clinical portal catherine kelly ehealth clinical lead scottish government

Clinical Portal

Catherine KellyeHealth Clinical LeadScottish Government

• Why do we need it?

• What is it?

• What decisions and progress have been made?

• What is happening now?

Why do we need a Clinical Portal?

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”

SCI-DC

SpecialtySystem

Theatresystem

PACS Lab system

SCI store

EmergencyCare

Summary

PatientManagement

System

GP IT system

PATIENT

What is a Clinical Portal?

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

databases

Info

rmat

ion

Inte

grat

ion

and

Inte

rope

rabi

lityAp

plica

tions

Info

rmat

ion

Acce

ss

Integration Platform

Record Locator Service

PMSGP

SCI Gateway

Labs PACS/RIS Other

ECS SCI Store CHI

A&E

Process Management

PortalFramework

ClinicalDashboard

Management Dashboard

Patient Dashboard

Identity and Access Management(including Single Sign On)

Technology

Launch existing

modules and legacy apps in context

Launch existing

modules and legacy apps in context

Admission Summary

from PAS/PMS/EPR

Admission Summary

from PAS/PMS/EPR

Visit historyVisit history

Discharge history

Discharge history

Radiology reports

Radiology reports

Forward results

Forward results

Pathology reports

Pathology reports

Acknowledge results

Acknowledge results

Alerts from PAS/PMSEPR

Alerts from PAS/PMSEPR

Workflow specific views

Workflow specific views

Local Applications

Local Data

National Data Centre

National Applications

Local Applications

Local Data



Local Applications

Local Data


• 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

Clinical Portal- benefits

What do we have already?

GG&C Clinical Portal Usage StatisticsResults & Documents Viewed

2009 - 2010

0

20000

40000

60000

80000

100000

120000

140000

160000

W/e

04/

10/0

9W

/e 1

1/10

/09

W/e

18/

10/0

9W

/e 2

5/10

/09

W/e

01/

11/0

9W

/e 0

8/11

/09

W/e

15/

11/0

9W

/e 2

2/11

/09

W/e

29/

11/0

9W

/e 0

6/12

/09

W/e

13/

12/0

9W

/e 2

0/12

/09

W/e

27/

12/0

9W

/e 0

3/01

/10

W/e

10/

01/1

0W

/e 1

7/01

/10

W/e

24/

01/1

0W

/e 3

1/01

/10

W/e

07/

02/1

0W

/e 1

4/02

/10

W/e

21/

02/1

0W

/e 2

8/02

/10

W/e

07/

03/1

0W

/e 1

4/03

/10

W/e

21/

03/1

0W

/e 2

8/03

/10

W/e

04/

04/1

0W

/e 1

1/04

/10

W/e

18/

04/1

0W

/e 2

5/04

/10

W/e

02/

05/1

0W

/e 0

9/05

/10

W/e

16/

05/1

0W

/e 2

3/05

/10

W/e

30/

05/1

0W

/e 0

6/06

/10

W/e

13/

06/1

0W

/e 2

0/06

/10

W/e

27/

06/1

0W

/e 0

4/07

/10

W/e

11/

07/1

0W

/e 1

8/07

/10

W/e

25/

07/1

0W

/e 0

1/08

/10

W/e

08/

08/1

0W

/e 1

5/08

/10

W/e

22/

08/1

0W

/e 2

9/08

/10

W/e

05/

09/1

0W

/e 1

2/09

/10

W/e

19/

09/1

0W

/e 2

6/09

/10

W/e

03/

10/1

0W

/e 1

0/10

/10

Total Results Viewed

Documents Viewed

What decisions and progress have we made?

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

Why a common Integration Platform?

Information Access

Identity and Access Management

Integration and Interoperability

Single Sign OneForms

Context sharingRole

Based Access

Audit

Single Window

Information service (Allergies)

Information service(Test results)

Information service(Letters)

Information service (guidelines)

Information service (demographics)

Clinical Information store (eg ECS)

Clinical Information store (eg SCI Store)

Clinical Information store (eg SCI Store) CHIeLibrary

GP systems

SCI Store

etcPMS

choice

.

Integration Platform Process Management

Information service(Record locator)

Record location index

. .

•Minimise duplication of effort•Promote re-use of components•Ease the flow of information between systems and between Health Boards•Simplify national interoperability





information sharing

Agreed information priorities

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





information sharing

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

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

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

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

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

Primary Care EPR

• 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

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

IntegrationPlatform

Record Locator Service

Primary Care EPR Secondary Care EPR

PortalFramework

Identity and Access Management(including Single Sign On)

AdminGP

Labs

PACS/RIS

IDL Generator

Letters Generator

CHI

OOH Pharmacy A&E

Positioning the INPS Solution

Vision 360 (clinical server)

MiG

Ensemble

South or West solution?

?

Board choice

Vision 360 Clinical Dashboard (portal server)

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

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

Sourcing the data

Source Data or Use Interaction

Lothian MPI SCI Store Patient Search, demographics

Portlet

4 Board SCI Stores Results, Reports, Documents

Portlet

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

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





information sharing

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

Role based access

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