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
•
•
•
•
•
•
•
Background
Requirement for an EPR
Funding
Procurement
Development
Implementation
Rollout
Multidisciplinary Care from birth to 20 yrs
Background to the UK cleft service
 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.
Concerns about the quality of care
 Resources should be concentrated
in 8 - 15 UK centres instead of the
current 57. There should be one
centre in Scotland
Reorganisation of Scottish services
following the CSAG report
A Managed Clinical Network (CLEFTSiS) was
established in April 2000 to provide and coordinate 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.
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”
•
•
•
•
•
•
•
Background
Requirement for an EPR
Funding
Procurement
Development
Implementation
Rollout
Combined clinic and treatment sites
Records required for outcome
assessments
•Photographs
•Study models
•Radiographs
•Video/sound recordings
•Audit data
•Surgery
•SLT
•Orthodontics/dentistry
•Audiology
•Clinical psychology
•
•
•
•
•
•
•
Background
Requirement for an EPR
Funding
Procurement
Development
Implementation
Rollout
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.
•
•
•
•
•
•
•
Background
Requirement for an EPR
Funding
Procurement
Development
Implementation
Rollout
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:
•
•
•
•
•
•
•
Background
Requirement for an EPR
Funding
Procurement
Development
Implementation
Rollout
Dataset and protocols
Design
A patient record familiar to clinicians
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
Manage the clinical network by
defining roles and including
participating hospitals or health
authorities
Examples of reports that
can be generated by
Excelicare
Patient review summary
•
•
•
•
•
•
•
Background
Requirement for an EPR
Funding
Procurement
Development
Implementation
Rollout
NW Manager and Audit secretaries
Audit Secretary, Glasgow
(Yorkhill/Dental Hospital) (0.6 WTE)
Audit Secretary, Edinburgh
(RHSC) (0.6 WTE)
Network Manager, Perth Royal
Infirmary (0.5 WTE)
CLEFTSiS Admin Support
03/12/2003 - v3
Audit Secretary, Aberdeen (RACH)
(0.4 WTE)
Audit Secretary, Perth Royal
Infirmary (1.0 WTE)
Architecture
Excelicare
Client PC
Modem /
ISDN
Grampian
Firewall
Dial In Server
Excelicare
Client PC
Excelicare
Data Store
Server
Inverness
Firewall
NHSNet /
Healthnet
Excelicare
Client PC
Excelicare
Client PC
Tayside
Firewall
Edinburgh
Firewall
Excelicare
Client PC
Excelicare
Client PC
Glasgow
Firewalls
Excelicare
Client PC
IT Infrastructure Challenges
Network firewalls
- chain of contacts/procedures
Switchover from CW to BT ( NHSNet / HNC)
Trouble-shooting - who can solve what?
IT Infrastructure solutions?
raise awareness at local Trust IT level of
usage of NHSNet/Firewalls for cross-Trust
projects
central Technical person to oversee xTrust interfaces / firewalls?
ensure support for tracing problems is part
of HNC contracts (or provide TraceRoute type
tools..)
•
•
•
•
•
•
•
Background
Requirement for an EPR
Funding
Procurement
Development
Implementation
Funding the rollout
£0
Western Isles
Tayside
Shetland
Orkney
Lothian
Lanarkshire
Highland
Greater Glasgow
Grampian
Forth Valley
Fife
Dumfries & Galloway
Borders
Ayrshire & Arran
Argyll & Clyde
Cost to Health Boards
£35,000
£30,000
Initial
Annual maintenance
£25,000
£20,000
£15,000
£10,000
£5,000
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
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