Integrated Care Records
Research & Practice Workshop
Edinburgh, 11th/12th December 2003
Lessons Learnt from ICR Initiatives
David Hancorn & Julia Hopper
HealthSystems Consultants Ltd
www.healthsysconsult.co.uk
Lessons Learnt from ICR Initiatives
“We are
where we are”
Some of the problems
and issues encountered
along the migration path
Collective
Vision
Destination
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Transition
Single
Organisation
Single Care Setting
Supporting organisational
administrative processes
Multiple
Organisations
Multiple Care Settings
Supporting
clinical practice
NonOrganisational
No Care Setting
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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”
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Migration 1
S
Y
S
T
E
M
S
National Services
Local eMPI
PCT
GP
Acute
MH
SS
I
N
T
E
G
R
A
T
I
O
N
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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
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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
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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
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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
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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
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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
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Migration 2
National Services
Local eMPI
Digital
Imaging
PCT
Document
Management
Integrated Clinicals
GP
Acute
MH
SS
S
Y
S
T
E
M
S
I
N
T
E
G
R
A
T
I
O
N
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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
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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
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Final Strategic Solution
National Services
Local eMPI
Digital
Imaging
Integrated
Clinicals & Administration
PCT
GP
Acute
MH
Document
Management
SS
S
Y
S
T
E
M
S
I
N
T
E
G
R
A
T
I
O
N
www.healthsysconsult.co.uk
Conclusion
• 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
THEREFORE
Must be a single integrated
clinical solution that supports the
whole continuum of care
“no pain = no gain”
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