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12 April 2015 National Docman Conference 2014 #Docman National Docman Conference 2014 Docman: 10 years in Scotland Dr. Colin Brown GP Glasgow, SCIMP National.

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Presentation on theme: "12 April 2015 National Docman Conference 2014 #Docman National Docman Conference 2014 Docman: 10 years in Scotland Dr. Colin Brown GP Glasgow, SCIMP National."— Presentation transcript:

1 12 April 2015 National Docman Conference 2014 #Docman National Docman Conference 2014 Docman: 10 years in Scotland Dr. Colin Brown GP Glasgow, SCIMP National Docman Conference 2014 #Docman

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3 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 and

4 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

5 National Docman Conference 2014 #Docman Custom names for documents Doc typeLocation / care setting

6 National Docman Conference 2014 #Docman Specialty:

7 National Docman Conference 2014 #Docman Introducing a standard Folder Name:

8 National Docman Conference 2014 #Docman 47 National Folder Names

9 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

10 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…..

11 National Docman Conference 2014 #Docman Accident & Emergency Include Accident and Emergency letters Exclude GP Out of hours contacts Out of hours) Administration Include General practice administrative paperwork, letters from patients, Benefits agency letters and requests, Insurance reports and requests. Criminal justice reports Exclude Scanned clinical GP notes (Clinical) Scanned nursing notes (nursing) Employment medicals (Occupational Health) Allergy Include Allergy clinic Exclude Patch testing (dermatology) RAST results (Labs) Breast Include Breast clinics, breast screening services Exclude Plastic surgery (Plastics) Genetic clinics (Genetics) Cardiology Include Cardiology, paediatric cardiology, cardiovascular risk factor clinics, cardiac surgery, thoracic surgery, ECG, ETT Exclude Thallium scans (Imaging) Clinical Include Scanned clinical GP notes Exclude General practice administrative paperwork, letters from patients (Administration) Scanned nursing notes (nursing) Complementary medicine Include Homoeopathy, 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 Include Community dentistry; oral medicine and surgery; orthodontics oral pathology; maxillofacial surgery Exclude Plastic surgery (Plastics) Dermatology Include Dermatology, paediatric dermatology, including patch testing and excisions carried out by dermatologists Exclude Excision carried out by plastic surgeons (Plastics) Dietetics Include General dietetic services as well as diabetic, nephrology and nutritional support services. Exclude Specialist multidisciplinary obesity services (general medicine)

12 National Docman Conference 2014 #Docman Update proposed 2014 (sample) Imaging Include Clinical radiology, ultrasounds, DEXA and nuclear medicine imaging Exclude Interventional radiology (Vascular), EEG (Neurology) Nuclear medicine laboratory results, e.g. C 13 urea, Schilling tests (Labs) Immediate Care Include Ambulance, other “999”, First Aid or voluntary services Out of Hours contacts with GP-, CMHT- and Nurse-led services NHS24 contacts and letters to NHS contacts Other national or international variants of these services Exclude A&E, Community Nurse-led service contacts (Nursing) International specialties equivalent to specialties listed here Infectious Diseases Include Infectious diseases, including HIV and AIDS, including paediatric infectious diseases Specialist immunisation notifications Infectious disease and tropical medicine reports Exclude Pulmonary tuberculosis (Respiratory) Labs Include All biochemistry, haematology, bacteriology and serology results, other Medical physics. Nuclear medicine laboratory results (C 13 urea, Schilling tests). Blood grouping reports. Exclude Radiology results, nuclear medicine imaging including bone scans and DEXA (Imaging) Biopsy and post mortem results (Pathology) Cervical cytology results (Pathology) Neurology Include Neurology, neurosurgery, neurophysiology, paediatric neurology, neuromuscular, EEG, EMG Exclude Neuro-psychology (Psychology) Spinal and head injury rehabilitation (Rehabilitation)

13 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

14 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

15 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

16 National Docman Conference 2014 #Docman Promotional Summary for D2D in 2008 FeaturesBenefits One-time IndexingEffective 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 Indexde-duplicates admin work across NHS so community clerical staff will love it too Indexing only - clinical content untouched. Data Quality 100% copy of original Compatible with other data typesANY data can be converted to paper and scanned; most can also be imported directly into Docman. Scalable to national coverShareable staff training by national orgs.

17 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

18 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

19 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

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21 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

22 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 - Clinical Description – GP System Record Organisation – Exporting Practice Name and Practice Code This can now be done directly, without printing. For individual system instructions on how to do this, see: Otherwise, GP Practices should print out the GP System Record and scan into Docman before exporting Standard Operating Procedures: example

23 National Docman Conference 2014 #Docman Document is human-readable - but clunky, and data not computable Structured data re-entry needed - promoted by nGMS QOF summarising Mediated by PSD - risk of delay to transfer – but is semi-automated - enables QA of received record re incompatible - attachment filetypes - destination / receiving practices - outwith Scotland - non-Docman Initiation is by pt. deduction via “Partners” message via eLinks to “push” from old practice, requiring some staff time > risk of delay D2D issues

24 National Docman Conference 2014 #Docman GP2GP solutions England GP2GP v1.1Scotland D2D TransportSpineeLinks Network topologyPeer-to-peerStar to 3 regions of PSD QABy senderBy PSD using MedEx InitiationPull by new practicePush from old practice GP system dataHL7TIF. MDI or JPG DocumentsTIF GP Data: Doc rel n.AttachmentInline MetadataHL7XML Destination exceptionsBy practiceBy PSD Cross-borderBy practiceBy PSD

25 National Docman Conference 2014 #Docman Scotland’s GP2GP(S) England GP2GP v2Scotland GP2GP(S) TransportSpineeLinks Network topologyPeer-to-peerStar to 3 regions of PSD QABy senderBy PSD using MedEx InitiationPull by new practicePush from old practice GP system dataHL7 DocumentsTIF GP Data: Doc rel n.InlineSpecial document MetadataHL7XML Destination exceptionsBy practiceBy PSD Cross-borderBy practiceBy PSD

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27 Naming the Specialties / Care Settings Docman name ISD Specialty name + code other common Specialty names Endocrine/ Diabetes A8 Endocrinology & Diabetes A81 Endocrinology A82 Diabetes Paediatric Endocrine & Diabetes Osteoporosis Clinic ENTC5 Ear, Nose & Throat (ENT) Paediatric ENT Gastro- enterology A9 Gastroenterology Liver Transplant General Medicine A1 General Medicine ITU Discharge to Physician Care Specialist Multidisciplinary Obesity General Surgery C1 General Surgery C11 General Surgery (excl Vascular) C3 Anaesthetics ITU Discharge to Surgeon Care Minor Surgery GeneticsA3 Clinical Genetics Family History Cancer Care Clinic GeriatricsAB Geriatric Medicine Geriatric Day Hospital Specialist Falls Clinic

28 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

29 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

30 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

31 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

32 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

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