• Tony Callaghan

Magic the problem away

Final Solution

Computerised
Records

GP2GP

• GP2GP has been operational in England since 2006
• Over 5000 practices in England live on system
• About 13,000 electronic transfers completed each week
• Both EMIS and INPS are accredited suppliers for
GP2GP in England
• System produces HL7 clinical summary and attachments which are automatically imported at the new practice, creating a electronic medical record
• In England the system pulls the data from the previous practice
• If both sending and receiving practices GP2GP enabled, transfer automatic within minutes of registration

• GP2GP in England works over the “SPINE” IT infrastructure which pulls data and sends it to the requesting practice. The sending practice has no control over despatch.
• In England, if either party not GP2GP enabled, record needs to be printed

• GP would have early access to full medical record including medication, medical history, allergies etc
• Automated import/export functionality
• Records could be available within hours of registering patient
• No need to re key information from paper records, fewer transcription errors or omissions
• Time saving as record rich source of information
• Completeness of the record
• Reduced admin support
• Improved security
• Driver to improve quality of records

• Limitations on the size of the attachment files within GP2GP, currently 5 meg and 99 attachments
• Cross Border transfers
• Returning patients A to B to A
• Limited data on actual true use of system, we know number of transfers but no data on imports
• No mechanism for late submissions

• Biggest challenge is that the GP2GP system in use in England cannot work over Scotland’s current infrastructure

• 2006 Docman scanners available at all GP practices
• “Docman Transfer” was developed, creating a patient summary with attached scanned images for electronically transfer between practices within
Scotland
• Standard folder structures agreed for use in
Docman
• 2013, 99.9% of practices are Docman Transfer enabled, with over 8000 electronic records transferred each week (includes records to storage)

140000
120000
100000
80000
60000
40000
20000
0
DocMan Transfer Figures
To Storage
Printed
Exceptions
Electronic - end to end

• Produces clinical summary
• Attaches Docman images
• Standard folder structure agreed for
Docman
• Record available more quickly
• Maintains electronic record format
• Full audit trail and recoverability
• Control with sending practice
• Ability to create new clinical record at the receiving practice manually from the clinical summary

• No ability to export/import the full patient clinical record.
• Creating a record for Docman Transfer is a manual process, which is time/resource consuming which can delay the deduction
• Record can only be transferred within Scotland
• Practices can save data using non standard file types, which cannot be read by the receiving practice
• PSD have to print out the clinical record for any transfer out with Scotland or for practices which are not Docman Transfer enabled

• It works well
• Proven track record
• Reliable
• Full audit trail
• Utilises existing infrastructure
• Links into Medex system to identify patients on CHI and retain records for long term storage

GP2GP
Docman
Transfer

• Deliver full GP2GP functionality, by building upon what we already have
• minimising risk
• No big infrastructure change
• Transitional approach
• Safety net, retain current processes
• Get the benefits from GP2GP without adversely disrupting GP Practices or dismantling their processes

Phase 1
• Ability to create, export and import HL7 message
• Link Docman images creating full medical record
• Automate Docman Transfer production, but retain manual control of deduction process
• Use existing Docman Transfer infrastructure to move both HL7 and Docman Images
• Ability to review content before import
Phase 2
• Link into GP2GP in England for cross border transactions
• Develop pull rather than push process for real time transfer

Export Process
Enabled Practice
GP
Clinical
System
Operator Triggers
Docman Export
API
Clinical
Summary
HL7 eLinks
Checks Manifest, attachments and
HL7
Docman
Outputs
Manifest & attachments
Compress files eLinks Transports to
PSD

eLink
Transport
Import Process
Uncompress
Staff select import or not
Docman files +
HL7
Enabled Practice
GP Clinical
System

• March Sept 2013 - CCN agreements
• Sept Nov - Requirements
Clarification
• Sept Jan 2014 - Development
• Feb March - Testing
• Feb April – Training (board)
• April May - Pilots
• June Dec 2014 - Implementation

• Patients returning to original practice,
A to B to A
• Testing( end to end, EMIS PCS currently accreditation)
• Timescales and aligning supplier deliverables
(INPS/EMIS/Docman/eLinks/Medex)
• Data Quality
• Frequency of Partners Transactions-
INPS
• Cross Border Transfers ( phase 2)
• Moving from push to pull ( phase 2)

• Looking to develop Docman to handle
TR’s
• Working with NHS Boards on unacceptable file types
• Transfer of correspondence for a deducted patient
• 7 Practices do not currently use
Docman Transfer

Will this reduce workload
Would you have the confidence in the data quality to import records
What do we do with the paper