Roadshow 6 03 AM

Slide1: 

GPASS/SCI Developments and The New GMS Contract

Clinical Developments at GPASS Kenneth HardenClinical Director GPass : 

Clinical Developments at GPASS Kenneth Harden Clinical Director GPass Original use of computer mainly to assist with clerical tasks e.g. repeat prescribing – gift from Dr David Ferguson Now much wider role in assisting with the clinical care of the patient Structuring of record Effective summary of relevant information Therapy list Problem list Allergies Reminders re necessary clinical action Clinical decision support Information source including patient leaflets THE RITCHIE REPORT

AND THEN: 

AND THEN Primary Care IM&T New Contract

The New GP Contract: 

The New GP Contract “To Deliver the Quality Component of the New Contract, Computers and Good Software Are Not a Luxury but an Essential.”

Significance for GPASS: 

Satisfactory response to the requirements of the new contract (if accepted) is vital for the survival of GPass Significance for GPASS

THE GPASS DIMENSION: 

THE GPASS DIMENSION 85% GP Practices in Scotland use GPass Delivery of the New Contract will be dependant on GPass delivering Easy input Easy output

Will GPass be able to meet the requirements of the new contract?: 

Will GPass be able to meet the requirements of the new contract? Yes Easy input options CDSS Modified Care management screens Reliable easy output Business Objects Run Overnight Standard Reports pdf files to demonstrate achievement mailmerge files of patients to be called

Will the new GP Contract Quality Indicators work?: 

Will the new GP Contract Quality Indicators work? Evidence based clinical benefit Adequately resourced (around £75,000 per annum per average Scottish practice) Support of the professional community Good IT support Simple data entry Effective feedback Realistically deliverable

What should practices do?: 

What should practices do? Don’t panic If Contract accepted achievement payment based on data submitted April 2005 Don’t waste time setting up your own Read codes or care management screens or searches One of the benefits of the New Contract is that the Read Codes will be specified and will be used by GPass /CDSS/all UK computer systems Attend (or ask your practice manager to attend) one of the regional GPass day conferences Use the GPass web site

GpassWebSite: 

Gpass Web Site www.show.scot nhs.uk/gpass/

What do practices need to do? (2): 

What do practices need to do? (2) Get a copy of “NEW GMS CONTRACT INVESTING IN GENERAL PRACTICE” GPass web site - http://www.show.scot.nhs.uk/gpass/ Create or update disease registers for CHD STROKE/TIA HYPERTENSION Diabetes COPD Asthma Hypothyroid Epilepsy All that is required to create a “disease register” is to ensure every patient who has the problem has the appropriate Read code recorded.

Options to create disease register: 

Options to create disease register Formal complete record summarisation process Quick search through records for specific diseases using medication searches to assist Progressive approach to record on contact all appropriate Read codes Decide whether to major on input by Care management/SPICE screens or CDSS B O will search for both but advantages in majoring on one or other.

HOWEVER THERE IS LIFE BEYOND THE NEW CONTRACT: 

HOWEVER THERE IS LIFE BEYOND THE NEW CONTRACT Primary Care IM&T New Contract

GPASS COMMITMENT: 

GPASS COMMITMENT To provide GP practices in Scotland with one of the best Primary Care computer systems in the world People always overestimate what can be done within 1 year and underestimate what can be done in 5. Time scale 3 years

GP - GP Data Exchange: 

GP - GP Data Exchange Phase I Export Record Transfer via PSD View Summary Phase II As Above + Import Record into Database Piloting in Borders and Grampian 14 practices

Lab Test Results: 

Downloading of Lab Results Selective Import of Results into GPASS Uses Lab Results Handling S/W XML Based Messages Accesses Results Held in SCI Store Piloting June – September Release to Significant Numbers by April 04 All Practices to Have Browser Access Lab Test Results

THE GPASS ROAD MAP: 

THE GPASS ROAD MAP Responding effectively to the new contract Making the infrastructure of GPass more robust (Ritchie report response) More user friendly interface Database improvements Values handling Responding to specific user request developments Clinical Steering Group SGPC RCGP GPASS USER GROUP Practice nurses Practice managers Scottish Executive P C Ts

Contract Reporting : 

Contract Reporting Bob Stoakes Head of Communications

Contract Reporting: 

Contract Reporting What is Needed? How are We Doing it? What are We Delivering? When and How is it Being Delivered? Further Developments

What is Needed?: 

What is Needed? Simple, Clear Reporting System Meets Quality and Outcomes Framework Guidance Enable Practices to Monitor Progress Enable Practices to Recall Patients Produce an Accredited Annual Report – April 2005 Report on Data Entered Using Different Methods SPICE pc Contract Screens CDSS Normal GPASS Data Entry Easy to Use

How Are We Doing It?: 

How Are We Doing It? Tool Selection Options Hard Code Reports in Delphi ? GPASS Search Templates ? Industry Standard Reporting Tool ? Labour Intensive Ongoing Maintenance Developer Time Easy to Create Limited Output Options Designed for the Job Query and Analysis

How Are We Doing It?: 

How Are We Doing It? Business Objects Integrated Query/Report/Analysis Tool Robust and Well Tried Skill/Resource Within NHSScotland NHS Licence for All Practices - PRISMS Contract Reports System Easy to Use - Automatic Clear Presentation Graphs Numbers and Percentages Recall Patients As Required

What Are We Delivering?: 

What Are We Delivering? A Comprehensive Report Quality and Outcomes Framework Guidance All Disease Categories All Clinical Quality Indicators Number and Percentage Attainment for Each Graphs to Display Progress for Each Reports Run Automatically Mail Merge Facility to Call Patients GP List eg Dosage Adjustments Nurse Lists Basic Data Input

Delivery - When & How?: 

Delivery - When & How? Release 5.4 Underway Phase II – ‘Application’ Release GPASS 5.4 New Consulting Room Interface Unified Value Handling Initial SPICE pc Contract Screens Initial Clinical Quality Indicator Reports Phase I – ‘Infrastructure’ Release Business Objects Installation Adobe Acrobat Internet Explorer 5.5 Drug Dictionary 32 Hypertension Coronary Heart Disease Diabetes Asthma

Further Developments: 

Further Developments Next 6 Disease Categories Final Annual Report April 2005 Formal Accreditation Process Web Based Delivery Other Reports?

So……?: 

So……? We Are Providing All The Tools Data Entry Screens GPASS/SPICE/PCCIU Pre Written Reports All Clinical Quality Indicators No Need For You To Set Up Searches Read Codes Standardised Download From www.ceppc.org Web Site Discussion Groups www.show.scot.nhs.uk/gpass

Slide27: 

Wider IM&T Developments In NHSScotland Ron Anderson Head of National IM&T Programmes

IM&T in Context: 

IM&T in Context ‘In a nutshell, it is people, not technology, that make the difference between success and failure’ Dennis Protti

New GMS Contract – IM&T issues: 

New GMS Contract – IM&T issues (….if Contract accepted)

Areas to cover: 

Areas to cover What are the main IT issues - now What will these mean for the practice What will this mean for GPASS What other aspects of the contract will have IM&T input How is all this being tackled

Background: 

Background Current ballot follows April 2002 draft, ‘yes voted’ by GPs   Key principles from draft retained, eg. system choice and full reimbursement/ funded IT equipment.   Further key principle was need to maintain equity i.e. a practice in Orkney should receive the same services and opportunities as one in central London. All of this predicated upon “yes” vote – so in some areas detail not yet fully worked up

Main IT Issues: 

Main IT Issues Transfer of Ownership / GP Choice Infrastructure Support & Maintenance, baseline audit, upgrades IM&T Training Links to National and local IM&T strategies and plans

Transfer of Ownership/ GP Choice: 

Transfer of Ownership/ GP Choice Ownership Only transfers when upgrade/ replacement occurs Choice Agreed parameters for change Business case as change vehicle Need to “consider” wider context (ie LHCC/ Trust plans) Guidance being prepared

Infrastructure: 

Infrastructure NHS Boards responsible for support & maintenance 4 country Service Level Agreement Local implementation to suit local circumstances Baseline Audit of practice IT to inform this Upgrades Position currently less clear But – linked to fitness for purpose

IM&T training: 

IM&T training Mentoring approach taken Initial focus Quality Indicator areas Establish practices’ QI aspirations Construct accurate disease registers Train staff who will input Longer term focus Holistic mentoring/ training programme

Local & national strategies: 

Local & national strategies Already a programme in national IM&T Strategy (Programme 12) Being enhanced for new contract Links to Local IM&T plans Contract offers opportunities for better integration

What will this mean for the practice: 

What will this mean for the practice A better service (hopefully!!) “Free IT …..” – although its not really about that ! IT progressively becomes a commodity – not a scary black hole Training for staff to exploit the IT resources they have

What will this mean for GPASS: 

What will this mean for GPASS A need to perform as per the contract terms Opportunities to improve Changing relationships – second line support via NHS Board etc Hence; Attention to enabling technologies Quarterly releases Faster development New products/facilities User focus

What other aspects ………?: 

What other aspects ………? Enhanced Services ? How will all this work What are the workflows/ information flows No one size fits all Payments – how will this work ? Will CHI need to change ? What about OOH services ?

How is all this being handled?: 

How is all this being handled? Co-ordinated programme CSA facilitating Assistance/ facilitation for “local” projects Coordination of central activities Reporting to National Infrastructure Programme Board Liasing with other countries – and SGPC Linking in with national GMS implementation programme

Work Programmes: 

Work Programmes Working Groups Service Level Agreements Training Choice Strategy Plus links to UK work and Professional Groups

On a Wider Front…..: 

On a Wider Front….. Beyond Contract

3. Clinical information services: 

3. Clinical information services Where are we now ECCI 40% GP practices with results reporting 9% GP practices receiving eDLs 30% “ “ able to transmit eReferrals (but only 6% of all referrals actually transmitted) 29% practices able to send clinical email and 30% consultant departments able to receive (but 4% actually did) Where we need to go: reliable, efficient and useful services capable of straddling organisational boundaries infrastructure for local ‘bolt-ons’ get beyond ‘semi-clinical’ to full clinical

3. Clinical information services: 

3. Clinical information services Issues SCI products becoming established (Store, Gateway, Outpatients) On the back of this – labs integration to GPASS GPEX – transfer electronic patient record Significant pressures on local skills, revenue, change fatigue Justifiable demand for further ‘gaps’ to be filled, eg…. A&E system, integrated to NHS 24, SAS etc PACS (digital X-Ray) systems Hospital electronic prescribing systems Document Management / paperless / paperlite

Slide51: 

So, increasingly focus will be on SCI Store and SCI Gateway as national infrastructure …. along with National ICR …. and range of standard transactions between them

Slide52: 

consistent patient ID staff ID/ permissions spanning systems homogeneous and ubiquitous telecoms/ Gateway defined datasets/ definitions information ‘provenance tagging’ DPA, consent etc support structures clinical leadership But all moonshine without that prerequisites are addressed ….

4. Making it happen: 

4. Making it happen Progress … first round of Board Plans and local spend assessed under PAF some establishing Board-wide services - some with clinical leads SEHD IM&T Clinical Lead post CMO-chaired Clinical Information Board Proposal for Ministerial chaired eHealth Board

In Conclusion: 

In Conclusion Serious IM&T exploitation underway Clinical ‘buy-in’ and benefit fundamental GPASS committed GPASS delivering - and will continue to deliver No system will be ‘perfect’ – but user commitment essential …. Thank You

Slide58: 

Overview of IM&T Strategy – Integrated/joined up care, clinical excellence, improving patients’ experience of NHS. Reference Acute services review/Designed to Care etc What is the Vision? What is the electronic patient record(s)? Where are we at the moment? What are the major systems? (CHI, SCI, PARTNERS, GPEX, links with Social Work, ETP etc) How do they interrelate? What is the infrastructure to support all this? NHSNet/HNC, upgraded practice links, SHOW etc What are the Major Issues at the moment? Security, Confidentiality, Patient Consent, Infrastructure capacity etc Upcoming technologies – Secure GPRS, new email systems, PDAs etc Web Based Access to practice systems? Jim Campbell's prescription/appts booking Also, maybe look at future GPASS developments. eg Portable Records, remote access to databases (Clinical Decision Support, Support for Paperless Practices, OOHs, Comm Nurses, House Visits, etc) Ritchie Review? ? Some points to make :- People + processes + technology make the systems work - not just the technology. Importance of training etc 'Rome wasn't built in a day'