e-Health in NHS Scotland

• Dr Stuart Scott• Clinical Director e-Health NHS Grampian• GP

• First point of contact - Health Records

• Support /Develop clinical systems for recording

clinical data

• Linking areas - Networked PCs - Firewall protection

• Facilitate Communication - National email system - Internet Access - SCI Gateway - SCI Store

• Provide Information - Service planning - WL Management

• Allows Labs/Radiology etc to function

• Get results to the treating clinicianPrimary Care

Acute Care

Self Care

And What Does eHealth Do For Clinicians???

• Reduces Clinical Risk - CHI

NHS Scotland Strategic Aims

Single Record

Core Application

PACs

A&ELabs

Rx PAS

Others

Others

NHS Scotland Strategic Aims

Single Record

HUB

PACs

A&ELabs Rx PAS

Others

NHS Scotland Strategic Aims

SCI Store

•All non-sensitive Labs results

•Radiology Reports

•PAS/CHI Demographics

•PAS ADT/OP

•Clinical Letters

•A&E Summaries

SCI Gateway•Standard Referral Letters (1-2)

•Cancer Ref. Letters (1-2)

•Lung Cancer IDL (2-1)

•A&E Summaries (2-1)

GP Portal

•SCI Store•PCI

•PAS

•CGI

•ECCI Letter Browser

•Other reference web links

eLinks

PAS

CHI

Labs

Abdn Radiology

Elgin Radiology

Legacy Systems

Other Systems:

•A&E

•PROTOS

•Clinical Vision

•CHEO Care

•Pharmacy

•Lung Cancer

•SCI Discharge

•EMAS

•TOM CAT

•ECS

•ERFS

CGI

INDIGO 4 Labs

X400 Referrals

ECCI Letters

PCI

GCS

HospitalGP Practice

ECCI Letters V2

I wouldn’t start from here….

• Federated approach doesn’t work

• Speed of standardisation• Not enough levers• Political pressure growing• England all sorted then!

Generic Clinical System

• Pressing ahead but should we be?

• What do we require to implement?– Training– Support– IM&T Staff– Project management– Authentication– Single sign-on– SCI-Store pre-requisites– Prioritisation – Local/National

PACS

• Advantages– Access to images where and when required– Remote diagnostic support– Financial savings– Political– Should beef up the locally available kit– Improved use of CHI number

• Disadvantages– Expensive– More technical than cultural– Political

HEPMA

• Case for– Safety– Governance– Clinical clamour

• Case against– Safety– Governance– Available products

Theatre Systems

• Case for– Major area of workload– Governance– Risk management

• Case against– Back to the waiting lists again– Bean counting mentality

Order Entry

• Safety• Data quality• Time saving• Governance• Embed in referral

• Add-on for SCI Store• Separate procurement

Infrastructural elements

• Much of the eHealth programme dependent upon robust and reliable telecoms

• Business continuity – no longer a luxury

• Standards

Consent

• Public engagement

• Emergency Care Summary – First Engagement• total records in the store 4,433,431• total no patients who have withdrawn consent 219

NPfIT aka CfH

• Why are we messing around trying to do our own thing?

Scottish Telemedicine Centre

• Delivering for Health proposed it

• Based in Aberdeen

PC Infrastructure• Mix of ancient kit will slow apps and increase

support

• Microsoft Enterprise Agreement

• Patches/Virus/Security

• Mix of software stacks

• Cost of maintaining

Single logon / Authentication

• Security model needs enhanced to cope with increasing mix of systems/users/roles

• Need technology

• Need resource to manage

Comms capacity

• What is the projected life of existing bandwidth?

• Users expect it to limitless….

Business Continuity

• Are we covered for clinical/key systems?

• Managed Service vs Local Board Level Provision

• 24/7 Support

Current Risks• iSOFT

• Gpass

• National Procurement/Local Implementation

• NHS Board Revenue Capabilities

Questions?