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Emergency Care Summary: NHS National Services Scotland

Winner: Best Use of IM&T Promote Patient Safety

Emergency care summaries for NHS patients in Scotland have been accessed more than 1.5m times. But as recently as 2006, the system did not exist.

Stephen Pritchard reports on how NHS National Services Scotland developed the summaries, which won Best Use of IM&T to Promote Patient Safety in last year’s BT e-Health Insider Awards – a category sponsored by NHS Connecting for Health.

Scotland’s Emergency Care Summary provides key medical information to 4,500 clinical staff working in out-of-hours centres, Accident and Emergency departments and NHS24.

Around 5.4m people – or 99% of the Scottish population – have an ECS and since the system was launched nationally in 2006, its records have been accessed more than1.5m times.

The ECS does not attempt to capture every medical detail about a patient. Instead, each summary contains a patient’s recorded allergies and adverse drug reactions, along with details of prescribed medication, including repeat prescriptions.

Improving patient care

“The system makes a big difference to patient care,” says Jonathan Cameron, ECS programme manager at NHS National Services Scotland, which developed it.

“Historically, information [about patients] tends to be held in a very localised way. Even if a patient moves into a different health board, it might not be available. Now it is available, with the added advantage of faster diagnosis and care.”

Cameron cites the example of a mental health patient found to be in a distressed state. Usually, such a patient would have to be admitted, observed and subject to tests, whilst staff made efforts to contact their GP.

With ECS, medical staff can quickly see what medication the patient should be taking, and establish whether they have failed to take a dose. A doctor can then prescribe medication and send the patient home after a short period of monitoring. Without ECS, the patient would probably have to be admitted overnight.

Working all hours

One impetus for the ECS project was a change to GP contracts in 2004. Under the new rules, local GPs were no longer responsible for out-of-hours services. A system was needed to make sure that out-of-hours care providers could access critical medical records, even when a patient’s surgery was shut.

NHS24 is currently the largest user for the service, followed by A&E departments, and out-of-hours care providers. “We are especially seeing an increase in ECS use by A&E, as people become more familiar with the system,” says Cameron.

The ECS team set out to use “stable, known technologies.” ECS was based around the XML data interchange standard and designed so that all vendors of GP systems serving the Scottish market could quickly make their software ECS compatible.

The team also felt it was essential to keep the project focused and the records small; both to keep down response times and to maintain patient trust.

“Because the information is only extracted from GPs’ systems, they are effectively the gatekeeper,” Cameron explains. “Records are reviewed by patients and that gives them the reassurance that records are up to date.”

Nonetheless, obtaining patient consent was one of the most time-consuming parts of the project, recalls Cameron; each household in Scotland received a leaflet explaining ECS before it went live.

Upgrades

NHS Scotland now plans some limited upgrades to the service and to address some additional user groups. However, Cameron stresses that response times and availability will not be compromised.

One area the ECS team has been working on is improving integration with existing hospital systems so staff can access the ECS via their main clinical system instead of having to use a separate and possibly unfamiliar application.

Meanwhile, a large – and important – user group that does not, as yet, have access to ECS is the ambulance service. Scotland’s ambulance service has been upgrading its own systems, which will make it easier to implement ECS access.

Within the ambulance service, most ECS users will be paramedics. The ambulance service deployment is likely to start with a pilot project, to ensure that all elements work as intended.

And expansion

Another area of expansion will be to create palliative care summaries. This is being piloted in NHS Grampian, and the ECS team is working with Marie Curie and also adhering to the MacMillan Nurses’ Gold Standard for care.

“We are moving paper records online so we can share that more widely,” says Cameron. “This allows carers to access very detailed information about very vulnerable patients.” The aim is to ensure that the patient is cared for according to her or his wishes, even in an emergency situation.

Expanding the system, both to cover paramedics and to record palliative care details, is being done to ensure that patients receive timely but safe emergency care wherever they are in Scotland, and at any time of the day.

Safety remains its focus. ECS does not, for example, pass updated records back to GPs following hospital treatment. “At worst that would be via paper records,” Cameron says. “The main reason for keeping that outside ECS, is because of the volume of information. We need to keep that controlled, so we can ensure fast access.”

“We remain very much focused on unscheduled episodes of care. That is what the system is set up to do. Other programmes cover the rest.”

Links

More about the BT e-Health Insider Awards 2008: The BT e-Health Insider Awards: live on the night

More about the Best Use of IM&T to Promote Patient Safety category, sponsored by NHS Connecting for Health

More news about Scotland’s e-Health plans and the ECS: Scotland commits to incremental e-health