The document discusses the development and findings of a pilot Electronic Care Record (ECR) project in Northern Ireland. The key points are: 1) The pilot integrated clinical information from 16 existing health systems and allowed clinicians to access patient data via a single login. 2) Evaluation found the ECR improved clinical outcomes and decision making. 97% of users were satisfied with ease of use and found it useful. 3) The pilot demonstrated that a regional ECR is achievable and could help improve patient safety, quality of care and reduce costs across Northern Ireland.

1. NI Electronic Care Record (ECR) Dr Roy Harper Consultant Physician and Endocrinologist Desmond O’Loan HSCB e Health & Social Care Team

15. Today PAS A&E PACS South Eastern Labs Renal G P Comm H&C Others Belfast Northern Southern Western Western GP’s

17. Tomorrow Patient Access to Personal Health Records Belfast Western Northern Southern Southeastern Single sign-on, Security, Auditing, Business rules GP’s

18. Technical design

19. Currently 16 interfaced systems External BCH Ulster H&C index Master Patient Index MPI A&E A&E General Practice -ECS Carryduff, Priory Laboratory Master lab Laboratory BSO PAS episodes PAS episodes IUVO Clinical documents Clinical documents Cloverleaf GE RIS Report + Image NIPACS Report + Image SoScare PARIS

22. Operational Design Overview

23. Technical Design Overview

44. NI Electronic Care Record (ECR) A Physician’s Perspective Dr Roy Harper Consultant Physician & Endocrinologist The Ulster Hospital Visiting Professor, School of Mathematics and Computing The University of Ulster

48. Connected Health in NI The road to a regional electronic care record for the population of NI Experience so far Strategy being realised

50. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Diamond Diabetes ECR installed HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ Emergency Care Record Pilot Goes Live ECCH set up Start of H&C Number roll out Wireless Carts NI BCS Healthset up First COM 723 at UUJ Local PACS Tablet PCs and remote access Regional EHR Research Group Established 2009 PatientCentre [email_address] Appointed as Physician in UCHT RPA Roll out of PCs in all OPD Consulting Rooms Pilot ECR NIPACS 2010

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

63. Washington Hospital Centre - EHR 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’

64. Washington Hospital Centre - EHR 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

65. 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 EHR across its catchment area and beyond Now well developed Cost 10 million Canadian dollars with a deployment time of 9 months

66. Capital Health - EHR 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) 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)

67. Capital Health - EHR ‘ 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

68. Capital Health - EHR 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

72. External BCH Ulster H&C index Master Patient Index MPI A&E A&E General Practice -ECS Carryduff, Priory Laboratory Master lab Laboratory BSO PAS episodes PAS episodes Clinical documents Clinical documents GE RIS Report + Image NIPACS Report + Image SoScare SoScare PARIS PARIS

81. Today PAS A&E PACS South Eastern Labs Renal G P Comm H&C Others Belfast Northern Southern Western Western GP’s and Community Services

82. Tomorrow Patient Access to Personal Health Records Belfast Western Northern Southern Southeastern Single sign-on, Security, Auditing, Business rules GP’s

86. Technically feasible Well accepted and used by clinicians Increased patient safety and reduction of medical errors. Decrease in unnecessary and costly medical tests and procedures. Increased efficiency and a shorter care cycle. Improved patient care. Improved integration between acute and primary care. ECR POC Evaluation

92. NI Electronic Care Record (ECR) A Physician’s Perspective Dr Roy Harper Consultant Physician & Endocrinologist The Ulster Hospital Visiting Professor, School of Mathematics and Computing The University of Ulster

100. Connected Health in NI The road to a regional electronic care record for the population of NI Experience so far Strategy realised