Transcript LTC Update Nov 2011 - Quality Improvement Hub

LTC-iHub Update
November 2011
Lanarkshire LTC-iHub
1. Brief reminder of what the project
is about
2. Progress to date and current status
3. What has been learned so far
4. How success will be/is being
evaluated
5. Potential for wider applicability
1. Brief reminder of what the
project is about
TrakCare/
Vision/
MiDiS
2. Progress to date and current
status
EDM
Communication
Interventions
Diagnostics
Digital
Data
Capture
Clarification of
Requirement 1
Long Term Conditions-iHub
Ensemble
Knowledge
Other
Meteor
Business
ECS
PACS
Intelligence
SCI
Store
ECGs
Guidelines etc
Vision
MiDis
Trak
Care
Labs
Interactive
NHS Lanarkshire Applications Strategy
Portal Options: Orion/MiDis/CareFX/Trak/Ensemble
Integration & Interoperability: Ensemble
Information
Strategic Application ( Vision; TrakCare; MIDID; MAS)
Acute Application (Theatres; Cardiology; PACS; Photoware)
Community/PC Application (Dental; SCI-DC; NASH;OOH; PIMS)
Other Applications (NHS Mail; EDM; eKSF; eExpenses; EDT etc)
Clarification
of
P1
P2
Requirement 3
User Details and Photo
My clinic list
New Referrals
My Theatre list
Lab & Rad Reports
Unread emails
Activity
Data
Patient Search
Sean Brennan
Newly diagnosed
LTC patients
Recently viewed patients
Journal
Links
MiDis
TrakCare
….Links to other applications….
Meteor
Athena
P1
Sean Brennan d.o.b 9th.August.1982?
Demographics
& Contacts
Social &
Personal
Alerts &
Risks
Healthcare
Encounters
Admin &
Patient
Preferences
Correspondence
Medications
& Devices
Notifications &
Legals
Investigations
& Results
Clinical
Notes
Observations
3rd
Party
Documents
Notifications
&
Legal
Miscellaneous
All records
….Links to other applications….
Allergies &
Adverse
events
P2
Clinical
History
Portal Level 1 (P1)
Information
My Clinic List
My Theatre Lists
New Referrals
New LTC patients
Clinical Activity Data
Clarification of
Requirement 2
From?
TrakCare
TrakCare
TrakCare
?
MiLan
Portal Level 2 (P2)
Category
GROUP
Information
PATIENT HEALTH
SUMMARY
1
1.
2.
3.
1.
2.
3.
TrakCare/Vision 360
GP Vision 360
GP Vision 360/ECS
4.
5.
Past medical history
Current problem list
Current medications (Including
GP/Hospital/Chemo etc)
Allergies
Alerts
4.
5.
Vision360/ TrakCare
Vision360/TrakCare
CLINICAL
LETTERS
1
1.
2.
3.
Referral
Hospital discharge
Outpatient clinic
1.
2.
3.
SCI Gateway
Winscribe
Winscribe
DIAGNOSTIC
TESTS RESULTS
1
1.
2.
3.
Laboratory results
Radiology results and images
Other diagnostic text results
1.
2.
3.
SCI Store/Labs
RIS
Various
KNOWLEDGE
SUPPORT
2
1.
2.
3.
Local clinical guidelines
National clinical guidelines
eBNF
1.
2.
3.
FirstPort
FirstPort
FirstPort
ADDITIONAL
FUNCTIONALITY
(LATER PHASE)
3
Context searching and switching to enable Order
Communications, etc
GP cardiovascular risk scores, a DAS (disease
activity score) calculator,
Access to MUSE ECG Images Echograms
Access to Meteor Rheumatology system
LTC-iHub & Wider Portal Programme: Interdependancies
NHS-L Portal Programme
LTC-iHub Project
Technical Projects
NHS-L LTC-iHub
Project Board
? Elderly
COPD
Rheumatology
Heart Failure
LTC-iHub Steering Group
Vision
Single
360
Sign On
Ensemble
Interface/Design
Data
Capture
Incl digital
dictation
Portal
Access Design
IG/
Labs/
OCS
Midis
EDM
3. What has been learned so far
• A lot of project inter-dependencies
–
–
–
–
–
Ensemble development
Single Sign On
EDM
Vision 360
Digital Dictation
• Must adopt national standards were possible
• Feeder system issues
– Labs
– Cardiology
• Clinical Coding may be an issue.
4. How success will be/is being
evaluated
Objective
How it will be measured
Patients; more effective interaction with the clinician they
are seeing
Clinician feedback: Survey
Clinicians; efficiency and satisfaction Organisation; better
use of existing systems and improved quality
Clinician feedback: Survey
Organisation: Information/IT Review
National Objective – The ability of other NHS Boards to
use templates developed as needed locally
Adoption of templates by other NHS Boards
Reduced admissions for some people with long term
conditions due to improved access to information to
inform decision making.
Pre and Post project admissions analysis
Improved prescribing via better medicines reconciliation
Analysis of the effect of the LTC: iHub by live audit
undertaken by clinicians on a sample of patients.
More patient centred care via involvement and improved
use of information about health planning
Capture feedback from a sample of patients?
Digital Pen sub project
Digital Pen
• One heart failure nurse
• Data Capture form created/revised
• Hardware delivered (one pen/docking
station)
• Dry run with forms
• 3 month trial
• Evaluation
A new approach to Paper
Review error
messages on mobile,
make corrections
and re-send
Complete
form
Automatic routing of
form images via email
if no data editing
required
Send via mobile
Or
Dock with PC
Check & edit of form data
on AuraQ forms
management portal prior
to publishing (if required)
Publish data and forms
to internal systems
OCR and Validation
Form filled in – Pen Strokes
Form filled in – Pen Strokes
Digital Pen Evaluation
1.
2.
3.
4.
5.
6.
A quantitative account of how long it takes to put the info into the
computer program now. This is at the office, before and after the
pen
A quantitative account of how many patients are seen and for how
long before and after, to ensure that any benefits are not lost
elsewhere
a qualitative account of whether there is a change in time for data
capture in consultation
a qualitative account of whether there is a downside to quality of
consult when using the system
a qualitative account of what any freed up time is used for
a quantitative account of communication with Drs./ others. How
long to get letters out faxes out etc., before and after pen.
Issues
•
•
•
•
•
What happens if………….
Meteor : off-shore based.
IG and GP data
Roll-out/Timescales
What happens if mixed notes (e.g.
Rheumatology patient attends for a routine
general surgical episode etc)
• Incremental :
– ACP’s ; KIS;