28/08/2015Changing Clinical Software1 Dr Colin Brown General Practitioner SCIMP Director eRecords SCIMP Conference Dunblane 2007

28/08/2015Changing Clinical Software2 Why are we doing this? Where are we starting from? Where are we starting from? Where are we going? Where are we going? How do we get there? How do we get there?

28/08/2015Changing Clinical Software3 Clinical System Changes Versions referenced: Ascribe to Vision 3 Ascribe to Vision 3 EMIS PCS to Vision 3 from GPASS 5x, Vision 3, EMIS LV EMIS PCS to Vision 3 from GPASS 5x, Vision 3, EMIS LV GPASS 5xto EMIS PCS, GPass Clinical/2007, Vision 3 from Torex HMC iSoft Synergy from Meditel, Premiere GPASS 5xto EMIS PCS, GPass Clinical/2007, Vision 3 from Torex HMC iSoft Synergy from Meditel, Premiere SystmOnefrom EMIS LV, Vision 3 SystmOnefrom EMIS LV, Vision 3 Vision 3to GPASS 4x from GPASS 4x, 5x, Seetec, Microtest, Vision 3to GPASS 4x from GPASS 4x, 5x, Seetec, Microtest, EMIS LV, VAMP Medical

28/08/2015Changing Clinical Software4 WHY? GP systems are specialist engineered products with these unique functions: constructing a life-long record constructing a life-long record audit trail of all users audit trail of all users unconstrained scale and content unconstrained scale and content structured to support computer processing structured to support computer processing security security usable in front of patients in their 10 mins usable in front of patients in their 10 mins by any users in Primary Care Team by any users in Primary Care Team

28/08/2015Changing Clinical Software5 Overall Plan Pre-migration practice development status - data quality issues - data quality issues Data migration issues Data freeze period Go Live Day New-system learning and design issues 3rd-party issues General and specific Lessons Learned

28/08/2015Changing Clinical Software6 Practice development status Practice development status Software Software Hardware and system - local, or remote Managed Technical Service - use of old system? - continuing use after GoLive? concurrent? Hardware and system - local, or remote Managed Technical Service - use of old system? - continuing use after GoLive? concurrent? Business processes Business processes Training - what are the training needs? - IT training - Specific new-system training Training - what are the training needs? - IT training - Specific new-system training

28/08/2015Changing Clinical Software7 Data qualityData quality pre-migration pre-migration Data qualitypre-migration Codes – standard? - Read versions 2 and 3, SNOMed Codes – standard? - Read versions 2 and 3, SNOMed Freetext Freetext Drug dictionary data – another migration? Issues - “OP”, ADRs, BAN/RINN, custom drug items, old scripts Drug dictionary data – another migration? Issues - “OP”, ADRs, BAN/RINN, custom drug items, old scripts Metadata: “data about data” e.g. Non-standard system admin data Priorities Recalls Reviews Metadata: “data about data” e.g. Non-standard system admin data Priorities Recalls Reviews

28/08/2015Changing Clinical Software8 Pre-migration Planning: phone a friend phone a friend ask the audience 1 - access the UG 2 - the patients - involve them 3 - check with occasional team users ask the audience 1 - access the UG 2 - the patients - involve them 3 - check with occasional team users split the options HB support staff? split the options HB support staff?

28/08/2015Changing Clinical Software9 Data Migration Data Migration Extraction of data from old database Conversion of the extracted data to new database Extraction of data from old database Conversion of the extracted data to new database format, and of old to new data types. Quality Assurance. format, and of old to new data types. Quality Assurance. Conversion accuracy? Conversion accuracy? Coded and Uncoded data Coded and Uncoded data InPS - 2 utilities provided InPS - 2 utilities provided EMIS - these functions built in to the main software EMIS - these functions built in to the main software

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28/08/2015Changing Clinical Software12 Data Freeze Datafreeze? = when your old data has gone for conversion, and your new system isn’t working yet to use the converted data when your old data has gone for conversion, and your new system isn’t working yet to use the converted data BUT - your old system is still working… So….. Computer Downtime - Is there any need for this? NO ………….. (mostly) NO ………….. (mostly)

28/08/2015Changing Clinical Software13 Go Live Day Hints and Tips from Supplier Go Live Day Hints and Tips from Supplier Business Continuity Plan – as if paperless Business Continuity Plan – as if paperless No routine surgeries, clinics No routine surgeries, clinics Print-offs for the datafreeze period Print-offs for the datafreeze period Hardware and system configuration on site Hardware and system configuration on site

28/08/2015Changing Clinical Software14 Data Melt = copying back data from the freeze. Data Melt = copying back data from the freeze. Data Melt Data Melt You've got to do this? - not necessarily so… You've got to do this? - not necessarily so… Clinical value is max. if sooner not later. Clinical value is max. if sooner not later. A technological fix? Post-GoLive datafreeze update

28/08/2015Changing Clinical Software15 New System Learning 1 New System Learning 1 Function re-modelling Function re-modelling - Predict the functions to be changed…. to anticipate how your new system will work differently and re-model your business processes - Original s/w method of delivering a function may not be the only way - Version-specific not brand-names

28/08/2015Changing Clinical Software16 New System Learning 2 New System Learning 2 Design issuesDesign issues e.g. Design issues on-the-fly coding on-the-fly coding Keyboard use Keyboard use Appointments Appointments Better Display > Data Quality issues Better Display > Data Quality issues

28/08/2015Changing Clinical Software17 3rd Party Issues 3rd Party Issues Docman Labeltrace SCI Gateway (2nd Opinion) 3rd Party Issues SCI Store(web access) SCI Store(web access) Managed Server

28/08/2015Changing Clinical Software18 GeneralGeneral Lessons Learned General Clinical - specific benefits Detailed Pros/Cons – per user Detailed Pros/Cons – per user Practice Management - similar challenges? Summarising for training status Summarising for training status Lloyd George to A4 Lloyd George to A4 Going paperlight Going paperlight Changing premises Changing premises Changing partners Changing partners Changing or new job Changing or new job Combine some of these? Combine some of these?

28/08/2015Changing Clinical Software19 DO - LIST #1 - for Suppliers online connectivity on Go Live Day√ online connectivity on Go Live Day√ share the Drug Dix / coding migrations √ share the Drug Dix / coding migrations √ improve handling of non-coded data improve handling of non-coded data implement post-GoLive datafreeze update implement post-GoLive datafreeze update consider appointments migrations consider appointments migrations customise migration advice for “donor” system customise migration advice for “donor” system custom-configure the initial setup of new system custom-configure the initial setup of new system guarantee access to archive data + audit trails guarantee access to archive data + audit trails

28/08/2015Changing Clinical Software20 DO - LIST #2 - for NHS Board IT Depts Original s/w + h/w: keep live√ Original s/w + h/w: keep live√ Prescription mapping: pharmacist support√ Prescription mapping: pharmacist support√ Share local expertise in new processes√ Share local expertise in new processes√ Test install /configure s/w on hardware platform before Go-Live. Test install /configure s/w on hardware platform before Go-Live. Archive data + audit trails: contract with suppliers to retain legibility Archive data + audit trails: contract with suppliers to retain legibility custom data quality fixes pre-migration: support GMS IT Facilitators custom data quality fixes pre-migration: support GMS IT Facilitators

28/08/2015Changing Clinical Software21 DO - LIST #3 - for Users custom benefit lists for each user custom benefit lists for each user prepare prepare engage your local friendly new-system user to check out your test data. engage your local friendly new-system user to check out your test data. engage your patients engage your patients access all UG support access all UG support

28/08/2015Changing Clinical Software22 DO - LIST #4 - for Scottish NHS Share lessons from GP2GP project Share lessons from GP2GP project on migrating data between systems on a per- patient basis Develop GP2GP v2 Develop GP2GP v2 A standard intermediate data format for migrations? Connect to….. Connect to….. Connecting for Health

28/08/2015Changing Clinical Software23 DON'T ( = specific "errors of commission“) Suppliers Suppliers Change the GoLiveDay Change the GoLiveDay Use non-standard pseudo-Read codes Use non-standard pseudo-Read codes Health Boards Strip kit needed for original s/w to run Health Boards Strip kit needed for original s/w to run Users Leave it all to the leader Go on Holiday! Users Leave it all to the leader Go on Holiday!

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28/08/2015Changing Clinical Software25 THE END …………………….