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NI Electronic Care Record - Des O'Loan
1. NI Electronic Care Record (ECR) Dr Roy Harper Consultant Physician and Endocrinologist Desmond O’Loan HSCB e Health & Social Care Team
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15. Today PAS A&E PACS South Eastern Labs Renal G P Comm H&C Others Belfast Northern Southern Western Western GP’s
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17. Tomorrow Patient Access to Personal Health Records Belfast Western Northern Southern Southeastern Single sign-on, Security, Auditing, Business rules GP’s
19. Currently 16 interfaced systems External BCH Ulster H&C index Master Patient Index MPI A&E A&E General Practice -ECS Carryduff, Priory Laboratory Master lab Laboratory BSO PAS episodes PAS episodes IUVO Clinical documents Clinical documents Cloverleaf GE RIS Report + Image NIPACS Report + Image SoScare PARIS
44. NI Electronic Care Record (ECR) A Physician’s Perspective Dr Roy Harper Consultant Physician & Endocrinologist The Ulster Hospital Visiting Professor, School of Mathematics and Computing The University of Ulster
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48. Connected Health in NI The road to a regional electronic care record for the population of NI Experience so far Strategy being realised
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50. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Diamond Diabetes ECR installed HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ Emergency Care Record Pilot Goes Live ECCH set up Start of H&C Number roll out Wireless Carts NI BCS Healthset up First COM 723 at UUJ Local PACS Tablet PCs and remote access Regional EHR Research Group Established 2009 PatientCentre [email_address] Appointed as Physician in UCHT RPA Roll out of PCs in all OPD Consulting Rooms Pilot ECR NIPACS 2010
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62. Washington Hospital Centre (MedStar Health), Washington DC, USA. Largest private academic hospital in Washington DC (926 beds) Leading centre for cardiology, oncology and trauma EHR originated from and designed by ER clinical staff Taken 15 years Originally known as Azyxii – now bought by Microsoft (Amalga TM )
63. Washington Hospital Centre - EHR Integrates data of all sorts from multiple legacy systems Displayed in a highly customisable role-based data dense user interface. ‘ Take it and show it’ philosophy Users define their own information needs and ‘views’
64. Washington Hospital Centre - EHR Listing and searching facilities are extensive Clinical questions easily answered ‘on the fly’ Limited direct data entry in the ER Some text-based information is scanned in Document creation Supporting hospital performance management and finance department
65. Capital Health Edmonton Area, Alberta, Canada (www.capitalhealth.ca) Provides a complete range of health services to 1.7 million people Employs 30,000 staff Pioneered the development of a web-based EHR across its catchment area and beyond Now well developed Cost 10 million Canadian dollars with a deployment time of 9 months
66. Capital Health - EHR Project driven by clinicians with total senior management buy-in Information from 25 data sources brought together using integration software (Concerto TM from Orion Health) Legacy systems stand as before – updated or replaced as needed The ‘netCARE’ portal is up and running and in use (>20,000 accessing per day)
67. Capital Health - EHR ‘ Dashboard’ presented to users is easy to use Training takes 5 minutes Single sign one with pass through to legacy systems as required Largely read only Linked to a pharmacy information network Bolted on chronic disease management modules
68. Capital Health - EHR Information for clinical use only No secondary uses allowed Local population buy-in Some patient data masked Access only to selected clinicians with robust audit of all ‘break the glass’ events
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72. External BCH Ulster H&C index Master Patient Index MPI A&E A&E General Practice -ECS Carryduff, Priory Laboratory Master lab Laboratory BSO PAS episodes PAS episodes Clinical documents Clinical documents GE RIS Report + Image NIPACS Report + Image SoScare SoScare PARIS PARIS
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81. Today PAS A&E PACS South Eastern Labs Renal G P Comm H&C Others Belfast Northern Southern Western Western GP’s and Community Services
82. Tomorrow Patient Access to Personal Health Records Belfast Western Northern Southern Southeastern Single sign-on, Security, Auditing, Business rules GP’s
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86. Technically feasible Well accepted and used by clinicians Increased patient safety and reduction of medical errors. Decrease in unnecessary and costly medical tests and procedures. Increased efficiency and a shorter care cycle. Improved patient care. Improved integration between acute and primary care. ECR POC Evaluation
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92. NI Electronic Care Record (ECR) A Physician’s Perspective Dr Roy Harper Consultant Physician & Endocrinologist The Ulster Hospital Visiting Professor, School of Mathematics and Computing The University of Ulster
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100. Connected Health in NI The road to a regional electronic care record for the population of NI Experience so far Strategy realised
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Hinweis der Redaktion
Collapse – world today - What is this attempting to convey? Regions are not sharing emr, ehr or domain data?
ECR VISION - is achievable
Introduction
Introduction – may not be needed as follow on from Johnny
Collapse - Is this a collage of 2 worlds? Paper and e? Not exactly sure what its conveying
Collapse -- What is this attempting to convey? Plethora of e-care solutions?
DW - Changed wording
The UKPDS showed that: Coronary artery disease is the major cause of mortality in patients with type 2 diabetes mellitus Patients without evidence of disease related to atheroma at diagnosis of type 2 diabetes mellitus had an increased standardised mortality ratio compared with the population of the United Kingdom 11% of patients in the study had a myocardial infarction or developed angina over a median of 8 years' follow up The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycaemia, and smoking; these are also risk factors for coronary artery disease in the general population Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). British Medical Journal 1998; 316: 823-828.
The UKPDS showed that: Coronary artery disease is the major cause of mortality in patients with type 2 diabetes mellitus Patients without evidence of disease related to atheroma at diagnosis of type 2 diabetes mellitus had an increased standardised mortality ratio compared with the population of the United Kingdom 11% of patients in the study had a myocardial infarction or developed angina over a median of 8 years' follow up The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycaemia, and smoking; these are also risk factors for coronary artery disease in the general population Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). British Medical Journal 1998; 316: 823-828.
The UKPDS showed that: Coronary artery disease is the major cause of mortality in patients with type 2 diabetes mellitus Patients without evidence of disease related to atheroma at diagnosis of type 2 diabetes mellitus had an increased standardised mortality ratio compared with the population of the United Kingdom 11% of patients in the study had a myocardial infarction or developed angina over a median of 8 years' follow up The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycaemia, and smoking; these are also risk factors for coronary artery disease in the general population Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). British Medical Journal 1998; 316: 823-828.
The UKPDS showed that: Coronary artery disease is the major cause of mortality in patients with type 2 diabetes mellitus Patients without evidence of disease related to atheroma at diagnosis of type 2 diabetes mellitus had an increased standardised mortality ratio compared with the population of the United Kingdom 11% of patients in the study had a myocardial infarction or developed angina over a median of 8 years' follow up The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycaemia, and smoking; these are also risk factors for coronary artery disease in the general population Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). British Medical Journal 1998; 316: 823-828.
The UKPDS showed that: Coronary artery disease is the major cause of mortality in patients with type 2 diabetes mellitus Patients without evidence of disease related to atheroma at diagnosis of type 2 diabetes mellitus had an increased standardised mortality ratio compared with the population of the United Kingdom 11% of patients in the study had a myocardial infarction or developed angina over a median of 8 years' follow up The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycaemia, and smoking; these are also risk factors for coronary artery disease in the general population Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). British Medical Journal 1998; 316: 823-828.
The UKPDS showed that: Coronary artery disease is the major cause of mortality in patients with type 2 diabetes mellitus Patients without evidence of disease related to atheroma at diagnosis of type 2 diabetes mellitus had an increased standardised mortality ratio compared with the population of the United Kingdom 11% of patients in the study had a myocardial infarction or developed angina over a median of 8 years' follow up The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycaemia, and smoking; these are also risk factors for coronary artery disease in the general population Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). British Medical Journal 1998; 316: 823-828.
The UKPDS showed that: Coronary artery disease is the major cause of mortality in patients with type 2 diabetes mellitus Patients without evidence of disease related to atheroma at diagnosis of type 2 diabetes mellitus had an increased standardised mortality ratio compared with the population of the United Kingdom 11% of patients in the study had a myocardial infarction or developed angina over a median of 8 years' follow up The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycaemia, and smoking; these are also risk factors for coronary artery disease in the general population Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). British Medical Journal 1998; 316: 823-828.
Show this is a high level plan – is the pilot funded? Outcomes? -Is a Business Case needed for full HSCNI? What does the business case need to have? What incremental Evidence of?
I do not have time to do a live demo but hear are a few screenshots of what the pilot ECR looks like. Amazing information. Looks complex but for clinicians easy – takes a few minutes training to get up to speed.
All the documents I need at the click of a button
Lab results collated from various laboratories
X-ray reports and images
Up to date medication lists. Some people are on a lot of pills!! No longer have to ring GP surgery and ask them to fax through list of medications!!
Collapse – world today - What is this attempting to convey? Regions are not sharing emr, ehr or domain data?
ECR VISION - is achievable
A match will be made if the data in the message exactly matches that in the MPI on the following items: HCN or PAS Internal Number or Casenote Number AND Surname and Date of Birth and Gender NB Blank spaces and punctuation marks have been removed from surnames for matching purposes to allow, for example, O’Connor, O Connor and OConnor to be read the same.
The role of ICT Success requires…Leadership and Funding
The role of ICT Success requires…Leadership and Funding
Introduction
Introduction – may not be needed as follow on from Johnny
Paperwork overload. Bit of an exaggeration – frontline HSC staff don’t have desks! Spending so much time documenting the care we give that it is seriously eating into the time we have for direct patient bed-side care. Well meaning folks from patient safety side, infection control, medicines management side, governance side are coming up with very valid new processes but what that usually means for staff on the frontline is another page or two of an A4 form to fill out!
What this means is that we are free of the dreaded charts. Instead of arriving at my clinic with a trolley load of charts I can at the click of a few computer keys see all the relevant information I need (and some besides) on all my patients. When on call I can be fully appraised of my patients clinical situation in a few seconds rather than wait until all the clinical offices and services start up on Monday morning!
What I have discovered is that a lot of the key information we need as clinicians to support patient care is already available in lots of different clinical computer systems spread across the service. Some are good some are not. Some we have access to some we don’t but there is information in there that is really valuable – allergies, medication lists, letters, laboratory results, x-ray reports and images, and lots more. Hard to get at as you can imagine. We need to bring it all together.
I do not have time to do a live demo but hear are a few screenshots of what the pilot ECR looks like. Amazing information. Looks complex but for clinicians easy – takes a few minutes training to get up to speed.
All the documents I need at the click of a button
Lab results collated from various laboratories
X-ray reports and images
Up to date medication lists. Some people are on a lot of pills!! No longer have to ring GP surgery and ask them to fax through list of medications!!
No surprises here – the solution is to move to computerized clinical information systems. Much better.. Have a good IT infrastructure. We have computing power right up to the bed-side now. We just don’t have the clinical information systems as yet but we need to be freed to work on these! We need to move away from the big bulky inflexible systems from large usual suspect suppliers who provide lousy solutions at inflated costs.