Health Informatics and Chronic Conditions

1. Health Informatics and Chronic Conditions A View from the Jurassic Coast Andy Hadley, MSc, MHIM, MUKCHIP

2. Supporting Chronic Conditions • 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 ?

3. Strategy 10 Domains 7 for RIS

4. 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

5. Have we got time for a shared record ?

6. When will the software and systems be up to it ? • Portability & connectivity • Swift login • Remembering patient context • Mix of diary, what was I doing last, what’s next priority • Flexibility to work with personal preferences • Portal style • Clear summaries when want them, detail if need it • Reminders driving the process • Pathways, how to guide the uncertain, but not disengage the experts • End to end experience – single system for a user

7. Who gets to share the NCRS SAP record ? The Patient Hospital Doctor Hospital Nurse/AHP General Practice Spine Summary ? Accident Department Ever ? Release 2 Case Manager Single Assessment Process Independent sector Hospitals/care settings Ever ? Nurse Practitioner Mobile Release 3 Ambulance Release 3 OTs / Physios Ambulance & Control Limited Integration ? Health Visitor Ever ? Social workers Home Care Contracted services Help at Home Voluntary sector

8. Cluster Proposed Interim Architecture for SAP

9. 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 Royal Bournemouth Clinical Viewer NHS Number (4 points of ID) and SnomedCT investigation Codes Are vital Poole Hospital EPR East Dorset Interface Engine (Websphere) East Dorset Interface Engine (Websphere) Electronic ECG Traces East Dorset Community Hospitals Cerner Millenium Dorset Community Hospitals R1 Acute Trusts R2 West Dorset Interface Engine (SeeBeyond) Indep Sector Diagnostic Services Report GP Interface Box for West Dorset GPs PMIP West Dorset Hospitals Electronic HL7 report Somerset Interface Engine (SeeBeyond) Multiple GP Systems, or Paper Cerner Millenium Somerset Trusts R0 “Significant Pathology” Report within 2 hours Or Fast track with report /images in 24 hours Indigo Prompt Somerset Interface Box GPs Indigo Prompt Somerset Interface Box GPs Image will need report and episode number to exist on cluster archive Multiple GP Systems, or Paper GE PACS GE PACS GE PACS GE PACS Southern Cluster Archive Electronic DICOM Images For requests, see incorporating requests Royal Bournemouth Storrcom PACS Andy Hadley, SED PCT, Feb 2006 Not yet accessible to view !

10. Dorset Interim Approach • Good existing systems – widely used • Go for short increments and quick gains • Gain consensus where we can • 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 • Wessex RISP • SW EPR (Shires) • NPfIT ?

11. COPD Admission Avoidance (Poole area) GP Clinical Systems Cardiac Department - Muse system Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries EMIS x 13 Proposals for Electronic requesting in, and reporting out to EPR InPractice x 3 Paper Casenote Poole EPR Isoft x 1 Hospital Doctors PORT Team Nurses GPs Practice Nurses Cardio-respiratory staff Poole CaMIS Patient Administration A&E Visits, Outpatients, Waiting Lists, Inpatients, feeds Choose and Book Admin, contracting, MDS

12. COPD (how record ?) EPR is already accessible in GP practices and Community hospitals GP Clinical Systems Cardiac Department - Muse system Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries EMIS x 13 Proposals for Electronic requesting in, and reporting out to EPR InPractice x 3 Paper Casenote Isoft x 1 Poole EPR GPs Practice Nurses Hospital Doctors PORT Team Nurses Cardio-respiratory staff PFT Tests in the practice PFT Tests on the ward & OPD PFT and stress tests In Cardiology A&E and MAU Assessments Collect audit data Preparing for COPD NSF Minimum Dataset (MDS) FAX – “your patient has been admitted” Discharge Summaries (some on EPR)

13. COPD (near future) Longer term Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries PFT Tests - Hospital PORT information Building COPD NSF MDS GP Clinical Systems Cardiac Department - Muse system Email or messaging “your patient has been admitted, details are on EPR” EMIS x 13 Proposals for Electronic requesting in, and reporting out to EPR InPractice x 3 Paper Casenote Isoft x 1 Poole EPR GPs Practice Nurses Hospital Doctors PORT Team Nurses Cardio-respiratory staff PFT Tests in the practice PFT and stress tests In Cardiology Walk-In Centre Out of Hours 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 Nurse Practitioner

14. Frank Burns interviewed by Sean Brennan Jan 2002 Would you advocate a national EPR solution ? • I do get nervous about • 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

15. Punt says many blue-chips rushed headlong into long-term 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.'

16. What are the successor arrangements ? • Release 2 – 2008 – start of clinical journey • 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 • Integration with • Social Services • Independent /private / voluntary sector • Foundation Hospitals • Patient access, and Care at home