key information summary (kis) nhs borders webex presentation 22 may 2013
TRANSCRIPT
Key Information Summary (KIS)
NHS Borders Webex Presentation
22 May 2013
Agenda
• Overview and Aims• What is in a KIS?• Consent Model• Link to GP Contract• EMIS Screenshots• Experience and Feedback – Forth
Valley• Who can access KIS?• Timescales and National Rollout• Further Information
KIS Overview
• Aims to replace paper based faxing of “Special Notes” from GP Practices
• More generic version of ePCS• Support for:
– Anticipatory Care Plans (ACP)– Long Term Conditions
• Utilise existing ECS infrastructure and process
• eHealth Strategy and Quality Strategy deliverable by 2014 – all patients where appropriate to do so to be offered a KIS
What is in a KIS?
• All ECS and ePCS information automatically included
• Medication changes to include:– Single Dose / Frequency field– Medication Prescribed elsewhere
detail– CMS Dispensed Date
• Triggers and reminders for expiry of information
• Consent to share information
4 Sections on KIS Form• Section 1 – “Special Note”
– Free text field of 2048 Characters– Expiry Date– Patient and Carer details including all
agencies involved in care– Other demographics (Next of Kin)
• Section 2 – Current Situation– Medical Information and Diagnosis– ACP / Self Management Plan
agreement– Home Oxygen
4 Sections on KIS Form
• Section 3 – Care and Support details– Homecare support– Incapacity / Guardianship– Power of Attorney
• Section 4 – Resuscitation– DNACPR– CYPADM (Children Resuscitation)– Current and Preferred Place of Care
KIS Consent Model
• Clinical decision to send KIS is made by GP
• Patient to be asked for consent to share information by GP– Different from ECS model– KIS is “Opt In”, ECS is “Opt Out”
• If patient unable to give consent then this is to be clearly recorded– Dementia patient– Patient who is a risk to others
• Emphasis is on sharing information if appropriate to do so
GP Contract
• New GP Contract in Scotland has QoF points available for Anticipatory Care Plans (ACP)– 0.75% of patients in each practice in 2013/14
to have ACP in place– 1.5% of patients in each practice in 2014/15 to
have ACP in place• Suggested that patients with SPARRA
score of 20% - 60% are selected first for ACP
• ACP’s to be shared using KIS• Guidance on SPARRA / ACP and KIS
published by Scottish Government
KIS Overview
• Emphasis on “Summary”• Only information appropriate to share
will be available• Only complete the fields you need to• KIS record can be “built up” over time• Sections are pre-populated as much as
possible• Read codes used as often as possible• Current feedback is that KIS takes about
5 minutes to fill in• KIS can be printed and shared with
carers
EMIS Screenshots
• About to start national rollout as part of Release B
• SUBJECT TO CHANGE• Provided as an overview and to show
layout of KIS• Further changes and improvements
planned for Release E and F in 2013• Training Guide UG190 available from
EMIS
Feedback from NHS Forth Valley
• All 56 GP practices have used KIS through EMIS as part of pilot
• Over 1000 patients have now had a KIS created
• Feedback provided via formal evaluation and PLT session
• Further evaluation ongoing
Feedback from NHS Forth Valley
• Time taken to complete KIS as part of ACP process varies from 2 minutes to 20 minutes– Depends on complexity of patient
needs• Most GP’s reported minimal impact on
workload• Positive feedback on layout and overall
process• Minimal requests for further information
from patients
What GPs liked
Good breadth of information
Ability to add descriptive text
Easy to use and navigate
Much better designed than ePCS
Structured, concise and easy to fill in
Excellent for sharing info with relevant others
What GPs disliked
Unable to import significant past problems (e.g. MI 1990)
Would like to see slightly fewer tabs
Entering carer information is not easy Delays to pilot
starting and delays to wider implementation
Feedback from patients
Very happy to share this information with relevant others
Gives confidence when GP surgery closed
Surprised that this was not happening already
No problem as long as information is ‘secure’
Excellent idea
Would not want some sensitive information from medical notes shared with others
End Users in Acute Hospital
Information is clear and concise
Would be good if we could also write to KIS rather than read-only
Some of the KISs in pilot were of limited quality
This information could dramatically improve the care we provide
Good that it is not just for palliative care
Anticipatory care information particularly useful
Who can access KIS?
• Any user of ECS will have access to KIS• This includes:
– NHS24– OOH– A+E Departments– Scottish Ambulance Service– Hospices– Hospital Pharmacy
• Rollout extending to include:– Other Secondary Care Departments– Community Nursing (through MIDIS)
End user screenshot of KIS – A+E
Timescales and National Rollout
• EMIS Release B Rollout complete– All EMIS practices switched on for KIS
automatically• Updated version of KIS / EMIS to be
released in September 2013 and November 2013– Release E and Release F
• National Release for Vision in May 2013 currently in pilot
Further Information
• KIS website: www.ecs.scot.nhs.uk/kis• KIS Blog: www.keyinformationsummary.org.uk• EMIS User Guide UG190 available from EMIS• Vision User Guide and information• http://www.inpshelp.co.uk/pilot/Emergency%20Care%20Summary/inde
x.htm
• Patient Information from NHS24:• http://www.nhs24.com/Explained/MyInfoNHS24/WhatisKIS
• http://www.commtacs.co.uk/nhs24/kis/draftclip.html (BSL Video)
Adastra Screenshots
• Provided as an overview and to show how KIS will appear in Out of Hours
• Important to note that Special Note field appears separately from KIS tab
• Alerts currently available in A+A and will be rolled out to all boards soon
On opening OLC warning appears to alert clinician – only if SPN, KIS or ePCS
End user screenshot of KIS – Adastra
End user screenshot of KIS – Adastra (Special Note)