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Lancashire clinicians access GP data

28 November 2012   Rebecca Todd

Urgent care doctors and pharmacists at East Lancashire Hospitals NHS Trust are accessing key information from the patient records of 91 GP practices using EMIS Web.

A&E clinicians and hospital pharmacists can access a core set of information - including active problems, medications and health status - through a secure, read-only view of the patient’s GP record via EMIS Web access points at hospital terminals.

Users within the trust calculate that since going live in April, the service has saved them hundreds of phone calls and faxes a month to GP practices to check patients’ medical details.

This equates to 3.5 working days a month.

In the medical assessment unit at Royal Blackburn Hospital, clinicians are now accessing EMIS Web 20-30 times a day.

Access has also been extended to other wards where qualified pharmacy staff are able to use EMIS Web after obtaining patient consent.

Lynn Bruce, pharmacy team leader in the Royal Blackburn Hospital MAU said: “EMIS Web has revolutionised our lives, saves an enormous amount of time and undoubtedly made the journey in and out of hospital much safer for patients.

“We have also been able to improve communication with GPs about changes to patients’ therapy while they are in hospital,” she added.

Witton Medical Centre GP Dr Paul Fourie said: “The benefits for patients are fantastic. One of the biggest problems for urgent care doctors is finding out what medication the patient is on, particularly out of hours.

“Record viewing via EMIS Web is unarguably safer than faxes or phone calls to practice staff who are not medically qualified.”

The record-sharing initiative is underpinned by strict local data-sharing agreements and ‘point of care’ patient consent.

 

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Related Articles:

News: Western Cheshire shares records | 24 September 2012
Insight: Spinning a Web | 4 September 2012
9 News: EMIS Web links GPs to St George's | 4 September 2012
Last updated: 29 November 2012 10:02

© 2012 EHealth Media.


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Local beats National (Summary) every time

williamlumb 85 weeks ago

Is the SCR real time? No. Is the SCR scaleable with non-core content? No. Does the SCR offer alternate views in variable care settings? No (in part because it doesn't do much that's useful). Does the SCR enshrine data control? No. Is the SCR a white elephant? .....

We can now export the patient record from EMIS and Vision in real time (with patient consent) to a set specification for each care setting. This extract is defined once and applied to all patient's at the same time. Hasn't anyone twigged that GP's simply don't have the time to sit with a patient and individually enhance their SCR file? If TPP joined in then we have a standard covering the whole of the primary care record in the UK (with apologies to Microtest)-and the ability to share data wherever and whenever the patient consents.

Once we have a robust data sharing standard that the professionals can sign up to (and it's coming-it just takes time) we can start plugging into other ePR's and connecting the whole NHS up. Add in Patient Acess to fill in any small gaps.

It works technically, it meets IG requirements and clinicians love it. So lets stop the politics (CCG's can't get authorised without a live SCR) and start looking after patients.


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Mandatory APIs?

CertaCitrus 85 weeks ago

I would hope this is covered via the proposed API's.

So a health care provider can demand a computer generated referral/summary care record on demand. Also list of child immunisations, I.e. all the existing communication (via telephone, fax, email, spreadsheet, etc) that is mandated or necessary for care.


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It could be described that way now

in arduis fidelis 85 weeks ago

But you have to go back and look at the original roadmap for the National SCR to see that before the "consent to share", "opt out", "to much information to be included" etc issues were raised as objections in its infancy, it was intended ultimately to function in the way that you outline it now does not. If it had been allowed to continue on its original path it would already be doing so Nationally regardless of GP system or EPR. It is only in danger of becoming a "white elephant" because it has had to be watered down to try to engage the vocal opposition. Sharing of patient information across different Health care settings - another initiative that has been delayed for more years than it should have by the unruly "teens" not wanting to do what the "parents" are telling them untill they can say look at this good idea "we" have had "isn't it brilliant".


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Differences ... and conflict

JackieOlive 85 weeks ago

One of the differences between the National SCR and Emis Web shared record is that the National SCR is National and records can be created from all accredited GPSoC systems. So the Emis solution is fine if you are in an Emis Web dominated area but do we want to introduce another Post Code lottery in the NHS?

If the Emis Web solution doesn't require the use of Smart Cards to view the records what system of security does it use?

What a shame we couldn't use the technical skills (and negotiation skills) available to Emis to help design and speed up the development and implementation of the National SCR rather than produce two conflcting systems. In Surrey where we have uploaded over 200,000 National SCRs from practices using Emis LV, Emis are now deleting these records from the NHS Spine when they move the practices to Emis Web!! ... And our emergency services don't have access to Emis Web. Let's learn to work together, guys.


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Re Surrey

jamesfone 85 weeks ago

Since EMIS Web does now support the SCR

http://www.emis-online.com/scr-now-available-in-emis-web

Presumably the deletion of 200,000 SCRs generated from LV would just be a prelude to a replacement by new versions from EMIS Web? (As part of an automated migration to a new system).


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Re Surrey

JackieOlive 85 weeks ago

Presumably, but we are still waiting. Oddly, Emis don't seem to have the resources to devote to the implementation of the National SCR in Web (a version with reduced functionality than LV - Core data only at the moment) and so these patients' National Summaries have become out of date / removed.


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Smartcard is a barrier to SCR use

wishfulthinker 85 weeks ago

A significant barrier to using the SCR in A&E is the need to logon using a Smartcard. A good idea in principle, but in the high-intensity A&E environment it simply gets in the way - and anything that slows them down won't get used.


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Development

in arduis fidelis 85 weeks ago

I think I'm right in saying that one of the developments that is being worked on in response to this issue (some functionality already being included in GEM software), is to move to proximity access smartcards to ease the login process.


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How does this work

CertaCitrus 86 weeks ago

If your not in EMIS web (system one portal or vision 360) land?

If your in an area where all three are used (plus others) do you have all three portals?

It seems a better more detailed SCR is justified and required. One portal, many sources


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Curious isn't it

in arduis fidelis 86 weeks ago

DoH/CfH: Heres a National SCR which has emergency care information and a summary of the patients primary care record

Clinicians:We don't need all that information, we haven't got the time to access that

DoH/CfH: Ok heres a scaled down version of the National SCR which just has emergency care information

Clinicians: Don't really see how thats going to be much help to us

EMIS/local interested parties: Heres remote, read only access of a patients full primary care record

Clinicians: Wow thats brilliant, how did we ever do without access to all that information

Anyone else spot the inconsistency. This level of sharing of patient information could have been in place years ago.


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Progress?

jamesfone 86 weeks ago

Hopefully, articles like the above will put paid to the view that electronic summary record sharing is not desired by any clinicians and is not beneficial to the patient.

I.e.

"(this summary sharing solution) has revolutionised our lives"

"The benefits for patients are fantastic"

EHI - any chance of a followup with Leeds on SCR access for pharmacists?

http://www.ehi.co.uk/news/EHI/7875/leeds-hospital-pharmacists-access-scr


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Default dataset vs optional

jamesfone 86 weeks ago

Right - the default SCR doesn't contain the active/past problems, but AFAIK these were specifically excluded from the default dataset around 2010 (I don't remember the reasons why). But they can be included (along with other information) with explicit consent from the patient.

Since the implication from the above article is that the model used in East Lancs is also explicit consent, then it sounds to me (as a naive outsider) that it does much the same thing.

Therefore I imagine there is some subtlety about one or other of the systems that makes one better than the other, and it would be useful to discuss this difference. E.g. that the method for recording explicit consent in the SCR is a pain to use (I've no idea BTW).

IF however the model used in East Lancs isn't explicit content to share, then it would seem that the EMIS Web solution might have been preferred because it doesn't have to abide by a rule imposed on the SCR?


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EMIS SCR vs NATIONAL SCR

ehealthsolutions 86 weeks ago

There isn't much point in having an up to date list of a patient's current medications unless they are linked to an active problem/diagnosis list. Many medications can be used for 2,3 or more clinical indications.

Thus, I conclude that the EMIS SCR will be of far more use to acute care clinicians.

Can the EMIS SCR solution be rolled out across NHS England please. Oh and make it quick - let's say a 6 month target time scale...


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Oops

jamesfone 86 weeks ago

Sorry - that comment was in response to RTodd


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Comparison to SCR?

jamesfone 86 weeks ago

As with any data-sharing of this kind, could EHI please always ask the interviewees how the chosen solution compares to the SCR.

From this description it appears as if the data being shared is mostly the same, and the benefits cited by interviewees are the same.

It would be useful to know the detail of how they differ, and why the trust is (appearing to) support a solution that can only come from the latest version of one supplier's software.


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Differences

mrtablet 86 weeks ago

Another major difference is that the EMIS solution comes in a couple of billion squid cheaper.


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Differences

RTodd 86 weeks ago

The SCR contains the patient’s demographics details, medications, allergies and adverse reactions.

Hospital clinicans using the service described above can see active problems, significant past problems, acute and repeat medication, allergies and health status including information such as BMI.


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Re simon1964

jamesfone 85 weeks ago

Having re-looked at the 2010 Keogh review of the SCR content

http://www.connectingforhealth.nhs.uk/systemsandservices/scr/staff/aboutscr/comms/pip/scrworkshop1.pdf

It clarifies that the default content of the SCR i.e. that which is uploaded under implied content should not contain patient health issues, but that these can be added via explicit consent. Reasons given:

- "start small in order to build medical and public confidence in the SCR"

- A smaller dataset was "a lower risk option"

Reading between the lines this sounds like a compromise that allowed the SCR to continue at all, without being completely derailed by the implied/explicit consent issue, while still providing value when used for hospital admissions. (By facilitating meds reconciliation and giving access to allergies & ADRs). 'Don't need it / no time to read' weren't the official reasons given, and as you say would have been poor reasons anyway.

'Reason for prescribing' was also excluded from the default dataset, because this would reveal the patient's current health issues and therefore be inconsistent with the decision taken on inclusion of health issues.

Which bring me back to my original point:

a) If the EMIS Web solution uses explicit consent, then it's 'the same' as the SCR (in one respect).

b) If the EMIS Web solution doesn't require explicit consent, then it succeeds (at least in part) by avoiding the limitations that the SCR has to operate under.

c) I imagine that there are other reasons why the EMIS Web solution might be superior to the SCR and I'd like to see these discussed so that we can better understand the situation and learn from it.


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But thats pretty much what they were offered with the original SCR

in arduis fidelis 85 weeks ago

In the early days of the National SCR, consultation with "Hospital clinicians" drew the response that they "didn't need access to that amount of information" as they hadn't got time to go through it all and most of it would be irrelevant. So the default setting for SCR was changed to just demographics details, medications, allergies and adverse reactions (with an option at patients request to include additional data ie LTC information), this was to try and improve engagement (somewhat unsuccessfully) based on responding to feedback from clinicians. Several years on and a similar solution from a different source and the benefits are being raved about, when those benefits could and should have been realised years ago with SCR!


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