An electronic patient record for CLEFTSiS – the National Managed Clinical Network for Cleft Services in Scotland John Clark, Lead Clinician CLEFTSiS and Trudie McDonald, Network Manager

The CLEFTSiS EPR project A pilot funded by the Scottish Telemedicine Action Forum (STAF) to develop an EPR linking 5 sites; Perth (Admin Centre for the MCN) Aberdeen Edinburgh Glasgow Inverness.

The CLEFTSiS EPR project Procurement Undertaken within the framework of EC/WTO rules governing Public Sector procurement under the direction of the Head of the Business Advisory Group of the Information Services Division (ISD). AxSys Technology commissioned to develop the EPR base on their system Requirement an electronic patient record which includes images (photographs, video, radiographs) and sound recordings. Application to STAF for funding

Concerns about the quality of care  The Clinical Standards Advisory Group (an independent source of advice to the UK Health Ministers and to the NHS) was asked to investigate the care provide in the UK. Background to the UK cleft service  Resources should be concentrated in UK centres instead of the current 57. There should be one centre in Scotland

Between 70 and 120 live births per year The Scottish solution

Care extends from birth to 20 years

Reorganisation of Scottish services following the CSAG report A Managed Clinical Network (CLEFTSiS) was established in April 2000 to provide and co- ordinate the highest standard of care for patients with cleft lip and/or palate, as far as possible in their own locality, to agreed national standards and guidelines. There would be only one centre – Scotland – with not less than two WTE cleft surgeons vested in three people who undertake surgery according to an agreed common protocol.

Combined clinic and treatment sites

The Managed Clinical Network

HDL (2002) 69 PROMOTING THE DEVELOPMENT OF MANAGED CLINICAL NETWORKS IN NHSSCOTLAND “A key factor in the success of MCNs is the use of integrated clinical information systems that span traditional organisational barriers”

A patient record familiar to clinicians.

Patient registered

Appropriate master protocol attached

Cleft lip and palate protocol attached

Relevant network personnel assigned to the patient’s Health Board

Clinicians reminded to collect audit records

Audiology audit form

Audit forms Photographs Study models Radiographs Video/sound recordings Progress notes Records collected

Record attached to EPR

Progress notes

Patient review summary

Special form activated from review summary

Reports

HDL (2002) 69 Provide more accurate ant timely information on the results of patient care and treatment in real time for the multidisciplinary team Connect patients with their carers for health education, disease prevention / management, and health promotion Promote professional education and implementation of agreed clinical guidelines Facilitate the tracking of patients through the healthcare system for the purposes of audit and quality improvement according to criteria defined by SIGN and Quality Insurance Scotland

Challenges Training Network members NHS Net Stretched IT resources in Trusts Difficulty in obtaining funding for additional licences and ongoing support

Thank you! to You, the audience for your attention STAF for funding the project CLEFTSiS members for their contribution and on-going support The staff of AxSys Technology