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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!