1. Emergency Care Summary Dunblane November hb2008

2. NHS in Scotland 14 Health Boards –Primary and Secondary Care 1030 Practices –GPASS, InPS, EMIS, Ascribe 1 National Ambulance Board Scottish Government Health Department

3. Agreed Dataset Patient demographics (address, telephone, CHI number) Allergies and Adverse Reactions to medications Medication history - Repeat prescriptions in past 12 months - Acute prescriptions in past 30 days Consent Flag – Patient opt out status

4. Progress to Date ECS Service pilot started in 2004 National ECS launched in Sept 2006 98.5% of Scottish GP Practices connected Full Integration and rollout: –NHS24 –OOH ECS available in A+E for 12 out of 14 Health Boards National Cross Border Access across all Health Boards in Scotland

5. Progress to Date Over 5.2 Million Patient Records extracted 1400 patients have ‘opted out’ of practices connected –Represents 0.02% of all patients Over 1.5 million accesses to date and increasing trend in use Expected increase in use as new developments are available

6. Users of ECS Over 5000 registered users (not including GP, Administrators or Audit) Access controlled through Local System Administrators in each Health Board System to system integration in place for: –Adastra and Taycare OOH –NHS24 –A+E Integration due in 2008 Web access for Audit –A+E, OOH Admin, System admin (per NHS Board)

7. Consent Model Implicit consent to extract / send the data –Regular extract and update of information Explicit Consent to view ECS record Patients can Opt Out / In at any time –Simple flag on GP Practice System ECS information is read only Only available to Emergency Care Clinicians

8. ECS Security and Audit Access and security controls with passwords and log on for all clinicians Patients must give permission for the clinician to view their records Practices can check who has accessed their patients’ records Audit controls in place for: –Practice Reporting –Health Board Audit –Cross Border Audit –National Audit

9. ECS Security and Audit National Audit checks include: –Unsuccessful log in attempts –Casual Browsing / suspicious behaviour –Long periods worked (trap sharing of passwords) –Check on practice files structure –National Access Protocols –Refresh of training information for Local System Administrators

12. ECS Access Report

13. Palliative Care Summary Macmillan Nurses led initiative Palliative Care Forms –Based on Gold Standards Framework Scotland (GSFS) –Paper process already in place in many GP Practices –IT Development to assist with key patient group

14. GSFS Solution Extension to ECS dataset to include more detailed information to send to OOH for Palliative Care patients (known as PCS) Move from paper to electronic information Reduction in faxes from GP Practices to OOH Centres Consent Model ECS – Implied to send, Explicit to view PCS – Explicit to send, Implied to view

15. Future Developments Integration with National A+E System Scottish Ambulance Service Preparation of Business Case –Patient Access –Extension of Users –Extension of Data Set NO DEVELOPMENT WITHOUT CONSULTATION

16. Future Developments –Patient Access –Extension of Users Other hospital departments Dentists Community pharmacists

17. Future Developments –Extension of Data Set Immunisations Special notes Past medical history Recent Consultations

18. Summary Good progress with use of ECS Security built in with fully integrated solutions Audit at all levels with focus on inter Health Board Access Palliative Care Summary next development Consultation and communications in planning for next stage

19. Questions? Dr Libby Morris (libby.morris@nhs.net) Jonathan Cameron (jcameron2@nhs.net)