National Docman Conference 2014

1. National Docman Conference 2014 Docman: 10 years in Scotland Dr. Colin Brown GP Glasgow, SCIMP National Docman Conference 2014 #Docman

3. 2003-4: Docman for all GP practices in Scotland • Central funding • Included training • Key work for nGMS IT facilitators • Conversion program for those using other suppliers e.g. Criffel, EMIS, InPS • Rapid upgrade of all practices to “paperlite” • Supported by www.scimp.scot.nhs.uk and www.microtechsupport.co.uk

4. Naming the documents Docman makes it easy to customise the several names that can be given to each document: The Document Naming sequence is • Document Type • Organisation (Location) • Specialty All these are configurable: here are the options in our practice for our local DGH

5. Custom names for documents Doc type Location / care setting

6. Specialty:

7. Introducing a standard Folder Name:

8. 47 National Folder Names

9. Key features of new Folder Names • Not customisable • Useable for our filing clerks • National agreement on Names 2005 • National standard, so may be mandated • Software upgrade to user interface to mandate the user to select and apply a National Folder Name 2006

10. Standards….. “The nice thing about standards is that there are so many to choose from” Andrew S Tanenbaum "Those are my principles, and if you don't like them... well, I have others." Groucho Marx The presence of a mandated National Folder Name is independent of any other local custom names for the document. Standardisation of this list of names (index) enables its automatic use in other standard contexts

12. Update proposed 2014 (sample)

13. Context of the National Folder nameset GP Practice only e.g. proposal to rename OOH folder “Immediate Care” – a new name to expand the scope of the Out of Hours folder to include various other new services from providers of healthcare directly to patients such as NHS24 (now operating both In and Out of Hours) and with urgency ranging from 999 calls to advice by the new 111 services, and services ranging from familiar local ones to those of international travel. These new services were creating new uncertainties for their best filing destination*, and it was considered that “Immediate Care” would capture both the direct access and speed of these services whatever the service provider or location.This therefore replaces the folder named “Out of Hours” * - note this addresses only the context of GP Practices

14. 2006 issues • PSD’s Project development re possible roles in scanning and archiving of records, as extension of role with deceased/embarked/untraced and Armed Forces records. • Accreditation? for true paperless users after a managed process for selective back-scanning • AvoidPrint outs? for paperlite practices • Audit trails: investigate persistence • GP2PG issues re transfer processes? • serial transfer is full or incremental?

15. Deployment issues • started 2007 in Ayrshire and Grampian • completed Scotland-wide in 2009 • except for 3 practices in Scotland If receiving practice doesn’t use Docman – who does the printing? - not the GPs, but Practitioner Services Dept. do • non-standard filetypes? • cross-border traffic for England, Wales and NI.

16. Promotional Summary for D2D in 2008

17. Transfer of documents FAQ 2008 • export Docman files for deceased patients? • QOF 8wks-to-summarise starts when? • use of eLinks background data transfer service • has eLinks run? • clear out the Docman Archive folder? • opening an archived record • comments are not transferred • including SCI Gateway referrals in export

18. How complete is Docman record? - 1 • Hospital specialty letters • Community letters • Lab results • Referral letters- automatically linked from SCI-Gateway- imported as .html file (web-format) • Any other documents: ad-hoc direct scans • GP system record?

19. Complete GP record - 2 Addition of GP system record as a document: How to avoid printing out and re-scanning? • InPS Vision, EMIS PCS, Ascribe and iSoft had “export whole record as document” options • is “the whole record” the Data Protection Summary? • GPASS work-around used Virtual Print Drivers to create a .pdf of the print output • deployment of Virtual Print Drivers:- by nGMS IT facilitators- by GPs per SCIMP website instructions

21. Automatic transfer • eLinks background automatic transfer system • transports all NHS claims e.g. ons/offs • star network topology, not peer-to-peer • 3 Regional offices of PSD • operates overnight • QoS-like Priority scheduling for GP records • “Docman Transfer” deployment 2009

22. Standard Operating Procedures: example FULL PATIENT RECORDS We would encourage GP Practices to create a wholly electronic Full Patient Record by adding the GP System Record to Docman before export. This should be filed in the: National Filing Folder Name - Clinical Description – GP System Record Organisation – ExportingPractice Name and Practice Code This can now be done directly, without printing. For individual system instructions on how to do this, see: http://www.scimp.scot.nhs.uk/eRecords_docman.html Otherwise, GP Practices should print out the GP System Record and scan into Docman before exporting

23. D2D issues Document is human-readable - but clunky, and data not computable Structured data re-entry needed- promoted by nGMS QOF summarising Mediated by PSD- risk of delay to transfer – but is semi-automated- enables QA of received record re incompatible - attachment filetypes - destination / receiving practices - outwith Scotland - non-Docman Initiation is by pt. deduction via “Partners” message via eLinks to “push” from old practice, requiring some staff time > risk of delay

24. GP2GP solutions

25. Scotland’s GP2GP(S)

27. Naming the Specialties / Care Settings

28. Connecting it all up - 1 Note how Docman has shown how multiple indexes can include Document Type and Care Setting. An index of these 2 types of data-about-data, or “metadata” can be made valid across all Care Settings, Now comes The Principle:

29. Connecting it all up - 2 “An index of Document Type, and an index of Care Setting, are sufficient to support automatic transfer of Document Types across all Care Settings on a national scale” • approved by Professional Record Standards Board • in application for British Standard approval • other indexes still valid for local use within own Care Setting.

30. Connecting it all up - 3 “To conform to the standard a document management system would need to hold one entry from each of the lists as an instance of metadata relating to each individual document in its store. From that metadata it would then be possible to construct a standard name in the form: “Care Setting”:“Document Type” e.g. if Care Setting = Gynaecology and Document Type = Discharge Letter then Name = Gynaecology Discharge Letter.

31. Connecting it all up - 4 Maintenance of DocType and Care Setting lists: each maintained as Snomed subset by UK Terminology Centre England RFCs to https://isd.hscic.gov.uk/rsp-snomed/user/guest/home.jsf Scotland RFCs via Clinical Document Reference Group

32. Benefits • Admin efficiency saving persists throughout a document’s lifespan in NHS • documents become portable between Care Settings with no further admin action • make document indexing a one-time action at document creation: “Index-at-Source” • use EDT - use Docman Hub • All suppliers can support interoperability of documents by conforming to The Standard • enables GPSoC support? • can include documents from Social Care • Data Quality 100% with digital copies of documents • Looks like an Integrated NHS to the patient

34. colin.brown99@nhs.net leo.fogarty@hscic.gov.uk www.scimp.scot.nhs.uk