Scottish National Users Group
GP IT and Computing for Scotland in the Future: Gathering the views of users
Context
General Practice in Scotland is currently supported by two principle clinical systems (EMIS and Vision) and a range of other support programs and applications which vary from Health Board to Health Board. Over the course of the last 5 years there have been problems with the timing of agreements about the content of the General Medical Services contract and delivery of the tools to fulfil these contract requirements. This is complicated by the development of enhanced services where each health board has a slightly different approach, requires different information and uses different mechanisms for reporting. This diversity has created a degree of confusion and practices are now disillusioned and frustrated.
The underlying principle for GPIT should be to support patient care and practice workflows in as safe and efficient a way as possible while reflecting the diversity of practice configurations and working arrangements. The patient’s experience of care should be the central consideration in planning GPIT for the future.
There are developments in the wider primary care setting with some community services now using versions of existing GP clinical software as their clinical recording tool and distinctive Scottish Government policy in the area of health and social care integration. This gradually evolving diversity from the shape of the NHS in the other 3 parts of the United Kingdom means we now need to have a distinctly Scottish view of what GPIT should be able to do. This paper aims to give some high level structure and functionality without trying to describe in detail exactly how it should be done or how it should look. It does not suggest how it should be delivered although to achieve what is required a high level of interoperability will be required. The ability for systems to evolve and develop is critical as are open interfaces to allow innovative developers and suppliers creative space.
What is the purpose of this paper?
This is a paper for discussion and debate which should evolve with time and reflect the views of users which will be gathered over the next 6 months. It will be used to inform the more formal process of defining requirements for the future tendering and procurement process for GP IT. Where we refer to ‘systems’ this should be considered to be the collective functionality provided rather than relating to a single suppliers product.
Fundamentals
Systems should provide an appropriate level of security to ensure sensitive data is accessed appropriately and stored safely.
The infrastructure supporting and running the system needs to resilient and allow uninterrupted operation. Performance needs to be slick enough to avoid slowing the pace of work for users. The user interface needs to be flexible enough to allow users to work with the system in a way that best suits them (keyboard, mouse, touch screen, mobile) and the needs or location of the patient. The system needs to be ‘easy’ to use meaning the use of minimum clicks, avoiding annoying pop up boxes, and having intuitive screen layouts and functional help scripts.
Support services and training should be freely available to support practices and new users in particular. These should be available through a range of approaches (actual or virtual) appropriate to the needs and location of the practice.
Recognised national data standards should be adhered to and as these develop the systems should be able to adopt them with ease. The functionality in the system should be readily able to evolve with the changing needs of the service without protracted debates about the process of agreeing the change.
Systems need to support innovative practice and not merely replicate the limitations of previous working practices.
Registration
Systems should be able to effectively manage a registered population for a GP practice and accommodate other individuals seeking services from the practice
Appointments
The system should run an appointments diary for all service providers in the practice. The display should be able to display slot details and reasons. It should be able to record a range of timings associated with these slots and provide audit data as a matter of routine. It should display warnings and alerts. It should be able to provide patients with a range of ways to access and book appointments including via on-line means.
Consulting and recording
The system should provide a tool for recording the detail of each patient contact and code as much of this activity as possible to allow easy searching for detail. The interface should allow simple access to other elements of the record as required depending on the needs of the patient. In particular it should present a clear summary of current and important past problems and alerts. The longitudinal medical record should be clearly visible. Systems need to accommodate a range of approaches to two way conversations with patients which reflect the increased use of hand held technology.
Prescribing
The system needs to provide a tool which manages the entirety of the medicines record for patients including prescribing, warnings, compliance monitoring and review processes. This needs to be capable of integrating or interacting with prescribed medication systems in other parts of the NHS in Scotland. This should be an entirely electronic process. The system should support the use of national and local formularies and formulary compliance and preparation swapping. It should support the needs of patient safety programs and finding patients who are subject to MRHA alerts.
Management of continuing problems
Long term condition management for single or multiple diseases should be integral to the record.
Decision support and patient support
The system should provide prompts to the clinician where appropriate to ensure optimal care or identification of potential risk. Supporting information for patients to enable them to manage their own problems more effectively should be linked to their clinical problems and care plans.
Recall and Screening
The system should be capable of running recall programs to enable effective screening and preventive approaches to care. This should include a patient centred approach supporting multimorbidity.
Managing investigations and practice related tasks
The system should support the integrated ordering of tests and investigations and the workflow and management of reports and results. As part of the routine workflow for clinicians there should be integrated functionality for day to day tasks.
Managing correspondence and record transfer
The system should support the creating and transmission of referrals and other clinical and supporting correspondence. It should manage the workflow of letters and reports coming into the practice for the patient. The GP electronic record should be transferable to a new GP surgery when the patients moves.
Reporting and Searching
There should be a slick flexible and speedy searching function able to create reports for the practice or the patient. There should be a range of standardised preloaded reports which meet agreed national or contractual requirements as well as the ability to easily design bespoke queries. Templates for searching should be easily shared. Results should be easily transmitted onwards.
Contract Management Tools
A suite of tools to manage any of the elements of the GP contract should be available at the start of the contract period.
Communications and Data sharing.
Systems should be able to support communication between health and social care professionals and the sharing of data within nationally and locally accepted protocols. This should include the recording of appropriate consent and an audit of accesses made. It should be possible to contribute data to central reporting and research functions should the practice wish.
Interoperability
The system should be able to interact with other eHealth systems within the NHS in Scotland which form part of the complete landscape of information technology for supporting the delivery of services to the population of Scotland. This will include the electronic transfer of prescriptions, correspondence, summary data, telemedicine systems and the transfer of records.
Access for Patients
Service users should be able to access aspects of their electronic medical record and interact with it in ways that enhance the patient experience as well as supporting them in the management of their medical problems. This might include appointment booking, prescription ordering, results reporting, messaging and recall, disease management information and opinion seeking.
Professional Development and support for revalidation.
Systems should provide appropriate evidence of clinical audit and the use of support tools in clinical work and decision making. Prescribing data should be associated with the authorising doctor.
Dr Neil Kelly
Co-Chairman of SNUG April 2014