eHealth Strategy 2011-2017 (Revised July 2012 to include a Sixth Strategic Aim)

2. How eHealth Is Making A Difference To Healthcare In Scotland

National programmes and projects have been delivered by the Scottish Government's eHealth Directorate in partnership with NHS Boards and Boards working together to acquire, implement and get the benefit from eHealth solutions. Our 2008 priorities were closely aligned to the key health service business challenges of 18 weeks Referral to Treatment, Mental Health, Long Term Conditions, integration across patient journeys and improving capability and capacity. Convergence around common technologies was a major eHealth strategic ambition, with the benefits of lower costs and simplified maintenance.

2.1 Working in collaboration

Boards are well advanced with collaboratively delivering the key aims of the 2008-11 strategy, such as the Patient Management System (PMS), new national GP IT solutions and clinical portal technologies (or electronic windows to information). Boards are also making progress with other shared clinical solutions, such as those supporting chemotherapy prescribing and the National Sexual Health System, and the national Picture Archiving and Communication System (PACS).

Stephen Kettlewell, Consultant Vascular Surgeon/Deputy Clinical Director, NHS Lanarkshire, said: "Just started using TrakCare this morning at my clinic. Admittedly it took us about half an hour to work it out, but now we are flying. It's absolutely brilliant. It's really easy to use, takes only a few seconds to complete and, best of all, you can see on a single screen exactly who you've still to see, whether they've arrived, whether you've done the outcome etc etc. And hats off to the IT guys who were around to hold our hands. At first I was blind, but now I can see..."

Paul Leonard, consultant in Emergency at St Johns Hospital and the Royal Hospital for Sick Children in Edinburgh, said: "All the Emergency Departments in NHS Lothian rely on TrakCare to support the delivery of high quality clinical care in a timely fashion. The electronic patient record allows clinicians to quickly review the clinical information and results relating to previous episodes as well as those from the current attendance, and the interaction with PACS makes viewing radiological investigations straightforward. It is difficult to imagine how we would manage without it".

A consortium of five Boards, supported by the Scottish Government, undertook a joint procurement and selected the TrakCare PMS. The benefits of this collaborative approach are considerable; driving the convergence and standardisation of IT systems at substantially lower cost than could be achieved if Boards were working locally and individually, while maintaining the local ownership that is vital to the successful implementation of these complex changes. Ensuring Boards are able to use the same system improves clinical and administrative management of patient information and frees up staff to spend more time in front-line services. This is releasing time for frontline care and reducing the burden of bureaucracy across NHSS. Collaborative working amongst these Boards is also leading to standardisation and has helped create a version of TrakCare that is known as the Scottish Foundation System. Six Boards now have the opportunity to share support, expertise and experience (TrakCare was already in use in one Board before the procurement), and when fully implemented this system will cover some 75% of NHSS by population.

NHS Boards are also working in three regional consortia, each developing different aspects of the Clinical Portal programme. The South and East region Boards have been working to deliver a prototype portal solution and in February 2011 awarded a contract to deploy a portal across the four Boards during 2011/12. Meanwhile actual use of NHS Greater Glasgow & Clyde's clinical portal continues to increase rapidly, demonstrating the value placed by clinicians on improved availability of patient information in support of direct patient care.

Dr Jamie Traynor, consultant in renal medicine at Monklands Hospital, NHS Lanarkshire, said: "This PMS is, to me, the first major leap towards a hospital wide electronic patient record with huge advantages in the delivery of patient care."

2.2 Sharing technology and services

A Chemotherapy Electronic Prescribing and Administration System (CEPAS) began operation at the Beatson West of Scotland cancer hub in December 2010, beginning a roll-out programme that will see implementation across four west of Scotland Boards in 2011. Benefits include: improved patient safety; more people centred delivery of services locally; improved communication; and effective use of resources. Other regional cancer networks are also implementing regionally networked CEPAS systems. Another shared solution is Renal PatientView (RPV), which gives patients with renal disease access to elements of their records.

Malcolm Gordon, NHS Greater Glasgow & Clyde, said: "The Clinical portal has almost eliminated the need to request paper case notes when seeing emergency patients. It has provided information from all Glasgow hospitals when in the past we were restricted to the case notes for one site plus the patient‟s memory. Having a view across the HB is enormously helpful…"

2.3 National systems and solutions

The national CHI Programme was established to support universal use of the CHI number as NHSS's unique patient identifier. During the lifetime of the Programme from 2005-10, Boards achieved significant improvements, resulting in a CHI compliance target of 97% on clinical communications being exceeded. The Programme focused on simple, sustainable changes to both culture and working practices that delivered significant and measurable improvements in the use of CHI across Scotland. Use of the CHI number as part of safe patient identification will continue to be key to current and future initiatives such as increased regional working, migration to new PMSs and increased use of portal technologies.

The national eReferral programme makes the referral process quicker, safer and better for both patients and staff. By the end of 2010 national monthly performance for referrals received through SCI Gateway had increased to 96%, with 66% of cases being managed electronically, and 6 Boards had an average referral time of less than 6 days.

Alistair Bryden, General Dental Practitioner in NHS Forth Valley, said: "There is now a facility to monitor the entire referral process from the (dental) practice to the patient being seen by the receiving consultant practitioner."

The PACs programme has supported the seamless acquisition, storage, retrieval and display of digital patient images within and between clinical sites across Scotland. It offers the opportunity for radiology reporting to be done remotely, utilising telehealth and potentially facilitating much more flexible working.

The national Emergency Care Summary (ECS) is making a big difference in the unscheduled care setting.

A&E clinician, said: "One of the best tools for improving patient safety. Before the ECS we often had to work blind with no information at all."

Its use is continuing to increase in all Boards across Scotland. In 2009 there were over 2.1 million accesses and in 2010 around 2.5 million accesses. By the end of 2010 there had been over 6.6 million assess since its launch.

The commitment in the 2008-11 Strategy to replace the most common GP IT system in Scotland (GPASS) has been taken forward. The Scottish Government commissioned a consortium of Boards, led by NHS Greater Glasgow & Clyde, to develop a business case and run the procurement process. The work was completed in 2010 with a framework contract allowing a choice of two modern commercial products. The products selected were the second and third most common in use in Scotland and the strategy will deliver improved IT facilities to General Practice, choice consistent with the GP contract and with convergence on fewer more modern IT systems.

A & E Department, Crosshouse Hospital, NHS Ayrshire & Arran: Boy B age 17, taken to A & E with O/D. Unconscious, ECS accessed, no medication listed. Fathers‟ ECS accessed with permission, lifesaving therapy started immediately.

In 2008 the ePharmacy Programme introduced the Electronic Transfer of Prescriptions (ETP) between GP practices, community pharmacies and Practitioner Services Division (PSD). This has improved patient safety by reducing transcribing errors, modernised service delivery and increased the efficiency of the processing of prescriptions by removing the reliance on paper. This is the first live national system to fully support ETP in the UK. The programme has also supported the development of a web-based pharmaceutical care planning tool, the Pharmacy Care Record (PCR), to assist pharmacists in providing pharmaceutical care for patients with long term conditions in order to ensure they get the best outcomes from their medicines.

The strategic building blocks of a national technical architecture have also been assembled. This has included standards, principles and access to enabling technologies.

Significant progress has been made on telehealth and telecare developments, with increasing convergence between these previously separate areas of activity over the past 18 months. A review of the Scottish Centre for Telehealth (SCT) in 2009 resulted in the SCT being brought within the organisation and governance framework of NHS 24 and an interim telehealth strategy (2010-12) being published in April 2010^[2]. This strategy re-focused telehealth activity on four clinical programmes of work which would be delivered across Scotland. From 1 April 2011, the activities of the national telecare programme have been merged with the SCT within NHS 24 offering considerable opportunities for improved health and social care integration. Continued links with the Joint Improvement Team will also be maintained to support local partnership programmes. A strategy which will bring the work of the SCT, the telecare programme and NHS 24 together will be developed.

The Scottish Government has been working with NHS Boards to promote safe, effective and appropriate use of information by providing strategic direction through the publication of an Information Assurance Strategy and core guidance including:

• Records Management: Code of Practice^[3]
• Mobile Data Protection Standard, which requires all mobile devices to be encrypted^[4]
• NHSS Code of Practice on Protecting Patient Confidentiality^[5] and
• Information Governance Educational Competency Framework^[6]

Through collaboration with the Academy of Medical Royal Colleges, the Scottish Government has developed a joint eHealth Competency Framework for practising clinicians who have a role in eHealth at local, regional or national level. It is anticipated that this Framework will inform the eHealth component for undergraduate and postgraduate training in Scotland and continuous professional development across NHSS^[7].

A summary of our performance against the actions and aims contained in the eHealth Strategy 2008-11 can be found in Annexe 1 of this document.