Transcript Clinical Portal Programme – where are we now

Clinical Portal
Catherine Kelly
eHealth Clinical Lead
Scottish Government
• Why do we need it?
• What is it?
• What decisions and progress have been
made?
• What is happening now?
Why do we need a Clinical Portal?
Key to realising the vision set out in Better
Health Better Care to
“..ensure that the right information is
available at the right time, in the right place,
to enable staff to provide the best possible
care”
GP IT
system
Patient
Management
System
SCI-DC
Emergency
Care
Summary
Specialty
System
PATIENT
Theatre
system
SCI store
PACS
Lab system
What is a Clinical Portal?
• Not single system but range of products and services
• Provides “virtual” electronic patient record
• Different types of information still held in separate
databases
Patient
Dashboard
Information
Applications
Portal
Framework
Clinical
Dashboard
Management
Dashboard
Identity and Access Management
(including Single Sign On)
Integration and
Interoperability
Information Access
Technology
SCI Gateway
Process Management
Record
Locator
Service
Integration Platform
ECS
GP
SCI Store
PMS
Labs
CHI
PACS/RIS
A&E
Other
Launch
existing
modules and
legacy apps
in context
Workflow
specific views
Admission
Summary from
PAS/PMS/EPR
Alerts from
PAS/PMSEPR
Visit history
Discharge
history
Acknowledge
results
Pathology
reports
Radiology
reports
Forward
results
Local Applications
Local Applications
National Applications
National Applications
Local Data
Local Applications
Local Data
National Data Centre
Local Data
National Applications
National Applications
Clinical Portal- benefits
• Reduced time spent searching for and retrieving
clinical information
• More complete and up to date patient record
• Information available to support effective and
safe delivery of clinical care
• Reduced adverse drug events due to availability
of medication information
• Availability of results may reduce unnecessary
duplicate tests
• Reduced reliance on paper based processes
What do we have already?
120000
W/e 04/10/09
W/e 11/10/09
W/e 18/10/09
W/e 25/10/09
W/e 01/11/09
W/e 08/11/09
W/e 15/11/09
W/e 22/11/09
W/e 29/11/09
W/e 06/12/09
W/e 13/12/09
W/e 20/12/09
W/e 27/12/09
W/e 03/01/10
W/e 10/01/10
W/e 17/01/10
W/e 24/01/10
W/e 31/01/10
W/e 07/02/10
W/e 14/02/10
W/e 21/02/10
W/e 28/02/10
W/e 07/03/10
W/e 14/03/10
W/e 21/03/10
W/e 28/03/10
W/e 04/04/10
W/e 11/04/10
W/e 18/04/10
W/e 25/04/10
W/e 02/05/10
W/e 09/05/10
W/e 16/05/10
W/e 23/05/10
W/e 30/05/10
W/e 06/06/10
W/e 13/06/10
W/e 20/06/10
W/e 27/06/10
W/e 04/07/10
W/e 11/07/10
W/e 18/07/10
W/e 25/07/10
W/e 01/08/10
W/e 08/08/10
W/e 15/08/10
W/e 22/08/10
W/e 29/08/10
W/e 05/09/10
W/e 12/09/10
W/e 19/09/10
W/e 26/09/10
W/e 03/10/10
W/e 10/10/10
GG&C Clinical Portal Usage Statistics
Results & Documents Viewed
2009 - 2010
160000
140000
Total Results Viewed
Documents Viewed
100000
80000
60000
40000
20000
0
What decisions and progress have
we made?
Clinical Portal Programme Board
• National Integration platform - Ensemble
• Non-proliferation
• Phased approach to delivery of key information
requirements
• Commissioned regional consortia work to
identify portal solutions
• Information assurance programme to support
information sharing
Why a common Integration Platform?
Identity and Access Management
Single Sign On
Role
Based
Access
Context sharing
Single Window
eForms
Audit
Information Access
Integration Platform
Integration and Interoperability
.
Information service
(Allergies)
Information service
(Letters)
Information service
(Test results)
Clinical Information
store (eg ECS)
Clinical Information
store (eg SCI Store)
Clinical Information
store (eg SCI Store)
.
.
Process Management
Information service
(guidelines)
eLibrary
Information service
(demographics)
CHI
SCI
Store
choice
GP
systems
PMS
etc
•Minimise duplication of effort
•Promote re-use of components
•Ease the flow of information between systems and between Health Boards
•Simplify national interoperability
Information service
(Record locator)
Record location index
Clinical Portal Programme Board
• National Integration platform - Ensemble
• Non-proliferation
• Phased approach to delivery of key information
requirements
• Commissioned regional consortia work to
identify portal solutions
• Information assurance programme to support
information sharing
Clinical Portal Programme Board
• National Integration platform - Ensemble
• Non-proliferation
• Phased approach to delivery of key information
requirements
• Commissioned regional consortia work to
identify portal solutions
• Information assurance programme to support
information sharing
Agreed information priorities
Discovery work
• NHS Boards in different stages of readiness for
implementing a clinical portal
• The data items exist across a wide range of
clinical systems within and across the NHS
Boards
• Varying levels of access to key data items that
are required for inclusion in the portal
• Key challenges
– Developing interfaces
– Data cleansing
– Information Governance arrangements
Clinical Portal Programme Board
• National Integration platform - Ensemble
• Non-proliferation
• Phased approach to delivery of key information
requirements
• Commissioned regional consortia work to
identify portal solutions
• Information assurance programme to support
information sharing
West consortium
• Dell-Perot commissioned report
• Assess current state and identify dependencies
• Investigate role of PMS in delivering clinical
portal
• Investigate whether Orion could be used in other
Western Boards
• Propose solution options and associated
benefits
• Make recommendations on way forward
Report findings
• All Boards keen to implement Clinical Portal
• Initial focus on Acute Services
• Strong clinical support
• Best options - Intersystem HealthShare and Orion Portal
• Significant benefits from shared work practices &
approaches
– Consistent clinical content and structure for presentation of
information
– Role Based Access Control (RBAC) + single sign-on
Recommendations
• Proof of concept with Intersystems using HealthShare
• Run under WoS Consortium as single Programme Board
– Confirm and document functional and technical
requirements
– Identify key interfaces and inter-board integration
– Review wider architecture (incl. data sources, EDMS
role)
– Agree compatible RBAC/IG/ Single sign-on to support
cross Board sharing
North consortium
• Understanding of clinical portal readiness and appetite
within the region, and identification of required
preparatory work
• Understanding of viability and desirability of building on
Clinical Portal solutions already in place within the region
• Assessment of the potential impact of the national PMS
and GPIT contracts on the approach to Clinical Portal
• A proposed clinical portal strategy for the region
Summary of Findings
• Consensus for adopting a regional clinical portal
• The majority of Health Boards currently do not have all
the information priorities available electronically
• Preference for an information focused incremental
approach and not getting distracted by the
presentation layer
• SCI Store (eventually PMS) and Central Vision (NHS
Tayside) are seen as the key sources for a Secondary
Care EPR
• Effort should be focused on exploring access to
primary care information to support a Primary Care
EPR
Primary Care EPR
Primary Care Summary
1
Past Medical History
2
Current Problem List
3
Current Medications
4
Allergies
5
Alerts

Conditions (i.e. diabetes)

Sensory Impairment

Communication Difficulties

Anaesthetic alerts

Mental Health Act

Child Protection Act

Adults with incapacity

Do not resuscitate

Risk Status
• Real time information
• GPs control what is
shared
• Coded information
• Opportunities to improve
data quality
• Secure method of data
extraction
• Supports interoperability
between INPS and EMIS
Positioning the INPS Solution
Vision 360 Clinical Dashboard
(portal server)
Portal
Framework
South or West solution?
?
Identity and Access Management
(including Single Sign On)
Vision 360
(clinical server)
CHI
Primary Care EPR
Secondary Care EPR
Record
Locator
Service
MiG
GP
OOH
Admin
Integration
Platform
IDL
Generator
Letters
Generator
Board choice
Labs
Ensemble
PACS/RIS
Pharmacy
A&E
Current position
• Regional database concept not approved by CPPB
• North consortium to further clarify its proposal and
provide evidence of key stakeholder buy-in
• Continue work to assess information governance
challenges
• North Consortium to be appraised of West and South
Consortia outcomes, to provide opportunities for
consideration of alternative /complementary proposals
South consortium
• Developed working prototype using Carefx portal to
test key concepts and deliver information priorities
• Aggregated data from multiple Boards from multiple
live systems
• Single sign and patient context management
• No central repository containing data copies
• Made use of Ensemble integration engine
• Video of Working Prototype
Sourcing the data
Source
Data or Use
Interaction
Lothian MPI SCI Store
Patient Search,
demographics
Portlet
4 Board SCI Stores
Results, Reports,
Documents
Portlet
Carestream PACS
Images
Standard AI
TRAKcare
Previous encounters
Portlet via Ensemble
ECS
Meds, Allergies
Launch from standard
AI
External Links
Knowledge Bases,
General Info
URL/HTTP
Current position
•
•
•
•
•
Solution assessed by >90 clinicians
Very positive clinical feedback
Approval to develop business case
Implementation if business case approved
Special Health Board assessment of options
Clinical Portal Programme Board
• National Integration platform - Ensemble
• Non-proliferation
• Phased approach to delivery of key information
requirements
• Commissioned regional consortia work to
identify portal solutions
• Information assurance programme to support
information sharing
Information Governance concerns
• Unauthorised staff will be able to access
clinical information
• Clinical portal will be “free for all”
• Password sharing
• Poor audit and monitoring of access to
clinical systems
• Staff not aware of their responsibilities
Role based access
Information Assurance
•
•
•
•
•
•
Single sign on
User passwords reset
User provisioning - Active directories/EESS
Role based access model
Audit of access e.g. Fairwarning
Consistent sanctions for dealing with
inappropriate access or breaches of
confidentiality
• Information governance awareness and training