Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Health Informatics and Chronic Conditions
Document related concepts
Transcript
Health Informatics and Chronic Conditions A View from the Jurassic Coast Andy Hadley, MSc, MHIM, MUKCHIP Supporting Chronic Conditions Co-ordinating across health and social care When might the national care record deliver ? Problems introduced by plurality of provision Short term plans for Dorset What happens in year 2013 ? Strategy 10 Domains 7 for RIS How often do we need to access full records ? GP Referral/Booking Reason for referral Signs and Symptoms Patient History Current Medications Alerts and ongoing conditions Current and Planned Care Hospital Discharge Diagnosis and Treatment Current and Changed Medications Planned Care by us Suggestions for follow up Have we got time for a shared record ? When will the software and systems be up to it ? Portability & connectivity Swift login Remembering patient context Flexibility to work with personal preferences Portal style Clear summaries when want them, detail if need it Reminders driving the process Mix of diary, what was I doing last, what’s next priority Pathways, how to guide the uncertain, but not disengage the experts End to end experience – single system for a user Who gets to share the NCRS SAP record ? The Patient Hospital Doctor General Practice Ever ? Case Manager Accident Department Release 2 Single Assessment Process Nurse Practitioner OTs / Physios Hospital Nurse/AHP Spine Summary ? Mobile Release 3 Health Visitor Ever ? Ambulance Release 3 Limited Integration ? Independent sector Hospitals/care settings Ambulance & Control Ever ? Social workers Help at Home Voluntary sector Home Care Contracted services Cluster Proposed Interim Architecture for SAP Healthcare Applications Framework environment Local Govt Applications synchronization Millennium Acute Social Care Shared Repository GP GP Community, Others Mental Health HUB Housing Shared Form Definitions / View Education Voluntary Local Govt users NHS users Interim or “non-aligned” users – e.g. voluntary sector Incorporating Independent Sector Reports onto NHS Systems in Dorset and Somerset Multiple GP Systems, or Paper Poole GP Interface Box for East Dorset GPs PMIP NHS Number (4 points of ID) and SnomedCT investigation Codes Are vital Electronic Royal Bournemouth Clinical Viewer Poole Hospital EPR East EastDorset DorsetInterface Interface Engine (Websphere) Engine (Websphere) East Dorset Community Hospitals Cerner Millenium Dorset Community Hospitals R1 Acute Trusts R2 ECG Traces Indep Sector Diagnostic Services Report “Significant Pathology” Report within 2 hours Or Fast track with report /images in 24 hours For requests, see incorporating requests Andy Hadley, SED PCT, Feb 2006 West Dorset Interface Engine (SeeBeyond) West Dorset Hospitals GP Interface Box for West Dorset GPs PMIP Electronic HL7 report Image will need report and episode number to exist on cluster archive Electronic DICOM Images Somerset Interface Engine (SeeBeyond) Multiple GP Systems, or Paper Indigo Prompt Indigo Prompt Somerset Somerset Interface Box GPs Interface Box GPs GE PACS GE PACS GE GEPACS PACS Royal Bournemouth Storrcom PACS Cerner Millenium Somerset Trusts R0 Multiple GP Systems, or Paper Southern Cluster Archive Not yet accessible to view ! Dorset Interim Approach Good existing systems – widely used Go for short increments and quick gains Gain consensus where we can Accept that dissenters may have valid reasons Integration engines to give flexibility If NPfIT ever catch up, the learning and experience will have been useful Maintain a healthy scepticism Wessex RISP SW EPR (Shires) NPfIT ? COPD Admission Avoidance (Poole area) GP Clinical Systems Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries EMIS x 13 InPractice x 3 Isoft x 1 GPs Practice Nurses Paper Casenote Poole EPR Hospital Doctors PORT Team Nurses Poole CaMIS Patient Administration A&E Visits, Outpatients, Waiting Lists, Inpatients, feeds Choose and Book Admin, contracting, MDS Cardiac Department - Muse system Proposals for Electronic requesting in, and reporting out to EPR Cardio-respiratory staff COPD (how record ?) GP Clinical Systems EMIS x 13 EPR is already accessible in GP practices and Community hospitals InPractice x 3 Isoft x 1 Paper Casenote GPs Practice Nurses PFT Tests in the practice FAX – “your patient has been admitted” Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries Proposals for Electronic requesting in, and reporting out to EPR Poole EPR Hospital Doctors PORT Team Nurses Cardio-respiratory staff PFT Tests on the ward & OPD A&E and MAU Assessments Cardiac Department - Muse system PFT and stress tests In Cardiology Collect audit data Preparing for COPD NSF Minimum Dataset (MDS) Discharge Summaries (some on EPR) Longer term COPD (near future) GP Clinical Systems EMIS x 13 Email or messaging “your patient has been admitted, details are on EPR” InPractice x 3 Paper Casenote Isoft x 1 GPs Practice Nurses PFT Tests in the practice Walk-In Centre Out of Hours Nurse Practitioner Clinical record Radiology/Pathology XDOCS – clinical notes Discharge Summaries PFT Tests - Hospital PORT information Building COPD NSF MDS Cardiac Department - Muse system Proposals for Electronic requesting in, and reporting out to EPR Poole EPR Hospital Doctors PORT Team Nurses Cardio-respiratory staff PFT and stress tests In Cardiology Migration to National Care Record … Community Hospitals – Release 1 - July 2007 Acute Hospitals – Release 2 – Summer 2008 … at time that this is capable to incorporate Frank Burns interviewed by Sean Brennan Jan 2002 Would you advocate a national EPR solution ? I do get nervous about people far away from reality of implementing Very far away from culture of NHS Who have this notion can simply contract at a national level I personally think it would be a disaster if ever such an approach were attempted Build and roll out as for supermarket checkouts displays incredible naivety … The higher the level of centralisation, the lower the spec. The NHS IT Project - Radcliffe 2005 Punt says many blue-chips rushed headlong into longterm outsourcing contracts, with the result that many IT leaders failed to clarify the relationship between supplier and customer. 'Once you get beyond the deal, they're not sure what they want,' he says. 'The vendor can manage the contract. As businesses change, so do third-party relationships. Provision will inevitably become more fluid and there will be a change in how such services are delivered. 'Insourcing is of interest because people are acknowledging that deals are not providing benefits.' What are the successor arrangements ? Release 2 – 2008 – start of clinical journey 10 year outsourcing deal to 2013 Only 5 years growth, not paperless ? Increasingly complex record Reliance on data for decision support Continuation of other systems to fill gaps Integration with Social Services Independent /private / voluntary sector Foundation Hospitals Patient access, and Care at home
