The Humber IHE-XDS Multi Disciplinary Team (MDT) Project

1. The Humber IHE-XDS Multi Disciplinary Team (MDT) Project Dr. Richard Harries, Consultant Radiologist Dr. Stephen Trowell, Head of Informatics Northern Lincolnshire and Goole NHS Foundation Trust

2. Humber XDS project initiation Clinically led: • Consultant Radiologist [Dr. Richard Harries] introduced IHE compatibility to the Trust during a Radiology Information system upgrade • Engaged SHA in discussions around potential benefits to the Local Health Community • Identified potential benefits to XDS deployment within a Multiple Disciplinary Team (MDT) meeting environment

3. Humber Current MDT facilities • Joint team meetings implemented using video conferencing facilities linking Hull and Grimsby • Two large flat panel screens for image display • PC linked microscope • PACS workstation • Laptop • Presentations by Radiologist, Pathologist etc referring to images shared on video screens • Patient records other than images in paper form (some recent records are available in electronic form, some only in hardcopy form)

4. Humber MDT meeting XDS enhancement • Two objectives • Proof of concept of XDS implementation in the UK environment • Enhancement of MDT meeting facilities by access to selected documents during and after meetings • Initial project: added functionality • Rapid selection and display of Discharge Summaries, Outpatient Clinic Notes and Operation Notes • Availability of these documents following the meeting • Follow on project: access to Reports e.g. CDA

5. Document Access • Document search and retrieval • Centralised XDS Registry/Repository • Document access from both Video conference rooms • Video conference room PCs upgraded for XDS document search and display (facility for panel monitor display of PC screen exists) • Document access from other locations? • Continuous subsequent access to documents by authorised staff

6. Document preparation for MDT meetings • Current process involves finding and collecting the record folders for the patients on the list for that day • Summaries and notes already in electronic from: • Pull from local hospital store • Convert to pdf • Create metadata • Some automatic • Some supplied by operator • Submit to XDS repository

7. Humber XDS deliverables Proof of concept will: • Define suitable metadata tags for each document type • Define tag creation process for text records • Using tagged documents in XDS repository • Use of central document registry • Document retrieval will be demonstrated from • Northern Lincolnshire and Goole Foundation Trust and • Hull and East Yorkshire Hospitals Trust • Access control will be established to ensure legitimate relationship policies are adhered to

8. Benefits to MDT participants • Less risk of errors when matching records to patients. • Greater probability that the entire relevant patient record will be used to support clinical decision making. • Facilitates ease of viewing key documents originating in other health care provider organisations. • Less manually resource intensive task to collate relevant records prior to MDT meeting. • During MDT meeting, more consistent and seamless presentation of information – fewer interruptions whilst looking for pertinent information.

9. Benefits to the Foundation Trust • Facilitates improved clinical decision making, thereby reducing risk of incorrect conclusions being drawn. • Facilitates a consistent, standard approach to MDT meetings so easier for staff to sit on multiple MDT’s. • Contributes to a culture of innovation.

10. Benefits to patients and GPs • Facilitates improved clinical decision making, thereby reducing risk of incorrect conclusions being drawn. • Potential to send a link electronically to GP and/or patient so that they can access a file summarising the outcome of MDT discussions. (patient only has access to that specific document)

11. Benefits to Local Health Community [SHA]: • Demonstrates potential for cross-organisational sharing of documentation – applicable to many areas beyond MDT environment. • Generates a local understanding of the benefits and issues around IHE XDS technology. • Continues to place the region at the forefront of health informatics advances.

12. Issues – implementation challenges Despite good alignment with national and local NHS Quality agenda….. • Understanding of XDS in both clinical and informatics/IT Trust departments is limited to a few individuals • Engagement of Trust in IHE technology • “We already have an Integration Engine and NPfIT products – why do we need another method of interfacing systems?” • SHA supportive – potential benefits to the LHC • Excellent support from IHE-UK, and commercial partners

13. Humber XDS project summary • The Humber IHE-XDS MDT project aims to develop local understanding of IHE technology • Through MDT’s, can demonstrate a proof of concept • Easily scalable rollout, engaging many clinicians • Suitable basis for future deployment • Small scale [Trust based] proof of concept carries minimal risk • XDS is a method, not a product – it does not specify everything that we need to make the project successful!

14. Group Feedback • Questions ? • What else should the project team consider? • How does this relate to your areas? • What other potential applications are there for XDS? • How does the NHS agree standard metadata for document classification?

15. Humber XDS project – related projects • Electronic Discharge summaries • Joining Pharmacy records to ward-based clinical records to create a single discharge summary • PAS developments • Clinical Viewer software could be configured to generate pdf documents at source • Electronic Document Management • Digitising legacy paper records – XDS compatible?