Looking forward, pulling together and pressing on Lewis Ritchie

Looking forward,pulling togetherand pressing on

Lewis Ritchie

SCIMP 2008 Conference BallotInvitation 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 BallotInvitation 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…..

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

…but beware the Dubya binocular trap!

• 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

Scotland’s Health Challenge

eHealth to support world class patient

care

New Evidence &Clinical Trials

ScottishScottishCareCare

NetworksNetworks

Confronting the Health Care ChallengeFrom Cell to Community

Translating Excellence

In Life Sciences

CommunityCommunity CellCell

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

Patient Home

Patient enters

hospital*Available as and when required

*CH, RGH,

DGH

Community Care

Health information

etc

Specialists 65 Specialties

GPwSI

Primary Care

Diagnostics

Sexual Health

Services

Mental Health

Services

Pharmacy Dentistry

Optometry

GPs GPwSI

Practice, District Nursing, Health Visiting, AHPs

Emergency Care

In the past organisational and perceptual barriers have separated primary and secondary care

NHS 24

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.ukHeather Strachan

What it looks like:What it looks like:

Info

rma

tion

Inte

gra

tion

an

d

Inte

rope

rab

ility

App

lica

tions

Info

rma

tion

Acc

ess

Portal

Integration Platform

Single-Sign-On

Record Locator Service

ClinicalDashboard

PMSGP

SCI Gateway

Management Dashboard

Labs PACS/RIS GCS Other

ECS SCI Store CHI

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

““eHealth eHealth supporting the supporting the

best clinical care best clinical care and research and research

environment in environment in the world”the world”

AM’s four year “manifesto” – opportunity for change

Better Health Better Care

•We are committed to the delivery of high quality palliative careto 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)Palliative Care Summary (PCS)

• Macmillan Nurses led initiativeMacmillan Nurses led initiative

• Palliative Care FormsPalliative Care Forms– Based on Gold Standards Framework Based on Gold Standards Framework

Scotland (GSFS)Scotland (GSFS)– Paper process already in place in many Paper process already in place in many

GP PracticesGP Practices– IT Development to assist with key patient IT Development to assist with key patient

groupgroup– Underpinned by new GMS DESUnderpinned by new GMS DES

Elizabeth Ireland and Libby Morris

“ 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.

18 Weeks Referral to Treatment Time

Tracey Gillies

Current view of many clinicians

Quality

Speed of access

Key Message: Both please! - Imperative of service redesignand cultural change

INFORMATION GOVERNANCE

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.

George Fernie

Key message: getting confidentiality right for bothpatients and professionals

A proportionality testA proportionality test

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

Use

Adapt

Share

Generate / Synthesise

Evaluate

Source –Find / Capture

Analyse need

Information

Literacy Cycle

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 Success is a journey, not a destination!destination!

Choosing but one – ECS a Choosing but one – ECS a singular successsingular success

• ECS connected to 99% of practicesECS connected to 99% of practices

• Accessed by A/E, NHS24 and OOHsAccessed by A/E, NHS24 and OOHs

• Palliative Care Summary next developmentPalliative Care Summary next development

• Pilots in Grampian for EMIS and INPSPilots in Grampian for EMIS and INPS

• Next year for GPASS and ASCRIBENext year for GPASS and ASCRIBE

ECS AccessesECS AccessesECS Accesses - Cumulative Totals

0

200000

400000

600000

800000

1000000

1200000

1400000

1600000

Acc

esse

s

Cumulative Totals

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

“Unless we share information reliably we can’t improve care”

8th Annual Conference

“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 youfor listening

Thank youforlistening!

…and safe home!