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2007 TPP All Rights Reserved . 2. Shared records are here its up to you to use them as agents for change. The major risk for new service delivery is the fragmentation of the clinical recordRecord sharing within and between traditional health communities is vitalEffective single records acr
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1. � 2007 TPP � All Rights Reserved 1 Shared clinical records in the world of PbC Dr John Parry
General Practitioner
Clinical Director TPP
2. � 2007 TPP � All Rights Reserved 2 Shared records are here � its up to you to use them as agents for change
3. � 2007 TPP � All Rights Reserved 3 Experience to date:
Single patient record system
Remotely hosted
Primary care system
GP, community, CHS
OOH, A&E, palliative care, diabetes unit, community teams, PCT wide reporting
Making it up as we went along?
4. � 2007 TPP � All Rights Reserved 4 Inescapable Issues Consent
Data Protection
Caldicott
ultra vires rules
5. � 2007 TPP � All Rights Reserved 5 Basics Keeping patient record accurate, relevant, useful and maintained
Keeping information secure
Security � inc physical
Security � confirm patient authority to release
Disclosure
Patient access
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10. � 2007 TPP � All Rights Reserved 10 From the NMC [http://www.nmc-uk.orgf ] (Draft code) Respect people�s confidentiality
You must respect people�s right to confidentiality
You must ensure people are informed about how and why information is shared by those who will be providing their care
You must not disclose confidential information unless this is done in line with the law of the country in which you are practising
Share information with your colleagues
You must keep your colleagues informed when you are sharing the care of others
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13. � 2007 TPP � All Rights Reserved 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61243
http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/422/422we22.htmhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61243
http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/422/422we22.htm
14. � 2007 TPP � All Rights Reserved 14 The Care Record GuaranteeOur Guarantee for NHS Care Records in England This new system will:
� hold records about your care in a national computer system so that, wherever in the
country you need care, health care professionals can have access to the most up-todate
information;
� allow you to control whether information in electronic records made about you by
the organisation providing your care can be seen elsewhere in the NHS;
� show only those parts of your record needed for your care;
� allow only authorised people (who will need a �Smartcard� as well as a password) to
access your records;
� allow only those involved in your care to have access to records about you from
which you can be identified, unless you give your permission or the law allows;
� allow us to use information about your health care, to improve the services we
offer or to support research, in a way that doesn�t reveal your identity;
� keep a note of everyone who accesses the records about you; and
� be operated in line with internationally approved information security standards.
15. � 2007 TPP � All Rights Reserved 15 No longer just a personal aide memoir � more a communication tool. Old message about making adequate notes still true; need to acknowledge other data used in decision making
Scrutiny by others becomes more routine
Strange sensation of having diabetic care looked at by consultant
What will happen when a clinician is �shopped� following shared medical record access?No longer just a personal aide memoir � more a communication tool. Old message about making adequate notes still true; need to acknowledge other data used in decision making
Scrutiny by others becomes more routine
Strange sensation of having diabetic care looked at by consultant
What will happen when a clinician is �shopped� following shared medical record access?
16. � 2007 TPP � All Rights Reserved 16 No longer just a personal aide memoir � more a communication tool. Old message about making adequate notes still true; need to acknowledge other data used in decision making
Scrutiny by others becomes more routine
Strange sensation of having diabetic care looked at by consultant
What will happen when a clinician is �shopped� following shared medical record access?No longer just a personal aide memoir � more a communication tool. Old message about making adequate notes still true; need to acknowledge other data used in decision making
Scrutiny by others becomes more routine
Strange sensation of having diabetic care looked at by consultant
What will happen when a clinician is �shopped� following shared medical record access?
17. � 2007 TPP � All Rights Reserved 17 Background [Dr Richard Pope Consultant Diabetologist & Medical Director Airedale NHS Trust] Why diabetes?In 1999 Secondary to primary care shift clinical effectiveness developing �shared� care � good relationships
no integrated record multi system, multi profession long term condition engaging patient central to success need for a single info system ��..the perfect exemplar
18. � 2007 TPP � All Rights Reserved 18 Issues with record sharing? Security
Confidentiality
Consent
What are we sharing
Practicality
Do we really understand what our patients� wishes are?
19. � 2007 TPP � All Rights Reserved 19 Record Sharing with secondary care � how is it used? In clinic consultation toolclear benefits access to information (common fields in templates) avoid duplication instant communication - into the record �active� messaging patient engagement �.doing what we do now � but better
20. � 2007 TPP � All Rights Reserved 20 Transformational change - a journey begins Intra- (district) team referrals
E-referral (predated choose and book)
The diabetes foot clinic
E-consultation
Pro-active record sharing
Targeted interventions (OOH)
21. � 2007 TPP � All Rights Reserved 21 Transformational change - at the tipping point Local delivery of healthcare
The financial demands on the NHS
Influence of PbR / PBC / Alliances
The growth/scope/cost of the GPwSI tier
Governance in the new primary care environment
Advances in telehealth
There is a need for the delivery of a different form of clinical support to staff seeing patients
22. � 2007 TPP � All Rights Reserved 22 Transformational change - one approach Shared records � a new way of thinking deploy the decision makers at the earliest appropriate point in a patient�s journey �but we do this now����..
23. � 2007 TPP � All Rights Reserved 23 Transformational change - one approach Shared records � a new way of thinking deploy the decision makers at the earliest appropriate point in a patient�s journey �but we do this now����..
Use shared records overtly to focus senior secondary care input outside the hospital � with the aim of preventing or streamlining face to face contacts in specialist clinics or an acute care setting
24. � 2007 TPP � All Rights Reserved 24 What does this mean? E-consultation � strategic and acute care support
potential for radical change in patient flows, with improved care and efficiency (even where good standards of referral practice exist now)
estimate � diabetes 50 � 70% of current referrals can be managed with remote support. Similar potential gains likely in other long term conditions
SystmOne � one (crucial) tool; many others (eg telemedicine) S1�s advantage? � its in the record
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26. � 2007 TPP � All Rights Reserved 26 Benefits of integrated shared records using SystmOne Palliative care
Westwood Park
A/E
LCD
Remote Access
Heart failure nurses
CKD
Community pharmacists
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42. � 2007 TPP � All Rights Reserved 42 Shared records are here � its up to you to use them as agents for change