Sharing electronic
records Lessons from the Emergency Care
Summary in Scotland
Libby Morris,
Clinical e health lead Scottish Government
2nd May 2012
Key Messages
– What is the Emergency care
Summary?
– Evaluation
– Progress
– Lessons learnt
What is ECS?
• Emergency Care Summary
• Patient information is extracted from
GP Practice computer systems
• Sent to ECS store twice daily
• Explicit Consent to view ECS record
• The information is ‘Read only’ and
available to Emergency Care
Providers
Responses of 118 NHS24 clinicians about the
value of ECS in the current care episode
Response of 118 NHS24 clinicians to the question:
Incremental steps
•
•
•
•
•
Discussions
Emergency Care Summary
Palliative Care Summary
Key Information Summary
Aims to replace paper based faxing of
“Special Notes” from GP Practices
• Better than ‘the whole record’
• Structured information and summary box
ePCS
• electronic Palliative Care
Summary
• MacMillan Cancer Nurses
and Marie Curie led initiative
• Contains significant and
sensitive information
–Resuscitation Status,
Preferred Place of Care
–Carer Details and Advice
for OOH
Feedback
•
•
•
•
Larger special notes free text box
Smaller special notes free text box
Consent rules clearer
User requests
– All on one data entry screen
– Message when sent
– Copy of report filed in record
– Messages to user when expired
– Must fit in with other business processes
Key Information Summary
• Contains:
– Diagnosis and Problems
– Contact / Carer details
– Anticipatory Care details
• Information only sent with patient consent (in
line with Palliative Care Summary)
• Where possible, information is already
captured in GP Systems
2009 Dumfries and Galloway
CHI
Patient Banner ( Demographics as CUI standard)_
Adverse
events
Demographics
& Contacts
Social &
Personal
Next of kin
Services
Involved in
care
Alerts &
Risks
Healthcare
Encounters
Admin &
Patient
Preferences
Carer
Details
Correspondence
Medications
& Devices
Notifications &
Legals
Investigations
& Results
Clinical
Notes
Observations
3rd
Party
Documents
Notifications
&
Legal
Miscellaneous
All records
….Links to other applications….
Clinical
History
OOH
attendances
On
opening
record
warning
appears to
alert
clinician
Patient with
KIS note,
KIS
summary,
ePCS and
ECS
Year on Year Comparison of Monthly Totals
300,000
250,000
Accesses
200,000
2008
2009
2010
2011
150,000
100,000
50,000
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Year on Year Comparison of Monthly Totals
300,000
250,000
Accesses
200,000
2008
2009
2010
2011
150,000
100,000
50,000
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Year on Year Comparison of Monthly Totals
300,000
250,000
Accesses
200,000
2008
2009
2010
2011
150,000
100,000
50,000
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Year on Year Comparison of Monthly Totals
300,000
250,000
Accesses
200,000
2008
2009
2010
2011
150,000
100,000
50,000
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Summary
• ECS developed in Scotland for 100%
• Palliative Care Summary(PCS) gave
important feedback
• Key Information Summary (KIS) will add
more information and include ‘medication
prescribed elsewhere’
• Agreed standards are key for sharing
• Access for meds reconciliation
• Further development continues
Lessons Learned…
•
•
•
•
Incremental approach works for Scotland
Cooperation and compromise
Joint approach with E, W and NI
It’s a concept, not a ‘thing’
• Keep it simple….
• Shared records are difficult but…
Not impossible!