Date post: | 07-May-2015 |
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NHS ScotlandeHealth Strategy
NHS for Scotland’s 5.2m citizens
• NHS devolved to Scottish Parliament
• Scottish Government Health Directorate
• 14 Health Boards
– all care within a geographical area
• 1030 GP Practices
• ‘special’ Health Boards, eg. national ambulance service
Four things…
1. Do things of use to all
2. Convince that convergence and collaboration is in theinterests of all
3. Incentivise that collaborative activity
4. Put in place appropriate governance
sub title: How do you do strategy in a federated health system?
Scotland’s approach to eHealth
All about the right information to the right people at the right time
• Incremental• Pragmatic• Partnerships • Focus on benefits and governance, not
technology
4
1. Doing things of use to all –how far did this get us up to c. 2008?
• unique patient ID number, national Wide Area Network
• all Health Boards with local instance of national product for online test results, letters etc (both for hospital and GPs)
• truly national PACS service
• national e-communications service (SCI Gateway): 97% GP referrals electronic and structured (but only 3% of discharge letters)
• mature GP EPRs, eg. 98% practices paperless, e-prescribing and transmission
• home telecare installed for 17,000 people, at cost of £7.4m
- evaluation: over 60% of patients feel their quality of life has improved, and 90% felt saver
- £23m efficiencies, eg. avoided unscheduled admissions
• telehealth strategy to focus on ‘mainstreaming’: -
telestroke- paediatrics- COPD- psychiatry- eye care
1. Doing things of use to all –how far did this get us up to c. 2008?
Emergency Care Summary
covering 99.9% of population
1. Doing things of use to all –how far did this get us up to c. 2008?
What’s ECS?
National database containing….
• Patient identity (address, telephone, CHI number, GP)
• Allergies and Adverse Reactions to medications
• Medication
- Repeat prescriptions in past 12 months
- One-off prescriptions in past 30 days
• Patient safety = key driver
• Too much unknown when patient comes to unscheduled care
• Efficient use of clinical time also important
Why did we do this difficult thing?
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System Overview
ECSSyste
m
Request & display
NHS 24
A&E
Ambulance
TBD…
PracticeServer
GP consultation
Check audit log
HealthBoard
GP Practiceadmin
Progress to Date
• 5.4 Million Patient Records available
• 1900 patients have ‘opted out’ of practices connected (represents 0.03% of all patients)
• 6 million accesses to date and increasing trend in use (currently > 50,000 per month)
• Over 11,000 users across different clinical areas
• Expected increase in use as new developments are available
Implementation Approach
• leadership by clinicians and patient reps
• incremental rollout in each Health Board
• national and local communication
• full technical integration where possible
• Assume consent to create an ECS record, but patients can opt out
• Explicit consent from patient for their record to be viewed at point of care
(these provisions go further than the law requires in Scotland/ UK)
• all ‘the usual’ technical security - encryption etc
Confidentiality protections
15
16
Costs and financing
• Total investment = £25.3m over 9 years
• IT cost: £3.3m = 13% of total (excludes broadband)
• annual costs now c. £0.6m (mainly 24x7 high specification data centre support)
Emergency Care Summary– benefits
0
1.000.000
2.000.000
3.000.000
4.000.000
5.000.000
6.000.000
7.000.000
2002 2003 2004 2005 2006 2007 2008 2009 2010
₤
Present value of total annual costs Present value of annual benefits
Patient Views
• Patients are very accepting of ECS with over 99.3% giving permission to access
• Patients in hospital or emergency situations (e.g. A/E Department) find it very useful when can’t remember their medication details
• Consumer Focus Scotland reported continued support for ECS
Clinicians Quotes
• “One of the best tools we have got for improving patient safety”
• “ECS has been a godsend, I can’t imagine how we managed without it”
• “It can take ages if we need to phone GP surgery”
• “Before ECS we often had to ‘work blind’ with no information at all.”
• “ECS information can help the most vulnerable patients, e.g. those who are admitted over the weekend who have no one to bring in their meds”
Lessons Learned…
• Incremental approach works for Scotland
• Careful consideration of patient groups and clinical need
• Patient Communication is key
• Clinical Leadership and Championship
Keep it simple
New Developments - ePCS
• electronic Palliative Care Summary
• Moving from paper based forms to shared electronic information for vulnerable group of patients
• Contains significant and sensitive information– Resuscitation Status, Preferred Place of Care– Diagnosis and Current Treatment– Carer Details and Advice for OOH
22
New Developments
Key Information Summary (KIS)
Patient name, Address, Patient mobile number
Next of kin details: Emergency contact phone numbers
Usual GP name, Nurse, Care Manager, Specialist Nurse or other contacts, involved in care
Carer Details
Access information
KIS – section 1 – Basic details
KIS – section 2 – Current SituationMain Diagnoses, Current problems
Patient and family understanding and wishes, including goals and expectations
Patient has
- self management plan Yes □ No □
- Anticipatory care plan Yes □ No □
- Shared Assessment Yes □ No □
Home Oxygen, Normal Oxygen saturation
Usual BP Additional drugs available at home
KIS – section 3 – Carer/ Support details
Power of attorney in place?
Adults with Incapacity form Yes □ No □
Compulsory treatment order in the community?
Mental Health Act detention? Yes □ No □
Homecare support in place?
Moving and handling information and equipment in place
Agreed actions
KIS – section 4 – care suggestions
Current place of care
Preferred Place of Care
Special instructions for OOHs
DNA form Yes □ No □
2. Convince that convergence andcollaboration is in the interests of all
relationships relationships relationships
(+ putting financial and delivery responsibilitywhere it should be)
Where common cause exists,national contribution to collaboration
(Hospital Patient Management Systemand
GP system procurements)
3. Incentivise that collaborative activity
Agree aims that have business relevance
Offer funds to support achievement
Health Boards to set outcomes and show 4 year plans for each aim
(acknowledges that Boards at different placesand have different local priorities)
3. Incentivise that collaborative activity
5 strategic eHealth aims
1. Maximise efficient working practices, minimise wasteful variation, bring about savings and value for money
2. Support people to communicate with NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive
To use information and technology in a coordinated way to:
1970 – 2000
2000 - 2011
2012 +
patient
£ andeffort
£ &£ &
adminadmin
clinical
clinical
patient
• Online administrative processes, eg. appointment booking, prescription renewal
• Trusted online information advice
• Online clinical services and support, eg. access to test results and e-consultation
• Patient self management
• Tele-monitoring
• Mobile telemetry
Patient eHealth - lots of possibilities
Solutions looking for problems?
yes but with what outcome?
• Improve patient’s health knowledge and ability to manage aspects of their health
• Improve access to services for citizens and patients
• Reduce admin costs
e-correspondence service?
how many paper letters does NHS Scotland send to its 5m citizens a year?
c. 25 million
compare that to banks and energy companies
opportunity to save costs, carbon and give a better service for patients who sign up for e-
correspondence?
Wha
t I w
ant
to do
My care
What I want
to know
My r
ecord
Citizen eHealth Strategy
5 strategic eHealth aims
To use information and technology in a coordinated way to:
1. Maximise efficient working practices, minimise wasteful variation, bring about savings and value for money
2. Support people to communicate with NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive
3. Contribute to care integration and to support people with long term conditions
identifying at-risk patients, anticipatory care,supporting virtual wards/ joined-up patient pathways…
5 strategic eHealth aims
To use information and technology in a coordinated way to:
1. Maximise efficient working practices, minimise wasteful variation, bring about savings and value for money
2. Support people to communicate with NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive
3. Contribute to care integration and to support people with long term conditions
4. Improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality
what information? survey said…
• Past medical history
• Current problem list
• Current medications
• Allergies and Alerts
• Letters – Referral, Outpatient, Discharge
• Tests – Laboratory, Radiology, etc
• Clinical Observations (pulse, BP etc.)
• Local and national clinical guidelines
• Drug reference information (British National Formulary)
clinical portal
‘virtual’ electronic patient record – not about large national database
electronic window to information held in different places, fetched and viewed by
clinician on an as-required basis
Greater Glasgow & Clyde
In a given week some 5500 active users,
accessing 250,000 documents (test results,
correspondence, operation notes, pre-op assessments,
clinic lists, scanned paper records, theatre lists, etc)
+ range of e-forms to replace standard assessments, notes etc
In a given week some 5500 active users,
accessing 250,000 documents (test results,
correspondence, operation notes, pre-op assessments,
clinic lists, scanned paper records, theatre lists, etc)
+ range of e-forms to replace standard assessments, notes etc
the right IT – necessary…
…but on its own not sufficient without that there’s trust in the
safeguards
the right safeguards
through training & awareness, authentication of users, role-based access, single sign-on, audit
log analysis etc
very necessary, but still not sufficient
agreement to share in the first place
5 strategic eHealth aims
To use information and technology in a coordinated way to:
1. Maximise efficient working practices, minimise wasteful variation, bring about savings and value for money
2. Support people to communicate with NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive
3. Contribute to care integration and to support people with long term conditions
4. Improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality
5. Improve the safety of people taking medicines and their effective use
medicines reconciliation…
NHS Lanarkshire trial
• ECS accessed for 405 admissions
• for 67 patients (22%) ECS contained additional info
for 23 (35%) of those patients potential harm was avoided courtesy of ECS access
+ a separate comparison of 30 referral letters - drugs vs. actual current prescription - found 119 discrepancies
4. Put in place appropriate governance
(with acknowledgements to Accenture)