2. Partners 30
11.3. Support 31
12. Benefits Summary 32
Attachment 1 - Interviewees 34
Attachment 2 – National Child Protection Alerts 35
Attachment 3 – Detailed Solution Catalogue 39
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1. Introduction
This document is intended to summarise the current and planned approaches health and social care
data sharing in Scotland. Input was obtained from all Data Sharing Partnership areas in Scotland
(henceforth referred to as areas or regions) on the data that they shared, or planned to share, how
sharing was achieved, as well as the achieved and expected business benefits.
The review has identified immediate and long term options for further improving the sharing of health
and social care data at a regional and national level.
The report assumes that the current national eCare solution will be decommissioned in 2013.
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2. Key Messages
A set of core data is being shared by the majority of areas reviewed (i.e. basic service use
demographics, professional contact details, various types of assessments and plans, child protection
alerts, and to a lesser extent, GIRFEC chronologies). See Section 5.2.
Various other types of data is being shared by a minority of areas, e.g. adult plans, service requests
and referrals. See Section 5.3.
Based on this commission there seems to be no general desire to share data nationally except child
protection messages / alerts. National level discussions are required on the requirements, solution
and architecture in this area. For example there may be architectural issues regarding the
connection of regional portal solutions to regional central store solutions that need to be considered.
See Section 5.2.3 and Attachment 2. UK wide child protection alert sharing, and Scottish data
sharing on Looked After Children was also seen as beneficial by some areas.
Various local data sharing solutions have been adopted that can be broadly categorised into 5 main
types, central store, portal, central messaging hub, stand-alone and single shared system (although
there overlaps between the solutions). There is no single correct solution. See Section 6.
Progress towards data sharing varies from mature live systems in a few areas, through systems in
various stages of planning and development, to a few areas with no firm plans for any data sharing.
Several key agency systems can be identified that will need to interface to multiple regional
solutions, in particular SWIFT (Northgate), CareFirst (OLM) and SEEMiS. Some form of national
vendor coordination and knowledge sharing could encourage synergies, reduce costs and speed up
implementation timescales. It is important to ensure that this generates leverage on suppliers rather
than one-size-fits-nobody outcomes. See Section 8.
There are number of achieved and expected benefits business benefits. See Section 12.
There is no national solution and no single approach for the further development of regional
solutions, but instead a spectrum of options comprising:
Development of solution from scratch
Extension of an existing regional health portal
Extension of regional portals or central stores to neighbouring regions and evolving as a single
solution
Copying all or some of an existing regional solution to other regions and evolving separately
(possibly using some different technologies)
Sharing discrete technical elements, for example interface software
Sharing of standardised information services at local, regional and national levels as appropriate
to the nature of the information/capability being delivered
Sharing lessons learned, best practice, standards etc.
These options are not necessarily exclusive. See Section 9.1 for more details.
There is a role for national organisations such as the Scottish Government and NHS NISG to provide
assistance and coordination to the regional integration efforts.
In the short term there are several activities that could be progressed quickly:
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Organise a workshop involving 2 or 3 key people from each area, for the purpose of sharing best
practice, considering reuse and getting to know who’s doing what.
Encourage vendor cooperation and coordination
Review how the proposed vulnerable persons i6 programme being undertaken by the Police
Service in Scotland will support data sharing with health and local authority agencies.
Define a Maturity Model for evaluating local solutions in more detail, eg to benchmark data
sharing success, assess technical reusability and determine capability.
3. Terms of Reference
Sopra Group were commissioned by the DSTB in September 2012 to undertake a short 34 day review
of the procedures and information that frontline personnel need to support integrated health and social
care provision. The high level terms of reference for the study were:
The information sharing required to support the key in-scope Health and Social Care operational
procedures, i.e.:
The registration and management of pre-birth concerns
Child protection and adult protection messages and alerts
Integrated Assessment Form (IAF) / Single Shared Assessment (SSA) processes
The impact of GIRFEC across these key processes.
The key business drivers/benefits for Health and Social Care integration, by key stakeholder area
The high-level organisational information stores (i.e. data and documents) involved in local and
national exchanges of information.
The improved information flows required to support the key procedures
A proposed engagement plan and a high level roadmap
It was not intended that the study would review governance agreements (e.g. Information Sharing
Protocols) or governance arrangements (e.g. Data Sharing Partnerships).
4. Approach Taken
The review has involved face to face meetings with representatives from the organisations listed below
(see Attachment 1 for full details of the personnel involved). Input was also obtained from the Scottish
Government eHealth area, and NHS NISG. In the end a total of 10 operational and planned systems
were reviewed.
Organisation Main Inputs
Scottish Government eHealth National strategies, eCare background
NHS NISG National strategies, NISG involvement
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Organisation Main Inputs
Scottish Government GIRFEC
Policy Area
National strategies, Children and Young Persons Bill detail.
Sopra Group Orion portal details
East Renfrewshire CHCP Local requirements and possible solutions
Lanarkshire DSP Local requirements, Lanarkshire eCare and national CPM
NHS Ayrshire & Arran Local requirements and the AYRshare solution
NHS GGC&C GGC&C requirements and the Orion Portal
Renfrewshire Council Local requirements and the Orion Portal
NHS Grampian Local requirements and the proposed Grampian solution
NHS Highlands Local requirements and the Highland SharePoint solution
NHS Lothian Local requirements and the Lothian CareFx Solution
NHS Tayside Local requirements and the proposed Tayside solution
Shetland Islands Council Local requirements and the Shetland SWIFT based solution
West Lothian Council Local requirements and the West Lothian C-me solution
Comhairle nan Eilean Siar Local requirements (via Scottish Government and Capita)
Borders Council Local requirements and proposed solution
NHS Dumfries & Galloway Local requirements and proposed solution
NHS Orkneys Local situation
NHS Fife Local requirements and proposed solution
NHS Forth Valley Local situation
In addition a considerable number of documents have been reviewed, both for specific solutions, e.g.
Statement of Requirements, Proposals, Business Requirements and PIDs, as well as various national
background documents.
To allow comparison of solutions a detailed profile of each solution was documented using the following
categories:
Partners involved
Current and planned interfaces
Service user / patient matching approach
Data shared
Functions provided
Approach taken to integration
User access method
Access control
Data volumes (expected and actual)
Planned features (i.e. reasonably firm plans)
Desirable features (wish list features)
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History of the solution
General notes
Benefits of sharing
See Attachment 3 for the full catalogue. Additional detail on the data held was recorded where it was
readily available.
An interim summary of findings were presented to the DTSB meeting on November 30th 2012 and a
further update was given on the 24th January 2013.
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5. Summary of Information Shared
5.1. Summary Table
Most of the solutions currently share, or plan to share, basic service use demographics, professional
contact details, various types of assessments and plans, and child protection messages / alerts.
Additionally there were a large number of other types of information that is shared by a minority of
organisations. It should be noted that the “Planned” category covers a wide range of situations, from
firm costed proposals to unscheduled wish-lists.
L = Live (non eCare) Le = Live (with eCare) T = In test P = Planned or Proposed
GG
&C
Lan
ark
sh
ire
West L
oth
ian
Lo
thia
n
Ayrs
hir
e
Taysid
e
Gram
pia
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Hig
hla
nd
Sh
etla
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Bo
rders
Weste
rn I
sle
s
D&
G
Fife
Ork
neys
Fo
rth
Valle
y
Service user demographics T L L P T P L P
Associated professional details T L L P T P P
Child protection messages / alerts T L L P Le P Le P Le P L Le P Le P
Assessments and plans T L L P T P P L P P
GIRFEC style chronologies T L L P T P P
Case lists T L L T
Additional health data, eg KIS & ECS* P L P P
Carer Demographics L
Adult protection messages L
Pre birth concern messages L
Service requests L
Secure email L
IAFs and IRDs ** P L
Referrals L L
Register of interest L
Telecare assessments P
Automatic equipment prescriptions P
Adult chronologies P
My World Triangle Assessments & Child’s plan
P
Request for assistance P
Concerns (inc. child’s concerns) P P
Services delivered P
Missing Persons Alerts
Automatic synch of demographics
Looked after children indicator
A&E attendance sharing
Third sector data sharing
Fire and rescue sharing
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Police sharing
* Additional health data may be available to health users of health portals such as Orion and CareFx.
KIS: Key Information Summary, ECS: Emergency Care Summary
** IAF: Integrated Assessment Form, IRD: Inter-agency Referral Discussion.
5.2. Common Locally Shared Information
5.2.1. Service User Demographics and Linked Professional Details
As can be seen from the table above most areas share some level of patient / service user
demographics (e.g. name, DoB, GP, addresses, relationships & carers, CHI number, other identifiers).
However the specific data shared varies. Some areas show data from 2 linked systems on the same
screen to allow comparisons.
Most areas also share basic details for linked professionals, e.g. name, organisation, contact details
(email and phone) and role (e.g. Lead Professional / Named Person).
5.2.2. Assessments and Plans
Various types of assessments and plans are currently being shared electronically, or are planned to be
shared in the near future, as detailed below.
There is no common national format for any of the document types and the contents are likely to vary
significantly between individual councils, and over time. For this reason, and because of the
complexity of the various types of documents, most areas do not try to extract data from the
documents but instead share documents in pdf or Word format. However some data is extracted by
West Lothian and documents are reconstructed by Lanarkshire and Lothian. Use of XML metadata for
documents is also common.
In the future the proposed Children and Young Person Bill which will be enacted in 2015 will suggest a
nationally agreed minimum data set for a child’s plan, chronology and a Well-being Concern form.
NHS GG&C Orion
Children's Integrated Assessment Framework and Shared Action Plan
Adult Standardised Shareable Assessment Forms
Lanarkshire eCare
Adult Shared Assessments (full Assessments, not just Practitioner Summaries). Assessment
types include long term conditions, mental health, learning disabilities, addictions and
substance misuse
Personal Outcome Plans
Care Plans
Child’s Single Agency Wellbeing Assessment and Plan
My World Triangle Assessments and Plan
Integrated Assessment and Plan
West Lothian C-me
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IRDs (Inter-agency Referral Discussion),
Single Share Assessments (SSAs)
Specialist Assessments and Care & Support Plans
Telecare Assessment (Safe at Home)
Lothian CareFx
Child Plans
SSAs
Ayrshire AYRshare
Wide range of assessments and plans for service users
Highland
Multi Agency Children's Plans
Shetland
SSAs (includes involvements, reviews, needs and consents)
Some areas only share the final version of a document whilst others share initial and interim versions.
This commission found no desire to share assessments and plans between regions. Where permanent
cross-border movements occur there are generally satisfactory processes in place to securely transfer
documents to the new responsible authority.
5.2.3. Child Protection Alerts and Messages
Ten areas are locally sharing child protection messages and alerts, although there is significant variety
in the types of alerts shared, and the information in the messages. Shetland share their complete
Child Protection Register (although numbers are low).
NHD GG&C (Orion Portal)
Warning / hazard indicator
Child Protection Register indicator
Lanarkshire (local eCare)
Child Protection Messages (4 main protection messages, i.e. Investigation, Investigation and
on the CP Register, Registration and Past Activity, and the 2 linked person messages)
Pre-birth concern messages (linked to the mother)
Adult protection messaging
West Lothian (C-me)
Alerts (wide range of types: 18 SWIFT, 23 TrakCare and also Education messages)
Lothian (CareFx)
Child Protection Messages (4 main protection messages and the 2 linked person messages)
Child protection alerts from Trak and SWIFT hazards
Ayrshire (currently via national eCare but will be replaced by AYRshare)
Child Protection Messages
Grampian (national eCare but to be replaced)
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Child Protection Messages (4 main protection messages, but not Linked Adult and Linked Child
messages).
Shetland
Child Protection Register is shared.
Borders (national eCare but to be replaced)
Child Protection Messages (6 types)
Tayside (national eCare but to be replaced)
Child Protection Messages
Western Isles (national eCare)
Child Protection Messages
5.2.4. GIRFEC Chronologies
A smaller number of areas share GIRFEC style chronologies of significant events in a child’s life (e.g.
date, type, title of event, recorded by, notes/action taken and a Red/Amber/Green code). Once shared
these chronologies can be integrated and all significant events in a child’s life at a particular point in
time can be viewed and assessed. The format of the chronologies are very similar with only a couple
of minor differences.
Lanarkshire eCare
West Lothian C-me
Ayrshire AYRshare
5.3. Other Locally Shared Information
As can be seen from the table in Section 5.1 a wide range of other data is also shared by one or two of
the areas reviewed, for example Service Requests, Referrals, Registers of Interests. West Lothian also
provides secure email between registered system users. There are also types of data that at least one
area have said they would like to share but are not currently being shared.
5.4. National Information Sharing
The study found very little appetite for national information sharing, with the exception of child
protection alerts. In this case there was a recognition that it would be beneficial if key NHS areas such
as Accident and Emergency, Child Protection specialist nurses, NHS Out of Hours and NHS Child
Protection Units could be given some indication that a child might be at risk. In general it was felt that
very little data needed to be shared, for example:
The minimum demographics needed to identify the child
An indication that there was an issue with the child. There was no consensus on the situation
that would trigger a national alert, e.g. just the four main protection messages, or being on the
child protection register, or a less precise criteria such a "vulnerable child". It maybe that any
national solution needs to leave this definition to the local source systems
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Contact details for a linked professional or organisation.
Lanarkshire have proposed a limited proof of concept for cross-boundary CPM sharing with two
neighbouring authorities using a central matching index and message store.
See Attachment 2 for a summary of the proposed Lanarkshire solution and possible issues integrating
with regional solutions.
Some areas expressed a desire for UK wide child protection alert sharing; for Scottish data sharing on
Looked After Children; and for a way to efficiently share UK missing persons alerts. Potentially a
national child protection alert system could be extended to feedback notifications of hospital
attendances to social work and education systems, at the discretion of the health professional. It could
also incorporate notification of Girfec concerns.
The study found little awareness of the likely duties to be imposed on Local authorities and Health
Boards by the Children and Young Persons Bill due in 2015. All public bodies will be required to share
any information that they have, which may indicate a risk to a child’s well-being. In effect this
introduces a threshold where information must be shared far below that which is currently regarded as
Child Protection.
It is recommended that the requirements and options for cross border data sharing are properly
reviewed with key stakeholders with scrutiny on the merits and sustainability of each approach.
There may be an opportunity to share well-being concerns in a similar or identical manner as Child
Protection alerts.
5.5. Status of Solutions
The solutions reviewed are at various stages of development, as follows:
Organisation Status
Operational (excluding national eCare)
Lanarkshire DSP (local eCare) Operational solution, further enhancements planned. Considering
migrating from ClearSpan to Ensemble
Shetland Islands Council (SWIFT) Operational solution, further enhancements planned
West Lothian Council (C-me) Operational solution, further enhancements planned
POC / Development / Testing
NHS Ayrshire & Arran (AYRShare) Ready to start end-to-end testing with SAC SWIS and NHSAA
FACE when network linkages complete
NHS GGC&C (Orion) Go live Q1 2013, phase 2 in planning
NHS Highlands (SharePoint) System under development with a limited pilot planned for March
2013
NHS Lothian (CareFx) 1st POC completed October 2012. To be followed by a business
case for integration between NHS Lothian and all Lothian councils
Proposal
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Organisation Status
NHS Grampian Proposal submitted for initial solution to replace eCare CPM using
Ensemble
NHS Tayside Proposal submitted for initial solution to replace eCare CPM
Borders Council Proposal submitted for solution to replace eCare CPM using same
Ensemble solution as Grampian.
Reviewing
Comhairle nan Eilean Siar and
NHS Western Isles
Using eCare for CPM and are considering options for an
alternative solution.
Dumfries and Galloway Considering using CareFx portal, Midis and dartEDM (Electronic
Document Management) system
Fife Considering the use of the CareFx portal to support sharing with
Fife social work.
Orkney No definite plans for regular electronic data sharing between
social work, NHS or education. Some health staff have access to
the Paris social work system.
Forth Valley No electronic data sharing in place. Work has taken place on
developing a clinical portal which could be expanded in the future.
Currently there is no funding available for data sharing and no
single point of responsibility.
6. Approaches Taken
The areas reviewed have, or propose to, adapt different solutions to sharing data, driven by different
local requirements, and different existing systems and infrastructure. However it is possible to identify
5 basic approaches, 2 of which allow data sharing but do not involve any system integration. These
models are not always mutually exclusive, for example a single shared system could be used in parallel
with a stand-alone central store to share different types of data. And a central store architecture could
exhibit some qualities of a portal and messaging Hub approach.
It is also possible that a stand-alone central store could evolve into an integrated central stored if the
architecture and infrastructure allows the development of electronic interfaces.
Given the diversity of existing and proposed solutions this study has not attempted to define a target
information architecture. The need for such an architecture and what it might look like need to be
debated by the key stakeholders who understand the issues involved.
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Hig
hla
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Lan
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West L
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Ayrs
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Gram
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Bo
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D&
G
Lo
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GG
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Fife
Taysid
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Sh
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Stand-alone Central Store Y
Integrated Central Store Y Y Y Y Y
Portal Y Y Y Y
Central Messaging Hub Y
Single Shared System Y
6.1. Stand-alone Central Store
6.1.1. Key Features
Centrally hosted database
No electronic links to agency systems (although view and update links could in theory be
implemented)
Direct browser based access allowing update and read access from any location provided
access security is sufficient
Separate logon (user ids can be set to the same as agency systems but not passwords)
6.1.2. Planned Implementations
Highland SharePoint Solution
6.2. Integrated Central Store
Example architecture:
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Central Store Council Social
Work Systems NHS systems
Automatic or manual export of
New/updated/deleted data
Read response
View / update
NHS systems
Matching Index
Read request
Automatic or manual
Export of
new / updated /
deleted data
View /
update
Read response
Read request
NHS system
Read response Read request
Notification of
data change
Notification of data change
View
only
Audit Log
View audit
log
View central
store
Update matching index
6.2.1. Key Features
Based on a publisher/subscriber concept with a central data store and a central matching index
Details of new, updated or deleted data is automatically or manually exported from the linked
agency systems into a central database. Notifications of changed data can be sent to the
linked systems. Acknowledgements of reads can be sent back to the central store and read by
the linked systems.
A central matching index holds 2 or more identifiers from the linked agency systems. The
index normally includes a CHI number but this not essential. It is not essential to CHI seed the
agency systems but this can still be done to aid manual information sharing. Matching is
achieved by a combination of automatic and manual processes.
Access can be limited to the patient or service user context in the linked agency systems
(which ensures greater access control), but direct access to the central store is also possible
(which will involve some form of search by an identifier or demographic data, or a user case
list). Direct access to the store can be read only, or direct update may be allowed (as
implemented in AYRShare).
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6.2.2. Operational and Planned Implementations
Lanarkshire eCare (using ClearSpan as an integration engine but considering its replacement
with Ensemble)
West Lothian Council C-me (using VisionWare MultiVue for central matching and integration)
Ayrshire AYRShare (using Ensemble for matching and integration)
Grampian (proposing to use Ensemble)
Borders (similar architecture to Grampian)
6.3. Portal
Example architecture:
Council Social
Work Systems
Integration and
MatchingCouncil Social
Work Systems
NHS systems
Read response
View / update
NHS systems
Read request
View /
update
Read response
Read request
Portal Viewer
Access control
Audit log
View audit
log
Read requestRead response
6.3.1. Key Features
Based on request / response model with no central data store or matching index
Linked agency systems are seeded with CHI numbers using a combination of automatic and
manual processes
Access can be via the patient context in a linked agency system (by selecting a portal icon), or
by logging directly onto the portal. Direct logon may provide a list of the user’s cases, or a
search page. Search could be by CHI number or a minimum number of demographic details
Users have access to restricted sets of data depending on role
Extends existing NHS portals to give shared access to data from non-NHS systems
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The Lothian CareFx solution could support deployment of eForms for update access, e.g. for
requests for services and additional notes
6.3.2. Operational and Planned Implementations
GG&C Orion Portal (using Rhapsody as the portal integration engine)
Lothian CareFx Portal (using Ensemble for integration)
Ayrshire and Arran are proposing to use Ensemble and Web Services to present multi-agency
information to the Orion Portal from AYRshare
Dumfries and Galloway are considering the use of the CareFx portal, although they may also
implement dartEDM as a central document repository.
Fife are considering using the CareFx portal in a similar way to NHS Lothian.
6.4. Central Messaging Hub
Example architecture:
Message HubRouting rules
Retrieving rules
Agency
System AAgency
System B
View / update2 Broadcast
Message
View /
update
1 Broadcast Message (Agency A only)
1 Data request & response
Agency
System C
Viewer
Application
View messages
(Search client)
A
P
I
A
P
I
A
P
I
2 Data request
& response
2 Data request
& response
1 Messages
Agency D
View messages
(pre selected client)
1 Collaboration
Request or Lock Notification
2 Collaboration
Request
View /
update
Matching
Framework
2 Match Request /
Response
Manual matchingMatch
requests
4 Match Request /
Response
1 Match Request / Response
SCI Store
3 Match Request /
Response
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6.4.1. Key Features
Uses a hub and spoke architecture utilising a small flexible API based on transmission of XML
messages via input and output streams
The message hub will provide the following functionality:
Agency system can post message and broadcast to other agency systems
Agency system can request information from other agency systems
Agency system can request other agency systems to work collaboratively on a dataset.
Actual data sharing is by the post or request methods
User index – the hub could access a virtual directory for each agency to allow messages to be
routed appropriately within each agency system, e.g. to users, mailboxes, teams etc
List of agencies – the hub could provide a list of agencies connected to it to support the
identification of the agency to route the message to
Linked agency systems would initially be pre-seeded with CHI numbers. New clients would
then be manually updated with a CHI number or use a matching framework that automatically
retrieves a CHI number from SCI Store using details provided, else passed for manual
matching.
6.4.2. Planned Implementations
Tayside (considering using Ensemble)
6.5. Single Shared System
6.5.1. Key Features
Information remains in a single agency system with no links to other systems
Update access is extended outside the normal user community provided access security is
sufficient, e.g. NHS staff are given access to SWIFT or social work staff to a health system
User access is carefully controlled to a limited subset of data with restricted search facilities
Associated agency systems may be seeded with CHI numbers to assist with manual record
identification.
6.5.2. Operational Implementations
Shetland Islands (using SWIFT)
7. Common Features
All the solutions described above present common functions (eg matching) and qualities (flexibility)
that need to be considered and implemented by any future data sharing solutions.
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Record matching – Client / patient records from several agency systems needs to be quickly
matched with a high degree of certainty. As far as possible this needs to be automatic with
minimal manual intervention.
CHI numbers are the best means of achieving satisfactory levels of matching and are used by
all the areas reviewed with the exception of Highland. However there may be a minority of
cases that require matching with no health involvement, eg between Education and Social
Work. In this situation the solution may need to support matching without CHI numbers.
Alternatively CHI numbers could still be used – subject to central guidance on their use where
health is not directly involved. None of the areas reviewed were considering using the Citizen’s
Account Unique Citizen’s Reference Number (UCRN).
Audit log – A comprehensive audit log of data updates and views is required, with a means to
quickly report on the log and identify misuse.
Management reporting – As solutions mature they could become an increasing source of
management information, e.g. identifying differing levels of sharing and trends.
Secure access – All solutions need a secure means to link systems. In many cases this is
based on secure links between the NHS N3 network and Local Authority networks to support
integration of health, social work and education systems. However further sharing with Police
and Fire & Rescue systems may require additional links. The effort required to implement
these links should not be underestimated. Links need to have sufficient capacity, availability
and reliability. The SWAN initiative may provide a good solution in the medium term.
Access by the Third Sector, private companies and the public – Giving access to non-agency
users has many benefits but presents several challenges which have not been widely
addressed. An architecture that works well with agencies may not lend itself to this purpose.
Access needs to be very secure and tightly managed. As increasingly the third sector are
contracted or commissioned to supply services, this issue will continue to occur.
User Access – There are several possible models for user access:
Individual professionals linked to service user cases
By role (e.g. Lead Professional, Named Person, Health Worker, Social Worker)
By agency (e.g. allow access by Health but not Education to a case
To areas of data (e.g. types of health data)
To subsets of data (e.g. limited or full assessment access)
Service user restrictions (i.e. no sharing allowed at all for a specified individual)
Emergency “break the glass” access
However access controls need to be kept as simple as possible and be consistent within the
region.
Scalability - Solutions need to be scalable to allow the integration of many agency systems, for
example an eventual solution for GG&C would need to allow data to be shared between up to 8
local authority systems, education systems, housing systems, a central police system,
secondary care systems, 2 types of GP systems and a fire and rescue system.
Flexibility - Solutions need to be flexible enough to support a variety of constantly changing
plans and assessments. They also need to be able to support regular upgrades to agency
systems and, and occasional replacements.
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8. Commercial Packages
There are a number of common agency systems where at least one region is planning to develop an
interface, or has already implemented an interface. The number is likely to increase as other areas
implement shared solutions. There are obvious opportunities to share knowledge, develop common
interface software, and work in a more joined up fashion with vendors. For example SEEMiS have
recently issued a proposal for a universal API for exchanging information with external agencies – the
Single Lightweight Interface for Data Exchange (SLIDE). It does not appear that Northgate or OLM
have made any similar proposals.
System Users Area
SWIS Social Work Lanarkshire and Ayrshire (planned)
SWIFT Social Work Ayrshire (planned), Renfrewshire (planned), West Lothian, Lothian (planned), Tayside (planned), Fife (considered)
CareFirst Social Work West Dunbartonshire (planned) and Ayrshire (planned), Tayside (planned), Grampian (Planned)
Frameworki Social Work Borders (planned), D&G (possible)
EMS Education West Lothian
SEEMiS Education Lanarkshire, West Lothian, Ayrshire (planned), Tayside (planned), Grampian (planned), Borders (planned)
Phoenix Education Grampian (planned)
FACE Health CN Lanarkshire
Orion Portal Health portal Renfrewshire
CNIS Health CN Renfrewshire (planned)
INPS GPs Lanarkshire
EMIS GPs Lanarkshire (planned)
MIDIS * Health Lanarkshire and Tayside (planned), D&G (possible). Other MIDIS consortium partners are NHS Fife, Forth Valley, D&G and Highland (although all have configured MIDIS differently).
PIMS Health Lanarkshire
Adastra Health NHS24 Lanarkshire
Academy Housing West Lothian
TrakCare PMS
Health Implemented by NHS Lothian, NHS GG&C, NHS Grampian, NHS A&A, NHS Borders and NHS Lanarkshire.
Additionally there are a further 4 Boards planning to take on Trakcare. NHS Highland have signed a contract and are due to start implementation in April. NHS Orkney are in the final stages of agreeing their business plan which involves a hosting arrangement with NHS Grampian. NHS Shetland and the NWTC are at an early stage of consideration.
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9. Strategic Options
9.1. Spectrum of Solutions
There is no single approach for the further development of regional solutions, but instead a spectrum
of solutions:
Development of a solution from scratch, ideally based on a package or framework used by
other areas
Extending an existing regional health portal to integrate with other non-health agency systems
Copying all or some of an existing regional solution to other regions and evolving separately
(possibly using some different technologies)
Sharing discrete technical elements, for example interfaces to agency systems, or
transformation technology
Sharing of standardised information services at local, regional and national levels as
appropriate to the nature of the information/capability being delivered
Extending an existing regional portal, central store or messaging solution to neighbouring
regions and evolving as a single solution.
Sharing lessons learned, best practice, standards etc.
These options are not necessarily mutually exclusive, for example lessons learned could be shared as
well as discrete technical elements.
Possible sharing options exist in some areas. For example:
The proposed Grampian Ensemble based central store solution could be extended to include
Borders agencies as they are both TrakCare PMS users, with similar initial requirements for
CPM sharing. Highland, Orkney and Shetland are also TrakCare PMS users with inter-regional
patient movements.
A full Lothian solution would require integration between the planned Lothian CareFx portal and
the West Lothian C-me solution.
The CareFx regional portal includes Lothian, Borders, Fife and Dumfries and Galloway.
MIDIS consortium partners are Lanarkshire, Tayside NHS Fife, Forth Valley, D&G and Highland.
A solution for NHS GG&C is important because of the 1.2 million core population in the area and the
number of Local Authorities (six plus parts of North and South Lanarkshire). Delivering portals for NHS
Lothian and NHS GG&C would cover nearly 2 million people, or nearly 40% of the Scottish population.
A move to a flexible, interoperable network of local / regional / national data services should be
informed by an Information Architecture that would be agreed by all the areas currently developing
solutions.
9.2. Central Assistance and Coordination
There is role for national organisations such as the DSTB, Scottish Government and NHS NISG to
provide assistance and coordination to the regional integration efforts, in particular:
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Assistance with the communications infrastructure required for data sharing, including the
SWAN initiative in the medium term
Coordinating the relationships with the vendors of key agency systems such as Northgate, OLM
and SEEMiS
Identifying common interfaces wherever possible, publicising standards and guiding their
shared adoption. As mentioned in Section 8 SEEMiS have recently issued a proposal for a
universal interface for exchanging information with external agencies. It is important to ensure
that this central activity generates leverage on suppliers rather than a one-size-fits-nobody
outcome
Defining suggested standards and providing advice on good practice in technical areas such as
network connectivity and security, as well as applications security
Suggesting good practice in governance areas such as Information Sharing Protocols
Co-ordinating knowledge sharing between the regions
Tracking national progress with data sharing
Developing a National Information Architecture (if there is a national consensus that this is
desirable)
9.3. National Child Protection Alerts
As described in Section 5.4 above most areas saw a need for some form of national sharing of child
protection alerts, especially given the planned decommissioning of eCare CPM. Some form of national
structure is required to develop this initiative. Activities could include:
Identifying stakeholders
Define a national policy
Defining requirements, benefits and options
Agree a strategic architecture
Agreement on an outline solution. It is likely that any solution would need to be able to
interface with individual agency systems as well as the various regional sharing solutions.
Solutions will need to be scalable and sustainable.
Development of a Proof of Concept, involving links to at least 1 agency system, 1 central store
and 1 portal, involving at least 3 regions
Full development of a national solution
The possibility of using the Emergency Care Summary (ECS) system to display alerts to A&E
staff could be considered, although the ECS consent model (i.e. opt –out) is different to that
required for CP alerts (i.e. mandatory). However concerns or alerts may be raised by A&E staff
and require to be directed to the Child’s Named Person.
Central coordination to reduce costs by maximising reuse and working with vendors in a joined
up fashion
See Attachment 2 for further details on possible options for an integrated National Child Protection
Alert solution. There are important architectural issues that need to be considered in relation to
integrating portal solutions with central data stores.
Assuming a gradual take-on of a national alert system then full business benefits will not be achieved
until a large proportion of the population were covered by linked social work systems. However
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defining a framework architecture and undertaking a proof of concept will encourage regions to build
compatible local solutions. Ideally there should be consensus on the conceptual architecture prior to
deciding which concept will be tested.
The GIRFEC focus on early and effective intervention requires information to be shared with a child’s
Named Person at the first sign of risk to well-being far in advance of Child Protection measures. Alerts
relating to child protection could be expanded to meet the requirements of the Children and Young
Persons Bill and the scope altered to include well-being concerns.
10. Short Term Actions
In the short term there are several activities that could be progressed quickly to improve information
sharing.
Organise a workshop involving 2 or 3 key people from each area, for the purpose of sharing
best practice, considering reuse and getting to know who’s doing what. This could include
streams on business requirements and possible solutions / architectures (including
requirements for a target information architecture)
Create a structure to encourage vendor cooperation to raise the profile of the programme,
improve reuse and reduce cost
Review how the i6 programme being undertaken by the Police Service in Scotland will support
data sharing with Health and Local Authority agencies. The purpose of the programme is to
develop a national solution to record and manage vulnerable persons. Assisted by Scottish
Government funding it has identified requirements and through a European Journal
Procurement exercise has identified a preferred supplier.
Review possible impacts of the proposed Children and Young Peoples Bill
Define the Maturity Model in more detail and agree at a national level
Define the expected benefits in more detail
Review the best model for manual data matching, ie local or national.
11. Maturity Model
This section attempts to define the key elements of a comprehensive data sharing solution, including
functions, qualities (eg flexibility and scalability), partners and the underpinning support required. It
does not define the intermediate steps to get to full maturity, and it unlikely that any area could ever
implement all the functions described below.
Local requirements will vary and it is unlikely that any single area will implement the full scope
described here; however a maturity model gives a possible target or benchmark for regional solutions,
including assessing technical reusability and determining capability. There may also be additional
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functions and partners that a region will decide to implement that are not described here. Finally
changing legislation and practices mean that a maturity model will never be static.
It may be desirable to prioritise the elements of the maturity model if a national consensus can be
obtained, although local priorities are likely to vary. It should also be noted that some of the lower
priority items listed in the Other Data area could be delivered as relatively quick wins on the back of
solutions developed for higher priority requirements, e.g. adult alerts, adult chronologies and
notification of A&E attendances.
11.1. Functions and Data
11.1.1. Service User Demographics
View integrated demographics from linked agency systems, possibly in a format that allows
easy comparison. Details could include the person’s name, address, contact details,
relationships, education establishments, GP details, health visitor, nurse, communication
details, and accommodation.
Some indication what assessments and plans are in development or completed for a service
user, e.g. IAF underway flag
Provide an indication to professionals that a child is classed as vulnerable
Automate the setup of demographics when a social work record is registered (e.g. by access to
SCI store)
11.1.2. Professional Details and Consents
List of contacts (professionals) with consent to share the service user data (name,
organisation, phone numbers and email)
Identification of Named Person and Lead Professional for the service user
Show the “network of support” or register of interests in the service user, i.e. a list of
important people who are linked to the child (but who are not necessarily all shared data
users)
Professionals could maintain their own contact details with the exception of emails which would
be maintained by a senior user or administrator
Key team details
Consent details (type and notes). The Children and Young Person Bill will negate any
requirement for consent prior to information sharing about a risk to a child’s well-being.
Consents broadcast to all agencies whenever they are changed by one agency
Consent to share is assumed for 1 year but can be switched of manually by a senior user or
administrator.
There need to be procedures for ensuring professional’s contact details are up-to-date - e.g.
created when undertaking training, or on registration with the system.
11.1.3. Assessments and Plans
Allow a wide range child and adult related documents to be shared
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Provide a mechanism to control the creation, updates and management of documents by the
Lead Professional, Named Person or other senior professionals, e.g. submission, review and
publication
Allow authorised professionals to contribute to all of a document, or only to limited areas of a
document
Identify the most recently issued document, and possibly display earlier versions
Display as pdf / Word files, or in a common structure (e.g. chapter / verse style), or collated
from data in the linked systems
Allows plans to be downloaded and printed, with the ability to disable this function for some
types of users, or by some other criteria
Allow documents to be shared with the service user and family whether in printed form or
view.
11.1.4. Child and Adult Protection
Show a warning / hazard indicator for the child with instructions to refer to practitioners for
more info, and the practitioner contact details.
Could share different types of alerts / messages, e.g.
Full range of messages from the agency systems
The 4 main Child Protection Messages, optionally with the 2 linked persons messages
Simply an indication that there is a protection issue with the child and the professional
should be contacted
Request a read acknowledgement from the viewing professional and keep a record of the
acknowledgement
Share pre-birth concern messages - linked to the mother and persist until birth/delivery date
Extend to support adult protection messaging,
Shared alerts need to be kept synchronised with the source system
Allow discretionary or automatic sharing from the source systems
11.1.5. GIRFEC Support
Chronologies
Show a chronology of significant events in the child’s life (e.g. start date, end date, type, title
of event, source agency, recorded by, notes/action taken and a RAG code or positive/negative
flag) ) including all well-being concerns
Support filtering and sorting by various criteria
A chronology could be merged from 2 or more sharing agencies, triggered by an authority to
share in the source system
The solution could also allow direct manual update of chronologies
Documentation
Allow sharing of My World Triangle Assessments, Plans, Well-being Indicators, Resilience Matrix
Concerns
Securely share information/concerns raised (by any adult who in the normal course of their
duties has contact with a child) with a child’s Named Person.
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Provide an acknowledgement that the information/concern has been received.
Provide a read receipt
Audits and checks
A configurable and flexible facility to audit the receipt of information shared and produce an
alert if the information remains unopened (as a fail-safe mechanism to ensure that messages
do not go unopened hence increasing the risk to the child.)
Alerts to be notified via e-mail (required by users working in remote areas who do not tend to
access LoB systems on a daily basis)
System to send an alert should information sharing have failed, the alert should clearly state
the reason for the failure
Management
Ability to transfer the role of the named person both within organisations and to other
organisations and to provide the ability for delegation
Named Person’s home organisation to be able to configure the system to direct a message for
the Named Person/Lead Professional to a unit, a person or a group - to ensure Business
Continuity in respect of all abstractions planned and unplanned
Be able to share information with a child’s Lead Professional.
Lead Professional to be able to securely share a completed child’s plan with others involved,
including the child and family
Support the coordination of a Child’s Plan by the Lead Professional - This will entail the LP
sending, and receiving information such as concerns, practitioner summaries and chronologies.
Lead Professional to be able to add a new partner to a plan and advise other partners.
The above GIRFEC points are largely based on the document General Business Requirements for an
Information Sharing System to Support GIRFEC, issued in February 2012.
It is possible that Concerns could be processed and managed in the same way as CP messages.
There are obvious common requirements with other areas such as the more general sharing of
assessments and the management of access to shared data.
11.1.6. Access Control
There are several possible models for controlling user access:
Individual professionals linked to service user cases by a senior user (e.g. the Lead
Professional) and/or a system administrator)
By user role (e.g. Lead Professional, Named Person, Health Worker, Social Worker)
By agency (e.g. allow access by Health users but not Education users to a case, or for Social
Work users from one council only)
To selected areas of data (e.g. to restricted types of health data for Social Work users, or to an
assessment summary only for some types of users)
Service user restrictions (i.e. no sharing allowed at all for a specified individual)
Emergency “break the glass” access, with a comprehensive audit trail of its user
Register / unregister an interest in a service user
Access can be managed centrally or in the lined agency systems. Approval to share could be
the norm (e.g. triggered by adding a CHI number to a social work record), or the exception
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Shared data could be accessed in several ways:
Only from the context of a service users record in a linked system (ensuring that data
access restrictions are the same as the linked system)
Directly in the shared data solution by a list of service users assigned to the
professional
Directly in the shared data solution by a search based on a CHI number or a minimum
number of demographic details (against cases who the user has consent to access due
to their role or team).
Possible single sign-on to local systems and the shared data solution.
11.1.7. Data Matching
A solution should have a means of automatically matching as many records as possible, with a
manual matching process for priority unmatched records. It is not necessary to match all
possible records, just data that needs to be shared.
Portal solutions generally need Social Work systems to be initially seeded with CHI numbers,
possibly by an initial automatic matching process.
Ongoing data sharing needs a mechanism to add CHI numbers to new referrals and un-seeded
existing records, and also manage merges, duplicates etc. This could take place by non-health
users contacting Health staff for a CHI staff, or by giving non health staff direct access to CHI
data.
Manual data matching could be provided locally or nationally (views differ)
A solution may need to allow for data sharing where the service user has no health record, e.g.
just between education and social work.
11.1.8. Auditing
The solution should collect audit data on direct access to shared data, and on access via the
linked agency systems
It should support reporting on specific situations e.g. access to a particular service user or by a
particular user
Also give the ability to identify patterns of suspicious behaviour, e.g. excessive searches for
service users outwith a user’s area
Audit data should only viewed by senior users and administrators
Retention and deletion arrangements for audit data would need to be implemented.
11.1.9. Reporting
The solution should provide operational and management reporting– e.g. number of cases per
user, levels of sharing by agency, report by school of activities linked to their pupils and
automatic production of appropriate SG healthcare assessment indicators.
11.1.10. General
Appropriate staff should receive notifications of new shared information available to view
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Central and interfacing systems may need high availability (e.g. as close to 24x7 as possible).
Archiving policies need to be implemented for central store style solutions (portal solutions do
not hold data centrally so archiving is as per linked agency systems)
System monitoring and alert tools will be required
11.1.11. Other Possible Data
There are a several other types of data that is already being shared by a minority of areas, are planned
to be shared, or have been suggested as desirable features by an area.
Concerns
Reviews
Notes and correspondence.
Encounters and appointments (current and future)
Ward stays
Carer demographics
Service requests for home care, equipment and adaptations, specialist assessments e.g. OT
and income maximisation.
Service provision e.g. actual verses requested
Adult chronologies (in a similar format to GIRFEC children’s chronologies)
Adult alerts, i.e. show a warning / hazard indicator with instructions to refer to practitioners for
more info, and the practitioner contact details
Secure messaging between professionals (possibly with restricted emails, e.g. .gov or .nhs
addresses only. But would then exclude use by third sector etc.). Emails could only contain the
service users name and link to the record in the shared data to reduce the risk of inappropriate
data sharing.
Automatic equipment prescriptions
Confidential transfer of case information with attachments
Search professional contact data
Case Load Management
A homescreen shows recent logins, site notifications, notifications of changes to linked service
and user history
Missing Persons Alerts
Automatic synchronisations of demographics between linked agency systems (eg Social Work)
and the NHS SCI Store
Looked after children indicator
Notification of A&E attendances to other agencies.
11.2. Partners
At the moment most data sharing only involves MHS secondary care and social work departments.
However in the longer term a much wider number of partners could be involved:
Health, including GPs, A&E, out-of-hours, community nursing, ambulance service and mental
health
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Local Authority, including Social Work, Education and Housing
Police
Fire and Rescue
Third sector agencies, e.g. charities providing services and running care homes
Private sector, e.g. care home providers, private nurseries, private schools
Members of the public, including children, families and guardians
Scottish Children's Reporter Administration
Other areas of the criminal justice system.
11.3. Support
Any data sharing solution will need a support and governance framework that will include:
An agreed Information Sharing Protocol between the partner agencies
Specific access protocols for each agency
Availability of personnel to administer the solution on an ongoing basis
Operational level agreements between agency system support areas
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12. Benefits Summary
The areas involved in the study have identified a variety of achieved and expected benefits in the core areas of information shared, i.e.
assessments, alerts/messages, chronologies, as well as general benefits. Benefits accrue to service users, practitioners and partner
organisations. It should be noted that this is not a comprehensive survey of the benefits of data sharing but it does provide an indication
of the benefits that can be achieved.
Service Users Practitioners Organisations
Assessments Speedier, more effective and accurate assessments
Better understanding of needs
Better planning leading to better outcomes for children and families
Providing accurate and up-to-date information to support early intervention and rapid identification of children at risk
Faster implementation of plans and services Reduce the replication /volume of questions
asked
Provides a more seamless service to children and their families.
Shortened pathways
Broader range of services can be put in place to support plans
A more comprehensive and integrated assessment can be done more easily, and the patient/client has a copy.
In future, opportunities for information to accessed electronically by patient/client s
Patient/client asked to give written consent to information being shared, recorded and reviewed, and have an immediate hard copy
Reduces duplication, time to process and time taken in discussing background
Improved quality and efficiency of Assessments
A more comprehensive assessment of risk
For professionals new to a case - reduced need for background information gathering.
Saves practitioner time and effort
Improved quality and efficiency of assessments
Streamlines the process for the Lead Professional
More effective alerting of linked professionals that a new plan has been created
Professionals are more likely to view plans, and more likely to view the most recent version
Immediate information sharing 24/7 Development of assessment skills
Obtaining consent formalised
Reduced risk of inappropriate sharing
Improved information security
Better sharing of plans with the 3rd sector and families
Faster sharing of plans, especially with those who don't have secure email
Consistent feedback from NHS to Social Work on the outcomes of contact with a child
Alerts / Messages / Concerns
Reduced risk to children and adults
Early intervention possible due to well-being concerns being raised.
Less crisis intervention
A&E and out of hours health see the most benefits in CPM, i.e. people not previously involved with a case
Child Protection awareness raising
Sharing of Alerts and Concerns reduces personal risk for practitioners
CP messaging supports Child Protection Procedures and raises practitioners’ awareness
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Service Users Practitioners Organisations
Improved outcomes for children and families
Adult Support & Protection awareness raising
Named Person has full picture of events impacting child
Named person has full picture of needs of child
of their responsibilities
Child Protection messaging links adult and child information systems and assist agencies meet the recommendations of inquiry reports into child deaths
Adult Protection messaging supports the Adult Support and Protection Procedures and arises practitioners awareness of their responsibilities
Legal Requirements of the CYP Bill met.
GIRFEC Chronologies enable practitioners to see an emerging pattern of events, leading to earlier identification of risk, appropriate intervention and prevention of harm
Working in a GIRFEC way requires an appropriate level of joint working – use IT to supplement current data sharing activities to improve the business process.
Information sharing with the Named Person and by the Named person to support the needs of the child.
Will provide a tool kit to support GIRFEC practice and integrated services for children and adults (the health and social care integration agenda)
General Earlier, better and more appropriate interventions and outcomes
Quicker services
Better protection and safeguarding
More accessible services
More capacity to deliver a tailored service Reduced risk to children
Vulnerable children and adults are identified to practitioners
Children receive the most appropriate intervention, care and protection
Better protection and Safeguarding of Children and Vulnerable Adults
Information sharing 24 x 7 supports partnership working
Reducing Duplication and Speeding Up Processes
Better knowledge of what other practitioners do
Reduces the possibility of crucial information not being shared
Linked Adult and Children’s Information systems
ISP training and guidance
more consistent recording practices improved data integrity help achieve national and local strategies
Statistical reporting is becoming easier – especially for activity between partnership agencies and teams.
Improved date integrity
More consistent and improved recording practices
Information sharing 24/7
Reduction in duplication across the partner agencies
Improved report and planning
Development of an ISP and a comprehensive package of supporting materials and a training programme
Other Functions
Ability to order services electronically Secure messaging enables rapid and effective communication between professionals.
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Attachment 1 - Interviewees
Name Organisation
Erik Sutherland East Renfrewshire CHCP
Mary Gallagher East Renfrewshire CHCP
Tim Eltringham East Renfrewshire CHCP
Bill McKechnie Lanarkshire DSP
Fraser McLellan Lanarkshire DSP
Kathy Shilliday Lanarkshire DSP
John Barrett NHS Ayrshire & Arran
Stephen Duffy NHS Ayrshire & Arran
Jane Ankori NHS GGC&C
Mark Darroch NHS GGC&C
Alison Hawkins NHS Grampian
George McCaig NHS Highlands
Kevin Colclough NHS Highlands
Phil Dixon NHS Highlands
Steve McGregor NHS Highlands
Barry Mcalister NHS Lanarkshire
John Sturgeon NHS Lothian
Andy Robertson NHS NISG
Stephen Pratt NHS NISG
Finlay Stewart NHS Tayside
Jenny Bodie NHS Tayside
George Lynch Renfrewshire Council
Anne Martin Scottish Government eHealth
Blythe Robertson Scottish Government eHealth
Eddie Turnbull Scottish Government eHealth
Gary Johnston Scottish Government eHealth
Johan Nolan Scottish Government eHealth
Stephen Pratt NHS NISG
Jane Cluness Shetland Islands Council
Dave Meikle Sopra Group
John Patterson Sopra Group
Martin Bucknall Sopra Group
Stefan Heuman Sopra Group
David Robertson West Lothian Council
Alan Small Scottish Government – GIRFEC Policy Area
Alan Geake Borders Council
Graham Gault NHS Dumfries and Galloway
Ronnie Monagham NHS Fife
Lorna Brown NHS Fife
Lesley Halliday NHS Fife
Tom Gilmour NHS Orkney
Mary Cameron NHS Forth Valley
John Wells NHS Forth Valley
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Attachment 2 – National Child Protection Alerts Lanarkshire eCare have recently proposed a Proof of Concept for a national child protection alert system using a central store and matching index. The proposed solution would need to interface directly with agency systems (example 1), and with regional data sharing solutions (examples 2 and 3). There will be other concepts which could be considered alongside the Lanarkshire proposal, e.g. federated information service brokerage. All proposals should be evaluated against criteria such as flexibility, sustainability, extensiblility, scalability etc. Example 1 – Alerts from Social Work to A&E
NHS A&E
Systems
Council Social
Work Systems
National
central
Store
2
New / Updated / Deleted
Alert
4
Read request
(by CHI number)
5
Alert details
Update alert in
the store
6
Alert read audit record
3
Access patient record
and view alert
Automatic
matching
service
8
Unmatched alert
(no CHI number)
10
Matched alert
Manual
matching
service
9
Unmatched
alert
11
Failed match notification
1 Update client record
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Example 2 – Alerts from Regional Central Store to Regional Portal
National
central
Store
Update alert in
the store
Council Social
Work Systems
Council Social
Work SystemsNHS systems
6 Access patient
record and
view alert
Request / response Request / response
4 Read request
(by CHI number)
7 Alert read audit record ?
3
Alert details
Regional portal
solution
Regional central
store solution
5 Alert details
Council Social
Work Systems
Council Social
Work SystemsNHS systems
2 Automatic export of
New/updated/deleted alert Read response
Automatic and
manual
matching
Unmatched alert
(no CHI number)
Failed match notification
Access patient
record and
view alert
1 Update client record
3 Automatic export of
New/updated/deleted alert
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It needs to be considered how the regional portal could generate an alert read notice for the central regional
store.
Example 3 – Alerts from Regional Portal to Regional Central Store
National
central
Store
Update alert in
the store
Council Social
Work Systems
Council Social
Work SystemsNHS systems
2 Access patient
record and
view alert
Request / response Request / response
Read request
(by CHI number)
Alert read audit record
3
New / Updated / Deleted
Alert
3
Alert details
Regional portal
solution
Regional central
store solution
Alert details
Council Social
Work Systems
Council Social
Work SystemsNHS systems
Automatic export Read response
1 Update client record
Automatic and
manual
matching
Unmatched alert
(no CHI number)
Failed match notification
Access patient
record and
view alert
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Issues to be considered are:
1. How does the portal get the new/updated/deleted message to the national central store? (does the portal
have a means to create this sort of message?)
2. How do we get the alert read notification back into the portal (if it’s required) as the portal doesn’t hold
data?
3. How does the regional central store access the national central store? May need a read request triggered
by NHS read?
4. Either the regional portal has to get messages into the store (somehow), or when a read request comes
into the NCS the store has to send a read request to all regional portals which then polls the linked SW
systems in the normal way, and passes any alerts found back to the NCS.
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Attachment 3 – Detailed Solution Catalogue
GG&C Orion Portal 40
Lanarkshire eCare 42
West Lothian C-me / eCare 46
Lothian CareFx Solution 48
Ayrshire AYRshare Solution 52
Tayside proposed solution 54
Grampian proposed solution 57
Highland solution 60
Shetland Solution 63
Western Isles 65
Borders 67
Dumfries and Galloway 69
Fife 70
Orkney 71
Forth Valley 73
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Solution GG&C Orion Portal Portal
Partners > NHS GC&C > Renfrewshire Council (1st phase) >West Dunbartonshire Council (2nd phase)
And in future phases > Other council social work areas completely in the GG&C area (Glasgow City, West and East Dunbartonshire and Inverclyde) and possibly other agencies, eg education, police and housing.
Current Area and System Technology
and planned interfaces
Integrated health data - Orion Portal Web based Integrates various NHS CG&C systems
NHS GCC Community Nursing - CNIS Web service interface
RC Social Work data - SWIFT Web service interface
WD Social Work - CareFirst Web service interface
Matching Approach
> Initial CHI seeding of SWIFT and CareFirst data using a batch load (98% matching) > Manual ongoing maintenance by a small number of SW staff who have access to CHI lookup in Clinical Portal but not the shared data > CHI number will be visible to all SW users
Data Shared > Basic demographics > Warning / hazard indicator - from WD and RC SW systems (with instructions to refer to SW practitioners for more info) > Child Protection Register indicator - from WD and RC SW systems (also with instructions to refer to SW practitioners) > Children's IAF documents from Renfrewshire EDMS system (including Shared Action Plan) > Children's IAF and Shared Action plan from SWIFT (RC) > Adult Standardised Shareable Assessment (SSA) Forms from WD CareFirst (CareAssess Module) and later CNIS SSA application > Initially only the latest versions of documents will be visible in the portal > Audit data (which Orion user invoked which web service call and when) > Audit trail of web service calls also held in the LoB systems > My case data for SW users - list of clients on that users case list from SWIFT / Care First (switched off in phase 1). No closed cases will be shown.
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Functions > View integrated demographics from Health and Social Work LoB systems (2 part screen) > View CP register indicators (no acknowledgement requested) > View latest version of IAF documents and SSA form in pdf format (within the Clinical Document Viewer area) > Warning / Hazard indicator - from WD and RC SW systems > View audit log of data views > System monitoring and alert tools > View professional contact details (addresses but not email or phone) > Search CHI number (by surname, first name and postcode) > Social Work client context access, or "my case list", or search own Council data by CHI no > Health staff access client details from context of patient details screen > Archiving policies depend on LoB system - no data held in the portal > Id of each clinical portal user is passed to the councils as part of each web service call and can be recorded
Integration Approach
> Orion will pass Web Service requests to linked systems which send back data (triggered by access of client record in Orion) > Health network already has 6 links to all council networks
Read only? All read only - update only in linked systems
User Access Method
> WD and RC Social Workers - read only direct logon. > Designated NHSGGC health staff - read only client context access > From CNIS - link in patient context. No search? > Same logon id for SWIFT and Orion (but not password) > SW staff click on a portal icon in LoB client details page > Or by logging directly onto the portal and accessing a "my case list" or search page (not phase 1). To be determined how access managed to case list. > Searches would be by CHI number
Access Control
> Access managed by Portal administrators > Various levels of health user access depending on professional grade > 2 types of social work access (standard and CHI lookup) > SWIFT confidential addresses not displayed in the portal > Role based access control (eg Renfrewshire Social Worker will only see RC SW clients)
Volumes > 190 Renfrewshire Social Work users > Possibly 40/50 CPMs in Renfrewshire
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Planned features
Phase 2 provisionally may include: > My case list (WD requirement) > Other service applications of NHS GG&C > Integration with remaining councils wholly within the GG&C area, ie ER, ED, Glasgow and Inverclyde > Sharing of Single Shared Assessments with CareFirst and CNIS > Sharing of Discharge Letters subject to consent > Access from SWIFT via an icon in the client context > Display first authorised and updated versions of documents > Display contact information (directories) for health and social workers (pulled from the agency systems) > Integrated children's chronologies > IAF underway flag. > Initial discussions with SEEMiS around the Education Information System utilised by the GGC DSP Local Authority Education services
Desirable features
> Access to Education (SEEMiS), Police and other areas. > Automate setup of demographics when a social work record is registered (ie by access to SCI store from SWIFT and CareFirst). However would need a lot of governance work and agreement > Vision of standard Assessment forms within all GG&C partners > National CPM
History Currently in testing (Oct 2012), go live Q4 2012
Notes > Both Glasgow (Orion) and Lothian (Harris) architectures are similar, although GG&C are using Rhapsody as the portal integration engine and Lothian are using Ensemble > East Renfrewshire have also considered the OLM MultiAgency View product. Would support a many to many between clients and professionals. > Integrated children's chronologies could be maintained by NHS Child Protection area if they could get access to SW systems
Benefits of sharing
> Business benefits of quick assessments to IAFs
Solution Lanarkshire eCare Central Store
Partners
> North Lanarkshire Council > South Lanarkshire Council > NHS Lanarkshire
> Strathclyde Police N and Q Divisions > SCRA > Strathclyde Fire and Rescue
Current Area and System Technology
and planned interfaces
Lanarkshire eCare > Central MS SQL Server database > ClearSpan integration software
GPs - INPS View access
GPs - EMIS EMIS link under consideration
NHS Comm Nursing & others - MIDIS & PIMS
Bi directional data exchange
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NL and SL Education - SEEMiS Bi directional data exchange
NL & SL Social Work - MySWIS & SWIS+ Bi directional data exchange
NHS 24 - Adastra/OOH View access via Adastra/OOH (inc mobile supp.)
NHS A&E and acute services inpatient and outpatient - TrakCare
View access via TrakCare
NHS SCI Store Automated reference look up
Strathclyde Police N&Q divisions
View access via SWIS logon
SCRA View access via SWIS logon
NL & SL Housing View access via SWIS logon
Matching Approach
> Central matching index of all indices - includes CHI number > Initial automatic matching against CHI by name etc (e.g. 60%), then manual matching as required (4%) via eCare Management application > Failed matches from CP messages go into a priority manual matching queue and are dealt with urgently. > If a match cannot be made, notification goes back to the sender to allow them to decide what to do. > Index updated automatically when new entry registration on any partner LoB system.
Data Shared > Primary care person demographics > Associated professionals contact details > GP details > Addictions Contact details > Referrals > Appointments > Ward stays > Carer demographics > CPM - 4 main protection messages and the 2 linked person messages. Persist until age 17. Alert messaging includes child protection subject, linked children and linked adult messaging, include relationship to subject child status, carer status, legally responsible status, lives at same address or not and if CP activity is current or past. > Pre-birth concern messages - linked to the mum persist until birth/delivery date > Adult protection messaging, investigation adult protection plan and AP activity ceased on date messages persist for three years from ceased on date > Shared Assessments (full assessments are shared, not just practitioner summaries). Assessment types- Long Term Conditions, mental health, learning disabilities, addictions and substance misuse > Personal outcome plans > Care plans > Service requests for home care, equipment and adaptations, specialist assessments e.g. OT and income maximisation. > Service provision e.g. actual verses requested > GIRFEC consent details – consent held centrally in MAS all partnership updated automatically when consent changes (continued >>) > Child integrated Chronologies each significant event record comprises – 7 or 8 fields
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and summary, > Single Named Person and “network of support” for the child, i.e. a list of important people who are linked to the child.
Functions > Appropriate staff receive notifications of new shared information available to view in the central database. > Update status of CP and AP messages in the MAS and issue alert for Child and Adult Protection Messages to the linked agency system > Acknowledgement has to be selected when viewing CP and AP Protection messages , this creates an audit trail in the MAS (CP and AP Messages can also be printed). > Consents broadcast to all agencies whenever they are changed by one agency, so they all follow the same rules. > Child Integrated Chronology - Merged from 2 or more sharing agencies (Significant events are authorised to share into the integrated chronology from source systems). > CP alerts are automatically deleted when the child reaches 17 years of age other Girfec components are removed when consent expires or is withdrawn. > Child Chronologies - Filter by date, source agency, category (e.g. well being of the child, legislation etc), or +ve/-ve/neutral indicator. > Consent model allows any participating agency to view shared information e.g. an integrated chronology where consent has been granted for that agency to view the information > CHI matching management application allows identifiers to be added where messages fail to comply with the eCare business rules e.g. a health assessment must have a social work identifier attached, social work assessment must have a health identifier and protection messages must have identifiers appropriate to all involved agencies > Service Requests (from PiMS or Midis - e.g. Health order Home Care, Equipment and Adaptations or Specialist Assessment)
Integration Approach
> Assessments - automatic export from SWIS and NHS systems to a central database. Notifications are then pushed to the recipient systems. The information is then viewed in all partnership systems via an embedded web application which appears as part of each host system > System supports sharing of assessments in different formats. All message construction is carried out by eCare adapters. > Messages - automatic export to central database then read from linked systems e.g. no additional operations required by system users. > Chronologies - user authorised export to central database where merged and read via an embedded web application which appears as part of each host system, i.e. Care Viewer
Read only? The eCare viewer application does not allow shared information to be altered and in this respect is view only. No user may update information shared by any other agency. New information may be shared from any of the agencies at anytime and new information may be recorded using the assessment server component or service request tabs of the eCare viewer. Any information shared e.g. an assessment or integrated chronology, from a source system may be added to or updated but only by that source system.
User Access Method
> Embedded in source systems. > Service user context only (access control advantages), i.e. no service user search facility Only Patient/Client context available.
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Access Control
> Granular access possible by agency (GIFREC compliant) but not by assessment section. > Information Shared is agreed on a process basis across the Partnership e.g. it is not appropriate to further restrict system user access. > Consents are broadcast to all agencies whenever they are changed by one agency, so they all follow the same rules. > Full assessments are shared, not just practitioner summaries.
Volumes > 19k CPMs to 4/2012, 9k in 2011, > 887 people with APMs in 2011 > Between 2k and 3k people with shared assessments in 2010 > Nearly 500 Health Service Requests in 2011
Planned features
>The Named Person and Lead Professional, start and end date, contact details and history > Child’s Single Agency Wellbeing Assessment and Plan > My World Triangle Assessments and Plan > Request for Assistance and Notification of Concern > Integrated Assessment and Plan > Adult chronologies > Police contribution to a chronology (with ACPOS and Scottish Government)
Desirable features
> Other 3rd sector access Care Home access (security issues need to be addressed), > Share referrals assessments etc with Meridian Services (addiction services) > Links to EMIS GP systems > Fire and Rescue access > Demonstrator project with 2 neighbouring areas to share public protection messaging e. g. child and adult protection messaging (any social work system with any A&E) > August DSTB meeting gave in principal support for Lanarkshire proposals for sharing public protection alert messaging across partnership boundaries and viewing and sharing alert messaging and shared care information with the third sector, whilst awaiting a detailed proposal. > Would like to investigate the capabilities of Ensemble to replace ClearSpan functions. Could then transfer all or parts of an Ensemble based solution to other areas
History 2003 SSAs, 2004 service requesting, 2005 CPM, 2011 APM, 2012 GIRFEC part 1
Notes
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> Source assessments content and format all differ but presented in same hierarchical book / chapter / verse format as a "report" > Selective sharing rarely occurs > Messaging to A&E very important > Would like to share messages with neighbouring areas, using a small central dataset, 1 adaptor, web services and matching by CHI number > Lanarkshire have a fully mirrored test environment > Current interfaces are:
Benefits of sharing
> Shared Assessments - within hospitals, the ability to access shared information reduces the need for staff to contact Social Work in the first instance > It also significantly reduces the time taken to gather information from families on GP, Care Manager and Social Worker contact details and to gather a full picture of patients’ circumstances. This has led to reductions in hospital stays for a number of cases. > Electronic requests for homecare equipment by health practitioners - has been a tremendous benefit to both patients and staff, and has incentivised health practitioners to use the electronic system > See full details in Lanarkshire benefits table
Solution West Lothian C-me / eCare Central Store
Partners
> NHS Lothian > West Lothian Council > Lothian and Borders Police >Children's Reporter
Current Area and System Technology
and planned interfaces
C-me VisionWare MultiVue for matching and merging
Social Work - SWIFT Direct duplex interface – bespoke from Northgate
Health - TrakCare & CIS Web service interface
Education - SEEMiS & EMS Web service interface
WL Council - ETS (enquiry tracking) Archive web service interface
Archive SW records - SSID Incorporated into SWIFT interface
GPs No direct system interface required
Health - Telecare No system interface required
Police users No system interface required
WL Housing users Web Service interface with Academy
Children's Reporter users No system interface required
Matching > Secure central matching and merging facility (VisionWare MultiVue)
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Approach > Automatic update between all systems via the central eCare matching facility > Manual review process for physical matching of non verified matched records > CHI number held as a secondary key in C-me - not visible to all Social Work users
Data Shared
> Detailed service user demographics, inc. Person details, relationships, education establishments, GP details, health visitor, nurse, communication details, accommodation) > Chronology of events (start date, end date, type, title of event, recorded by, notes). RAG coded. > Alerts (wide range: 18 SWIFT, +23 TrakCare + Education messages) > IRDs (Inter-agency Referral Discussion), SSA’s, specialist assessments and Care & Support Plans > Consent details (type and notes) > Professional contact data > Register of interests in service users by professionals
Functions > Searchable client database (by N&A, DoB & Swift ID) > CPM (RAG coded) > Update shared SSAs, IRDs, and Care & Support Plans > Secure messaging between professionals > Confidential transfer of case information with attachments > Search professional contact data > Update chronology of events > Automatic Alert Notification > Case Load Management > Register / unregister an interest in a service user > Care home staff can use secure email (including to securely send assessments) > Reports/extracts, e.g. report by school of activities linked to their pupils and automatic production of SG healthcare assessment indicators.
Integration Approach
> Duplex adaptors in the linked systems > SEEMiS - scheduled extracts >TrakCare - outward only > Use published APIs to write directly to SWIFT database > Event driven extracts from SWIFT
Read only? No - all sharable data items can be updated in C-me if the user has the correct permissions.
User Access Method
> Logon to C-me portal from within linked systems
Access > Role based access control
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Control > Consent controls > Access can be restricted by service user (client) or web-part > No requirement for GIRFEC style granular access (full sharing or none) > Two levels of access (1 = child's core data and other linked professionals, 2 = chronology and assessments)
Volumes > 500,000 matched records > 10,000 completed assessments (all client groups) > 3,000 users > WL population is 170,000
Planned features
> Telecare assessment (Safe at Home) > Automatic equipment prescriptions
Desirable features
> Share messages with Lanarkshire > Update of functionality for children’s services to support the GIRFEC agenda – updated chronology, shared child’s plan and interface with education. > Extended proof of concept with NHS wrt Community portal technology. > Extended geographical propagation of web services
History Launched 2004
Benefits of sharing
> Overarching aim: "To improve the quality and integration of services for children and adults in West Lothian through effective sharing of information between involved agencies, children and families at every point in their care". > Chronologies - enables practitioners to see an emerging pattern of events, leading to earlier identification of risk, appropriate intervention and prevention of harm. > Earlier Identification and Intervention > Sharing of Alerts and Concerns – reduced personal risk for practitioners and safeguarding children > Referral and Assessment history – more effective and accurate assessment of the individual, less time taken in discussing background, fewer repeated questions and better understanding of the needs relating to a child. > Reducing Duplication and Speeding Up Processes > Rapid Effective Communication - secure messaging enables rapid and effective communication between professionals. > Improving the Quality and Efficiency of Assessments > For professionals new to a case - reduced need for background information gathering. Saves practitioner time and effort but also to improving the quality and efficiency of assessments and providing a more seamless service to children and their families. > Statistical reporting is becoming easier – especially for activity between partnership agencies and teams.
Solution Lothian CareFx Solut ion Portal
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Partners > NHS Lothian, with: > Initially: Edinburgh Council, SW Initially POC core information set
> In the future: Enhanced datasets, actual assessments, and CP messaging SW, Education, Housing etc in > East Lothian > Mid Lothian > West Lothian Council And Consider other agencies > Police > Voluntary Services
Current Area and System Technology
and planned interfaces
NHS Lothian - CareFx regional portal > Ensemble for integration and aggregation > Web services > Uses Carefx’s Fusionfx platform
TrakCare - NHS EPR Already integrated with CareFx (however enhancement required from further integration with other agencies) Webservices / Ensemble
ECS - NHS Emergency Care Summary Already integrated with CareFx (however enhancement required from further integration with other agencies) Webservices / Ensemble
Edinburgh SW - SWIFT POC adaptor completed(however enhancement required from further integration with other agencies)
And in the future:
Borders NHS – Trak. Currently integrated for Regional NHS Clinical Portal, but local partner agency implications needs assessed for SC Portal and associated Child Protection messaging
Webservices / Ensemble
Dumfries – Topaz. Currently integrated for Regional NHS Clinical Portal, but local partner agency implications needs assessed for SC Portal and associated Child Protection messaging
Webservices / Ensemble
Fife NHS - Oasis Patient Administration (PAS)/Electronic Patient Record (EPR) Currently integrated for Regional NHS Clinical Portal, but local partner agency implications needs assessed for SC Portal and associated Child Protection messaging
Webservices / Ensemble
Police – IRDs (Inter-agency Referral Discussion) (Child Concern / Child
Webservices / Ensemble
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Protection related documentation and associated Child Protection messaging)
Matching Approach
> Social Work systems will initially be manually seeded with CHI numbers (Social Work staff need to obtain CHI numbers by phoning NHS staff for the POC – Any final production solution would need CHI search / update mechanism agreed for Social Care, (and other agencies – Voluntary, Police) > CHI numbers will need to be manually added to new data and existing data where the seed failed (Part of any new protocol for CHI access and maintenance > New DSTB working group on CHI use across agencies, guidance on usage scenarios, seeding, view / sharing and updates (also dealing with validation, matching and CHI and local demographic variance between agencies)
Data Shared The final Portal solution will display: > Wide range of patient data available for health and social care users (subset provided for POC) appropriately filtered based on usage roles / need to know, including: > Demographics from SWIFT / NHS > Standard child protection messages > Alerts from Trak and SWIFT hazards > Key worker details > Teams involved / Services provided > Notes > Patient/Client Contacts > Adult and Child plans > Shared assessments and chronologies > Requests for Service > The combined social and NHS summary screen, holds demographics / NOK contact details from each system, concerns, teams involved, services delivered, assessments , reviews, notes and correspondence. > Trak referral, diagnosis and GP / HCP information was also provided. > A further workshop is arranged at the end of Jan 13 to detail the exact datasets that require to be shared, and to work cooperatively with Glasgow on integration approach and message content (and any other regional portal providers)
Functions > NHS users can enter a CHI number or search by DOB, name, post code etc, or by grouping (eg clinic or ward) > Social Work users have to enter a valid CHI number (no search facilities on CHI data sources) The Social Care user search criteria would also be limited to CHI. > Displays various tabs and portlets to present data from various sources, patient context retained > Portal Application Extensions to be developed (there for Clinical Portal already, e.g. Trak), which allow seamless launching of client systems (e.g SWIFT) in patient context for data entry > Review of options to use Portal Clinical / Social Care forms to collect data and post back to client systems > Assessments - portal will allow various source formats to be displayed in a "report" style (built from source data, rather than in a pdf format). > Share alerts from Trak and SWIFT hazards > Encounters and appointments (current and future) > Consents (need Portal controls added over records to be shared / with-held) > Linked professionals
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> Demographics from SWIFT and SCI store / Trak > Key team details > Authorised NHS users can get full access to Clinical Portal clinical content from Trak, all regional SCI Stores, ECS (medication / Allergies) and shared Social Care / NHS summary > The Social Care user portal contains more limited NHS encounter and appointment information and the shared Social Care / NHS summary. > Future functional Social Care interface needs to deal with CHI access, End User (AD/federated domains) or Trusted system-system credentials and Access audit, also Additional Data Items including Assessment Documentation, GIRFEC information and messaging) > Record locator service (generally Board level SCI Store) to limit access requests to operational systems
Integration Approach
> Users of linked systems will supply a CHI number and the relevant data will be pulled from the source systems on demand. > Need to agree any additional patient/client data for validation (e.g. Surname, Sex, DOB) > There will be no patient / client data held centrally, portal pulls data on demand from client systems > Access Control data will need to be held within portal, e.g. user accounts, roles, access logs etc (need to define production approach here)
Read only? > Initially yes > However CareFx could support deployment of eForms for update access, eg for requests for services, additional notes, input to client systems
User Access Method
> Logon via secure communications infrastructure (to be determined, additional SC networking SWAN, existing GSI/GSX, Secure VPN Tunnelling etc) > Also need Defined Approach to user identification, role management and system-system trusted communications
Access Control
> Different users get access to different tabs and portlets, e.g. Social Work staff get a restricted view of health data > Audit trail maintained for Portal accesses > Sharing can be blocked in the source systems for defined individuals (part of consent to share flags within source systems, need agreed standards here) > To be decided if a positive decision to share, (adding a CHI number in SWIFT could be taken as a positive decision to share but that’s a very high level approach more granularity likely required> To be determined who will manage user access. > Will need restrictions on cross-board and cross-council access - to be worked out (part of a new interagency gateway architecture) > CHI guidance required on use with other agencies, where health not directly involved (eg between SC and Education) > Updated rules on non-disclosure patients
Volumes To be supplied
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Planned features
> Integration with Mid Lothian and East Lothian Social Work systems (both CoreLogic/Frameworki) > Integration with West Lothian eCare system and/or Social care system (Swift) As noted also need Defined Social Care (and Other agency) Gateways, to limit connection complexity and broker access requests (e.g. Social care, Education and Housing behind a SC gateway – Board / regional / national ?) This depends on Ensemble Architectural and Licensing decisions > Put each agency dependent system upgrade plans on a common timeline along with health to assist coordinating portal approach
Desirable features
> Possible single sign-on to local systems and the portal > Portlets for GIRFEC concepts such as Well-being Indicators, My World Triangle and Resilience Matrix, Chronology, Child Plan etc > Agency based and integrated chronologies > Interface with Education SEEMiS systems (would need to be CHI seeded) and similar controls to Social Care Systems > Alerts (currently manually typed into Trak). Would need to be synchronised, and also allow discretionary sharing from the source systems. > Secure messaging with partners (CareFx has secure messaging that could be extended) > Social care (and Other Agency Integration) to be an extension to existing Portal (NHS) National Data Standards (NDS) – Small Agile interfaces (vs complex / expensive earlier eCare adapters – APIs need unlocked from each supplier and web Service Standards agreed (need authentication, legitimate interest (roles) etc)
History > Social Care POC completed October 2012, > Additional Patient Portal POC in progress (likely Nov / Dec) > To be followed by business case for integration between NHS Lothian and all Lothian councils including West Lothian (and other agencies including Education, Housing and Voluntary Sector, Police). DSP to own business case.
Notes > CareFx regional portal includes Lothian, Borders, Fife and Dumfries and Galloway > Ensemble license issues need to be addressed (use outwith NHS) – Possible National Ensemble license > Need to consider national System Access standards (e.g. ECS, Child health Screening, and CHI) through National Ensemble Integration gateway
Solution Ayrshire AYRshare Solut ion Stand-alone
Partners
NHS Ayrshire & Arran East Ayrshire Council South Ayrshire Council
North Ayrshire Council
Current Area and System Technology
and planned interfaces
AYRshare central database > Hosted in NHS environment > Ensemble for matching and integration > .Net front end
NHS Ayrshire Health Visitors - FACE Specified XML format output transformed by Ensemble
North Ayrshire Council SW - CareFirst Specified XML format output transformed by Ensemble East Ayrshire Council SW - SWIFT
South Ayrshire Council - SWIS Adaptor in SWIS
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All 3 councils Education - SEEMiS XML output
Matching Approach
> Central index of identifiers, ie CHI number, SW LoB system ids > Match on demand > CHI number desirable but not mandatory (eg for unborn children and transient individuals) > NHS staff add CHI numbers to central index
Data Shared > Homescreen shows recent logins, site notifications, notifications of changes to linked service user history > Summary list of linked service users (My Folders) > Basic service user demographics (CHI no. Gender, DOB, Age, Address) > Contact details for Named Person and Lead Professional (name, email and phone numbers) > Assessments and plans for service users (as a list of documents in various formats) > Chronology of significant events for service users (organisation, source, recorded by, date recorded, title, notes/action taken, category, RAG significance - alert, +ve or -ve) > All child data at present > List of contacts (professionals) with consent to share the service user data (name, org, phone nos. email) > Audit trail of all user actions (including queries)
Functions All users who have access to the child's record can > Upload documents > Add chronology events (but not edit existing events) > Search for service users which they have consent to access (by id, inc. CHI number or at least 3 items of demographic data) > Maintain own contact details (phone numbers - not emails) In addition Named Person and Lead Professional can: > Give contacts (professionals) access to a service user's data (can see all data - no partial access) > Delete and hide documents > Delete and edit chronologies > View the audit log > 2 sources for chronologies, linked LoB systems and direct manual entry. > Some actions in LoB systems automatically send data to AYRshare, or data can be manually sent. > Some users can be given emergency access to all service user records because of the nature of their job, eg A&E, 24 hour cross-Ayrshire Social Work Team > Any user can raise a concern. When it is agreed to share information a record is created automatically in AYRshare when information first sent, or manually by request to System Admin to do so. > NHS staff add the CHI number > Contact emails restricted, eg .gov or .nhs addresses. > Emails only contain the child's name and link to the record in AYRshare > Various reports on data stats and system usage will be possible > Consent to share is assumed for 1 year but can be switched of manually by NP or LP > Archiving strategy is to be finalised - probably driven by the LoB system
Integration Approach
> Central store database holds assessments, plans and chronologies > Adaptors / XML exports from LoB systems > 3 council networks need to be hooked into the Ayrshire & Arran NHS Network
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Read only? No - users can directly upload documents and create chronology events.
User Access Method
> Browser based stand alone access (ie not via LoB systems)
Access Control
> Via secure network (Local authority or NHS) > Police and 3rd Sector access might need a different approach > Named Person and Lead Professional control access for Contacts (Professionals) > No attempt to manage access by roles, agencies or to sub-sets of data - regarded as adding to much complexity
Volumes Difficult to forecast, maybe: > 1 in 10 children > 3000 active cases per year
Planned features
> CPM needs more analysis > CPM in NAC between health (FACE) and Social Work (CareFirst) uses eCare.
Desirable features
> Open access to areas outwith LAs and NHS, eg 3rd sector, police, fire and rescue. But would need a secure means of access. > Could be by direct logon initially, then LoB system integration > Cross border CPM (in discussions with Lanarkshire and D&G)
History > Ready to start end to end testing with SAC SWIS when network linkages complete > Then integrate with FACE > Bring in EAC when they have completed an upgrade to SWIFT > NAC integration at the proposal (development) stage > Could tap into Lanarkshire SEEMiS changes
Notes > Don't under estimate the effort to link council networks to NHS network > Decided that all was needed were documents and metadata rather than XML. The Chronology is produced in XML. > ISP in draft for Ayrshire DSP. AYRshare will be covered by a local guidance procedure.
Benefits of sharing
> Children & families quicker services better protection and safeguarding more appropriate interventions and outcomes > Practitioners Information sharing 24 x 7 reduces duplication and time to process supports partnership working better outcomes for children > Organisations improved data integrity more consistent recording practices help achieve national and local strategies extend to other areas
Solution Tayside proposed solut ion Central Messaging Hub
Partners
> Tayside NHS > Dundee Council > Angus Council
> Perth and Kinross Council > Tayside Police > Tayside Fire and Rescue > Voluntary Agencies
Current Area and System Technology
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and planned interfaces
NHS Tayside - MiDIS Clinical Portal To be agreed. Solution may use a hub and spoke architecture utilising a very small flexible API based on transmission of XML messages via input and output streams. System interfaces would need to be implemented by each agency system. Interfaces would need to support: receive message, send message, get user directory, and get agencies
Angus Social Work - OLM CareFirst
Dundee Social Work - K2 (in-house)
P&K Council Social Work - Northgate SWIFT
P&K, Angus & Dundee Education – SEEMiS
(but no involvement from private schools or private nurseries)
Matching Approach
> Use CHI number as a the as the central index that all other agencies match to > Agreed that CHI ids can be held on other agency systems > Agency systems will need to be bulk matched and pre-seeded for initial connection to the hub but can then either match new clients via a manual process or use a matching framework provided > Unmatched requests would be processed manually by a matching clerk in NHS Tayside > Ideally would like to get notifications from SCI Store of demographic changes
Data Shared > Initial focus is on CPM framework as well as an indexing and matching service > Initially just CPM for Dundee and Angus - P&K are not using CPM at the moment > The proposed framework would support 4 types of data sharing: 1. Sending Information - An agency can send information to one or more other agencies via the message hub but can also restrict the message to specific agencies, eg CPM. 2. Requesting Information - An agency can request information from one or more agencies via the message hub, eg a portal type application that just needs to display information on demand. 3. View only - The ability to only view shared data will be required if an agency does not have an application of its own, is not connected to the message hub, or the agency system cannot process all message types. 4. Collaborative Working - 2 or more agencies may require to work together to complete a joint record and the hub will provide the mechanisms for doing so. For example collaboration between Social Work and Health to complete a Single Shared Assessment. > Tayside Fire and Rescue currently have restricted access to MIDIS for referrals only - they then need to contact the appropriate professional > Tayside police can access CPMs via a restricted MIDIS logon > NHS out of hours can access MIDIS.
Functions > Sharing of Child Protection Messages between all partner agencies > Central indexing and matching function > Ideally the solution should allow true collaborative working on a dataset, including record locking > Broadcast messages based on information in the message or default routing information > Allow agencies to request information from other agencies
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> Hold a virtual directory for each agency to allow message routing to users, teams etc > Provide a dynamic list of agencies connected to the hub > Optionally hold historic messages in the hub
Integration Approach
> Solution would be based on standard services > N3 connectivity will be required for some sites. Any sites not on N3 (eg Police) will need an internet facing architecture > Solution likely to be based on the following principles: • Be lightweight with low barrier to connect • Be simple • Keep business logic within the agency systems • Use CHI as a matching index • Be flexible to accommodate new datasets as they are introduced • Use a hub and spoke architecture to reduce point to point connections and impact of connecting new systems.
Read only? Yes - all updates would be via agency LoB systems
User Access Method
> Both via LoB and stand alone viewer. > A viewer application will be created independently of the message hub and will receive messages from the message hub for storing and viewing based on routing rules within the hub. The application will be accessible either as a standalone application that a user logs into and searches for a client to view or via an interface to allow a third party application to open the viewer with a pre-selected client.
Access Control
> An internet-facing service would require an internet security management solution to continually protect the site from any potential threats.
Volumes > In eCare number of new children with CP warning 2011/2012 averaged about 30 per month > Number of new children with linked person CP warning averaged about 4 per month > Number of CPMs retrieved via agency adaptors between 180 and 250 per month (all for Dundee City and Angus Councils only)
Planned features
> Proposed to build a solution utilising local architecture but using underlying principles that allow collaboration to support future multiple partner consortiums or centralised national solutions
Desirable features
> Recognised that GIRFEC may change requirements for CPM. Could be the subject of a future bid for funding.
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> Perceived need for Scottish national CPM, especially with A&E. > UK wide CPM would also be useful > National CPM would just involve general alert messages with no specific details about the alert > Scottish wide data sharing on Looked After Children would also be useful > Have discussed options for sharing data on fire starters with Tayside Fire Service (currently on spreadsheets) > Proposed CPM framework could be used for adult messages in the future > Extend scope of MIDIS to include more hospitals and GP systems (4 EMIS and 63 INPS). MIDIS is mainly community nurses and mental health at the moment) > Integrate Adastra in the future (NHS out of hours) > Share solutions with other regional MIDIS consortium partners (NHS Fife, Forth Valley, Lanarkshire, D&G and Highland). Although all have configured MIDIS differently.
History > Tayside have adopted eCare CPM in Dundee City and Angus Councils. MiDIS, Clinical Portal, SEEMiS, K2 (Dundee social work), and CareFirst OLM (Angus social work) are all connected. > October 2012 submitted a funding request to the SG to define the business requirements and identifying the business solution and technology required to deliver replacement solutions for the services provided within the eCare framework (i.e. an indexing and matching service and a CPM framework).
Notes > Would need continuously available hardware, with 24/7 monitoring and application support. > Above information based on meetings with Jeni Bodie and Finlay Stewart also the following documents: Data Sharing Technologies Board - 30 October 2012 - Tayside Funding Request.doc Data Sharing Technologies Board - 30 October 2012 - Tayside Data Sharing Framework Proposal.doc > Although a fully defined architecture for the CPM replacement work is not yet available, the solution is likely to be developed outside the Ensemble framework initially but equally developed such that it converts to an Ensemble platform relatively easily in order to aid any wider collaborative approach
Benefits of sharing
> A&E and out of hours health see the most benefits in CPM, ie people not previously involved with a case. > New initiatives, such as GIRFEC, are introduced that require an increased level of joint working there is a greater opportunity to use IT to supplement current data sharing activities to improve the business process
Solution Grampian proposed solut ion Central Store
Partners
> NHS Grampian > Aberdeenshire Council > Aberdeen City Council > Moray Council
> Grampian Police
Current Area and System Technology
and planned interfaces
NHS Grampian - Trakcare PMS system > To be determined > Possibly based on Ensemble, Cache and HealthShare Foundation from InterSystems All council Social Work areas - CareFirst
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Aberdeenshire and Moray Education - SEEMiS
> Reuse existing adaptors for CPM if possible > Proposed interface technologies are: TrakCare - HL7 CareFirst - XML SEEMiS - XML EMS/Vision - OpenHR/CDA
Aberdeen City Education - Phoenix
Matching Approach
> Probably a central matching index of identifiers from linked systems, including CHI numbers and CareFirst ids > InterSystems have proposed using the HealthShare Patient Index for record linking > A simple ZEN user interface could be developed and integrated with the Patient Index to allow manual matching/analysis > It is possible but highly unlikely that an alert could be raised against a client in CareFirst and shared with SEEMiS even if the child doesn't have a patient record in TrakCare PMS. Any child born in Grampian is registered on PMS at birth and any child moving into the area and registering with a GP would be picked up by PMS. > But also considering CHI seeding of LoB systems > 97% of the Grampian population have a CHI number
Data Shared
> First priority is to implement CPM between NHS PMS system and Moray CareFirst SW system > Initially would support 4 main protection messages, ie: Investigation Investigation and on the CP Register Registration Past activity But not the linked adult and linked child messages
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Functions Core functional requirements are: > Ability for CareFirst to send CPM messages to SEEMiS. > Ability for CareFirst to send CPM messages to TrakCare, and for alerts to be displayed next to the correct patient data > TrakCare and SEEMiS users to be able to view the CPM message in context. > A process to match identifiers across the different systems > An interface for CHI lookup and CHI broadcast would also be required. > The solution would need to ensure that shared messages are kept synchronised with the source data > May also want users to be able to see expired messages
Integration Approach
> Will use a publisher / subscriber model that supports extensibility > Information will be exchanged with a surrounding "wrapper" A possible initial messaging scenario is: > A CareFirst registration triggers the send of an XML CPM message > HealthShare Foundation receives the messages and uses the algorithms defined in Patient Index to match/record link the patient. > The message is stored in the message store. > The message is converted to HL7 and sent to TrakCare, if the patient is currently known in TrakCare an alert will appear next to the patient. > The message will be sent to the SEEMiS system as XML. > TrakCare and SEEMiS users will be able to view the CPM in the message store using the Viewing/Matching UI. > The message store will also be used periodically by TrakCare to query for CPM messages on admission of a new patient.
Read only? > Centrally held message data can not be updated directly - only viewed via LoB systems or by the Viewing / Matching UI > Centrally held matching data in the Patient Index could be able to be updated directly by the Viewing / Matching UI
User Access Method
> To be determined, but possibly only matching index held centrally so all access via patient/client context in linked LoB systems
Access Control
> PMS operates a Role Based Access model. CPM messages would be treated as a medical alert ie restricted access. > SSAs would need to allow the source agency to configure which parts of the source document will be shared
Volumes > Grampian CPM messages on eCare (between Moray Council Social Work and Education systems only) averaged about 10 new warnings per month in early 2011. > Potential full volumes have not been estimated.
Planned features
As stated above
Desirable features
> Sharing of SSAs and other types of assessments and plans > All parties should be able to contribute to an assessment > Governance issues would need to be addressed > Give GP practices access to PMS (some have access already), or integrate GP systems (mainly Vision INPS, some EMIS). PMS has the CHI number and GP code > Bring community nursing onto PMS (no IT systems at the moment) > Integrate NHS out of hours (on Adastra) > Possibly GIRFEC chronologies
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> Extend CPM sharing to Highland, Orkney and Shetland (all TrakCare PMS users) > In the future maybe integration with national CPM (proposed InterSystems architecture would support this) > Any solution needs to be flexible enough to support vulnerable adults messages, plans and assessments > The proposed Ensemble / HealthShare architecture would allow TrakCare to publish attendance messages with CareFirst and SEEMiS
History > Grampian are using eCare CPM between Moray Council SW CareFirst and Education SEEMiS system > Now need to find a replacement due to the pending decommissioning of eCare > Sharing of SSAs has been piloted between NHS Grampian and Aberdeenshire Social Work, however was stopped to allow existing processes and paper forms to be refined > InterSystems have recently (Nov 2012) proposed an solution for the delivery of CPM.
Notes > It is important to stress that any IT solutions are the belt and braces and don't in any way replace good business systems and personal contact between professionals > Solutions should work on the presumption to share supported by a high level governance document > Borders are also TrakCare PMS users and are interested in the discussions with InterSystems > Likely that Helix and Topaz in Orkney and Shetland will be replaced with PMS eventually (hosted by Grampian) > Grampian, Orkney and Shetland currently use SCI store to share patient information, eg discharge notes, lab results > The proposed InterSystems architecture is very similar to the existing Lanarkshire architecture. Lanarkshire are considering rebasing their solution on Ensemble.
Benefits of sharing
Not yet fully articulated but initially mainly patient safety and care as a result of CPM, then better outcomes as a result of shared assessments and GIRFEC.
Solution Highland solut ion
(pending verification by Highland Representatives)
Stand-alone
Partners
> NHS Highland (A&E, children's & maternity wards, public health nurses, community nurses) > Highland Council Social Work Services > Highland Council Education, Culture and Sport > Northern Constabulary
> Voluntary Sector > Children and families > And in the future, Argyll and Bute Council areas and Strathclyde Police
Current Area and System Technology
and planned interfaces
Highland Council Social Work - CareFirst Highland are developing a stand-alone SharePoint based solution. There are no electronic interfaces to the agency systems.
Highland Council Education - E1
NHS Highland - MIDIS
Matching Approach
> All matching is manual by the Lead Professional so there is no requirement for a central matching index or CHI seeding of LoB systems.
Data Shared > The initial solution will support the sharing of Multi Agency Children's Plans > CareFirst can output the plans as pdf documents. > The CareFirst user can select what information to output and hence what to share > Education will provide plans in Word format
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> The solution will also hold information about consents.
Functions > The Lead Professional will create a SharePoint site for a case > They will then give other registered users access to the site as required > Professionals will see a list of cases assigned to them by the Lead Professional > The Lead Professional is responsible for requesting input to the plan from the other professionals > Professionals will supply a "practitioner summary" document that will be reviewed by the Lead Professional > The Lead Professional will then create the Childs Plan and share with the other linked professionals > Users will only be able to see information they have uploaded themselves or plans that have been made available for sharing by the Lead Professional > Plans can be downloaded if the ability to download a Plan has been enabled (at the site and/or user level?) > Access to a site can be suspended by the SharePoint System Administration when requested by the Lead Professional (eg when multi-agency intervention is no longer appropriate). The data will remain on the system but will not be visible to the linked professionals. > The system retains an audit trail of all access and updates to the system > Random audits of user access to the Childs Plan sites will be undertaken by the SharePoint Administration > Is the SharePoint search function enabled?
Integration Approach
> No direct system to system integration is involved in the solution > However Highland Council, NHS Highland and Northern Constabulary users will access the system via linked secure networks, which will require firewall configuration by NHS Highland
Read only? > No - linked professionals can contribute documents directly to the system
User Access Method
> Direct logon to the SharePoint system > Access can be made available to users in public sector organisations, those providing commissioned services in from the third sector, and to children and families directly involved in Childs Plans
Access Control
> There will be one site per child > Users will be added to a trusted user list by SharePoint Administration. This does not automatically provide access to any sites. > The Lead Professional will control access to a site by selecting one or more users from a list of registered users > In the absence of the Lead Professional a system administrator will be able to control access > The Lead Professional may also be the Named Person > There is no role or team based access - all access is managed at the level of individual users > Blanket sharing consents only - no granular access by professional area > Users will only be able to see information they have uploaded themselves, or information that has been released for sharing by the Lead Professional > Sites will be made unavailable for sharing when a child turns 17?
Volumes > To be determined but probably 1000s of children will have plans across Highland > A professional could potentially have 100s of cases in the system
Planned > Planned to get CHI numbers seeded into CareFirst (as part of a national initiative - not
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features essential for the new system)
Desirable features
Possibly in the future: > Provide an indication to users (especially in A&E) that a child is on the CPR and/or Looked After Children (Highland view is that CPM conflicts with the role of the Named Person in GIRFEC, however they would like to provide a central CP register that locations such as A&E departments and children’s wards can have lookup access to - as stated in the eCare Review Document Sept 2012) > Provide an indication to users that a child is classed as vulnerable (see note below) > Indicator to Police that a person had a plan and who the Lead Professional is > Show the name and contact details for the Lead Professional > Show basic demographic details for the child > Allow access by fire and rescue staff > The system could be used for Adult Personal Plans in the future > Management reporting on usage of the system > No immediate requirements for local sharing of concerns regarding children > No strong desire for a national CPM solution > No current requirements for an electronic GIRFEC chronology - the Children's Plan includes a chronology
History > The Highland DSP tried to develop a local collaborative SSA solution that progressed as far as the trials stage > However, the trials showed it had too many critical bugs and would have been too expensive to develop further > Highland are now trialling the adult Personal Plan, which is adult version of the GIRFEC Child Plan. Highland do not really like SSA as a business process and will probably phase out SSA and adopt the Personal Plan. > A SharePoint system, initially for sharing Childrens Plans, is under development by Fujitsu > A limited pilot is planned for March 2013, involving representatives from education, social work, NHS Highlands and Northern Constabulary.
Notes > GPs should know that a child is on the CP Register but this information may not always be shared with secondary care professionals > NHS out of hours staff have access to CareFirst but not the CP data > It is worth noting that basic level technologies such as mobile phones and secure email have already improved information sharing > GPs have restricted access to CareFirst (including basic client details, chronologies, part of CPR) > There is no agreed or legal definition of a "vulnerable child". It may include all or part of the group of children who are part of a live case in CareFirst > A minimum specification of internet browser is required to access the system (what types / versions? IE7 and later?)
Benefits of Sharing
> Streamlines the process for the Lead Professional > Faster creation of plans > More effective alerting of linked professionals that a new plan has been created > Reduced risk of inappropriate sharing > Improved information security > Professionals are more likely to view plans, and more likely to view the most recent version > Better sharing of plans with the 3rd sector and families
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> Faster sharing of plans, especially with those who don't have secure email > Providing accurate and up-to-date information to support early intervention and rapid identification of children at risk > Consistent feedback from NHS Highland to Social Work on the outcomes of contact with a child
Solution Shet land Solut ion Single Shared System
Partners > Shetland Islands Council Community Care, Social Work, ASBO team, Education, Housing Outreach, Youth Team > NHS Shetland
> Voluntary sector (eg befriending service), Community Alcohol and Drugs Services > Skills Development Scotland
Current Area and System Technology
and planned interfaces
Shetland Islands Council - SWIFT Shetland use SWIFT as an area for data sharing with direct access by professionals. There are no electronic interfaces to other systems.
Matching Approach
> Matching is manually achieved by the practitioners. However, there is a problem of similar names. > Will be seeding the CHI number into SWIFT to improve matching.
Data Shared SSAs > SSAs are created as PDF documents and attached to client records in SWIFT (A subset of SSA data is held as SWIFT data) > The SWIFT data for SSA includes basic demographic data, assessment dates, involvements (in particular lead professional), reviews, needs and consent status. > Non social work partner agencies have been given access to SWIFT and can view a subset of the system and only the SSA clients > Partner agencies can see basic demographic data, SSA only contacts, assessment dates, involvements, needs, consent, eligibility criteria and reviews. CP register > The Children & Families team manually update a CP register. > Register details are securely shared by attaching them to a “false” record in SWIFT. > Health then access the record and put the details into their A&E system. > Also planning to do similar with adult protection.
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Functions SSAs > An on-line PDF document is completed by the first practitioner in contact with the client. It is then uploaded to SWIFT and the client is marked as SSA. > SSAs generally originate from Community Care practitioners although a few can come from health professionals, especially community care nurses or ward staff prior to discharges. > Ward staff access SWIFT from a PC on the ward and attach a document to the case record > SWIFT system administrators audit for searches (eg interested in searches for people not linked to a case) CP Register > Health staff are manually notified of additions/changes to the CP register on SWIFT. They then update EDIS for A&E access with an alert that a child is on the register (also CP specialist nurses) > Health staff can then contact the duty social worker
Integration Approach
> NHS and Council networks are securely linked via Firewalls > Health and Council Staff can access SWIFT (but currently not GPs outside Lerwick) > Voluntary sector users are co-located in a building which is on the Council network so many VS users can be given secure access to SWIFT
Read only? > No - linked professionals can contribute documents directly to the system > Read only access can be achieved where required, e.g. audits, inspections.
User Access Method
> Users can search in SWIFT by demographics. Would also like to add CHI number to SWIFT to facilitate searches. > The search is restricted to the search functionality on that screen in SWIFT. Users typically use names, dob or addresses.
Access Control
> Electronic access is managed by SWIFT System Admin. > Users are assigned to a group based on approval by appropriate managements. > The audit record can track attempts to access records where a user does not have a clear involvement > Typically professionals have more than one case. Assignment to cases is managed on a team by team basis > SWIFT supports role based access and non-social work users are assigned to a role with limited access. There is a completely separate security model for Partner SSA only access > Possible issue with large case loads and staff turnover > Access to the CP register Swift record is restricted to a group of staff agreed by the Child Protection Committee. It is managed by the SWIFT System Admin team.
Volumes > 10 to 15 children on the CP register > There are approximately 700 adult assessments under With You For You
Planned features
> Shetland are running a pilot based on consent to share information on chaotic young people using the same SWIFT based approaches.
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Desirable features
> The GIRFEC principles are supported but are still working through the practicalities. > Will possibly use some variation of the SSA solution for the Child Plan > Would like to get CHI numbers seeded into SWIFT to assist manual client identification (especially for service users with similar names) > Would not expect NHS staff to do the seeding > Considering CP alerts into the GPs EMIS systems > Would like to get all GPs access to SWIFT (not just Lerwick) > Are considering using a more modern system than SWIFT to share data in a similar way. Ultimately would like to get to a portal solution.l > A Scottish or UK wide CP alert system would be useful - people tend to runaway to Shetland > Some sort of way to share UK missing persons alerts would also be highly desirable. At the moment Shetland Islands Council receive requests from English local authorities to log into their own (English individual LA system) to view missing child alerts. This will become more and more risky as more English local authorities introduce individual systems. Some way to feed all UK alerts into a Scottish notification system would be very useful.
History > Shetland did not use any of the eCare functions > SWIFT based solution is operational
Notes > Shetland have used a LEAN exercise to simplify the existing process for SSAs and reduce the paperwork > SSAs are used for a range of functions, including children transitioning to adult services, supported living, employability, housing and older persons services > No Fire and Rescue data sharing at the moment > Police do not access SWIFT but do hold weekly meetings with Social Work staff – > There is a paper based process for the police to notify Social Work of concerns > GIRFEC chronologies are under review but no firm plans for sharing them
Benefits of sharing
> Less repetition of assessments > Speedier assessments > Shortened pathways > Broader range of services can be put in place to support plans > Faster implementation of plans > More accessible services > More capacity to deliver a tailored service > Better information security > Reduced risk to children > Better knowledge of what other practitioners do > Supporting principles and practice of early intervention.
Solution Western Isles
Partners > Comhairle Nan Eilean Siar > NHS Western Isles
Current Area and System Technology
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and planned interfaces
NHS Western Isles - Tynedale There is currently no data sharing solution in use in the area apart from eCare CPM between Children’s Services and Social & Community services with NHS Western Isles
Comhairle nan Eilean Siar (CNES) Social Work - OLM CareFirst
Comhairle nan Eilean Siar Education - E1
Matching Approach
> No data matching is undertaken > Low volumes may mean that manual matching would be sufficient in the future > In the future agreed that there needs to be a master indexing methodology but not agreed what this should be. Each of the agencies systems generate unique referencing for their system. The use of CHI index has been discussed but not agreed that this should be the master index.
Data Shared > SSAs are used electronically within CNES Social & Community services (S&CS) but only shared on paper with NHS. > eCare CPM is currently used. Children’s Services and S&CS generate messages and the functionality to pick up messages is available to NHS via the Tynedale system. The functionality is not available outwith S&CS and NHS > There are plans to replace the Tynedale system which is the vehicle for eCare CPM in Health.
Integration Approach
No system integration takes place apart from eCare CPM as outlined above
Volumes 2 people on the CP register
Planned features
No definite plans for a replacement data sharing system
Desirable features
> The DSP consider it vital to be able share data across DSP boundaries. However rather than wait for an all singing all dancing system they would be happy to see the local solution further developed initially rather than try to accommodate every scenario at the outset. > Common interface standards and sharing protocols, and a secure infrastructure would be required for national sharing. > Pro-active alerts to users when records added or changed in the CPR > Need to share a chronological history of an engagement > The ability to have remote access to information might be helpful but was not seen as a driver. There is concern that the challenges presented by the islands infrastructure technology might not support this > There is a strong consensus of opinion that the system must be managed, maintained and developed at a local level > The system must be scalable to allow communications with other Board’s systems in the future > Existing systems should be utilised if practical, eg SCI Store
History Using eCare for CPM but not SSAs
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Notes > Currently Use of NHS mail for secure messaging. However there is some embryonic work looking at the possibility of extending the use of digital pens/ forms into this area, using a jointly designed form > GIRFEC business processes have been developed by Education and Children’s Services and the associated sharing will follow the DSP protocol. > Children’s Services have commissioned Carefirst to create a Child’s Plan Form and the plan will be stored in MS Word format in the Education Service MIS e1 for school and Education staff > Need to complete protocols, procedures and agreements between all the agencies involved > Meetings are held on a weekly basis where all the currently involved agencies discuss specific cases, this provides opportunities to discuss the issues in more detail > The three main agencies are using their own systems and believe that these are sufficient , and that any new arrangements must provide improvements/value above and beyond the current arrangements which include a very successful networking arrangement based on telephone, conversations, e-mails and meetings. > General view that perhaps information flows should be one-way, with certain agencies providing information, but not having access to “read” information on the system(s). There would need to be greater involvement in the weekly meetings.
Benefits of sharing
Not reviewed as part of this study.
Solution Borders Central Store
Partners > NHS Borders > Borders Council
Current Area and System Technology
and planned interfaces
Borders Social Work – Frameworki from CoreLogic Borders Education – SEEMIS Probably NHS Borders - Trakcare PMS system
To be determined > Possibly based on Ensemble, Cache and HealthShare Foundation from InterSystems as per Grampian > Proposed interface technologies are: TrakCare - HL7 Frameworki – XML ? SEEMiS - XML
Matching Approach
> If Grampian architecture is followed then will use a central matching index of identifiers from linked systems, including CHI numbers and Frameworki ids. > Not considering CHI seeding of social work data in Frameworki – business have reservations about data protection.
Data Shared > Proposed scope only includes CPM as a replacement for eCare CPM, between Social Work and Education. > Also likely to share CPM with NHS users but may depend on the solution chosen, eg if Intersystems Ensemble as a solution then it will include NHS Borders > Would like to support 6 main messages (including linked adult and linked child messages) > May want to include some form of descriptive free text or lookup value in the message
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Functions > Would like to send CPMs from Social Work (Frameworki ) to Borders Education (SEEMiS) as this is happening by national eCare at the moment > If possible also send CPM messages from Frameworki to TrakCare for NHS users, and for alerts to be displayed next to the correct patient data > A process to match identifiers across the 2 systems would be required > Not decided if an interface for CHI lookup and CHI broadcast would also be required. > The solution would need to ensure that shared messages are kept synchronised with the source data > Important for users to be able to see expired messages
Integration Approach
> Possibly as per Grampian use a publisher / subscriber model, with information exchanged with a surrounding "wrapper" > Not determined what format of messages from Frameworki – possibly XLM > Believed that comms infrastructure in place
Read only? > If Grampian architecture utilised then Centrally held message data can not be updated directly - only viewed via LoB systems or by the Viewing / Matching UI > Centrally held matching data in the Patient Index could be able to be updated directly by the Viewing / Matching UI
User Access Method
> To be determined, but possibly only matching index held centrally so all access via patient/client context in linked LoB systems
Access Control
> PMS operates a Role Based Access model. CPM messages would be treated as a medical alert ie restricted access
Volumes Border eCare CPM activity during the financial year 2011/2012: > Number of new children with a Child Protection warning - 168 > Number of new children with a Linked Person CP warning - 2 > Number of CPMs retrieved by agency adaptors - 296 (from Stephen Pratt’s Review of the existing national eCare Framework) Believed to be less than 50 entries on the CP Register
Planned features
> No desire for sharing CPM outwith Borders, although thought to be cross border movements, eg Borders resident children attending school and hospital in Edinburgh > However local solution identified should not be incompatible with solutions within other DSPs so that connection between DSP regions can be attained if a child enters or leaves a region. > The solution should also support the amalgamation of statistical information for national purposes. > Not considering police, 3rd sector of Fire & Rescue involvement at present > Sharing of assessments and plans has been looked at in the past but not in scope of current proposal.
Desirable features
The ability to provide Integrated Assessments for children (GIRFEC)
History > Borders had started using the eCare CPM facilities and now need to implement a replacement given the planned decommissioning of eCare > eCare CP messages were only shared between Education and Social Work professionals, with the matching data provided by NHS Borders. > Have submitted an application to the SG for funding to develop a replacement > Have considered 3 options: do nothing; implement in-house solution; implement a solution based on Ensemble and the Grampian architecture.
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Notes > Borders DSP has been disbanded > A project board has been appointed to manage the implementation of a replacement
Business Benefits
> Want to retain benefits of electronic CPM post eCare > Want to share CPM with NHS > Would like to build a platform to support future health and social care data sharing
Solution Dumfries and Galloway Portal / Central Store
Partners > NHS Dumfries and Galloway > Dumfries and Galloway Council
Current Area and System Technology
and planned interfaces
Social Work - – Frameworki from CoreLogic NHS secondary care – MiDIS NHS GP systems – INPS (1) / EMIS (33)
Matching Approach
> F rameworki records are seeded with CHI numbers > To be determined how dartEDM data will be matched, albeit CHI is used throughout.
Data Shared > Plans and assessments > Child Protection alerts / messages
Planned Functions
> Create and maintain shared plans and assessments in dartEDM > Create child protection messages / alerts in Frameworki for distribution to NHS secondary care users (including read acknowledgements) > Good audit trail in dartEDM
Integration Approach
> Link dartEDM to Frameworki (has been done in England) > Link dartEDM to GP systems (both INPS and EMIS) > Midis / dartEDM integration – dartEDM will be fed by completed documents > Use Ensemble for matching and integration, > Use XML messages as part of Ensemble > Use the dartEDM alerting and messaging function > Use CareFx as an overall portal to provide an integrated view of data in dartEDM, Midis and Frameworki > CareFx forces the synchronisation of views for a patient.
Read only? > Social Workers could have a read only view of documents in dartEDM
User Access Method
> Via CareFx > Direct to dartEDM
Access Control
> Time limited consents in dartEDM > Self consent model - dartEDM asks what relationship the user has with the patient and why they want access > Looking at how social work access can be managed
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Volumes Relatively low volumes of children on the CP register
Desirable features
> Links to data in SEEMIS > DartEDM could provide true document collaboration using local forms
History > In the past both the council and NHS secondary care had in-house developed systems linked using JWS (Joint Working System) with an architecture similar to eCare. Subsequently both have moved to commercial packages and the linkage has been lost. > Have never used national eCare system
Notes > Unitary authority - 1 health board and 1 council > Information currently shared manually via weekly case conferences, email and non-electronic means > Have worked with Martin Egan at NHS Lothian at NHS Lothian on Midis integration > As part of the drive to reduce the usage of paper NHS D&G have purchased the DartEDM electronic document management system from Plumtree Group. This will be used for electronic case notes management. > Part of the MIDIS consortium with Lothian, Fife and Borders > Are adopting SASPI to manage information sharing governance (would include police, education and the 3rd sector) > 20% patients are from England so no CHI numbers. D&G residents also use English hospitals.
Business Benefits
Solution Fife Portal Notes to be confirmed by NHS Fife
Partners > NHS Fife > Fife Council
Current Area and System Technology
and planned interfaces
> Social Work - –Swift from Northgate > NHS – MiDIS and CareFx Patient Portal,
Excelicare, Adastra > NHS GP systems – 15% INPS / 85% EMIS
Matching Approach
> Clinical Portal using CHI as master – Record Locator Service to provide matching > Unmatched record processing as follows - Sits on exception file, NHS Access SCI and
Clinical Portal, duplication Records, Non NHS limited access to SCI store, Store-to-Store, Record Locator Service (to be developed).
Data Shared > Planned to share: SSA (Single Share Assessments), Emergency Care Summary (ECS), Key Information Summary (KIS), Palliative Care Summary (ePCS), GP Summary (recent GP tratement), GIRFEC (but not looked at in any detail).
> All these data types could be shared with non NHS professionals, eg Social Work staff? Or just extend access to KIS to non NHS professionals?
> Includes basic patient demographics in ECS and KIS, and professional contacts in KIS (the Patient Contact List).
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> There are currently 6 health apps integrated with MiDIS, including district nursing and other community based services.
> Would also like to share selected social work data from SWIFT.
Planned Functions
> Making health information available in the clinical portal. > Integration with selected social work data from SWIFT
Integration Approach
> Ensemble as an integration engine. > CareFx Clinical Portal (extended to include Social Record in SWIFT – could use same
approach as NHS Lothian) > Patient Portal > CDR
Read only? > Phase One – View Only > Phase Two – View and Do using Portal forms. Could deliver proper integrated
assessments. Could also use for GIRFEC chronologies.
User Access Method
> Access directly into SWIFT via a landing portal – view only > Precise access model needs to be resolved – likely to be role based.
Access Control
> Managed by Fife Council. > Use proxy cards to access the portal at the moment with strong authentication.
Volumes > Currently very limited with limited links in place > In the future there will be large volumes increasing as solutions to record electronic
information increase and opportunities to share increase.
Desirable features
> Augmenting clinical portal with local authority, police, 3rd sector etc electronic information.
> Would like to provide mobile access > Automatic access from SWIFT to SCI store to obtain CHI numbers > Cross border sharing of data is important for the future, although users might need to
accept slower response times when accessing cross border data, > CPM could be developed via the portal (including acknowledgements)
History > Currently much sharing is done via the emailing of information between secure email addresses
> An ISP between health and social care has been developed > NHS staff in some areas currently have access to SWIFT – view only access to SSAs > There has been some CHI seeding in SWIFT
Notes > Already use DartEDM electronic document management system from Plumtree Group to hold archived documents (see D&G notes).
Business Benefits
> Minimise the risk to patients/clients and therefore the organisation of out of date information.
> Reduced delays information sharing
Solution Orkney Notes to be confirmed by NHS Orkney
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Partners > NHS Orkney > Orkney Islands Council
Current Area and System Social Work – Paris from In4tek Ltd NHS Orkney – what A&E systems now? What GP systems?
Technology There is currently no electronic data sharing between health and social work or any other agencies.
and planned interfaces
> No system to system interfaces planned at the moment
Matching Approach
> No data matching at present > CHI numbers are manually added to some records in Paris (to be confirmed if this happens and how they are obtained)
Data Shared > There is no dedicated systems for data sharing between health and social work > No data shared with Education apart from ad-hoc data requests
Planned Functions
> No plans at the moment for regular electronic data sharing between social work, NHS or education.
Integration Approach
> Secure private fibre link between the Council and NHS
Read only?
User Access Method
> Some health staff are given access to Paris by social work staff. To be confirmed what data can be accessed. Assessments and plans?
Access Control
> Paris provides role based access > A data sharing protocol between health and social care has been agreed at a high level but not signed off – more work is required.
Volumes > Number of children on the CPR is very low – approximate numbers to be confirmed
Desirable features
> Could possibly use Ensemble to exchange data between PMS TrakCare (if implemented) and Paris, however no definite plans at the moment – could be 2 years away. > There is no requirement to share Child Protection messages with areas outwith Orkney
History > Information currently shared manually between health and social care via weekly case conferences, email and non-electronic means > Orkney Health and Care organisation was established in April 2010. It manages the full range of social services previously provided by Orkney Islands Council, and a number of services previously provided by NHS Orkney. There is no DSP.
Notes > Unitary authority - 1 health board and 1 council > Improved information sharing is not one of the key themes of the Orkney Health and Care Local Delivery Plan for 2011/12 – the focus has been on other areas to date. > NHS A&E have system for managing child protection concerns. Any contact with social work is by manual means. > NHS Orkney are considering implementing the Grampian hosted PMS TrakCare to support community nursing. > Have never used the national eCare system in the Orkneys > Significant numbers of patients are treated by NHS Grampian and Highland. Data is shared on these patients in formal and ad hoc ways. Sharing could be improved if PMS
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Trakcare is implemented. > Orkney NHS staff can view the Grampian SCI store.
Business Benefits
> Not properly considered
Solution Forth Valley Notes to be confirmed by NHS Forth Valley
Partners
> NHS Forth Valley > Stirling Council > Clackmannanshire Council
> Falkirk Council > Central Scotland Police > Fire & Rescue > Scottish Ambulance service (Intended)
Planned interfaces
Area and System Technology
> NHS Forth Valley Secondary Care – MIDIS > Stirling Council Social Work – SWIFT > Stirling Council Education – SEEMIS > Falkirk Council Social Work – In house solution > Falkirk Council Education – SEEMIS > Clackmannanshire Council Social Work – CCIS > Clackmannanshire Council Education - SEEMIS
There is currently no technical data sharing solution in use between health and social care. This is done manually through integrated teams or direct data requests via face to face, phone or email. NHS FV have implemented a clinical portal (NHS FV version of the Tayside portal) to link with secondary care, which is currently in Phase 1 and being tested in specific outpatient clinics. This allows clinicians to access collated patient based information from a variety of systems. In the future this could expand to other partners including social care.
Matching Approach
> No electronic data matching is undertaken > Manual matching is conducted using patient demographics > Historically for eCart CHI matching was undertaken but no seeding
Data Shared > CPM email alerts are received > SSA printed from MIDIS and shared upon request > Clinical portal currently shares details of previous and current admissions, details of previous and current outpatient appointments, allergies and alerts, referral letters, discharge letters, clinic letters, labs results, radiology results, links to SID, clinical guidance websites on the intranet and internet and BNF website
Functions N/A
Integration Approach
No system integration takes place between health and social care
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Read only? >Clinical portal currently only allows read only access to clinicians > In future if a portal solution is implemented providing access to social care and partners read only access would be granted by role on a ‘need to know’ basis
User Access Method
> For clinical portal it is a single sign on approach > For social care data sharing this is requested through face to face, email or phone interactions
Access Control
> Would be role based
Volumes > 1,300 episodes of electronic information transfer between LA/Police per month (excluding telephone and face to face transfer)
Planned features
>MIDIS to comply with GIRFEC requirements > Clinical portal future phases – to included users beyond secondary care such as primary care, community care and longer term LA partners
Desirable features
>Portal & ensemble solution > Share data with all partners involved > Two way sharing process between NHS and partners > Share CPM & VA data across the 3 LA’s and nationally > SSAs > Share change of details i.e. carer information
History > Part of the eCare programme, NHS Forth Valley got to the testing stage with eCart. However, there were problems regarding this solution such as inability to access data from community sites and security issues, and eventually this was not progressed. > eCart and the council systems also had an interface with MAS whereby any demographics/shared assessments could be viewed, however when eCart was pulled so was the MAS and instead NHS Forth Valley implemented MIDIS but didn’t link to a MAS because they feel that this has been discontinued at a National level.
Notes > All forms used are GIRFEC compliant > No current plan (over next 2 years) to share ECS/KIS with social workers. KIS easier to access via web services therefore could be a possibility if/when portal is implemented > No funding available for data sharing and so no one has that role/responsibility > There has been more of a focus on telehealth/telecare as being one of the DALLAS partners > NHS Forth Valley have complications with the 3 Councils as they all employ their own systems. There is no standardisation/consistency between them which makes it difficult to integrate the systems > NHS Forth Valley have developed a protocol for sharing information and are awaiting signatures from partners involved > A lot of groundwork has been done for Information Sharing Procedures but nothing has materialised into plans yet
Benefits of sharing
> Shared Assessments > Avoiding duplication > More joined up services > Increase patient safety