Singing in the rain

It is 20 degrees and sunny in London when I get on the train to Glasgow. When I get off the train again after five hours, it’s freezing cold and pouring with rain.

Yet it often feels as if the outlook for NHS IT down south is looking considerably gloomier than it is in Scotland.

According to speakers at the BCS Health Scotland conference I’m attending, major projects are being rolled out here successfully – if slowly – with buy in from both patients and clinicians.

The Emergency Palliative Care Summary, for example, has been rolled out across the country and is accessed more than 200,000 times a month by those providing out-of-hours care.

An as yet unpublished study has reportedly found that clinical decisions are more timely, accurate and patient-centric when they are taken using the EPCS.

Back in England, the Summary Care Record, which holds slightly more core patient information, started to gain momentum but ground to a halt amid rows about its consent model.

A report by University College, London, also found little direct evidence that it was leading to faster, safer or more patient-centric care in pilot areas.

The UK’s coalition government called for another review; only to decide to carry on with an SCR limited in scope and with easier ways for patients to opt-out if they want to.

John Cameron, programme manager for National Information Systems Group in Scotland outlines some of the key differences that he sees between the approach to summary records in the two countries.

“I think there are so few problems around consent in Scotland because it’s such a tightly controlled data set,” he says. “It’s only allergies and medication. Consent to view has also been consistent since 2002.

“Another key has been that it has all been clinically led from the outset. The realisation of how much time is saved is particularly important to NHS24, where staff used to spend a lot of time flicking through books trying to find different colour pills [to work out what their users were taking].”

Cameron says patients have also noticed benefits. He says the evidence is that patients feel much closer to their caregiver when they don’t have sit down and explain basic details over and over again.

Scotland is now extending the ECPS. As the ‘p’ indicates, palliative care information has already been added to the original Emergency Care Summary; and around a quarter of health boards are now including this.

There are also plans to integrate a key information summary providing support for anticipatory care plans, long term conditions and mental health, using existing EPCS infrastructure.

No deadlines

Health boards are not being given strict or centrally set targets for using the summary or its new elements. Cameron says: “A lot of the boards are in the middle of their migration from GPASS [a failed attempt to introduce one GP system across Scotland] to their replacement systems. We’ve been very aware of that, so it’s kind of organic and up to the GPs when they want to switch it on.”

Alan Hyslop, head of ehealth strategy for the Scottish Government, says it is not going to rush into big bang deployments for any of its strategies. Instead, he says it will continue to take an incremental approach, involving all of the necessary stakeholders.

Aside from the EPCS, Scotland is pushing forward with electronic health records in two different ways. First, it is working on a patient management system, using what Hyslop describes as a ‘middle out’ approach.

After a lengthy18 month procurement process, five health boards awarded a contract to InterSystems for its TrakCare product; with the other health boards given the option of joining in later.

The first five boards will soon be going live with the first elements of the system, which will eventually include general hospital patient administration, mental health patient administration and complex scheduling and order communications, including results reporting.

“That’s s going to be a major thing for the next three years; all the boards migrating from their existing patient administration systems not only to the administrative bits of PMS but to the clinical bits, the test requests and the information recording,” Hyslop says. “I think it’s going to be heads down for all the boards exploiting that tool.”

The second front for health records, and the one that will pull all the different elements together, will be Scotland’s clinical portal project. This will draw together information shared between GPs, the PMS and other national systems such as PACS, and present it to relevant, authorised staff.

“We doubt that there will be one single clinical portal for the whole of Scotland,” Hyslop says. “We’ve got regional boards collaborating on how they best think they should get ahead.

“We’d imagine that over the next few years, funds should be used for further implementation and rollout; because it’s really powerful stuff if you can get the info governance right.”

Realising benefits

While the climate for healthcare IT in Scotland feels balmy, there are some potential chills in the air. “The 2010-14 strategy will be determined by budget which, of course, could be changed following the [upcoming Scottish Government] election,” Hyslop says.

“Our assumption is that we will be working with less money. Because of that, one of the things we’ll be doing is making savings from existing business as usual spend, so we can do all we can to make sure there is some money for fresh investment.

“The current strategy has bought quite a lot of things, and we feel we now have pretty powerful suite of products and applications. So the next strategy should be about exploiting these, getting them implemented, getting the benefit rather than going to large procurements.”

In London, the UK coalition government has signaled a move away from the top-down approach epitomised by the National Programme for IT in the NHS; although issues around its local service provider contracts have yet to be resolved.

Asked whether he thinks English decision makers should abandon their centralised approach altogether and adopt something like the Scottish way forward, Hyslop is cautious. He says it’s a difficult question to answer because there is such a difference in population size.

He adds: “I was quite struck by a recent report that said that top down doesn’t work, but bottom up ends up with a thousand flowers blooming.

“It suggested that the right approach is what it called called middle out. It kind of sounds a bit like what we think is working for us; which is a very collaborative approach between the centre and the health boards.”