NHS Scotland eHealth Strategy
NHS for Scotland’s 5.2m citizens <ul><li>NHS devolved to Scottish Parliament </li></ul><ul><li>Scottish Government Health ...
sub title: How do you do strategy in a federated health system? <ul><li>Four things… </li></ul><ul><li>Do things of use to...
Scotland’s approach to eHealth <ul><li>All about the right information to the right people at the right time </li></ul><ul...
1.  Doing things of use to all – how far did this get us up to c. 2008? <ul><li>unique patient ID number, national Wide Ar...
 
 
<ul><li>home telecare  installed for 17,000 people, at cost of £7.4m  - evaluation: over 60% of patients feel their qualit...
<ul><li>Emergency Care Summary </li></ul><ul><li>covering 99.9% of population </li></ul>1.  Doing things of use to all – h...
What’s ECS? <ul><li>National database containing…. </li></ul><ul><li>Patient identity (address, telephone, CHI number, GP)...
<ul><li>Patient safety = key driver </li></ul><ul><li>Too much unknown when patient comes to unscheduled care </li></ul><u...
System Overview GP consultation ECS System Request & display NHS 24 A&E Ambulance TBD… Check  audit log Health Board GP Pr...
Progress to Date <ul><li>5.4 Million Patient Records available </li></ul><ul><li>1900 patients have ‘opted out’ of practic...
Implementation Approach <ul><li>leadership by clinicians and patient reps </li></ul><ul><li>incremental rollout in each He...
<ul><li>Assume consent to create an ECS record, but patients can opt out </li></ul><ul><li>Explicit consent from patient f...
Costs and financing <ul><li>Total investment = £25.3m over 9 years </li></ul><ul><li>IT cost: £3.3m = 13% of total (exclud...
Emergency Care Summary – benefits
Patient Views <ul><li>Patients are very accepting of ECS with over 99.3% giving permission to access </li></ul><ul><li>Pat...
Clinicians Quotes <ul><li>“ One of the best tools we have got for improving patient safety”  </li></ul><ul><li>“ ECS has b...
Lessons Learned… <ul><li>Incremental approach works for Scotland </li></ul><ul><li>Careful consideration of patient groups...
New Developments - ePCS <ul><li>electronic Palliative Care Summary </li></ul><ul><li>Moving from paper based forms to shar...
New Developments <ul><ul><li>Key Information Summary  (KIS) </li></ul></ul>
<ul><li>Patient name, Address, Patient mobile number </li></ul><ul><li>Next of kin details:  </li></ul><ul><li>Emergency c...
KIS – section 2 – Current Situation <ul><li>Main Diagnoses, Current problems  </li></ul><ul><li>Patient and family underst...
KIS – section 3 – Carer/ Support details <ul><li>Power of attorney in place?  </li></ul><ul><li>Adults with Incapacity for...
KIS – section 4 – care suggestions <ul><li>Current place of care  </li></ul><ul><li>Preferred Place of Care  </li></ul><ul...
2. Convince that convergence and collaboration is in the interests of all relationships  relationships  relationships (+ p...
Where common cause exists, national contribution to collaboration (Hospital Patient Management System and GP system procur...
Agree aims that have business relevance Offer funds to support achievement Health Boards to set outcomes and show  4 year ...
5 strategic eHealth aims <ul><li>Maximise efficient working practices, minimise wasteful variation, bring about  savings a...
1970 – 2000 2000 - 2011 2012 + patient £ and effort £ & £ & admin admin clinical clinical patient
<ul><li>Online administrative processes, eg. appointment booking, prescription renewal </li></ul><ul><li>Trusted online in...
yes but with what outcome? <ul><li>Improve patient’s health knowledge and ability to manage aspects of their health </li><...
e-correspondence service? <ul><li>how many paper letters does NHS Scotland send to its 5m citizens a year? </li></ul><ul><...
Citizen eHealth Strategy
5 strategic eHealth aims <ul><li>To use information and technology in a coordinated way to: </li></ul><ul><li>Maximise eff...
5 strategic eHealth aims <ul><li>To use information and technology in a coordinated way to: </li></ul><ul><li>Maximise eff...
what information?  survey said… <ul><li>Past medical history </li></ul><ul><li>Current problem list </li></ul><ul><li>Curr...
<ul><li>‘virtual’ electronic patient record – not about large national database </li></ul><ul><li>electronic window to inf...
Greater Glasgow & Clyde In a given week some 5500 active users,  accessing 250,000 documents (test results,  correspondenc...
the right IT – necessary… … but on its own not sufficient without that there’s trust in the safeguards
the right safeguards through training & awareness, authentication of users, role-based access, single sign-on, audit log a...
agreement to share in the first place
5 strategic eHealth aims <ul><li>To use information and technology in a coordinated way to: </li></ul><ul><li>Maximise eff...
medicines reconciliation…
NHS Lanarkshire trial <ul><li>ECS accessed for 405 admissions </li></ul><ul><li>for 67 patients (22%) ECS contained additi...
4.  Put in place appropriate governance
(with acknowledgements to Accenture)
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NHS Scotland Ehealth Strategy - Alan Hyslop

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  • Identified by the eHealth Strategy Board as the priorities and developed in collaboration with stakeholders 5 broad themes where Boards will be expected to focus their eHealth activity going forward Closely linked to activity across the Scottish Government
  • Identified by the eHealth Strategy Board as the priorities and developed in collaboration with stakeholders 5 broad themes where Boards will be expected to focus their eHealth activity going forward Closely linked to activity across the Scottish Government
  • Identified by the eHealth Strategy Board as the priorities and developed in collaboration with stakeholders 5 broad themes where Boards will be expected to focus their eHealth activity going forward Closely linked to activity across the Scottish Government
  • Identified by the eHealth Strategy Board as the priorities and developed in collaboration with stakeholders 5 broad themes where Boards will be expected to focus their eHealth activity going forward Closely linked to activity across the Scottish Government
  • ECS has worked well, with clear benefits to patient safety. Irony that people have noticed is that safer to go into hosp as an emergency as opposed to OP or arranged admission etc Lanarkshire study…letters were on average 110 days old when the patient was admitted for treatment. In the 24 referral letters examined there were a total of 119 discrepancies in the medications listed by the time of the patient’s hospital admission when compared with the information on ECS. The clinicians who did this study also looked at potential for harm in not having the up to date prescription at the outpatient appointment or admission. They concluded that there may have been some degree of avoidable harm for 23 out of the 305 patients studied, which is a significant finding given the numbers of outpatient appointments and admissions across NHS Scotland.
  • NHS Scotland Ehealth Strategy - Alan Hyslop

    1. 1. NHS Scotland eHealth Strategy
    2. 2. NHS for Scotland’s 5.2m citizens <ul><li>NHS devolved to Scottish Parliament </li></ul><ul><li>Scottish Government Health Directorate </li></ul><ul><li>14 Health Boards </li></ul><ul><ul><li>all care within a geographical area </li></ul></ul><ul><li>1030 GP Practices </li></ul><ul><li>‘ special’ Health Boards, eg. national ambulance service </li></ul>
    3. 3. sub title: How do you do strategy in a federated health system? <ul><li>Four things… </li></ul><ul><li>Do things of use to all </li></ul><ul><li>Convince that convergence and collaboration is in the interests of all </li></ul><ul><li>Incentivise that collaborative activity </li></ul><ul><li>Put in place appropriate governance </li></ul>
    4. 4. Scotland’s approach to eHealth <ul><li>All about the right information to the right people at the right time </li></ul><ul><li>Incremental </li></ul><ul><li>Pragmatic </li></ul><ul><li>Partnerships </li></ul><ul><li>Focus on benefits and governance, not technology </li></ul>
    5. 5. 1. Doing things of use to all – how far did this get us up to c. 2008? <ul><li>unique patient ID number, national Wide Area Network </li></ul><ul><li>all Health Boards with local instance of national product for online test results, letters etc (both for hospital and GPs) </li></ul><ul><li>truly national PACS service </li></ul><ul><li>national e-communications service (SCI Gateway): 97% GP referrals electronic and structured (but only 3% of discharge letters) </li></ul><ul><li>mature GP EPRs, eg. 98% practices paperless, e-prescribing and transmission </li></ul>
    6. 8. <ul><li>home telecare installed for 17,000 people, at cost of £7.4m - evaluation: over 60% of patients feel their quality of life has improved, and 90% felt saver - £23m efficiencies, eg. avoided unscheduled admissions </li></ul><ul><li>telehealth strategy to focus on ‘mainstreaming’: - telestroke - paediatrics - COPD - psychiatry - eye care </li></ul>1. Doing things of use to all – how far did this get us up to c. 2008?
    7. 9. <ul><li>Emergency Care Summary </li></ul><ul><li>covering 99.9% of population </li></ul>1. Doing things of use to all – how far did this get us up to c. 2008?
    8. 10. What’s ECS? <ul><li>National database containing…. </li></ul><ul><li>Patient identity (address, telephone, CHI number, GP) </li></ul><ul><li>Allergies and Adverse Reactions to medications </li></ul><ul><li>Medication </li></ul><ul><li>- Repeat prescriptions in past 12 months </li></ul><ul><li>- One-off prescriptions in past 30 days </li></ul>
    9. 11. <ul><li>Patient safety = key driver </li></ul><ul><li>Too much unknown when patient comes to unscheduled care </li></ul><ul><li>Efficient use of clinical time also important </li></ul>Why did we do this difficult thing?
    10. 12. System Overview GP consultation ECS System Request & display NHS 24 A&E Ambulance TBD… Check audit log Health Board GP Practice admin
    11. 13. Progress to Date <ul><li>5.4 Million Patient Records available </li></ul><ul><li>1900 patients have ‘opted out’ of practices connected (represents 0.03% of all patients) </li></ul><ul><li>6 million accesses to date and increasing trend in use (currently > 50,000 per month) </li></ul><ul><li>Over 11,000 users across different clinical areas </li></ul><ul><li>Expected increase in use as new developments are available </li></ul>
    12. 14. Implementation Approach <ul><li>leadership by clinicians and patient reps </li></ul><ul><li>incremental rollout in each Health Board </li></ul><ul><li>national and local communication </li></ul><ul><li>full technical integration where possible </li></ul>
    13. 15. <ul><li>Assume consent to create an ECS record, but patients can opt out </li></ul><ul><li>Explicit consent from patient for their record to be viewed at point of care (these provisions go further than the law requires in Scotland/ UK) </li></ul><ul><li>all ‘the usual’ technical security - encryption etc </li></ul>Confidentiality protections
    14. 16. Costs and financing <ul><li>Total investment = £25.3m over 9 years </li></ul><ul><li>IT cost: £3.3m = 13% of total (excludes broadband) </li></ul><ul><li>annual costs now c. £0.6m (mainly 24x7 high specification data centre support) </li></ul>
    15. 17. Emergency Care Summary – benefits
    16. 18. Patient Views <ul><li>Patients are very accepting of ECS with over 99.3% giving permission to access </li></ul><ul><li>Patients in hospital or emergency situations (e.g. A/E Department) find it very useful when can’t remember their medication details </li></ul><ul><li>Consumer Focus Scotland reported continued support for ECS </li></ul>
    17. 19. Clinicians Quotes <ul><li>“ One of the best tools we have got for improving patient safety” </li></ul><ul><li>“ ECS has been a godsend, I can’t imagine how we managed without it” </li></ul><ul><li>“ It can take ages if we need to phone GP surgery” </li></ul><ul><li>“ Before ECS we often had to ‘work blind’ with no information at all.” </li></ul><ul><li>“ ECS information can help the most vulnerable patients, e.g. those who are admitted over the weekend who have no one to bring in their meds” </li></ul>
    18. 20. Lessons Learned… <ul><li>Incremental approach works for Scotland </li></ul><ul><li>Careful consideration of patient groups and clinical need </li></ul><ul><li>Patient Communication is key </li></ul><ul><li>Clinical Leadership and Championship </li></ul><ul><li>Keep it simple </li></ul>
    19. 21. New Developments - ePCS <ul><li>electronic Palliative Care Summary </li></ul><ul><li>Moving from paper based forms to shared electronic information for vulnerable group of patients </li></ul><ul><li>Contains significant and sensitive information </li></ul><ul><ul><li>Resuscitation Status, Preferred Place of Care </li></ul></ul><ul><ul><li>Diagnosis and Current Treatment </li></ul></ul><ul><ul><li>Carer Details and Advice for OOH </li></ul></ul>
    20. 22.
    21. 23. New Developments <ul><ul><li>Key Information Summary (KIS) </li></ul></ul>
    22. 24. <ul><li>Patient name, Address, Patient mobile number </li></ul><ul><li>Next of kin details: </li></ul><ul><li>Emergency contact phone numbers </li></ul><ul><li>Usual GP name, Nurse, Care Manager, Specialist Nurse or other contacts, involved in care </li></ul><ul><li>Carer Details </li></ul><ul><li>Access information </li></ul>KIS – section 1 – Basic details
    23. 25. KIS – section 2 – Current Situation <ul><li>Main Diagnoses, Current problems </li></ul><ul><li>Patient and family understanding and wishes, including goals and expectations </li></ul><ul><li>Patient has </li></ul><ul><li>- self management plan Yes □ No □ </li></ul><ul><li>- Anticipatory care plan Yes □ No □ </li></ul><ul><li>- Shared Assessment Yes □ No □ </li></ul><ul><li>Home Oxygen, Normal Oxygen saturation </li></ul><ul><li>Usual BP Additional drugs available at home </li></ul>
    24. 26. KIS – section 3 – Carer/ Support details <ul><li>Power of attorney in place? </li></ul><ul><li>Adults with Incapacity form Yes □ No □ </li></ul><ul><li>Compulsory treatment order in the community? </li></ul><ul><li>Mental Health Act detention? Yes □ No □ </li></ul><ul><li>Homecare support in place? </li></ul><ul><li>Moving and handling information and equipment in place </li></ul><ul><li>Agreed actions </li></ul>
    25. 27. KIS – section 4 – care suggestions <ul><li>Current place of care </li></ul><ul><li>Preferred Place of Care </li></ul><ul><li>Special instructions for OOHs </li></ul><ul><li>DNA form Yes □ No □ </li></ul>
    26. 28. 2. Convince that convergence and collaboration is in the interests of all relationships relationships relationships (+ putting financial and delivery responsibility where it should be)
    27. 29. Where common cause exists, national contribution to collaboration (Hospital Patient Management System and GP system procurements) 3. Incentivise that collaborative activity
    28. 30. Agree aims that have business relevance Offer funds to support achievement Health Boards to set outcomes and show 4 year plans for each aim (acknowledges that Boards at different places and have different local priorities) 3. Incentivise that collaborative activity
    29. 31. 5 strategic eHealth aims <ul><li>Maximise efficient working practices, minimise wasteful variation, bring about savings and value for money </li></ul><ul><li>Support people to communicate with NHSS , manage their own health and wellbeing, and to become more active participants in the care and services they receive </li></ul>To use information and technology in a coordinated way to:
    30. 32. 1970 – 2000 2000 - 2011 2012 + patient £ and effort £ & £ & admin admin clinical clinical patient
    31. 33. <ul><li>Online administrative processes, eg. appointment booking, prescription renewal </li></ul><ul><li>Trusted online information advice </li></ul><ul><li>Online clinical services and support, eg. access to test results and e-consultation </li></ul><ul><li>Patient self management </li></ul><ul><li>Tele-monitoring </li></ul><ul><li>Mobile telemetry </li></ul>Patient eHealth - lots of possibilities Solutions looking for problems?
    32. 34. yes but with what outcome? <ul><li>Improve patient’s health knowledge and ability to manage aspects of their health </li></ul><ul><li>Improve access to services for citizens and patients </li></ul><ul><li>Reduce admin costs </li></ul>
    33. 35. e-correspondence service? <ul><li>how many paper letters does NHS Scotland send to its 5m citizens a year? </li></ul><ul><li>c. 25 million </li></ul><ul><li>compare that to banks and energy companies opportunity to save costs, carbon and give a better service for patients who sign up for e-correspondence? </li></ul>
    34. 36. Citizen eHealth Strategy
    35. 37. 5 strategic eHealth aims <ul><li>To use information and technology in a coordinated way to: </li></ul><ul><li>Maximise efficient working practices, minimise wasteful variation, bring about savings and value for money </li></ul><ul><li>Support people to communicate with NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive </li></ul><ul><li>Contribute to care integration and to support people with long term conditions </li></ul>identifying at-risk patients, anticipatory care, supporting virtual wards/ joined-up patient pathways…
    36. 38. 5 strategic eHealth aims <ul><li>To use information and technology in a coordinated way to: </li></ul><ul><li>Maximise efficient working practices, minimise wasteful variation, bring about savings and value for money </li></ul><ul><li>Support people to communicate with NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive </li></ul><ul><li>Contribute to care integration and to support people with long term conditions </li></ul><ul><li>Improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality </li></ul>
    37. 39. what information? survey said… <ul><li>Past medical history </li></ul><ul><li>Current problem list </li></ul><ul><li>Current medications </li></ul><ul><li>Allergies and Alerts </li></ul><ul><li>Letters – Referral, Outpatient, Discharge </li></ul><ul><li>Tests – Laboratory, Radiology, etc </li></ul><ul><li>Clinical Observations (pulse, BP etc.) </li></ul><ul><li>Local and national clinical guidelines </li></ul><ul><li>Drug reference information (British National Formulary) </li></ul>
    38. 40. <ul><li>‘virtual’ electronic patient record – not about large national database </li></ul><ul><li>electronic window to information held in different places, fetched and viewed by clinician on an as-required basis </li></ul>clinical portal
    39. 41. Greater Glasgow & Clyde In a given week some 5500 active users, accessing 250,000 documents (test results, correspondence, operation notes, pre-op assessments, clinic lists, scanned paper records, theatre lists, etc) + range of e-forms to replace standard assessments, notes etc
    40. 42. the right IT – necessary… … but on its own not sufficient without that there’s trust in the safeguards
    41. 43. the right safeguards through training & awareness, authentication of users, role-based access, single sign-on, audit log analysis etc very necessary, but still not sufficient
    42. 44. agreement to share in the first place
    43. 45. 5 strategic eHealth aims <ul><li>To use information and technology in a coordinated way to: </li></ul><ul><li>Maximise efficient working practices, minimise wasteful variation, bring about savings and value for money </li></ul><ul><li>Support people to communicate with NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive </li></ul><ul><li>Contribute to care integration and to support people with long term conditions </li></ul><ul><li>Improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality </li></ul><ul><li>Improve the safety of people taking medicines and their effective use </li></ul>
    44. 46. medicines reconciliation…
    45. 47. NHS Lanarkshire trial <ul><li>ECS accessed for 405 admissions </li></ul><ul><li>for 67 patients (22%) ECS contained additional info </li></ul><ul><li>for 23 (35%) of those patients potential harm was avoided courtesy of ECS access </li></ul><ul><li>+ a separate comparison of 30 referral letters - drugs vs. actual current prescription - found 119 discrepancies </li></ul>
    46. 48. 4. Put in place appropriate governance
    47. 49. (with acknowledgements to Accenture)

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