1. An electronic Patient Record for the Cleft Lip and Palate Managed Clinical Network in Scotland (CLEFTSiS). A solution not without challenges. John Clark, Lead Clinician and Trudie McDonald, Network Manager

2. Background Requirement for an EPR Funding Procurement Development Implementation Rollout

3. Multidisciplinary Care from birth to 20 yrs

4. Concerns about the quality of care  The Clinical Standards Advisory Group (an independent source of advice to the UK Health Ministers and to the NHS) was asked to investigate the care provide in the UK. Background to the UK cleft service  Resources should be concentrated in 8 - 15 UK centres instead of the current 57. There should be one centre in Scotland

5. Reorganisation of Scottish services following the CSAG report A Managed Clinical Network (CLEFTSiS) was established in April 2000 to provide and co- ordinate the highest standard of care for patients with cleft lip and/or palate, as far as possible in their own locality, to agreed national standards and guidelines. There would be only one centre – Scotland – with not less than two WTE cleft surgeons vested in three people who undertake surgery according to an agreed common protocol.

6. HDL (2002) 69 PROMOTING THE DEVELOPMENT OF MANAGED CLINICAL NETWORKS IN NHSSCOTLAND “A key factor in the success of MCNs is the use of integrated clinical information systems that span traditional organisational barriers”

7. Background Requirement for an EPR Funding Procurement Development Implementation Rollout

8. Combined clinic and treatment sites

9. Photographs Study models Radiographs Video/sound recordings Audit data Surgery SLT Orthodontics/dentistry Audiology Clinical psychology Records required for outcome assessments

10. Background Requirement for an EPR Funding Procurement Development Implementation Rollout

11. Scottish Telemedicine Action Forum (STAF) Funded a pilot to develop an EPR linking 5 sites;  Perth (Admin Centre for the MCN)  Aberdeen  Edinburgh  Glasgow  Inverness.

12. Background Requirement for an EPR Funding Procurement Development Implementation Rollout

13. The CLEFTSiS EPR project Procurement Undertaken within the framework of EC/WTO rules governing Public Sector procurement under the direction of the Head of the Business Advisory Group of the Information Services Division (ISD). commissioned to develop the EPR based on their system:

14. Background Requirement for an EPR Funding Procurement Development Implementation Rollout

15. Dataset and protocols Design

16. A patient record familiar to clinicians

17. Stages in a protocol clearly displayed with coloured buttons providing links to other forms Colour coded flags are set to show the status of interactions with the patient

18. Manage the clinical network by defining roles and including participating hospitals or health authorities

19. Examples of reports that can be generated by Excelicare

20. Patient review summary

22. Background Requirement for an EPR Funding Procurement Development Implementation Rollout

23. NW Manager and Audit secretaries

24. Architecture

25. IT Infrastructure Challenges Network firewalls - chain of contacts/procedures Switchover from CW to BT ( NHSNet / HNC) Trouble-shooting - who can solve what?

26. IT Infrastructure solutions? raise awareness at local Trust IT level of usage of NHSNet/Firewalls for cross-Trust projects central Technical person to oversee x- Trust interfaces / firewalls? ensure support for tracing problems is part of HNC contracts (or provide TraceRoute type tools..)

27. Background Requirement for an EPR Funding Procurement Development Implementation Funding the rollout

28. Cost to Health Boards

29. Achievements Improved collection of audit records Able to perform ad-hoc queries for analysis/research National system with centrally held data (including multi media) and client connections into five Trusts Software EPR tool with potential to grow with the service Developing good relationships with IT staff in the five sites Possibility that it will be adopted UK wide

30. Thank you! to  You, the audience for your attention  STAF for funding the project  CLEFTSiS members for their contribution and on-going support  The staff of AxSys Technology