Looking forward, pulling together and pressing on Lewis Ritchie

SCIMP 2008 Conference Ballot Invitation to give final talk Please choose and tick only one of the following options:- I am delighted & honoured to accept  I am reluctant & have serious misgivings about this great responsibility  You have sent this invitation to me by mistake 

SCIMP 2008 Conference Ballot Invitation to give final talk Please choose and tick only one of the following options:- I am delighted & honoured to accept  I am reluctant & have serious misgivings about this great responsibility  You have sent this invitation to me by mistake 

“Small men….. cannot handle great events” General Charles de Gaulle

Learning from the mistakes of others…..

To summarise key principles and take home messages The task: To summarise key principles and take home messages

An excellent Conference - packing it all in…..

Not biting off more than we can chew

A fair sense of proportion…. (proportionality)

Looking forward…. Values, vision and leadership Opportunities and obligations Pulling together and pressing on

What of our values….?

A rapidly changing and uncertain world..

Remembering why we are all here

The importance of the clinician-patient relationship: Essential humanity Intimacy Safety Truthfulness Mutual understanding Workable consent for information sharing

Key value: “…Do unto others as you would have done unto yourself…..”

A few guiding principles…..

Guiding principles Patient centred care = patient centred records Patient and health professional needs main drivers - not available technology Imperative of strong clinical leadership and professionalism

Guiding principles Universal CHI - key for successful record linkage – “journey of care” Cultural change and confidentiality concerns – are the ultimate obstacles - not technological constraints Incremental, measured progress v “big bang”

“Prove all things…hold fast to that which is good” The imperative of evaluation – establishing resilient models, sharing success and the avoidance of duplication of effort

Our Vision

…but beware the Dubya binocular trap!

Scotland’s Health Challenge Ageing population Increase in long term conditions Unhealthy lifestyles / obesity epidemic Leading to: Growth in emergency hospital admissions Pressure on services / waiting times & lists Compounded by: Remote and rural dimension Deprivation and inequalities Increasing public expectations Technological advances / cost pressures 24

Confronting the Health Care Challenge From Cell to Community Scottish Care Networks eHealth to support world class patient care New Evidence & Clinical Trials Translating Excellence In Life Sciences Community Cell

Vision Traditional boundaries of care – demarcated by sectors of provision - must give way to integrated care, focused on the patient ‘journey of care’ Primary and secondary care – the language of the past?

A patient centred service: the journey of care In the past organisational and perceptual barriers have separated primary and secondary care *CH, RGH, DGH Patient enters hospital* Patient Home Available as and when required NHS 24 Specialists 65 Specialties GPwSI Health information etc Pharmacy Dentistry Optometry Mental Health Services Sexual Health Services Diagnostics Primary Care Emergency Care Community Care GPs GPwSI Practice, District Nursing, Health Visiting, AHPs Source: Carol Black (modified), 2006

Our Vision for eHealth “exploiting the power of electronic information to help ensure that patients get the right care, involving the right clinicians, at the right time, to deliver the right outcome” Better eHealth Better Care NHS Scotland eHealth Strategy 2008 www.ehealth.show.scot.nhs.uk Our eHealth vision for eHealth in Scotland is to take a stepped approach towards the virtual electronic patient record. Electronic communication will become the primary means of sharing healthcare information eHealth will fast becoming a tool of clinical practice just like the stethoscope but it is more than that. It will also become a way of thinking as well as a way of working. It will support effective communication in an increasingly complex multidisciplinary and multiagency system, as well as providing information to support clinical decision and better knowledge management. Heather Strachan 28

eHealth strategy in the round: Continuing an incremental and pragmatic approach to long-term aim of electronic records Focus on: eHealth’s contribution to priorities such as 18 weeks and Shifting the Balance of Care Delivering benefits, not systems Integration across patient journeys Safer, more effective and efficient care Promoting patient engagement and self-care

What it looks like:

Without vision, we perish…… without values, we decay… without leadership, we lose our way

….and the leadership thing?

“essential…in partnership with technical and other health professional and administrative support staff – the team”

A defining moment, a new morning, hope for the future

Opportunities & Obligations

AM’s four year “manifesto” – opportunity for change “eHealth supporting the best clinical care and research environment in the world”

Better Health Better Care We are committed to the delivery of high quality palliative care to everyone in Scotland who needs it, on the basis of need not diagnosis, and according to established principles of equity and personal dignity. Extend the use of high quality generalist palliative care standards in all care settings

Palliative Care Summary (PCS) Macmillan Nurses led initiative Palliative Care Forms Based on Gold Standards Framework Scotland (GSFS) Paper process already in place in many GP Practices IT Development to assist with key patient group Underpinned by new GMS DES Elizabeth Ireland and Libby Morris

18 Weeks Referral to Treatment Time “ a whole journey waiting time target of 18 weeks from general practitioner referral to treatment …. by December 2011” Cabinet Secretary for Health and Wellbeing, Scottish Parliament – Official Report, 28th June 2007. Tracey Gillies

Current view of many clinicians Speed of access Quality Key Message: Both please! - Imperative of service redesign and cultural change

INFORMATION GOVERNANCE George Fernie Information Governance ensures necessary safeguards for, and appropriate use of, patient and personal information. Key areas are information policy for health and social care, IG standards for National Programme for IT systems and development of guidance for NHS and partner organisations. The MDDUS is a non-profit making, mutual, professional indemnity organisation which has been looking after the interests of doctors and dentists since its foundation in 1902. There are 3 medical defence organisations in the UK, the MDU, the MPS and ourselves. Our aim is to protect, support and safeguard the character and interest of our members and promote high standards of honourable practice. In order to do this we employ specialised and experienced doctors and dentists to advise on a personal basis to our members. Also, we retain solicitors with unrivalled knowledge and experience of medical litigation in both Scottish and English law. Further, we have access to experienced experts in all fields and dentistry. There is an active commitment by our organisation to both undergraduate and post graduate education in medico-legal and ethical matters. The Union is governed by its Council made up of medical and dental practitioners in general and hospital practice and is staffed by experts in the field of medical and dental negligence claims. The sort of work that we do involves the following areas:- · Consent · Confidentiality · Disclosure of Records · Court Appearances · Preparation of reports · Complaint by patients Key message: getting confidentiality right for both patients and professionals

A proportionality test A test of proportionality is the application of objective judgement as to whether the benefits outweigh the risks, using what some might call the test of reasonableness or common sense. Proportionality involves making a considered and high-quality decision based on the circumstances of the case, including the consequence of not sharing.

HealthSpace Development Patient portal through which they have a secure on line domain for their transactions with health service Aligned with Choices Place to store records – access on line electronic records-and also from which they can send information to their clinician Gillian Braunold

Key Messages - HealthSpace: Considerable potential for real patient engagement and supported self care enhancement Enhanced consent model possibilities Patient audit of care and of professional access Universality of eHealth – need to learn from other systems (to avoid the ‘Scots Wha Hae’ syndrome)

Information Literacy Cycle The intellectual processes, whether you call them knowledge management or information literacy, invovled in searching for and finding information to adapt and apply in new contexts are similar in the 18th and 21st centuries. Now we have a of variety tools at our disposal to find what we are looking for in a vast array of media. The healthcare practitioner has to make countless information choices everyday. Although we rely heavily on published information, personal contact still plays an important role in knowledge development, and the portal has been developed to support that fundamental requirement. eHealth has the potential to support and underpin every aspect of healthcare and delivery of services. Yet the sheer abundance of information is overwhelming in our time pressured and resource stretched work environment. Heather Strachan

Key Message Shared understanding and optimal use of health care information key for both patients and health professionals

Data Transfer v Data Migration Not synonymous Complex and usually incomplete Classification of Diseases etc continues to evolve “Transfer of electronic patient records from one general practice to another a key milestone in primary care computing” Leo Fogarty

Pulling together and pressing on

Looking forward…a word of encouragement

Success is a journey, not a destination! 53

Choosing but one – ECS a singular success ECS connected to 99% of practices Accessed by A/E, NHS24 and OOHs Palliative Care Summary next development Pilots in Grampian for EMIS and INPS Next year for GPASS and ASCRIBE

ECS Accesses

“Much has been achieved… there is much still to do…”

“Unless we share information reliably we can’t improve care” 8th Annual Conference “Unless we share information reliably we can’t improve care”

“That will require high quality leadership, professionalism and commitment at all levels… and we’re all in this together

Scary journey but safe outcome!

“We can achieve more provided we are prepared to give others the credit” Ronald Regan

Final thoughts:

America today has a new face as President, so farewell Dubya!

Size does matter…..

Thank you for listening

…and safe home!