NHS South East Essex has created a shared electronic patient record across primary, secondary and community care for patients with COPD.
The primary care trust decided some years ago to develop an integrated primary care system strategy.
This involved moving the majority of its GP practices onto the hosted SystmOne GP, and deploying SystmOne systems into its community services and prison.
It has now been able to create the integrated record for COPD patients by giving clinicians at Southend Hospital – which uses McKesson’s Totalcare PAS – access to the SystmOne GP COPD unit.
The PCT’s clinical lead for the National Programme for IT in the NHS, David Allan-Smith, said the hospital was initially looking to buy a bespoke system to handle administration of patients with chest disease.
However, Allan-Smith argued SystmOne could be adapted to meet the requirement for a shared single record between GPs, the hospital and community care.
With patient consent, clinicians at the hospital view the COPD unit and update the record using GP codes. They can then share the information with community services, including specialist respiratory and long-term care services, by email.
Allan-Smith said that as a result of the IT strategy 80% of GPs in South East Essex are using SystmOne, and that these practices cover most of the 400-500 COPD patients in the area.
Of the patients given the opportunity to share their information with hospital clinicians, fewer than 1% had refused.
“It’s a little bit more sensitive when you’re asking for the GP information to be shared because you’re asking for the whole patient record to be shared,” Allan-Smith said.
“We’ve had about three or four patients... who have refused to share their record. But the vast majority of patients have shared, and 95% of the practices have shared as well.”
Allan-Smith said the GPs who hadn’t been convinced to share their data were mostly concerned about providing information to other clinicians that patients might later decide they didn’t want shared.
However, he said the PCT was going through a stringent process of using formally signed acceptance letters from patients and holding these on file.
Meanwhile, he added that the hospital would like to create similar services for cardiac, renal and other patients needing services from a number of providers.
The primary care trust has also been working to develop an end of life register using SystmOne.
This will present an integrated, summary view of a patient’s record to out-of-hours providers before they visit a patient, and give them information about medications, care plans, planned visits by other services and the patient’s preferred place of death.
The idea is for information entered by GPs, Macmillan cancer nurses to be shared with the register in real time, so it is always up to date for the out-of-hours providers. Allan-Smith said the PCT was also hoping to get local hospices on board.
“In the long term the only areas are where we have an issue is the practices that aren’t on SystmOne,” he said. “Until they get onto EMIS, and then at least we can incorporate the summary care record.
“Other than that, potentially we could have a single electronic record across primary secondary and community care across a large number of our services.”
However, he warned that the “disintegration” of the NHS in the coming reorganisation would pose problems to maintaining such services, and called for a clear strategy to promote them.
© 2011 EHealth Media.
EPR or Sharing of records between Primary & Secondary CareNeelam Dugar 157 weeks ago
It seems to me that sharing of information beween primary & secondary care is being called "EPR". Whilst I commend those involved in the project, I am concerned about the use of the term "EPR"
If NHS were to adopt common global standards
1. XDS for EPR (in primary or secondary care)
2. CDA for medical documents (referral letters, clinical letters, lab results etc)
3. DICOM for images
XDR --an extension of XDS will allow for for electronic tranfer of document between Trusts/GP etc (similar to snail mail, e-mail etc)
XCA--another extension of XDS will allow patient centric view/sharing of information held in multiple organizations
XDS family of global standards allow for a stepwise approach of optimising communication within an organization & between organizations.
If you are sceptical, attend some of our educational presentations on this issue from Intersystems, Karos Health, Rogan Delft, Soliton IT etc. They will bring in the views from around the world USA, Canada, Europe etc
7th Nov RCR Imaging Informatics Group Meeting
Co-located with EHI Live at NEC Birmingham
Maybe not perfect but clearly very worthwhile - good for themJohn Aird 157 weeks ago
It has always seemed a great absurdity to me that there ever was a gap between primary, community and secondary care anyway. I would also guess that if you asked patients they expect the NHS to be already providing a shared or single record, after all, from a patient's perspective, why wouldn't they?
But the NHS was ever a service at the whim of polititical ideas, but even if the politics require split services IT could so easilly have bridged that gap with single systems, while still enabling commissioning to function.
As to systems, full EPR or otherwise, there are several capable of meeting basic shared records, Order/comms and letter/document sharing. But once you start to look at specialty specific decision support and data structure the design of systems expands in many different directions. Yes there are many specialty EPRs, designed to meet the needs of specific clinical specialties, but no one such system will meet the extremely varied needs of every patient.
But only by trusts (Health Communities) pursuing such ideas and pushing the boundaries will bith NHS service and IT capabity improve. What they are doing might not be perfect but it sounds very good and worthwhile on many fronts.
Definition of EPRNeelam Dugar 157 weeks ago
EPR for a 2ndary care Trust is one indexes & displays
1. GP referral letters
2. Clinic review letters
3. Lab results
4. Radiology reports
5. Path results
6. Ward discharge letters
8. Radiology images
9. Medical photographs
10. Operative notes
11. Any clinical doc
All these documents & images may be created in a myriad of best of breed healthcare IT systems. Clinical user managing the patient has a comprehensive patient record to support patient management. This improves patient safety.
Scheduling & Billing etc is admin functions. It does not need to be part of EPR. It can be done by departmental systems/PAS etc
EPR in NHS must replace current PPR (Paper Patient Record) or clinical notes. PPR in NHS does not perform scheduling, etc.
XDS of IHE is the emerging global vendor neutral standard for EPR.
Comments and queriesJack Barker 157 weeks ago
For info: We had a web based system working across Kings GSTT and Primary Care to support dedicated COPD services. Unfortunately the funding was not sustained and the clinics were disbanded. We still use the system internally at Kings.
How does the S1 system integrate with the hospital EPR? Are the staff in the COPD clinic using two systems? How do their letters get into the hospital EPR.
Also I am not quite sure what peole mean by scheduling in this context.
No they don't use two systems!smudger 157 weeks ago
One of the tricky parts of this deployment was exactly that. You can't just take one department out of the information loop within a big hospital. A lot of work was done by the hospital IT team to ensure that info recorded by the clinical staff into S1 could then be copied into the electronic paper management systems where it is then available to all of the other hospital departments that may need it. Its admin time that’s wasted in doing this, however when taken into account time saved in letters and calls etc it’s still a net gain. Access to the pathology was facilitated via S1 also.
On the right track...ehealthsolutions 157 weeks ago
SE Sussex are definately on the right track with their cross-sector "disease based" EPR. George385 comments suggest that an "oncology module" might be the next step forward.
With the possible exception of the complex and high risk area of in-patient e-Prescribing and the need to map READ codes to ICD10/OPCS, I am sure that SystmOne can cope with the other elements of an integrated EPR.
Maybe someone from TPP could comment?
EPR?Daniel Defoe 157 weeks ago
Here we go again; this time the suggestion seems to be "disease-based EPRs" with the patient's GP record as the prime. It might be a good thing but it certainly wouldn't be a credible "EPR" with all the wealth of functionalities that a credible RPR requires e.g., OC/RR, Care Pathways, Complex Scheduling, ePrescribing, Full Clinical Noting etc., etc.
No its not just diseased based ERPsmudger 157 weeks ago
The system has been set up for the COPD clinic but the whole key to using S1 is that the record from any S1 unit can be shared.
This is as fuller record as clinically required so it can and usually does, include prescribed medication, full clinical noting, scheduling etc. It can be read and contributed to by any service the patient is registered with and who they consent to having that record shared with. In fact its everything an EPR needs to be.
Is doing nothing better for the patient?george385 157 weeks ago
I would tend to agree with some of the previous posters comments - however wrt to Cancer Care in particular (which I've had personal and recent experience of) anything to help the sharing of information between secondary care, the GP, Ambulance services and palliative care services is a good thing.
Cancer patients tend to be in and out of hospital during their care (beit active treatment or palliative care) and each time this happens their care becomes disjointed (it certainly was the case with my late mother's lung cancer care). Analgesia in particular can become in-adequately managed when being moved from hospital back into the care of primary/ palliative care.
The failure of the NPfIT to offer healthcare professionals anything in this area has meant that they have had to improvise.
Doing something that benefits the patient is welcome but as the report stated the constant remodelling of the NHS (by politicians) does not improve or promote progress – it hinders it.