lessons learned from scotland’s electronicehealth.org.hk/forum2011/ppt/07oct/kerry...
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Lessons Learned from Scotland’s Electronic
Health Record Programme
Greater China e-Health Forum
7th October 2011
InterSystems
• Established in 1978
• Headquartered in Cambridge, MA
– Healthcare solutions headquartered in Sydney
• Worldwide leader in healthcare IT
• 30+ years of profitability and customer success
• 1,300+ partners
• Consistent growth and profitability
• Private, no outside investors, no debt
• Offices in 30 countries
– England Office Opened 1985
– Scotland Office Opened 2010
• Over 1,400 employees
• Over 800 TrakCare Sites
InterSystems’ Offering
Regional /
National EHR
Patient Care
Infrastructure
HealthShare Platform for healthcare informatics and
regional/national health information
exchange
TrakCare Web-based healthcare information system
Ensemble Integration and development platform
Caché Database and application development
DeepSee Actionable Analytics
Partnering with Leading Local Healthcare
Providers
United Family Hospitals
• Premier network of six clinics and four hospitals in Beijing, Shanghai, Guangzhou and Tianjin
• TrakCare selected across all sites for unified patient administration, clinicals and lab
WCI
• Series of Polyclinics running TrakCare as a Software-as-a-Service model
Hong Kong Baptist Hospital
• 900 bed private hospital in Kowloon
• Currently installing TrakCare across the hospital network for unified patient administration, clinicals and lab
Hospitals Then
Hospitals Now
Theatres Then
Theatres Now
Medical Records Then
Medical Records Now
What is Required?
International Clinical Requirements
• Single clinical view EPR
• Clinical information at the point of care
• ePrescribing
• Decision Support
• Order Communications
– Acute care
– Primary care
– Community care
• Discharge Summary
• Online patient bookings and scheduling
• Real-time clinical & business analytics
What is Needed to be Successful?
• Business commitment with administrative & clinical champions
• Access to a single Patient Record (EPR)
• A strong implementation process
• We need doctors to enter the key clinical information
How do we get them to do it?
Needs to be intuitive
Needs to be entered unstructured
Needs to be presented structured & in context
Needs to be quick
Needs to provide the right information at the
right time and place
• Realistic budget, business plan & cost savings
TrakCare - Healthcare Information System
• TrakCare is one product – not multiple products “connected”
Application
Ensemble
Caché
• Multi-language system designed to be sold internationally
• Easy to change appearance of screens and
workflows
• Easier to tightly integrate to other applications
• Can be sold as a true enterprise solution
• Positioned in the “Visionaries” quadrant by Gartner, Inc. in their 2011 Global Enterprise EHR magic quadrant
• Customers in 25 countries with over 800 sites worldwide
• Information at the point of care
• Browser-based for everywhere access
• User interface flexibility
• Multi-media
• Messaging
• Active decision support
• Freedom of choice
• Many settings – one solution
• Investment protection
• Foundation implementation
• Embedded analytics
TrakCare Benefits
Applications – For All HealthCare Settings
• Primary Care Clinics.
– TrakCare Clinic - registration, appointments, clinical (SIDRA, Hong Kong).
• Community
– TrakCare Community - vaccinations, home nursing, allied health, home monitoring, social care, mental health, ambulance (Victoria Australia, NHS Lothian)
• Acute Care Hospitals
– TrakCare - PAS, Clinical, Departmental, Labs. (Austin Health, Einstein Hospital, Bangkok General Hospital).
• Tertiary Care Hospitals.
– TrakCare - PAS, Clinical, Departmental, Labs (Molinette, NHS Lothian)
• Regional Healthcare
– TrakCare - PAS, Clinical, Departmental, Labs (GDF, SWARH, SSMOC)
– HealthShare – EHR Clinical Record. (BHIX New York).
• National HealthCare
– TrakCare – PAS, Clinical, Mental Health (Scotland, UK)
– HealthShare – EHR Summary Clinical Record (Sweden)
Customer Challenges
• Worldwide economic crisis
• Huge cost cutting – UK 20% effecting NHS frontline
services
• Fast moving complex environment:
Stringent targets
Improve efficiency
Reduction of paperwork
Reduction of errors
Improve patient experience/safety
• Old disparate systems = multiple sources of
information
NHS England – Connecting for Health
• Centralised Procurement & Design
• Massive Scale, Scope & Budget
• National Messaging Infrastructure
• National Demographic & Access Services
• Choose & Book
• Electronic Transmission of Prescriptions
• 100% PACS deployment
• Single-Solution Vision for Care Records
• Reconfiguration to allow solutions choice
• Re-evaluation of existing systems
• Driving a focus on integration
NHS Scotland
NHS Scotland’s Approach
• A consortium of five NHS health boards was formed to lead
the procurement (Ayrshire & Arran, Borders, Grampian,
Greater Glasgow & Clyde, Lanarkshire)
• The remit of these boards was to act on NHS Scotland’s
behalf and procure a Patient Management System which
was:
– Affordable
– Clinically acceptable
– Could be implemented across five health boards in two
and half years
NHS Scotland – Procurement Process
• Tender submitted (October 2008)
– National tender for PAS and Clinicals including Accident
& Emergency, Mental Health, Orders, Prescribing
– Optional modules
– 1600 page response
• Vendor shortlist (January 2009)
• Workshops commenced (February 2009)
– Application presentations
– Technical discussions & presentations
• Down to three vendors (March 2009)
– Application presentations
– Technical discussions & presentations
– Commercial & legal discussions
• Best and final offer (September 2009)
• Contract awarded (February 2010)
TrakCare - PMS Scotland
“ This contract will enable Health Boards
across Scotland to implement a single,
nationally available patient management
system that will play a major role in
improving patient services. Clinicians and
patients will both be winners from a
system which will track patient journeys
from referral to discharge. It means
clinicians will have easier and quicker
access to medical records and patients
will benefit from having more time with
healthcare professionals.”
Nicola Sturgeon, Health Secretary
Clinical Support Tools
Maternity
Order Communications
A&E
PMS/PAS incl. Mental Health
Neonatal
Clinical Mental Health
HEPMA Pharmacy
TrakCare - PMS Scotland
• PMS including Mental Health
– New Ways SMRs & ISDs
– Simplecode & QAS
• Order Communications
• Reporting and Management Information
– DeepSee
– Business Objects
• Clinical Tools
• A&E
• Maternity
• Neonatal
• Clinical Mental Health
• Interfacing & Interoperability
– National CHI
– SCI Store / SCI Gateway
– Carestream PACS
– Special Needs (SNS)
TrakCare - PMS Scotland
NHS Lanarkshire - Some Metrics
• 7 miles of records on acute sites
• 5 miles of records in Secondary Store
• Each year create further 1 mile of records
• Retention Periods:
– 3 Years after death
– 25 Years For Obstetrics, Children and
Psychiatry
– 6 Years Everything Else
NHS Lanarkshire - Some Metrics
• 85wte (£1.5m) directly handling pulling and filing of 1.5m case notes per annum
• 4wte (£70K) maintaining secondary store - alternative to commercial storage
• Each new record costs £1.30 – order 75,000 per annum
• 5 minutes to pull and prep a case record for a clinic • 25% of records missing at first pull • Other costs secretaries, ward clerks, porters,
transport, clinical, labels, energy, paper • Incomplete, inaccurate, inaccessible, inconvenient
Implementation
Process
The Process
TrakCare Implementation Key Strengths
• Speed of the installation
• Implementation methodology
• Staff experience
PIOVTC10A
Implementation Plan
• Series of 10 steps
• Aimed to get live in an agreed timeframe
• “Foundation” is key to this approach:
– Provides certainty with deliverables
– Eliminates a large number of tasks from the project plan
– Changes to Foundation are analysed and agreed
10 Steps to Go Live!
1. Prepare Infrastructure & Install TrakCare Foundation
2. Project Kick Off
3. Local Data Collection Training
4. Local Data Collection
5. Population of Pre-Production Environment
6. User Acceptance Testing
7. Super User Training
8. Site Implementation
9. Final Installation and End User Training
10. Pre Go Live Check & Cutover
TrakCare Delivery Principle
• Implementations can be delayed through over-
configuration and system complexity
• We can make the mistake of trying to become system
experts before implementing the system
• Methodology aims to develop expertise of customers
through the implementation process
• This delivery principle ensures the customer achieves
Go-Live in the fastest possible time
Implementation Based on Foundation
TrakCare Global Foundation
TrakCare Scottish Foundation
TrakCare Local Configuration
• Core, Optional & Additional Modules
– Proven software
• Scottish Functionality
– New Ways
– SMR/ISD/Data Dictionary
– National CHI
– SCI Store / SCI Gateway
– A&E 4 Hour Wait
– Carestream PACS
– SNS
– eReferrals
• Unrivalled Flexibility
– User interface
– Workflow
– Interoperability
Implementation Schedule
Results To Date
NHS Scotland - Results
• Office opened in Edinburgh (May 2010)
• TrakCare implementation team Program Manager
6 Project Managers
2 Healthcare Architects
45 Application Specialists
5 Integration Specialist
5 Technical Specialists
• Foundation completed on time (August 2010)
• Boards Go-Live PAS, EPR & A&E First Board “Borders” goes Live on time
(November 2010)
Lanarkshire, Grampian, Lanarkshire &
Glasgow (stage 1) all Live September 2011
• Go-Lives next steps LanarkShire Lab November 2011
Mental Health Grampian by March 2012
Order Comms. All Boards by July 2012
• Additional Boards start (Late 2012)
The Differentiation
Factors
Solution Summary
• The procurement process was open & honest - allowed greater
understanding of customer requirement
• Commitment nationally; clinical & admininstrative champions at
Boards
• Direct access with the customer
• Experienced staff on both sides - “no nurse Nellys”
• Unified application with portfolio of modules, with one shared data
model, on one database.
• Enabled enterprise standardisation
• Ease of connecting existing applications with embedded integration
platform
• National product Foundation resulting in better timely role out
• Unmatched flexibility for screen layouts and workflows
• Proven in large and complex health environments
Thank You
&
Questions
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