Integrated Health Records in NHS Scotland
Val Baker
e-Health Clinical Lead
NHS Lothian
Strategy revision
Why? Not just another week, another strategy - need
to reflect Delivering for Health …
Delivering for Health
Patient and carer
involvement
• patient/ carer access to own eRecord
• access to knowledge to support self care
• pilot home-based information technology
Best and safe care
• patient pathways
• access to knowledge and decision support
• HEPMA/ risk of errors reduced
Integrated Healthcare
• single/ shared record
• passing-the baton communication
• collaborative care planning
Community-based
care
• Community, MH, Child Health
• primary care, links with LA
Support for
scheduled hospital
care
• referral and waiting list management
• day case procedures/ theatres
• diagnostic services bottlenecks
Support for
unscheduled care
• A&E, NHS 24, Ambulance links
Information
intelligence
• anticipatory care ‘at risk’ indicator
• national tariff
• better financial data, incl. cost and activity
Strategy revision – IT systems and
associated services
• goal is a single comprehensive arrangement of IT
systems and services for NHSScotland built around
an Electronic Health Record
• collaborative national procurements to become the
norm – EHR, obviously, but ? Sexual Health,
Theatres, other
• progressive harmonisation and standardisation
Strategy revision – Technical Infrastructure
• similar harmonisation goal, plus more structured
• adopt similar approach to common telecommunications
network, eg …
– common desk-top devices in sufficient numbers
and locations to meet staff needs
– robust and reliable arrangements to provide
business continuity
– consistent staff and patient identification,
authentication and capability.
• Technical Architecture standard for consultation
Strategy revision – Information
• By product information for management
• develop Secondary Uses Service for ...
–
–
–
–
secure data storage
anonymisation of data
quality control and quality assurance
flexible reporting – supporting bespoke and
dynamic information requirements
Strategy revision – Managing the
Programme
Ministers
eHealth Strategy Board
other members
SYSTEMS & INFRASTRUCTURE
DELIVERY NSS
Programme Board
POLICY & STRATEGY
SEHD eHealth
other members
CHANGE & BENEFITS
DELIVERY SEHD CCI
eHealth Programme
Manager
eHealth Delivery
Manager
Design Authority
Change Programme
Manager
Policy/ Strategy
Existing Systems
Infrastructure
Electronic Health
Record
Confidentiality and
Information Governance
Business Change
Business
Change
Managers
Business
Change
Managers
Managers
‘Integration Hub’
Shared/ National Services
email service
telecomms service
staff directory service
CHI service
SCI Gateway
Emergency Care Summary
GP drugs, allergies
SCI Store
EHR
(copy-based)
SCI Store
NHS Board A
Labs Cancer
GP
CHD
A&E
HEPMA
MH
PAS
PACS
NHS Board A
Regional/ National
records
Child Health x 4, NHS24,
CHI Screening, ETP,
SCI DC, other MCN,
SAS, SBR, SMR
Labs Cancer
GP
CHD
A&E
HEPMA
MH
PAS
PACS
Core Application
Shared/ National Services
email service
telecomms service
staff directory service
CHI service
SCI Gateway
EHR record and
functions
Labs Cancer
GP
CHD
A&E
HEPMA
MH
PAS
PACS
Regional/ National
records
Child Health x 4, NHS24,
CHI Screening, ETP,
SCI DC, other MCN,
SAS, SBR, SMR
Labs Cancer
GP
CHD
A&E
HEPMA
MH
PAS
PACS
EHR project – Risk findings
• c. 70 risks in 8 categories …Recent report
–
–
–
–
–
–
–
–
Benefits Realization
Clinical Change
User Functionality
Programme Governance
Implementation
Through-Life Ownership
Stakeholder Support
Suppliers & Resources
• Report also looked at relative costs, implementation
timescales, plus global experience
EHR project – Risk findings
• lowest risk and cost option is ‘Exploit & Fill Gaps’, but
not by much … but doesn’t deliver the full vision
• but if looking for a ‘core application’ to cover all (or
virtually all) our business then not clear whether the
market can deliver – depends on vision and scope
decided
• ‘Integration Hub’ had most risk and cost
• global experience suggests 10-15 years to complete
EHR Project: instinctual votes?
1. Do nothing/ continue present course
2. Accelerate present course
3. Foundation services/ solutions only
4. Foundation + potentially/ probably more
5. Full monty
SO …..this probably means :
•
•
•
•
•
•
•
•
•
SCI store, Gateway, DC etc
N3, NHS Mail
A&E system
PACS and Radiology
PAS system
GCS
Scanning
GP system / choice
e-Care …beyond health
Underpinned by :
• NCDDP data set developments
• Technical standards
• National programme leads in each
board
• e-Health KPIs for Boards
• Registers of clinical systems
• Central projects and funding streams