National Docman
Conference 2014
Docman:
10
years
in
Scotland
13 April 2015
Dr. Colin Brown
GP Glasgow, SCIMP
National Docman Conference 2014
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2003-4: Docman for all GP practices in Scotland
• Central funding
• Included training
• Key work for nGMS IT facilitators
• Conversion program for those using other
suppliers e.g. Criffel, EMIS, InPS
• Rapid upgrade of all practices to “paperlite”
• Supported by www.scimp.scot.nhs.uk and
www.microtechsupport.co.uk
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Naming the documents
Docman makes it easy to customise the several
names that can be given to each document:
The Document Naming sequence is
• Document Type
• Organisation (Location)
• Specialty
All these are configurable: here are the options in
our practice for our local DGH
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Custom names for documents
Doc type
Location / care setting
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Specialty:
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Introducing a standard Folder Name:
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47 National Folder Names
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Key features of new Folder Names
•
•
•
•
•
Not customisable
Useable for our filing clerks
National agreement on Names
2005
National standard, so may be mandated
Software upgrade to user interface to mandate
the user to select and apply a
National Folder Name
2006
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Standards…..
“The nice thing about standards is that there are so
many to choose from” Andrew S Tanenbaum
"Those are my principles, and if you don't like them...
well, I have others." Groucho Marx
The presence of a mandated National Folder Name is
independent of any other local custom names for
the document.
Standardisation of this list of names (index) enables
its automatic use in other standard contexts
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Include
Accident &
Emergency
Exclude
Include
Administration
Exclude
Include
Allergy
Exclude
Include
Breast
Cardiology
Exclude
Include
Exclude
Include
Clinical
Complementary
medicine
Dental / MaxFac
Dermatology
Dietetics
Accident and Emergency letters
GP Out of hours contacts Out of hours)
Exclude
Include
General practice administrative paperwork, letters from patients, Benefits agency letters and
requests, Insurance reports and requests. Criminal justice reports
Scanned clinical GP notes (Clinical)
Scanned nursing notes (nursing)
Employment medicals (Occupational Health)
Allergy clinic
Patch testing (dermatology)
RAST results (Labs)
Breast clinics, breast screening services
Plastic surgery (Plastics)
Genetic clinics (Genetics)
Cardiology, paediatric cardiology, cardiovascular risk factor clinics, cardiac surgery, thoracic
surgery, ECG, ETT
Thallium scans (Imaging)
Scanned clinical GP notes
General practice administrative paperwork, letters from patients (Administration)
Scanned nursing notes (nursing)
Homoeopathy, chiropractic, osteopathy, herbal medicine and any other complementary medication.
Acupuncture except given as part of a physiotherapy programme or at pain clinic
Exclude Acupuncture given as part of a physiotherapy programme or at pain clinic (Pain)
Community dentistry; oral medicine and surgery; orthodontics oral pathology; maxillofacial
Include
surgery
Exclude Plastic surgery (Plastics)
Dermatology, paediatric dermatology, including patch testing and excisions carried out by
Include
dermatologists
Exclude Excision carried out by plastic surgeons (Plastics)
Include General dietetic services as well as diabetic, nephrology and nutritional support services.
Exclude Specialist multidisciplinary obesity services (general medicine)
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Update proposed 2014 (sample)
Include
Clinical radiology, ultrasounds, DEXA and nuclear medicine imaging
Exclude
Interventional radiology (Vascular), EEG (Neurology)
Nuclear medicine laboratory results, e.g. C13 urea, Schilling tests (Labs)
Include
Ambulance, other “999”, First Aid or voluntary services
Out of Hours contacts with GP-, CMHT- and Nurse-led services
NHS24 contacts and letters to NHS24
111 contacts
Other national or international variants of these services
Exclude
A&E, Community Nurse-led service contacts (Nursing)
International specialties equivalent to specialties listed here
Include
Infectious diseases, including HIV and AIDS, including paediatric infectious diseases
Specialist immunisation notifications
Infectious disease and tropical medicine reports
Imaging
Immediate
Care
Infectious
Diseases
Exclude
Include
Labs
Exclude
Include
Neurology
Exclude
Pulmonary tuberculosis (Respiratory)
All biochemistry, haematology, bacteriology and serology results, other Medical physics.
Nuclear medicine laboratory results (C13 urea, Schilling tests). Blood grouping reports.
Radiology results, nuclear medicine imaging including bone scans and DEXA (Imaging)
Biopsy and post mortem results (Pathology)
Cervical cytology results (Pathology)
Neurology, neurosurgery, neurophysiology, paediatric neurology, neuromuscular, EEG,
EMG
Neuro-psychology (Psychology)
Spinal and head injury rehabilitation (Rehabilitation)
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Context of the National Folder nameset
GP Practice only e.g. proposal to rename OOH folder
“Immediate Care” – a new name to expand the scope of the
Out of Hours folder to include various other new services
from providers of healthcare directly to patients such as
NHS24 (now operating both In and Out of Hours) and with
urgency ranging from 999 calls to advice by the new 111
services, and services ranging from familiar local ones to
those of international travel.
These new services were creating new uncertainties for their
best filing destination*, and it was considered that
“Immediate Care” would capture both the direct access and
speed of these services whatever the service provider or
location.
This therefore replaces the folder named “Out of Hours”
* - note this addresses only the context of GP Practices
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2006 issues
• PSD’s Project development re possible roles in
scanning and archiving of records, as extension
of role with deceased/embarked/untraced and
Armed Forces records.
• Accreditation? for true paperless users after a
managed process for selective back-scanning
• Avoid Print outs? for paperlite practices
• Audit trails: investigate persistence
• GP2PG issues re transfer processes?
• serial transfer is full or incremental?
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Deployment issues
• started 2007 in Ayrshire and Grampian
• completed Scotland-wide in 2009
• except for 3 practices in Scotland
If receiving practice doesn’t use Docman – who
does the printing? - not the GPs, but
Practitioner Services Dept. do
• non-standard filetypes?
• cross-border traffic for England, Wales and NI.
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Promotional Summary for D2D in 2008
Features
Benefits
One-time Indexing
Effective indexing due to universal standard
Automatic transfer between sites
- immediate access for current “live” clinician
- follows the patient between practices
- practice staff and clinicians love it
- looks like an integrated NHS to the new patient
All Primary Care covered in Index
de-duplicates admin work across NHS
so community clerical staff will love it too
Indexing only
- clinical content untouched.
Data Quality 100% copy of original
Compatible with other data types
ANY data can be converted to paper and scanned;
most can also be imported directly into Docman.
Scalable to national cover
Shareable staff training by national orgs.
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Transfer of documents FAQ 2008
•
•
•
•
•
•
•
•
export Docman files for deceased patients?
QOF 8wks-to-summarise starts when?
use of eLinks background data transfer service
has eLinks run?
clear out the Docman Archive folder?
opening an archived record
comments are not transferred
including SCI Gateway referrals in export
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How complete is Docman record? - 1
•
•
•
•
Hospital specialty letters
Community letters
Lab results
Referral letters
- automatically linked from SCI-Gateway
- imported as .html file (web-format)
• Any other documents: ad-hoc direct scans
• GP system record?
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Complete GP record - 2
Addition of GP system record as a document:
How to avoid printing out and re-scanning?
• InPS Vision, EMIS PCS, Ascribe and iSoft had “export
whole record as document” options
• is “the whole record” the Data Protection Summary?
• GPASS work-around used Virtual Print Drivers to create
a .pdf of the print output
• deployment of Virtual Print Drivers:
- by nGMS IT facilitators
- by GPs per SCIMP website instructions
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Automatic transfer
•
•
•
•
•
•
eLinks background automatic transfer system
transports all NHS claims e.g. ons/offs
star network topology, not peer-to-peer
3 Regional offices of PSD
operates overnight
QoS-like Priority scheduling for GP records
• “Docman Transfer” deployment 2009
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Standard Operating Procedures: example
FULL PATIENT RECORDS
We would encourage GP Practices to create a wholly electronic Full Patient Record by
adding the GP System Record to Docman before export.
This should be filed in the:
National Filing Folder Name - Clinical
Description – GP System Record
Organisation – Exporting Practice Name and Practice Code
This can now be done directly, without printing.
For individual system instructions on how to do this, see:
http://www.scimp.scot.nhs.uk/eRecords_docman.html
Otherwise, GP Practices should print out the GP System Record and
scan into Docman before exporting
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D2D issues
Document is human-readable
- but clunky, and data not computable
Structured data re-entry needed
- promoted by nGMS QOF summarising
Mediated by PSD
- risk of delay to transfer – but is semi-automated
- enables QA of received record re incompatible
- attachment filetypes
- destination / receiving practices
- outwith Scotland
- non-Docman
Initiation is by pt. deduction via “Partners” message via
eLinks to “push” from old practice, requiring some
staff time > risk of delay
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GP2GP solutions
England GP2GP v1.1
Scotland D2D
Transport
Spine
eLinks
Network topology
Peer-to-peer
Star to 3 regions of PSD
QA
By sender
By PSD using MedEx
Initiation
Pull by new practice
Push from old practice
GP system data
HL7
TIF. MDI or JPG
Documents
TIF
TIF
GP Data: Doc reln.
Attachment
Inline
Metadata
HL7
XML
Destination exceptions
By practice
By PSD
Cross-border
By practice
By PSD
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Scotland’s GP2GP(S)
England GP2GP v2
Scotland GP2GP(S)
Transport
Spine
eLinks
Network topology
Peer-to-peer
Star to 3 regions of PSD
QA
By sender
By PSD using MedEx
Initiation
Pull by new practice
Push from old practice
GP system data
HL7
HL7
Documents
TIF
TIF
GP Data: Doc reln.
Inline
Special document
Metadata
HL7
XML
Destination exceptions
By practice
By PSD
Cross-border
By practice
By PSD
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Naming the Specialties / Care Settings
Docman
name
Endocrine/
Diabetes
ISD Specialty name + code
ENT
C5 Ear, Nose & Throat
(ENT)
A9 Gastroenterology
Paediatric ENT
A1 General Medicine
ITU Discharge to Physician Care
Specialist Multidisciplinary Obesity
ITU Discharge to Surgeon Care
Minor Surgery
Genetics
C1 General Surgery
C11 General Surgery
(excl Vascular)
C3 Anaesthetics
A3 Clinical Genetics
Geriatrics
AB Geriatric Medicine
Geriatric Day Hospital
Specialist Falls Clinic
Gastroenterology
General
Medicine
General
Surgery
other common Specialty names
A8 Endocrinology & Diabetes Paediatric Endocrine & Diabetes
A81 Endocrinology
Osteoporosis Clinic
A82 Diabetes
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Liver Transplant
Family History Cancer Care Clinic
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Connecting it all up - 1
Note how Docman has shown how multiple
indexes can include Document Type and Care
Setting.
An index of these 2 types of data-about-data, or
“metadata” can be made valid across all Care
Settings,
Now comes The Principle:
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Connecting it all up - 2
“An index of Document Type, and an index of
Care Setting, are sufficient to support automatic
transfer of Document Types across all Care
Settings on a national scale”
• approved by Professional Record Standards
Board
• in application for British Standard approval
• other indexes still valid for local use within own
Care Setting.
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Connecting it all up - 3
“To conform to the standard a document management
system would need to hold one entry from each of the
lists as an instance of metadata relating to each
individual document in its store.
From that metadata it would then be possible to construct
a standard name in the form:
“Care Setting”:“Document Type”
e.g. if
Care Setting = Gynaecology
and
Document Type = Discharge Letter
then
Name = Gynaecology Discharge Letter.
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Connecting it all up - 4
Maintenance of DocType and Care Setting lists:
each maintained as Snomed subset by
UK Terminology Centre
England RFCs to
https://isd.hscic.gov.uk/rsp-snomed/user/guest/home.jsf
Scotland RFCs via Clinical Document Reference Group
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Benefits
• Admin efficiency saving persists throughout a
document’s lifespan in NHS
– documents become portable between Care Settings with no
further admin action
– make document indexing a one-time action at document
creation: “Index-at-Source”
– use EDT
- use Docman Hub
• All suppliers can support interoperability of documents
by conforming to The Standard
– enables GPSoC support?
– can include documents from Social Care
• Data Quality 100% with digital copies of documents
• Looks like an Integrated NHS to the patient
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colin.brown99@nhs.net
leo.fogarty@hscic.gov.uk
www.scimp.scot.nhs.uk
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