BMA guidance on Scotland's eHealth Strategy


December 2007

Index The National eHealth/IM&T Strategy – ‘Delivering for Health’, was published in Scotland in April 2004. It provides the vision of a single electronic record. Developments in Scotland will largely be based on existing structures and the procurement of a set of products rather than a single system. Components of the programme include the following:

Community Health Index (CHI) number
The CHI is a unique identifier for each patient in Scotland. It will ensure that when a patient receives care in different places, parts of the record e.g. requests, referrals letters etc can be tagged with this number and collated together.

Emergency Care Summary (ECS)
The Emergency Care Summary system extracts demographical and clinical information from GP systems and holds it centrally so that it can be accessed by healthcare professionals working in an out of hours settings including NHS24. In addition to demographics, the record contains details of allergies, adverse reactions and current medication. Clinicians must ask their patient for their explicit consent to view their record before it is displayed on the screen. All accesses to this data will be audited, and the practice will be able to check who has looked at their own patients' records. Audits will also be run weekly by the PCT IT dept to check for fraud.

Phase 1 of the ECS Project is almost complete. The rollout, to all practices who wish to be connected, has been successful for over 90% of practices to date. At the time of writing 957 practices were actively sending data to the ECS store.

Work has been approved to incorporate a Palliative Care Summary in ECS. This will be the agreed ‘Gold Standards Framework’ summary, which many practices already use actively (using paper forms) to care for cancer patients. Systems are currently developing and testing to allow this to be implemented early next year.

The ECS Cross Border Access for all Health Boards was activated on 26th July. This will enable all Health Boards to view patient details if the patient is from out with their area. This is particularly important in areas such as Ayrshire and Arran where an estimated 40% of patients treated in A&E are from outside the Health Board.

Access to the ECS is being extended to A&E Departments and acute receiving units. Further plans for expanding ECS are being considered by the ECS board. Child protection status has been requested by SEHD as a high priority for inclusion.

A half million pound Scottish Information Campaign was rolled out across Scotland. A leaflet, explaining the Emergency Care Summary was sent to each individual. The leaflet included details of how they can opt out. The Emergency Care Summary Record has largely been welcomed by clinicians in Scotland although there were calls at the ARM 2007 for the Scottish Executive to agree appropriate security and policing for the increasing amount of confidential patient data held centrally.

The Scottish Care Information (SCI) Store
The Scottish Care Information Store is an information repository, connected to local systems, which has been designed to collate, store and provide controlled access to patient clinical information. The store contains information such as clinical letters and diagnostic results. You can see more about this .

SCI Gateway
The SCI gateway is a national system, which connects primary care and secondary care systems using internet technology. At present 35,000 referrals and discharges are made per month via the gateway. The site includes user guides, news and downloads.

SCI Discharge
Test results, diagnosis, treatment and discharge drugs are recorded using this software and then can be automatically incorporated into a patient’s discharge letter. The discharge letter can be sent electronically using the SCI Gateway.

SCI Outpatients
This supports the outpatient referral process. Components include an online appointment slot search, clinic management support and bar coding of patient information. Further information is available here.

Picture Archiving and Communications System (PACS)
National deployment of PACS began in October 2007 following pilots in hospitals across Glasgow and Dumfries and Galloway. It is hoped that the new system, Carestream Health, will be deployed across Scotland by January 2009. The project aims to create a platform to enable the seamless acquisition, storage, retrieval and display of digital patient images within and between clinical sites across Scotland.

Emergency Department Information System (EDIS)
This National A&E system allows patient tracking using a ‘whiteboard’ feature. Eventually touch screen technology will be incorporated. EDIS is currently being rolled out across Scotland and to date it has been rolled out in six Board areas.

GP Data Exchange Systems (GPEX)
This allows transfer of electronic patient summaries, consisting of a list of diagnosis Read codes and repeat prescriptions. In addition, a Docman transfer project allows the electronic transfer of scanned documents between practices, without the need to print them all out when a patient leaves.

ePharmacy
The ePharmacy service provides an electronic solution for the processing of prescriptions, provides support to pharmacists and should reduce the number of patients needing to visit their doctor to collect a prescription. The project includes developing a central patient registration system and more efficient payment processing systems and establishing training and support programmes for community pharmacists and their staff on the use of new systems. Over a million electronic prescriptions are already transferred per year.

Directed Enhanced Service (DES) for Benchmarking Information Governance and Data Quality Standards in GP Practices
A Directed Enhanced Service on Benchmarking Information Governance and Data Quality Standards has been agreed with the Scottish General Practitioners Committee. £3.885 million of funding has been earmarked. The DES will run from 1st October 2007 to 31st March 2008. Full details of the DES are available here.

Engagement
Engagement with clinicians to date has been positive and the BMA was represented on the National ehealth/IMT Board and on the Clinical Information Steering group. The governance process is currently under review.

The BMA is in the process of setting up a Scottish IT Committee and further details will follow.

© British Medical Association 2008

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