2. Catherine Kelly eHealth Clinical Lead Scottish Government
Clinical Portal
Catherine Kelly
eHealth Clinical Lead
Scottish Government

3. Why do we need it?
What is it?
What decisions and progress have been made?
What is happening now?

4. Why do we need a Clinical Portal?

5. Key to realising the vision set out in Better Health Better Care to
“..ensure that the right information is available at the right time, in the right place, to enable staff to provide the best possible care”
BHBC 2008

6. Those working in Primary Care will be familiar with use of computers to access and record clinical information.

7. Those working in secondary care more familiar with this model.
Information in multiple systems – multiple usernames and passwords.
No one has access to all information they need electronically.

8. There is marked inequity of access to electronic information between GPs and other doctors.
For patient health summary information, which all doctors ranked as being essential, access by GPs varies from 69% for patient alerts to 94% for current medication and allergies.
For other doctors 12% have access to current medication, 10% to allergies and 7% to past medical history
There is a similar inequity of access to clinical letters with 71-86% of GPs having access to all types of clinical letters compared with 2-26% of all other doctors.

9. Non-GP doctors have better access to lab and radiology results than to any other type of clinical information however, with the exception of Radiology images, GPs have better access to all types of diagnostic results.

10. What is a Clinical Portal?

11. Not single system but range of products and services
Provides “virtual” electronic patient record
Different types of information still held in separate databases

12. Technology

13. Launch existing modules and legacy apps in context
Workflow specific views
Admission Summary from PAS/PMS/EPR
Alerts from PAS/PMSEPR
Visit history
Discharge history
Portal provides virtual patient record for user even though information displayed on screen may have come from several sources
Acknowledge results
Radiology reports
Pathology reports
Forward results

14. National Applications
Local Applications
Local Data
National Applications
Local Applications
National Applications
Local Applications
Local Data
Local Data
Customisable – same as iGoogle page.
Can show information most relevant to different clinical groups
National Data Centre
National Applications

15. Clinical Portal- benefits
Reduced time spent searching for and retrieving clinical information
More complete and up to date patient record
Information available to support effective and safe delivery of clinical care
Reduced adverse drug events due to availability of medication information
Availability of results may reduce unnecessary duplicate tests
Reduced reliance on paper based processes

16. What do we have already?

17. Primary care information from GP IT and LTC systems
Roll out in Primary Care then to Secondary Care starting with ED

18. GG&C portal
Secondary care info- PAS, SCI store etc

19. 3156 clinical users
27,022 log ins
59,784 documents viewed
145,495 results viewed

20. What decisions and progress have we made?

21. Clinical Portal Programme Board
National Integration platform - Ensemble
Non-proliferation
Phased approach to delivery of key information requirements
Commissioned regional consortia work to identify portal solutions
Information assurance programme to support information sharing
CPPB established a year ago.
Chaired by DF.
Representation from Chief Exec, Medical and Nursing Directors, Patient Groups, BMA SGPC, CCLG

22. Why a common Integration Platform?
Minimise duplication of effort
Promote re-use of components
Ease the flow of information between systems and between Health Boards
Simplify national interoperability

23. Clinical Portal Programme Board
National Integration platform - Ensemble
Non-proliferation
Phased approach to delivery of key information requirements
Commissioned regional consortia work to identify portal solutions
Information assurance programme to support information sharing
2 portal already
No more than 2 others
Common look and feel to portals

24. Clinical Portal Programme Board
National Integration platform - Ensemble
Non-proliferation
Phased approach to delivery of key information requirements
Commissioned regional consortia work to identify portal solutions
Information assurance programme to support information sharing

25. Top 20 average scores across all clinical professional groups
Can be summarised as:
Patient Health Summary
PMH and current problem list
Current medication
Allergies and alerts
Treatment or Care plan
Events or procedures
Clinical Letters
Results
Knowledge Support
Clinical Notes
Clinical Observations

26. Agreed information priorities
Minimum requirement.
Initial plan to provide information within Board then across Boards

27. Discovery work
NHS Boards in different stages of readiness for implementing a clinical portal
The data items exist across a wide range of clinical systems within and across the NHS Boards
Varying levels of access to key data items that are required for inclusion in the portal
Key challenges
Developing interfaces
Data cleansing
Information Governance arrangements
Discovery work led by NHS Lothian with Deloitte – published Jan 2010

28. Clinical Portal Programme Board
National Integration platform - Ensemble
Non-proliferation
Phased approach to delivery of key information requirements
Commissioned regional consortia work to identify portal solutions
Information assurance programme to support information sharing

29. West consortium Dell-Perot commissioned report
Assess current state and identify dependencies
Investigate role of PMS in delivering clinical portal
Investigate whether Orion could be used in other Western Boards
Propose solution options and associated benefits
Make recommendations on way forward
West = GG&C, Lanarkshire, A&A, Golden Jubilee, Forth Valley
2 Boards in region implementing Intersystems PMS
GG&C – using Orion portal

30. Report findings All Boards keen to implement Clinical Portal
Initial focus on Acute Services
Strong clinical support
Best options - Intersystem HealthShare and Orion Portal
Significant benefits from shared work practices & approaches
Consistent clinical content and structure for presentation of information
Role Based Access Control (RBAC) + single sign-on

31. Recommendations Proof of concept with Intersystems using HealthShare
Run under WoS Consortium as single Programme Board
Confirm and document functional and technical requirements
Identify key interfaces and inter-board integration
Review wider architecture (incl. data sources, EDMS role)
Agree compatible RBAC/IG/ Single sign-on to support cross Board sharing
Want to explore option of PMS first – develop proof of concept to test capabilities - approval given to explore this option
Second approach would be to use Orion portal

32. North consortium
Understanding of clinical portal readiness and appetite within the region, and identification of required preparatory work
Understanding of viability and desirability of building on Clinical Portal solutions already in place within the region
Assessment of the potential impact of the national PMS and GPIT contracts on the approach to Clinical Portal
A proposed clinical portal strategy for the region
North = Tayside, Grampian, Highland, Shetland, Orkney, Western Isles
Deloitte commission – further investigation of options using GP IT systems

33. Summary of Findings Consensus for adopting a regional clinical portal
The majority of Health Boards currently do not have all the information priorities available electronically
Preference for an information focused incremental approach and not getting distracted by the presentation layer
SCI Store (eventually PMS) and Central Vision (NHS Tayside) are seen as the key sources for a Secondary Care EPR
Effort should be focused on exploring access to primary care information to support a Primary Care EPR

34. Primary Care EPR Real time information GPs control what is shared
Primary Care Summary 1
Past Medical History 2
Current Problem List 3
Current Medications 4
Allergies 5
Alerts
·       Conditions (i.e. diabetes)
·       Sensory Impairment
·       Communication Difficulties
·       Anaesthetic alerts
·       Mental Health Act
·       Child Protection Act
·       Adults with incapacity
·       Do not resuscitate
·       Risk Status
Real time information
GPs control what is shared
Coded information
Opportunities to improve data quality
Secure method of data extraction
Supports interoperability between INPS and EMIS

35. Positioning the INPS Solution
South or West solution?
Vision 360 Clinical Dashboard (portal server) ?
Vision 360
(clinical server)
Board choice
MiG
Developing a Primary Care EPR, which could then be shared with secondary care or others as applicable
Ensemble

36. Current position Regional database concept not approved by CPPB
North consortium to further clarify its proposal and provide evidence of key stakeholder buy-in
Continue work to assess information governance challenges
North Consortium to be appraised of West and South Consortia outcomes, to provide opportunities for consideration of alternative /complementary proposals

37. South consortium
Developed working prototype using Carefx portal to test key concepts and deliver information priorities
Aggregated data from multiple Boards from multiple live systems
Single sign and patient context management
No central repository containing data copies
Made use of Ensemble integration engine
Video of Working Prototype
South = Lothian, D&G, Fife, Borders
Only region without existing portal
Breast cancer network
3 months start to finish including evaluation
Test proof of concept and outline costs

38. Sourcing the data Source Data or Use Interaction Lothian MPI SCI Store
Patient Search, demographics
Portlet
4 Board SCI Stores
Results, Reports, Documents
Carestream PACS
Images
Standard AI
TRAKcare
Previous encounters
Portlet via Ensemble
ECS
Meds, Allergies
Launch from standard AI
External Links
Knowledge Bases, General Info
URL/HTTP
Developed “basic” portal to demonstrate information display

40. Current position Solution assessed by >90 clinicians
Very positive clinical feedback
Approval to develop business case
Implementation if business case approved
Special Health Board assessment of options

41. Clinical Portal Programme Board
National Integration platform - Ensemble
Non-proliferation
Phased approach to delivery of key information requirements
Commissioned regional consortia work to identify portal solutions
Information assurance programme to support information sharing

42. Information Governance concerns
Unauthorised staff will be able to access clinical information
Clinical portal will be “free for all”
Password sharing
Poor audit and monitoring of access to clinical systems
Staff not aware of their responsibilities
No single solution required but multipronged approach
Proposed IAM technical solution not achievable – user provisioning challenges

43. Role based access

44. Information Assurance
Single sign on
User passwords reset
User provisioning - Active directories/EESS
Role based access model
Audit of access e.g. Fairwarning
Consistent sanctions for dealing with inappropriate access or breaches of confidentiality
Information governance awareness and training
Multiple different strands of work
Needs to apply to all healthcare sectors – not just secondary care