PORTAL TECHNOLOGY SUPPORTING EPR: TARTAN FLAVOUR Graham Gault, General Manager ICT Dumfries & Galloway UK & IRELAND CUSTOMER CONFERENCE ORION HEALTH OCTOBER 2016
I would like to share the following.. NHS Dumfries & Galloway : who we are/ what we are trying to solve. A short Portal History : Our vision of a paperless working environment. Specifics: An EMPI - NexGATE Index - WHY eforms HCP : work so far Where to from here? Extending beyond our region. Going Mobile Patient Portal Close Page 2 2016 Orion Health group of companies
NHS Dumfries & Galloway South West Scotland Population 147,000 (3.1% of Scotland Population) 2,100 Square Miles 11 small towns ( community hospitals) 9 Health Centres 33 GP Practices 17 Optometrists 17 Pharmacies Co located with Local Authority Higher than Scottish Average Deprivation Much higher than average elderly population. Page 3 2016 Orion Health group of companies
New Hospital single Integrated EPR fully operational across region Outpatients Electronic communication / checkin Minimal use of paper Increased use of mobile technologies PORTAL/OC/HEPMA Page 4 2016 Orion Health group of companies
Challenge No 1... Efficiency, Productivity, Safety, Cost effective Disparate systems Multiple Logins Repetitive searches Never seeing the whole picture Still use paper case notes as well (or not) Multiple Database Systems Administration inefficient data capture significant paper work to manage on a daily basis significant support required to deliver basic service ( Secretarial/Health Records) Lots of clinical time wasting managing paper Digital Archive Scan paper case note to enable new build to be paper lite/less Create electronic forms to replace paper. Electronic Patient Record Find new ways to input data efficiently reducing reliance on paper. Find more efficient ways to present a holistic view of ALL patient information remove multiple logins/searching Develop complimentary platform for incremental improvement. Tasks/ Electronic Forms / Mobile Access / My Todo list Pathways of care : Improve Patient Safety.
Electronic Document Management 1948 2012 2012-2015 ecasenote Page 6 2016 Orion Health group of companies
What is it we are trying to do? 2015 1948 11% of lab tests are repeated because of lost reports 30% of treatment orders are not documented Doctors & nurses spend 35% of their time doing paperwork 20-30% of healthcare resources spent on managing paper 50% of paper records are either missing or contain incomplete 2012-2014 ecasenote paperwork Source : Kingsfund 2011..as well as building a new hospital with no Medical Records Store. Page 7 2016 Orion Health group of companies
Creating a Digital Archive GP Data from Your Surgery X Ray System Reports Lab System Reports Page 8 2016 Orion Health group of companies
Challenge No 2. Protecting Children and Vulnerable Adults Lots of great ideas Really good advice Good model for service improvements National Strength Inter Agency Sharing Alerting/Chronologies/Integrated working? Service delivery model ( Practical Challenge)? Safety nets?? Significant Event management? Assessments ( numerous)? Request for assistance? Meeting Notes? Action planning and tracking
Defining Integrated Care - Summary Progress Work Priorities described above for multi Agency Services to contribute. Develop sharing ICT infrastructure between Public Bodies. Agree / Procure / Build / Deploy Portal Health Summaries Social Work Summaries Education Summaries Police Summaries Chronology / Request for assistance eforms. Introduce eird and National Child Protection Messaging Post delivery across NHS: Roll out Solution to all Agencies Extend to include Adult Services.
Solution Develop EPR (Clinical PORTAL) Nursing Doctors Other Clinical Administration Staff Application Layer Search Viewing Results Timeline Specialist View Forms Referrals Scheduling Functional Layer Master Index Consent Workflow Reporting Messaging Alerting System Layer TOPAS & A&E PACS Laboratory & Other Tests ( ECG,Stress,PF T) GP Data HEPMA SCI-STORE Reports (Endoscopy, Radiology) Primary & Community Care Mental Health Documents & Digital Archive
Solution Develop EPR (Clinical PORTAL) Nursing Doctors Other Clinical Administration Staff Applicatio n Layer Functional Layer Search Viewing Results Timeline Specialist View Forms Referrals Scheduling NEXTGATE Enterprise MPI Master Index Consent Workflow Reporting Messaging Alerting System Layer TOPAS & A&E PACS Laboratory & Other Tests ( ECG,Stress,PF T) GP Data HEPMA SCI-STORE Reports (Endoscopy, Radiology) Primary & Community Care Mental Health Documents & Digital Archive
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Solution Develop EPR (Clinical PORTAL) Nursing Doctors Other Clinical Administration Staff Applicatio n Layer Search Viewing Results Timeline Specialist View Forms Referrals Scheduling Functional Layer Master Index Consent Workflow Reporting Messaging Alerting System Layer TOPAS & A&E PACS Laboratory & Other Tests ( ECG,Stress,PF T) GP Data HEPMA SCI-STORE Reports (Endoscopy, Radiology) Primary & Community Care Mental Health Documents & Digital Archive 16 NHS systems Social Care (Frameworki) Education Police
Portal Timeline 18 months addressing 2 problems ( Replace Doc Mgt System / Sharing Data with Other Agencies) Image Purchased ORION PORTAL Build Application [Jun 2014] [Apr 2016] [Oct 2016] [Mar 2015] Go LIVE Image Failed Doc Mgt System Image Need to share between POLICE/ SOCIAL CARE/NHS (GIRFEC Go LIVE Precision Medicine Vulnerable Children) Page 15 2016 Orion Health group of companies
Going Paperless So we have built a Clinical PORTAL..BUT >>>>>>>>>>> 1. District General (387,000 paper case notes now backscanned) 2. 25,000 sheets are created each day. 3. 800 paper forms used daily in District General Hospital. 4. Most workflows still build around paper. 5. Almost all safety processes are built around paper. 6. Staff reluctant to change. Page 16 2016 Orion Health group of companies
Develop New ways to capture Information. 1. epen 2. Mobile 1. Extend epen solution to include Community / Acute staff (500 staff) 2. Commission new Mobile data recording solution (ipad/tablet input) 3. Develop eforms to map processes (800 forms) 4. Transition Organisation using SMART Scanning techniques. 3. Portal eforms Portal Database 4. SCAN
eforms and Health Care Pathways The answer at last..or was it? Challenges in using the base tools. Started exchanging frustrations across Scottish & Irish Health boards. Developed an eforms Network to start the idea of sharing. Training/Manuals/Help/Support Lets build a simple eform and modify an existing HCP solution: eform: Colposcopy HCP: Surgical Pre-assessment Page 18 2016 Orion Health group of companies
Colposcopy Form Page 19 2016 Orion Health group of companies
HCP workflow Page 20 2016 Orion Health group of companies
An ORION eform Page 21 2016 Orion Health group of companies
A First Sharing an eform Designed and Built in GLASGOW, exported and Installed in DUMFRIES PORTAL So it can be done! So why so difficult? Page 22 2016 Orion Health group of companies
A First Sharing an eform Designed and Built in GLASGOW, exported and Installed in DUMFRIES PORTAL Page 23 2016 Orion Health group of companies
eforms & HCP : Feedback to ORION HEALTH Modern PORTALS need good, easy to use DATA CAPTURE Facilities. Help us leverage the solution to be able to easily create simple eforms and PATHWAYs. What we see is really good, but need more support/product evolution. Invest in UK through supporting a sharing network for eforms/hcp. Invest in supporting Boards/Trusts to use your eforms / HCP products. Make available resource to support us to learn to help ourselves. Page 24 2016 Orion Health group of companies
Where to from here? Extending beyond our region Patient Portal Going Mobile Page 25 2016 Orion Health group of companies
Information Sharing Objectives 1. Organisational and system boundaries should not be barriers to patient centred care; 2. Clinicians within a region should have access to information for any patient, regardless of where and when the patient receives care in order to support care decisions; 3. Patient care pathways should be managed through shared regional / national workflows that enable tasks to be performed and to which new information can be added at each step in the process; 4. Information should be accessible via the Electronic Patient Record (EPR); and 5. Integration between health and social care should be supported. Page 26 2016 Orion Health group of companies 26
Patient Flows Totals across all WoS Boards: Elective Episodes 574,408 Out-Patient Attendances 736,444 Emergency Admissions 305,815 A&E Attendances 776,574 Total 2,393,241 Totals for WoS Boards providing treatment to a resident of another WoS Board Elective Episodes 78,965 Out-Patient Attendances 64,353 Emergency Admissions 17,506 A&E Attendances 51,646 Total 212,470 Elective Episodes % 13.7% Out-Patient Attendances % 8.7% Emergency Admissions % 5.7% A&E Attendances % 6.6% Cross-Board Average % 8.8% Page 27 2016 Orion Health group of companies Data from ISD 14/15: Number of Elective Episodes (in-patients or day cases) delivered by each NHS Board 27
Implementation Phase 1 NHS D&G Clinical Portal NHS GG&C Clinical Portal Page 28 2016 Orion Health group of companies 28
Patient Portal Pilot
Patient PORTAL Roll OUT PLAN Phase 1 Phase 2 Phase 3 Adult Congenital Heart Disease National Service patients across Scotland Patient access to current summary record Current medication Documentation discharge letters etc Patient can share with circle of care Appointments Goal setting Test results Library videos, documents Messaging with clinician Patient can upload data Co-creating electronic health record Orthopaedics National Service patients across Scotland 5,7 10 year review following joint replacement Online assessment Messaging with clinician Follow-up appointment only if required Page 31 2016 Orion Health group of companies
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Offline Working Rural Scotland Page 38 2016 Orion Health group of companies 38
Off Lining PORTAL for Community Staff Garry Sheriff: Cambric Systems http://www.cambric.co.uk/ Online Offline Forms Notes Page 39 2016 Orion Health group of companies
And all this wouldn t be possible without..scotland's Famous Nick.. Page 40 2016 Orion Health group of companies 40
Scotland's Famous Nick.. Page 41 2016 Orion Health group of companies 41
Scotland's Famous Nick.. Page 42 2016 Orion Health group of companies 42
THANK YOU Graham Gault, General Manager ICT Dumfries & Galloway UK & IRELAND CUSTOMER CONFERENCE ORION HEALTH OCTOBER 2016