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