emergency care summary
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Emergency Care SummaryLibby Morris
Chair of ECS Programme Board
General Practitioner Scotland
Agenda
• Emergency Care Summary
• Dataset
• System Overview
• Usage
• Palliative Care Summary
• Evaluations and Clinical Feedback
• Future Direction and Challenges
Overview
• Patient Safety is key driver
• Read only record extracted twice daily from
GP Practice Systems
• Integration with Out of Hours and
Emergency (A+E) Departments
• One national store for all of Scotland
• Explicit Consent to view ECS record
Agreed Dataset
• Patient demographics (address, telephone, CHI
number)
• Allergies and Adverse Reactions to medications
• Medication history
- Repeat prescriptions in past 12 months
- Acute prescriptions in past 30 days
• Consent Flag
• Patient opt out status
OOH
clinician ECS summary
request &
display
ECS update
1. During consultation
2. Due to prescription
3. Other Patient contact
Who saw
who for
practice?
ECS
System
NHS
24
A&E
Ambulance
TBD…
Practice Admin.
Staff
GP
consultation
PRACTICE
System Overview
Usage
• Pilot in 2004, National Rollout in 2006
• Over 5.4 Million Patient Records extracted
• 1600 patients have „opted out‟ of practices
connected
• Represents 0.03% of all patients
• Over 4.7 million accesses and increasing trend in
use
• 2.1 million accesses in 2009
Total Accesses to ECS
2009 Dumfries and Galloway
Palliative Care Summary (ePCS)
• Moving from paper based forms to shared electronic
information
• National rollout across Scotland
• Integration with patient pathway at critical stage
• Contains significant and sensitive information
• Resuscitation Status
• Preferred Place of Care and Patient Wishes
• Diagnosis and Current Treatment
• Carer Details and Advice for OOH
New Developments - SAS
• ECS use to be piloted by Scottish Ambulance
Service (SAS)
• Rollout to Paramedic “in-cab” systems
• Fully integrated with clinical reporting
• Consent will be given by patients
• Pilot underway….
• National rollout following pilot
• Focus on clinical benefit
• Performance review
EHR Impact Evaluation
• Formal evaluation carried out by EHR Impact Programme
• Focus on Social and Economic benefits
• Extensive review of all stages of ECS project
• Quality, risk reduction and efficiency savings• Not cash saving!
• Benefits can be expressed in financial terms
• Initial findings presented at WoHIT Conference in Nov 2008• Final report published Dec 2009
0
1.000.000
2.000.000
3.000.000
4.000.000
5.000.000
6.000.000
7.000.000
2002 2003 2004 2005 2006 2007 2008 2009 2010
₤
Present value of total annual costs Present value of annual benefits
Clinicians Views
• Improves patient care by making decisions safer
• Many people have no idea what medication they are taking • Especially in an emergency when they are ill and confused
• At least 50% of details given by patients is wrong or has something missing when checked against ECS
• Local evaluations have found that: • Clinical decisions can be more timely, accurate and
patient centred
• Pharmacists are using ECS as the key tool for medicines reconciliation
Clinicians Quotes
• “One of the best tools we have got for improving patient
safety”
• “ECS has been a godsend, I can‟t imagine how we
managed without it”
• “It can take ages if we need to phone GP surgery”
• “ECS information can help the most vulnerable patients,
especially those who are admitted over the weekend who
have no one to bring in their meds”
• “Before ECS we often had to „work blind‟ with no
information at all”
Lessons Learned…
• Incremental approach works for Scotland
• Careful consideration of patient groups and
clinical need
• Evidence emerging of clinical benefits
• Integration is more than just technology
• Must build ECS into main clinical system
• Keep it simple….
Questions?
• Jonathan Cameron (jcameron2@nhs.net)
• Programme Manager
• Dr Libby Morris (libby.morris@nhs.net)
• National Clinical Lead
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