national docman conference 2014
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National Docman Conference 2014. Docman: 10 years in Scotland Dr. Colin Brown GP Glasgow, SCIMP. National Docman Conference 2014 #Docman. 2003-4: Docman for all GP practices in Scotland Central funding Included training Key work for nGMS IT facilitators - PowerPoint PPT PresentationTRANSCRIPT
20 April 2023
National Docman Conference 2014 #Docman
National Docman Conference 2014Docman: 10 years in ScotlandDr. Colin Brown
GP Glasgow, SCIMP
National Docman Conference 2014 #Docman
National Docman Conference 2014 #Docman
National Docman Conference 2014 #Docman
2003-4: Docman for all GP practices in Scotland• Central funding• Included training• Key work for nGMS IT facilitators• Conversion program for those using other
suppliers e.g. Criffel, EMIS, InPS• Rapid upgrade of all practices to “paperlite”• Supported by www.scimp.scot.nhs.uk and
www.microtechsupport.co.uk
National Docman Conference 2014 #Docman
Docman makes it easy to customise the several names that can be given to each document:
The Document Naming sequence is • Document Type• Organisation (Location)• Specialty
All these are configurable: here are the options in our practice for our local DGH
Naming the documents
National Docman Conference 2014 #Docman
Custom names for documentsDoc type Location / care setting
National Docman Conference 2014 #Docman
Specialty:
National Docman Conference 2014 #Docman
Introducing a standard Folder Name:
National Docman Conference 2014 #Docman
47 National Folder Names
National Docman Conference 2014 #Docman
• Not customisable• Useable for our filing clerks• National agreement on Names 2005• National standard, so may be mandated• Software upgrade to user interface to mandate
the user to select and apply a National Folder Name 2006
Key features of new Folder Names
National Docman Conference 2014 #Docman
“The nice thing about standards is that there are so many to choose from” Andrew S Tanenbaum
"Those are my principles, and if you don't like them... well, I have others." Groucho Marx
The presence of a mandated National Folder Name is independent of any other local custom names for the document.
Standardisation of this list of names (index) enables its automatic use in other standard contexts
Standards…..
National Docman Conference 2014 #Docman
Accident & Emergency
Include Accident and Emergency letters
ExcludeGP Out of hours contacts Out of hours)
Administration
IncludeGeneral practice administrative paperwork, letters from patients, Benefits agency letters and requests, Insurance reports and requests. Criminal justice reports
ExcludeScanned clinical GP notes (Clinical)Scanned nursing notes (nursing)Employment medicals (Occupational Health)
AllergyInclude Allergy clinic
ExcludePatch testing (dermatology)RAST results (Labs)
BreastInclude Breast clinics, breast screening services
ExcludePlastic surgery (Plastics)Genetic clinics (Genetics)
CardiologyInclude
Cardiology, paediatric cardiology, cardiovascular risk factor clinics, cardiac surgery, thoracic surgery, ECG, ETT
Exclude Thallium scans (Imaging)
ClinicalInclude Scanned clinical GP notes
ExcludeGeneral practice administrative paperwork, letters from patients (Administration)Scanned nursing notes (nursing)
Complementary medicine
IncludeHomoeopathy, chiropractic, osteopathy, herbal medicine and any other complementary medication.Acupuncture except given as part of a physiotherapy programme or at pain clinic
Exclude Acupuncture given as part of a physiotherapy programme or at pain clinic (Pain)
Dental / Max-Fac
IncludeCommunity dentistry; oral medicine and surgery; orthodontics oral pathology; maxillofacial surgery
Exclude Plastic surgery (Plastics)
DermatologyInclude
Dermatology, paediatric dermatology, including patch testing and excisions carried out by dermatologists
Exclude Excision carried out by plastic surgeons (Plastics)
DieteticsInclude General dietetic services as well as diabetic, nephrology and nutritional support services.Exclude Specialist multidisciplinary obesity services (general medicine)
National Docman Conference 2014 #Docman
Update proposed 2014 (sample)
Imaging
Include Clinical radiology, ultrasounds, DEXA and nuclear medicine imaging
ExcludeInterventional radiology (Vascular), EEG (Neurology)Nuclear medicine laboratory results, e.g. C13 urea, Schilling tests (Labs)
Immediate Care
Include
Ambulance, other “999”, First Aid or voluntary servicesOut of Hours contacts with GP-, CMHT- and Nurse-led servicesNHS24 contacts and letters to NHS24111 contactsOther national or international variants of these services
ExcludeA&E, Community Nurse-led service contacts (Nursing)International specialties equivalent to specialties listed here
Infectious Diseases
IncludeInfectious diseases, including HIV and AIDS, including paediatric infectious diseasesSpecialist immunisation notificationsInfectious disease and tropical medicine reports
Exclude Pulmonary tuberculosis (Respiratory)
Labs
IncludeAll biochemistry, haematology, bacteriology and serology results, other Medical physics. Nuclear medicine laboratory results (C13 urea, Schilling tests). Blood grouping reports.
ExcludeRadiology results, nuclear medicine imaging including bone scans and DEXA (Imaging)Biopsy and post mortem results (Pathology)Cervical cytology results (Pathology)
Neurology
IncludeNeurology, neurosurgery, neurophysiology, paediatric neurology, neuromuscular, EEG, EMG
ExcludeNeuro-psychology (Psychology)Spinal and head injury rehabilitation (Rehabilitation)
National Docman Conference 2014 #Docman
GP Practice only e.g. proposal to rename OOH folder“Immediate Care” – a new name to expand the scope of the
Out of Hours folder to include various other new services from providers of healthcare directly to patients such as NHS24 (now operating both In and Out of Hours) and with urgency ranging from 999 calls to advice by the new 111 services, and services ranging from familiar local ones to those of international travel.
These new services were creating new uncertainties for their best filing destination*, and it was considered that “Immediate Care” would capture both the direct access and speed of these services whatever the service provider or location.This therefore replaces the folder named “Out of Hours”
* - note this addresses only the context of GP Practices
Context of the National Folder nameset
National Docman Conference 2014 #Docman
• PSD’s Project development re possible roles in scanning and archiving of records, as extension of role with deceased/embarked/untraced and Armed Forces records.
• Accreditation? for true paperless users after a managed process for selective back-scanning
• Avoid Print outs? for paperlite practices• Audit trails: investigate persistence• GP2PG issues re transfer processes?• serial transfer is full or incremental?
2006 issues
National Docman Conference 2014 #Docman
• started 2007 in Ayrshire and Grampian• completed Scotland-wide in 2009• except for 3 practices in Scotland
If receiving practice doesn’t use Docman – who does the printing? - not the GPs, but Practitioner Services Dept. do
• non-standard filetypes?• cross-border traffic for England, Wales and NI.
Deployment issues
National Docman Conference 2014 #Docman
Promotional Summary for D2D in 2008
Features Benefits
One-time Indexing Effective indexing due to universal standard
Automatic transfer between sites - immediate access for current “live” clinician- follows the patient between practices - practice staff and clinicians love it- looks like an integrated NHS to the new patient
All Primary Care covered in Index de-duplicates admin work across NHSso community clerical staff will love it too
Indexing only - clinical content untouched.
Data Quality 100% copy of original
Compatible with other data types ANY data can be converted to paper and scanned; most can also be imported directly into Docman.
Scalable to national cover Shareable staff training by national orgs.
National Docman Conference 2014 #Docman
• export Docman files for deceased patients?• QOF 8wks-to-summarise starts when?• use of eLinks background data transfer service• has eLinks run?• clear out the Docman Archive folder?• opening an archived record• comments are not transferred• including SCI Gateway referrals in export
Transfer of documents FAQ 2008
National Docman Conference 2014 #Docman
• Hospital specialty letters• Community letters• Lab results• Referral letters
- automatically linked from SCI-Gateway- imported as .html file (web-format)
• Any other documents: ad-hoc direct scans
• GP system record?
How complete is Docman record? - 1
National Docman Conference 2014 #Docman
Addition of GP system record as a document:
How to avoid printing out and re-scanning?• InPS Vision, EMIS PCS, Ascribe and iSoft had “export
whole record as document” options• is “the whole record” the Data Protection Summary?• GPASS work-around used Virtual Print Drivers to create
a .pdf of the print output• deployment of Virtual Print Drivers:
- by nGMS IT facilitators- by GPs per SCIMP website instructions
Complete GP record - 2
National Docman Conference 2014 #Docman
National Docman Conference 2014 #Docman
• eLinks background automatic transfer system• transports all NHS claims e.g. ons/offs• star network topology, not peer-to-peer• 3 Regional offices of PSD• operates overnight• QoS-like Priority scheduling for GP records
• “Docman Transfer” deployment 2009
Automatic transfer
National Docman Conference 2014 #Docman
FULL PATIENT RECORDS We would encourage GP Practices to create a wholly electronic Full Patient Record by
adding the GP System Record to Docman before export. This should be filed in the: National Filing Folder Name - ClinicalDescription – GP System RecordOrganisation – Exporting Practice Name and Practice Code This can now be done directly, without printing.For individual system instructions on how to do this, see: http://www.scimp.scot.nhs.uk/eRecords_docman.html Otherwise, GP Practices should print out the GP System Record and scan into Docman before exporting
Standard Operating Procedures: example
National Docman Conference 2014 #Docman
D2D issues
National Docman Conference 2014 #Docman
GP2GP solutions
England GP2GP v1.1 Scotland D2D
Transport Spine eLinks
Network topology Peer-to-peer Star to 3 regions of PSD
QA By sender By PSD using MedEx
Initiation Pull by new practice Push from old practice
GP system data HL7 TIF. MDI or JPG
Documents TIF TIF
GP Data: Doc reln. Attachment Inline
Metadata HL7 XML
Destination exceptions By practice By PSD
Cross-border By practice By PSD
National Docman Conference 2014 #Docman
Scotland’s GP2GP(S)
England GP2GP v2 Scotland GP2GP(S)
Transport Spine eLinks
Network topology Peer-to-peer Star to 3 regions of PSD
QA By sender By PSD using MedEx
Initiation Pull by new practice Push from old practice
GP system data HL7 HL7
Documents TIF TIF
GP Data: Doc reln. Inline Special document
Metadata HL7 XML
Destination exceptions By practice By PSD
Cross-border By practice By PSD
National Docman Conference 2014 #Docman
National Docman Conference 2014 #Docman
Naming the Specialties / Care SettingsDocman name ISD Specialty name + code other common Specialty names
Endocrine/Diabetes
A8 Endocrinology & DiabetesA81 EndocrinologyA82 Diabetes
Paediatric Endocrine & DiabetesOsteoporosis Clinic
ENT C5 Ear, Nose & Throat (ENT)
Paediatric ENT
Gastro-enterology
A9 Gastroenterology Liver Transplant
General Medicine
A1 General Medicine ITU Discharge to Physician CareSpecialist Multidisciplinary Obesity
General Surgery
C1 General Surgery
C11 General Surgery (excl Vascular)C3 Anaesthetics
ITU Discharge to Surgeon CareMinor Surgery
Genetics A3 Clinical Genetics Family History Cancer Care Clinic
Geriatrics AB Geriatric Medicine Geriatric Day Hospital Specialist Falls Clinic
National Docman Conference 2014 #Docman
Note how Docman has shown how multiple indexes can include Document Type and Care Setting.
An index of these 2 types of data-about-data, or “metadata” can be made valid across all Care Settings,
Now comes The Principle:
Connecting it all up - 1
National Docman Conference 2014 #Docman
“An index of Document Type, and an index of Care Setting, are sufficient to support automatic transfer of Document Types across all Care Settings on a national scale”
• approved by Professional Record Standards Board
• in application for British Standard approval• other indexes still valid for local use within own
Care Setting.
Connecting it all up - 2
National Docman Conference 2014 #Docman
“To conform to the standard a document management system would need to hold one entry from each of the lists as an instance of metadata relating to each individual document in its store.
From that metadata it would then be possible to construct a standard name in the form:
“Care Setting”:“Document Type”
e.g. if Care Setting = Gynaecology
and Document Type = Discharge Letter
then Name = Gynaecology Discharge Letter.
Connecting it all up - 3
National Docman Conference 2014 #Docman
Maintenance of DocType and Care Setting lists:
each maintained as Snomed subset by
UK Terminology Centre
England RFCs to
https://isd.hscic.gov.uk/rsp-snomed/user/guest/home.jsf
Scotland RFCs via Clinical Document Reference Group
Connecting it all up - 4
National Docman Conference 2014 #Docman
• Admin efficiency saving persists throughout a document’s lifespan in NHS– documents become portable between Care Settings with no
further admin action– make document indexing a one-time action at document
creation: “Index-at-Source”– use EDT - use Docman Hub
• All suppliers can support interoperability of documents by conforming to The Standard– enables GPSoC support?– can include documents from Social Care
• Data Quality 100% with digital copies of documents• Looks like an Integrated NHS to the patient
Benefits
National Docman Conference 2014 #Docman
National Docman Conference 2014 #Docman
The End
www.scimp.scot.nhs.uk
National Docman Conference 2014 #Docman
http://www.psd.scot.nhs.uk/professionals/medical/DocmanTransfer.html