An electronic Patient Record for the Cleft Lip and Palate Managed

Clinical Network in Scotland (CLEFTSiS).

A solution not without challenges.

John Clark, Lead Clinicianand

Trudie McDonald, Network Manager

• Background• Requirement for an EPR• Funding• Procurement• Development• Implementation• Rollout

Multidisciplinary Care from birth to 20 yrs

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 8 - 15 UK centres instead of the current 57. There should be one centre in Scotland

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.

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”

• Background• Requirement for an EPR• Funding• Procurement• Development• Implementation• Rollout

Combined clinic and treatment sites

•Photographs•Study models•Radiographs•Video/sound recordings•Audit data

•Surgery•SLT•Orthodontics/dentistry•Audiology•Clinical psychology

Records required for outcome assessments

• Background• Requirement for an EPR• Funding• Procurement• Development• Implementation• Rollout

Scottish Telemedicine Action Forum (STAF)

Funded a pilot to develop an EPR linking 5 sites;

Perth(Admin Centre for the MCN)

AberdeenEdinburghGlasgowInverness.

• Background• Requirement for an EPR• Funding• Procurement• Development• Implementation• Rollout

The CLEFTSiS EPR project

ProcurementUndertaken 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).

commissioned to develop the EPR based on their system:

• Background• Requirement for an EPR• Funding• Procurement• Development• Implementation• Rollout

Dataset and protocols

Design

A patient record familiar to clinicians

Stages in a protocol clearly displayed with coloured

buttons providing links to other forms

Colour coded flags are set to show the status of interactions with the

patient

Manage the clinical network by defining roles and including

participating hospitals or health authorities

Examples of reports that can be generated by

Excelicare

Patient review summary

• Background• Requirement for an EPR• Funding• Procurement• Development• Implementation• Rollout

NW Manager and Audit secretaries

Network Manager, Perth Royal Infirmary (0.5 WTE)

Audit Secretary, Perth Royal Infirmary (1.0 WTE)

Audit Secretary, Glasgow (Yorkhill/Dental Hospital) (0.6 WTE)

Audit Secretary, Edinburgh (RHSC) (0.6 WTE)

Audit Secretary, Aberdeen (RACH) (0.4 WTE)

CLEFTSiS Admin Support03/12/2003 - v3

Architecture ExcelicareClient PC

ExcelicareData Store

Server

ExcelicareClient PC

TaysideFirewall

ExcelicareClient PC

InvernessFirewall

EdinburghFirewall

ExcelicareClient PC

Dial In Server

ExcelicareClient PC

NHSNet /Healthnet

GrampianFirewall

GlasgowFirewalls

ExcelicareClient PC

ExcelicareClient PC

IT Infrastructure Challenges

Network firewalls - chain of contacts/procedures

Switchover from CW to BT ( NHSNet / HNC)

Trouble-shooting - who can solve what?

IT Infrastructure solutions?

raise awareness at local Trust IT level of usage of NHSNet/Firewalls for cross-Trust projects

central Technical person to oversee x-Trust interfaces / firewalls?

ensure support for tracing problems is part of HNC contracts (or provide TraceRoute type tools..)

• Background• Requirement for an EPR• Funding• Procurement• Development• Implementation• Funding the rollout

Cost to Health Boards

£0

£5,000

£10,000

£15,000

£20,000

£25,000

£30,000

£35,000

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InitialAnnual maintenance

Achievements

Improved collection of audit recordsAble to perform ad-hoc queries for analysis/researchNational system with centrally held data (including multi

media) and client connections into five TrustsSoftware EPR tool with potential to grow with the serviceDeveloping good relationships with IT staff in the five sitesPossibility that it will be adopted UK wide

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