Health Informatics and Chronic Conditions A View from the Jurassic Coast Andy Hadley, MSc, MHIM, MUKCHIP

Supporting Chronic Conditions Co-ordinating across health and social care Co-ordinating across health and social care When might the national care record deliver ? When might the national care record deliver ? Problems introduced by plurality of provision Problems introduced by plurality of provision Short term plans for Dorset Short term plans for Dorset What happens in year 2013 ? What happens in year 2013 ?

Strategy 10 Domains 7 for RIS

How often do we need to access full records ? GP Referral/Booking Reason for referral Signs and Symptoms Patient History Current Medications Alerts and ongoing conditions Current and Planned Care Hospital Discharge Diagnosis and Treatment Current and Changed Medications Planned Care by us Suggestions for follow up

Have we got time for a shared record ?

When will the software and systems be up to it ? Portability & connectivity Portability & connectivity Swift login Swift login Remembering patient context Remembering patient context Mix of diary, what was I doing last, what’s next priority Mix of diary, what was I doing last, what’s next priority Flexibility to work with personal preferences Flexibility to work with personal preferences Portal style Portal style Clear summaries when want them, detail if need it Clear summaries when want them, detail if need it Reminders driving the process Reminders driving the process Pathways, how to guide the uncertain, but not disengage the experts Pathways, how to guide the uncertain, but not disengage the experts End to end experience – single system for a user End to end experience – single system for a user

Who gets to share the NCRS SAP record ? Single Assessment Process General Practice Nurse Practitioner Health Visitor Hospital Doctor Accident Department Ambulance & Control Social workers Help at Home Voluntary sector Home Care Contracted services Case Manager Mobile Release 3 Release 2 Ambulance Release 3 Ever ? Limited Integration ? OTs / Physios Independent sector Hospitals/care settings Ever ? The Patient Spine Summary ? Hospital Nurse/AHP

Cluster Proposed Interim Architecture for SAP

Incorporating Independent Sector Reports onto NHS Systems in Dorset and Somerset NHS Number (4 points of ID) and SnomedCT investigation Codes Are vital Indep Sector Diagnostic Services Report Royal Bournemouth Clinical Viewer Poole Hospital EPR East Dorset Community Hospitals Electronic HL7 report Multiple GP Systems, or Paper Poole GP Interface Box for East Dorset GPs PMIP East Dorset Interface Engine (Websphere) Electronic DICOM Images GE PACS Royal Bournemouth Storrcom PACS Southern Cluster Archive Not yet accessible to view ! Electronic ECG Traces Cerner Millenium Somerset Trusts R0 For requests, see incorporating requests “Significant Pathology” Report within 2 hours Or Fast track with report /images in 24 hours GE PACS Indigo Prompt Somerset Interface Box GPs Indigo Prompt Somerset Interface Box GPs Somerset Interface Engine (SeeBeyond) Cerner Millenium Dorset Community Hospitals R1 Acute Trusts R2 East Dorset Interface Engine (Websphere) West Dorset Interface Engine (SeeBeyond) Andy Hadley, SED PCT, Feb 2006 Multiple GP Systems, or Paper West Dorset Hospitals GP Interface Box for West Dorset GPs PMIP Multiple GP Systems, or Paper Image will need report and episode number to exist on cluster archive

Dorset Interim Approach Good existing systems – widely used Good existing systems – widely used Go for short increments and quick gains Go for short increments and quick gains Gain consensus where we can Gain consensus where we can Accept that dissenters may have valid reasons Accept that dissenters may have valid reasons Integration engines to give flexibility Integration engines to give flexibility If NPfIT ever catch up, the learning and experience will have been useful If NPfIT ever catch up, the learning and experience will have been useful Maintain a healthy scepticism Maintain a healthy scepticism Wessex RISP Wessex RISP SW EPR (Shires) SW EPR (Shires) NPfIT ? NPfIT ?

Cardio-respiratory staff COPD Admission Avoidance (Poole area) GP Clinical Systems EMIS x 13 InPractice x 3 Isoft x 1 Poole EPR Poole CaMIS Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries Patient Administration A&E Visits, Outpatients, Waiting Lists, Inpatients, feeds Choose and Book GPs Practice Nurses Hospital Doctors PORT Team Nurses Cardiac Department - Muse system Proposals for Electronic requesting in, and reporting out to EPR Paper Casenote Admin, contracting, MDS

COPD (how record ?) GP Clinical Systems EMIS x 13 InPractice x 3 Isoft x 1 Poole EPR Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries EPR is already accessible in GP practices and Community hospitals GPs Practice Nurses Hospital Doctors PORT Team Nurses Cardiac Department - Muse system Proposals for Electronic requesting in, and reporting out to EPR Paper Casenote PFT Tests in the practice PFT Tests on the ward & OPD A&E and MAU Assessments FAX – “your patient has been admitted” Discharge Summaries (some on EPR) PFT and stress tests In Cardiology Collect audit data Preparing for COPD NSF Minimum Dataset (MDS) Cardio-respiratory staff

COPD (near future) GP Clinical Systems EMIS x 13 InPractice x 3 Isoft x 1 Poole EPR Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries PFT Tests - Hospital PORT information Building COPD NSF MDS GPs Practice Nurses Hospital Doctors PORT Team Nurses Cardiac Department - Muse system Proposals for Electronic requesting in, and reporting out to EPR Paper Casenote PFT Tests in the practice or messaging “your patient has been admitted, details are on EPR” PFT and stress tests In Cardiology Migration to National Care Record … Community Hospitals – Release 1 - July 2007 Acute Hospitals – Release 2 – Summer 2008 … at time that this is capable to incorporate Cardio-respiratory staff Longer term Walk-In Centre Out of Hours Nurse Practitioner

Frank Burns interviewed by Sean Brennan Jan 2002 Would you advocate a national EPR solution ? I do get nervous about I do get nervous about people far away from reality of implementing people far away from reality of implementing Very far away from culture of NHS Very far away from culture of NHS Who have this notion can simply contract at a national level Who have this notion can simply contract at a national level I personally think it would be a disaster if ever such an approach were attempted I personally think it would be a disaster if ever such an approach were attempted Build and roll out as for supermarket checkouts - displays incredible naivety Build and roll out as for supermarket checkouts - displays incredible naivety … The higher the level of centralisation, the lower the spec. … The higher the level of centralisation, the lower the spec. The NHS IT Project - Radcliffe 2005 The NHS IT Project - Radcliffe 2005

Punt says many blue-chips rushed headlong into long- term outsourcing contracts, with the result that many IT leaders failed to clarify the relationship between supplier and customer. 'Once you get beyond the deal, they're not sure what they want,' he says. 'The vendor can manage the contract. As businesses change, so do third-party relationships. Provision will inevitably become more fluid and there will be a change in how such services are delivered. 'Insourcing is of interest because people are acknowledging that deals are not providing benefits.'

What are the successor arrangements ? Release 2 – 2008 – start of clinical journey Release 2 – 2008 – start of clinical journey 10 year outsourcing deal to year outsourcing deal to 2013 Only 5 years growth, not paperless ? Only 5 years growth, not paperless ? Increasingly complex record Increasingly complex record Reliance on data for decision support Reliance on data for decision support Continuation of other systems to fill gaps Continuation of other systems to fill gaps Integration with Integration with Social Services Social Services Independent /private / voluntary sector Independent /private / voluntary sector Foundation Hospitals Foundation Hospitals Patient access, and Care at home Patient access, and Care at home