An electronic Patient Record for the Cleft Lip and Palate... Network in Scotland (CLEFTSiS). A solution not without challenges.

An electronic Patient Record for the Cleft Lip and Palate Managed Clinical
Network in Scotland (CLEFTSiS). A solution not without challenges.
John D Clark1, Project Leader and Lead Clinician, CLEFTSiS
Trudie McDonald, Project Manager and CLEFTSiS Network Manager
Room 17, Admin Block, Perth Royal Infirmary, Perth PH1 1NX
Following concern about the quality and outcome of care for patients with cleft lip and
palate in the United Kingdom, the Clinical Standards Advisory Group (CSAG) [1] undertook a
wide review which was completed in 1998. The CSAG report recommended a re-structuring of
the service to reduce the number of multi-disciplinary personnel involved thereby maximising
clinical experience and expediting outcome assessments.
In the same year a Scottish Needs Assessment Programme (SNAP) report [2] was published
which recommended, “….the future configuration (in Scotland) should operate on the basis of
a managed clinical network. A National Managed Clinical Network for Cleft Lip and Palate
Services in Scotland (CLEFTSiS) was established in April 2000 with the aim of “providing and
co-ordinating 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”. The service was
developed on the core principles set out in the management Executive’s letter “Formation of
National managed Clinical Networks”
It was obvious that the shortcomings of the traditional paper-based medical record would be
multiplied in the context of CLEFTSiS - a multidisciplinary network of 84 clinicians working in
both primary and secondary care settings throughout Scotland. An electronic patient record
(EPR) was seen as essential to ensure coordination and cooperation between CLEFTSiS
members by making available more and better quality information, which would lead to better
treatment and the realisation of 'seamless' healthcare. This view was compatible with the
Scottish Executive Health Department who acknowledged that “a key factor in the success of
MCNs is the use of integrated clinical information systems that span traditional organisational
Funding was obtained from the Scottish Telemedicine Action Forum (STAF) to develop and
pilot an EPR at five Scottish sites.
The paper will describe the challenges of developing the specification, procurement, design and
deployment of the EPR and reflects on changes in the quality of the care provided.
1. CSAG (Clinical Standards Advisory Group report): Cleft lip and/or palate. London:
HMSO; 1998
2. SNAP Report Scottish Needs Assessment Programme. Cleft Lip and Palate Scottish
Forum for Public Health Medicine, 69 Oakfield Avenue, Glasgow, November 1998