Key Information Summary (KIS) NHS Borders Webex Presentation 22 May 2013

Agenda Overview and Aims What is in a KIS? Consent Model Link to GP Contract EMIS Screenshots Experience and Feedback – Forth Valley Who can access KIS? Timescales and National Rollout Further Information

KIS Overview Aims to replace paper based faxing of “Special Notes” from GP Practices More generic version of ePCS Support for: –Anticipatory Care Plans (ACP) –Long Term Conditions Utilise existing ECS infrastructure and process eHealth Strategy and Quality Strategy deliverable by 2014 – all patients where appropriate to do so to be offered a KIS

What is in a KIS? All ECS and ePCS information automatically included Medication changes to include: –Single Dose / Frequency field –Medication Prescribed elsewhere detail –CMS Dispensed Date Triggers and reminders for expiry of information Consent to share information

4 Sections on KIS Form Section 1 – “Special Note” –Free text field of 2048 Characters –Expiry Date –Patient and Carer details including all agencies involved in care –Other demographics (Next of Kin) Section 2 – Current Situation –Medical Information and Diagnosis –ACP / Self Management Plan agreement –Home Oxygen

4 Sections on KIS Form Section 3 – Care and Support details –Homecare support –Incapacity / Guardianship –Power of Attorney Section 4 – Resuscitation –DNACPR –CYPADM (Children Resuscitation) –Current and Preferred Place of Care

KIS Consent Model Clinical decision to send KIS is made by GP Patient to be asked for consent to share information by GP –Different from ECS model –KIS is “Opt In”, ECS is “Opt Out” If patient unable to give consent then this is to be clearly recorded –Dementia patient –Patient who is a risk to others Emphasis is on sharing information if appropriate to do so

GP Contract New GP Contract in Scotland has QoF points available for Anticipatory Care Plans (ACP) –0.75% of patients in each practice in 2013/14 to have ACP in place –1.5% of patients in each practice in 2014/15 to have ACP in place Suggested that patients with SPARRA score of 20% - 60% are selected first for ACP ACP’s to be shared using KIS Guidance on SPARRA / ACP and KIS published by Scottish Government

KIS Overview Emphasis on “Summary” Only information appropriate to share will be available Only complete the fields you need to KIS record can be “built up” over time Sections are pre-populated as much as possible Read codes used as often as possible Current feedback is that KIS takes about 5 minutes to fill in KIS can be printed and shared with carers

EMIS Screenshots About to start national rollout as part of Release B SUBJECT TO CHANGE Provided as an overview and to show layout of KIS Further changes and improvements planned for Release E and F in 2013 Training Guide UG190 available from EMIS

Feedback from NHS Forth Valley All 56 GP practices have used KIS through EMIS as part of pilot Over 1000 patients have now had a KIS created Feedback provided via formal evaluation and PLT session Further evaluation ongoing

Feedback from NHS Forth Valley Time taken to complete KIS as part of ACP process varies from 2 minutes to 20 minutes –Depends on complexity of patient needs Most GP’s reported minimal impact on workload Positive feedback on layout and overall process Minimal requests for further information from patients

What GPs liked Good breadth of information Ability to add descriptive text Easy to use and navigate Much better designed than ePCS Structured, concise and easy to fill in Excellent for sharing info with relevant others

What GPs disliked Unable to import significant past problems (e.g. MI 1990) Would like to see slightly fewer tabs Entering carer information is not easy Delays to pilot starting and delays to wider implementation

Feedback from patients Very happy to share this information with relevant others Gives confidence when GP surgery closed Surprised that this was not happening already No problem as long as information is ‘secure’ Excellent idea Would not want some sensitive information from medical notes shared with others

End Users in Acute Hospital Information is clear and concise Would be good if we could also write to KIS rather than read- only Some of the KISs in pilot were of limited quality This information could dramatically improve the care we provide Good that it is not just for palliative care Anticipatory care information particularly useful

Who can access KIS? Any user of ECS will have access to KIS This includes: –NHS24 –OOH –A+E Departments –Scottish Ambulance Service –Hospices –Hospital Pharmacy Rollout extending to include: –Other Secondary Care Departments –Community Nursing (through MIDIS)

End user screenshot of KIS – A+E

Timescales and National Rollout EMIS Release B Rollout complete –All EMIS practices switched on for KIS automatically Updated version of KIS / EMIS to be released in September 2013 and November 2013 –Release E and Release F National Release for Vision in May 2013 currently in pilot

Further Information KIS website: KIS Blog: EMIS User Guide UG190 available from EMIS Vision User Guide and information Patient Information from NHS24: (BSL Video)

Questions?

Adastra Screenshots Provided as an overview and to show how KIS will appear in Out of Hours Important to note that Special Note field appears separately from KIS tab Alerts currently available in A+A and will be rolled out to all boards soon

On opening OLC warning appears to alert clinician – only if SPN, KIS or ePCS

End user screenshot of KIS – Adastra

End user screenshot of KIS – Adastra (Special Note)