An Electronic Care Record For Northern Ireland

1. An Electronic Care Record For Northern Ireland Report on Study Trip to USA and Canada (8th –15th June 2008)

2. Nature of the problem • To make the best clinical decisions and to deliver safe and effective care clinicians need access to many different pieces of clinical information • Northern Ireland is rich in clinical data on individual patients • Much of the data is in electronic formats (laboratory, radiology, documents, PAS, CIS) • but

3. The problem is in accessing key information • Many disparate clinical systems and sources • Multiple log-on’s and Passwords • Only access to a single clinical domain or service • Lots of time devoted to locating information • Preventing effective and timely decision-making

4. Clinical Integration Framework Existing I.T. Systems Clinical Users

5. The answer – a NI-wide ECR Information from various disparate legacy clinical information systems brought together effectively and collated within a secure password protected regional electronic care record (ECR) Quite feasible - we have seen it in action !

6. What again is an ECR?

7. Clinical Integration Framework Existing I.T. Systems Clinical Users Integration

8. Clinical Integration Framework Existing I.T. Systems Clinical Users Access Integration

9. Clinical Integration Framework Existing I.T. Systems Clinical Users Access Add / change systems Integration

10. Clinical Integration Framework Existing I.T. Systems Clinical Users Access EMPI Terminology Coding etc… Integration

11. Clinical Integration Framework Existing I.T. Systems Clinical Users Patient Access to Personal Health Records Access EMPI Terminology Coding etc… Integration

12. What again is an ECR? A population-based electronic care record (ECR) brings together all types of patient data from lots of different sources and makes them instantly available to designated care professionals at the point of care in order to aid decision making

13. Washington Hospital Centre (MedStar Health), Washington DC, USA. Largest private academic hospital in Washington DC (926 beds) Leading centre for cardiology, oncology and trauma ECR originated from and designed by ER clinical staff Taken 15 years Originally known as Azyxii – now bought by Microsoft (AmalgaTM)

14. Washington Hospital Centre - ECR Integrates data of all sorts from multiple legacy systems Displayed in a highly customisable role-based data dense user interface. ‘Take it and show it’ philosophy Users define their own information needs and ‘views’

15. Washington Hospital Centre - ECR Listing and searching facilities are extensive Clinical questions easily answered ‘on the fly’ Limited direct data entry in the ER Some text-based information is scanned in Document creation Supporting hospital performance management and finance department

16. Capital Health Edmonton Area, Alberta, Canada (www.capitalhealth.ca) Provides a complete range of health services to 1.7 million people Employs 30,000 staff Pioneered the development of a web-based ECR across its catchment area and beyond Now well developed Cost 10 million Canadian dollars with a deployment time of 9 months

17. Capital Health - ECR Project driven by clinicians with total senior management buy-in Information from 25 data sources brought together using integration software (Concerto TM from Orion Health) ‘Patient centric approach’ Legacy systems stand as before – updated or replaced as needed The ‘netCARE’ portal is up and running and in use (>20,000 accessing per day)

18. Capital Health - ECR ‘Dashboard’ presented to users is easy to use Training takes 5 minutes Single sign one with pass through to legacy systems as required Largely read only Linked to a pharmacy information network Bolted on chronic disease management modules

19. Capital Health - ECR Information for clinical use only No secondary uses allowed Local population buy-in Some patient data masked Access only to selected clinicians with robust audit of all ‘break the glass’ events

20. Key steps towards an effective ECR • See it as an essential core tool for care professionals • Acceptance that it is a ‘no brainer’ and must happen • Buy in from population, care professionals and management • Master Person Index is fundamental for correct identification • Clinicians drive the project – IT deliver on specifications • IT investment (2.5% of total Capital Health spending)

21. Key components of an effective ECR • Password protected single sign-on with pass through • Fast, easy-to-use, intuitive, training in 5 minutes • Quick wins with early release and ‘quarterly pearls’ approach • Read only data to start then bolt on direct data entry, chronic disease management, etc • Security paramount with user groupings and access levels carefully defined with routine auditing of access • Opt out is the only viable consent model • Agreed processes to add additional data sources

22. A NI-wide ECR? • We have seen - real live, well used ECRs which are indispensable clinical information tools • We have seen - ECRs producing untold benefits for patients, for healthcare professionals and for healthcare systems • We have seen - that it can be done and fairly quickly with early wins

23. A NI-wide ECR? Making the right decision for the right patient at the right time

24. Next Steps • Get all to agree that ECR needs to happen • Spread the word • Pilot project (low-cost, time limited) • Scope it out asap • Obtain resources • Remember it can be done and fairly quickly with early wins

25. An Electronic Care Record For Northern Ireland Report on Study Trip to USA and Canada (8th –15th June 2008)