Transcript Health Informatics and Chronic Conditions

Health Informatics and Chronic
Conditions
A View from the Jurassic Coast
Andy Hadley, MSc, MHIM, MUKCHIP
Supporting Chronic Conditions
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Co-ordinating across health and social care
When might the national care record deliver ?
Problems introduced by plurality of provision
Short term plans for Dorset
What happens in year 2013 ?
Strategy
10 Domains
7 for RIS
How often do we need to access full
records ?
GP Referral/Booking
Reason for referral
Signs and Symptoms
Patient History
Current Medications
Alerts and ongoing conditions
Current and Planned Care
Hospital Discharge
Diagnosis and Treatment
Current and Changed Medications
Planned Care by us
Suggestions for follow up
Have we got time for a shared record ?
When will the software and systems be
up to it ?
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Portability & connectivity
Swift login
Remembering patient context
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Flexibility to work with personal preferences
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Portal style
Clear summaries when want them, detail if need it
Reminders driving the process
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Mix of diary, what was I doing last, what’s next priority
Pathways, how to guide the uncertain, but not disengage the
experts
End to end experience – single system for a user
Who gets to share the NCRS SAP record ?
The Patient
Hospital Doctor
General Practice
Ever ?
Case Manager
Accident Department
Release 2
Single
Assessment
Process
Nurse Practitioner
OTs / Physios
Hospital Nurse/AHP
Spine Summary ?
Mobile
Release 3
Health Visitor
Ever ?
Ambulance
Release 3
Limited
Integration ?
Independent sector
Hospitals/care settings
Ambulance & Control
Ever ?
Social workers
Help at Home
Voluntary sector
Home Care
Contracted services
Cluster Proposed Interim
Architecture for SAP
Healthcare
Applications
Framework
environment
Local Govt
Applications
synchronization
Millennium
Acute
Social Care
Shared
Repository
GP
GP
Community,
Others
Mental Health
HUB
Housing
Shared Form
Definitions
/ View
Education
Voluntary
Local Govt
users
NHS users
Interim or “non-aligned”
users – e.g. voluntary sector
Incorporating Independent Sector Reports onto
NHS Systems in Dorset and Somerset
Multiple GP Systems, or Paper
Poole GP
Interface Box for
East Dorset GPs PMIP
NHS Number (4 points of ID)
and SnomedCT investigation
Codes
Are vital
Electronic
Royal Bournemouth
Clinical Viewer
Poole
Hospital EPR
East
EastDorset
DorsetInterface
Interface
Engine
(Websphere)
Engine (Websphere)
East Dorset
Community Hospitals
Cerner Millenium Dorset
Community Hospitals R1
Acute Trusts R2
ECG Traces
Indep Sector
Diagnostic
Services
Report
“Significant Pathology”
Report within 2 hours
Or
Fast track with report
/images in 24 hours
For requests, see
incorporating requests
Andy Hadley, SED PCT, Feb 2006
West Dorset Interface
Engine (SeeBeyond)
West Dorset
Hospitals
GP Interface Box for
West Dorset GPs PMIP
Electronic
HL7 report
Image will need
report and
episode number
to exist on
cluster archive
Electronic
DICOM
Images
Somerset Interface
Engine (SeeBeyond)
Multiple GP Systems, or Paper
Indigo Prompt
Indigo Prompt
Somerset
Somerset
Interface
Box GPs
Interface Box GPs
GE
PACS
GE
PACS
GE
GEPACS
PACS
Royal
Bournemouth
Storrcom PACS
Cerner Millenium
Somerset Trusts R0
Multiple GP Systems, or Paper
Southern
Cluster
Archive
Not yet accessible to view !
Dorset Interim Approach
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Good existing systems – widely used
Go for short increments and quick gains
Gain consensus where we can
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Accept that dissenters may have valid reasons
Integration engines to give flexibility
If NPfIT ever catch up, the learning and experience will
have been useful
Maintain a healthy scepticism
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Wessex RISP
SW EPR (Shires)
NPfIT ?
COPD Admission Avoidance
(Poole area)
GP Clinical
Systems
Clinical record
Radiology/Pathology
XDOCS – clinical notes
Discharge Summaries
EMIS x 13
InPractice x 3
Isoft x 1
GPs
Practice Nurses
Paper
Casenote
Poole EPR
Hospital Doctors
PORT Team
Nurses
Poole CaMIS
Patient Administration
A&E Visits, Outpatients,
Waiting Lists, Inpatients,
feeds Choose and Book
Admin, contracting, MDS
Cardiac
Department
- Muse system
Proposals for
Electronic requesting
in, and reporting out
to EPR
Cardio-respiratory
staff
COPD (how record ?)
GP Clinical
Systems
EMIS x 13
EPR is already
accessible in GP
practices and
Community
hospitals
InPractice x 3
Isoft x 1
Paper
Casenote
GPs
Practice Nurses
PFT Tests
in the practice
FAX – “your patient
has been admitted”
Clinical record
Radiology/Pathology
XDOCS – clinical notes
Discharge Summaries
Proposals for
Electronic requesting
in, and reporting out
to EPR
Poole EPR
Hospital Doctors
PORT Team
Nurses
Cardio-respiratory
staff
PFT Tests
on the ward & OPD
A&E and MAU
Assessments
Cardiac
Department
- Muse system
PFT and stress tests
In Cardiology
Collect audit data
Preparing for COPD NSF
Minimum Dataset (MDS)
Discharge Summaries (some on EPR)
Longer
term
COPD (near
future)
GP Clinical
Systems
EMIS x 13
Email or messaging
“your patient
has been admitted,
details are on EPR”
InPractice x 3
Paper
Casenote
Isoft x 1
GPs
Practice Nurses
PFT Tests
in the practice
Walk-In Centre
Out of Hours
Nurse Practitioner
Clinical record
Radiology/Pathology
XDOCS – clinical notes
Discharge Summaries
PFT Tests - Hospital
PORT information
Building COPD NSF MDS
Cardiac
Department
- Muse system
Proposals for
Electronic requesting
in, and reporting out
to EPR
Poole EPR
Hospital Doctors
PORT Team
Nurses
Cardio-respiratory
staff
PFT and stress tests
In Cardiology
Migration to National Care Record …
Community Hospitals – Release 1 - July 2007
Acute Hospitals – Release 2 – Summer 2008
… at time that this is capable to incorporate
Frank Burns interviewed by
Sean Brennan Jan 2002
Would you advocate a national EPR solution ?
 I do get nervous about
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people far away from reality of implementing
Very far away from culture of NHS
Who have this notion can simply contract at a national level
I personally think it would be a disaster if ever such an
approach were attempted
Build and roll out as for supermarket checkouts displays incredible naivety
… The higher the level of centralisation, the lower the
spec.
 The NHS IT Project - Radcliffe 2005
Punt says many blue-chips rushed headlong into longterm outsourcing contracts, with the result that many IT
leaders failed to clarify the relationship between supplier
and customer. 'Once you get beyond the deal, they're not
sure what they want,' he says.
'The vendor can manage the contract. As businesses
change, so do third-party relationships. Provision will
inevitably become more fluid and there will be a change
in how such services are delivered.
'Insourcing is of interest because people are
acknowledging that deals are not providing benefits.'
What are the successor arrangements ?
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Release 2 – 2008 – start of clinical journey
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10 year outsourcing deal to 2013
Only 5 years growth, not paperless ?
Increasingly complex record
 Reliance on data for decision support
 Continuation of other systems to fill gaps
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Integration with
Social Services
 Independent /private / voluntary sector
 Foundation Hospitals
 Patient access, and Care at home
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