Integrated Care Records David Hancorn & Julia Hopper HealthSystems Consultants Ltd Research & Practice Workshop Edinburgh, 11th/12 th December 2003 Lessons Learnt from ICR Initiatives

We are where we are Collective Vision Destination Some of the problems and issues encountered along the migration path

Transition Single Organisation Single Care Setting Multiple Organisations Multiple Care Settings Non- Organisational No Care Setting Supporting organisational administrative processes Supporting clinical practice

Establish the Baseline Need to consolidate before going forward eMPI is a key technology component Reconciliation of multiple disparate records based on unique patient identifier (NHS Number/CHI) Consolidation comes first

Migration 1 National Services SYSTEMSINTEGRATIONSYSTEMSINTEGRATION Local eMPI PCTGP Acute MH SS

Case Studies Virtual Cancer Network ERDIP –Bradford –Cornwall Merged Acute Trust PACS All address the same issue: Need to centralise care processes and records around the patient rather than organisations

Virtual Cancer Network Characteristics: Focus on NSF Development of a longitudinal clinical record Supports new frameworks of care Main Obstacles to change: New models of care cross organisational boundaries and care settings No existing systems Need interfaces to multiple systems Lack of supporting infrastructure Lack of fit to operational clinical processes Separate data collection No funding or means of obtaining it

Bradford ERDIP Project Characteristics: Focus on EHR Development of a central clinical repository Primary care driven Not linked to operational processes Main Obstacles to change: Existing care settings Centralised database for Primary Care Lack of complete information – not all organisations subscribe Access security Separate system access Different user interfaces

Cornwall ERDIP Project Characteristics: Secondary care driven EHR development Development of a clinical repository Not linked to operational processes Main Obstacles to change: Existing care settings Difficulties in sharing information from disparate systems Difficulties in reconciling patient records No fit to clinical process Separate system access Different user interfaces

Merged Trust Characteristics: Legacy systems New organisation structures Process redesign needed to adapt to new organisation Change management Main Obstacles to change: Multiple records Multiple processes Lack of resources to bring records together Resistance to change Lack of standardisation of process, data & terminology Poor communications Lack of training

PACS Characteristics: New application (not legacy) Opportunity to implement a solution that crosses organisational boundaries Requires changes to clinical processes Provides a community-wide solution – but the eMPI must be established first Main Obstacles to change: New technology No eMPI Different organisations with different strategies Lack of organisational readiness Strategic reliance on robust core systems Uncertain access rules

Migration 2 National Services SYSTEMSINTEGRATIONSYSTEMSINTEGRATION Local eMPI PCTGP Acute MH SS Digital Imaging Document Management Integrated Clinicals

Barriers Encountered Cross organisation & care setting solutions do not currently exist Difficulty in maintaining competition - Supplier fears for their markets Systems interfaces are not the answer for a single patient record Difficulties in establishing unique patient identification Must have: Scalability and robust/mitigate single point of failure Appropriate infrastructure (i.e. must not implement on top of existing processes) Clinical support for a major change exercise Adequate and appropriate system access Proper staff training

Lessons Learnt Need for established standards for process, data and technology eMPI is a fundamental early requirement Ability to reconcile different records from same patient across all care settings and departments Must have a single shared record across the whole continuum of care Quick wins: – Optimise robust legacy systems and data flows – Manage transition of Medical Records – Build system links between Mental Health & Social Care

Final Strategic Solution National Services SYSTEMSINTEGRATIONSYSTEMSINTEGRATION Local eMPI Integrated Clinicals & Administration Digital Imaging Document Management PCTGP Acute MH SS

Conclusion no pain = no gain ICR will only work if it is truly clinically focussed Benefits will only be optimised if ICRS is operational rather than enquiry only Must not be orientated to organisation or care setting Must be a single integrated clinical solution that supports the whole continuum of care THEREFORE