e-Health in NHS Scotland Dr Stuart Scott Clinical Director e-Health NHS Grampian GP

And What Does eHealth Do For Clinicians??? Facilitate Communication - National email system - Internet Access - SCI Gateway - SCI Store First point of contact - Health Records Allows Labs/Radiology etc to function Primary Care Acute Care Self Care Get results to the treating clinician Support /Develop clinical systems for recording clinical data Reduces Clinical Risk - CHI Linking areas - Networked PCs - Firewall protection Provide Information - Service planning - WL Management

NHS Scotland Strategic Aims Core Application Labs Others A&E PACs Rx PAS Others Single Record

NHS Scotland Strategic Aims PACs PAS Labs Rx Others A&E Single Record HUB

NHS Scotland Strategic Aims

GP Practice Hospital CHI Elgin Radiology SCI Store eLinks GP Portal PCI CHI PAS Abdn Radiology Elgin Radiology Other Systems: A&E PROTOS Clinical Vision CHEO Care Pharmacy Labs INDIGO 4 Labs Lung Cancer SCI Discharge EMAS TOM CAT ECS ERFS SCI Store All non-sensitive Labs results Radiology Reports PAS/CHI Demographics PAS ADT/OP Clinical Letters A&E Summaries eLinks Legacy Systems GP Portal SCI Store PCI PAS CGI ECCI Letter Browser Other reference web links GCS GP Practice Hospital ECCI Letters ECCI Letters V2 SCI Gateway Standard Referral Letters (1-2) Cancer Ref. Letters (1-2) Lung Cancer IDL (2-1) A&E Summaries (2-1) CGI X400 Referrals

I wouldn’t start from here…. Federated approach doesn’t work Speed of standardisation Not enough levers Political pressure growing England all sorted then!

Generic Clinical System Pressing ahead but should we be? What do we require to implement? Training Support IM&T Staff Project management Authentication Single sign-on SCI-Store pre-requisites Prioritisation – Local/National

PACS Access to images where and when required Advantages Access to images where and when required Remote diagnostic support Financial savings Political Should beef up the locally available kit Improved use of CHI number Disadvantages Expensive More technical than cultural

HEPMA Safety Governance Clinical clamour Available products Case for Case against Available products

Theatre Systems Case for Major area of workload Governance Risk management Case against Back to the waiting lists again Bean counting mentality

Order Entry Safety Data quality Time saving Governance Embed in referral Add-on for SCI Store Separate procurement

Infrastructural elements Much of the eHealth programme dependent upon robust and reliable telecoms Business continuity – no longer a luxury Standards

Consent Public engagement Emergency Care Summary – First Engagement total records in the store 4,433,431 total no patients who have withdrawn consent 219

NPfIT aka CfH Why are we messing around trying to do our own thing?

Scottish Telemedicine Centre Delivering for Health proposed it Based in Aberdeen

PC Infrastructure Mix of ancient kit will slow apps and increase support Microsoft Enterprise Agreement Patches/Virus/Security Mix of software stacks Cost of maintaining

Single logon / Authentication Security model needs enhanced to cope with increasing mix of systems/users/roles Need technology Need resource to manage

Comms capacity What is the projected life of existing bandwidth? Users expect it to limitless….

Business Continuity Are we covered for clinical/key systems? Managed Service vs Local Board Level Provision 24/7 Support

Current Risks iSOFT Gpass National Procurement/Local Implementation NHS Board Revenue Capabilities

Questions?