Local Clinician Involvement in Clinical Information Systems: of International Experiences

Local Clinician Involvement in
Clinical Information Systems:
Necessity or Luxury – A Review
of International Experiences
ASSIST (Harrogate, Preston)
October 1 & 2, 2003
21-Sep-16
Denis Protti - University of Victoria
1
21-Sep-16
Denis Protti - University of Victoria
2
Questions to be discussed
• Is it important to solicit meaningful
physician input early and often and act
upon it?
• Does finding meaningful ways to
engage physicians require creating an
organizational climate and culture that
respects the heart of medicine?
– Is this the key to maintaining physician
loyalty and involvement?
21-Sep-16
Denis Protti - University of Victoria
3
• Some management teams believe
that ideas should be well fleshed
out and ready for implementation
before discussing them with
physicians.
– When that occurs, do physicians feel
their input is actually sought?
– And if they recommend changes at
that point, will it be difficult for
management to retreat and follow
another course of action?
21-Sep-16
Denis Protti - University of Victoria
4
• How can one best square the need
for centralised/standardised policy
with getting local support and use?
• Does the opinion of national
clinical bodies matter?
21-Sep-16
Denis Protti - University of Victoria
5
Outline
• The Danish Experience
• The New Zealand Experience
• An American Experience
• The British Experience
• NPfIT – Clinicians Involved?
21-Sep-16
Denis Protti - University of Victoria
6
The challenge of being an afternoon
speaker
21-Sep-16
Denis Protti - University of Victoria
7
Outline
• The Danish Experience
• The New Zealand Experience
• An American Experience
• The British Experience
• NPfIT – Clinicians Involved?
21-Sep-16
Denis Protti - University of Victoria
8
EPR in Danish Hospitals
• 11/14 counties have an IT strategy for the
health care sector.
• As of 2001, there were a total of 52 EPR
projects in the country.
• The projects were in different phases
and were controlled on different levels
• Between 5% and 10% of all beds in
Danish hospitals are covered by an EPR
system.
21-Sep-16
Denis Protti - University of Victoria
9
What’s most interesting about
Denmark is
MedCom
21-Sep-16
Denis Protti - University of Victoria
10
Pre-MedCom
• Late ’80s
– A GP who also worked P/T in
hospital biochemistry lab
– Chief pathologist at the hospital
– Head of IT in the county
– Proposed a project for Funen County
IT strategy
• Electronically transmitting lab results
21-Sep-16
Denis Protti - University of Victoria
11
MedCom Today
• Over 90% of 2000 GP clinics/practices
are computerized
– 86% use their computers to send and
receive clinical EDI messages
• 10% of non-users
– Those who will retire in next 3 years
– Those just starting without the capital
(1-2 year delay)
21-Sep-16
Denis Protti - University of Victoria
12
MedCom Facts
• Used by ¾ of the healthcare sector
– >2,500 different organisations
• All hospitals, all pharmacies, all
laboratories and ~1,800 general
practices take part
• ~Two million messages a month
are exchanged (over 60% of the
total communication in the primary
sector)
21-Sep-16
Denis Protti - University of Victoria
13
MedCom Facts (cont’d)
21-Sep-16
Denis Protti - University of Victoria
14
MedCom Facts (cont’d)
• MedCom’s standardised messages
implemented in 50 IT systems,
including:
– 16 doctor systems
– 12 laboratory systems
– 9 hospital systems
– 4 pharmacy systems
21-Sep-16
Denis Protti - University of Victoria
16
MedCom Facts (cont’d)
• Physicians pay for their own systems
• Upcoming agreement with County
Association and the PLO will mandate
electronic communication
• Specialists use of computers range from 4090% depending on the county with their
use of EDI clinical messages ranging from
15-70%
21-Sep-16
Denis Protti - University of Victoria
17
MedCom funders
• 1/3 from Ministry of Health
• 1/3 from County Association
• 1/3 from Other Sources
– Ministry of Social Services (recently)
– Danish Doctors Association (early on
only)
– Dan NET
– Danish Pharmacy Association
21-Sep-16
Denis Protti - University of Victoria
18
Seven Driving Forces
1. Communication benefits of MedCom
•
•
•
•
21-Sep-16
Improves dialog with hospitals
use to wait 5 days for results of tests (now
almost as soon as it comes off the
equipment)
Automatically notified when patient
registered in an Emergency department
Discharge summaries now arrive within 13 days (use to be 4+ weeks) – standard set
by Counties
Denis Protti - University of Victoria
19
Driving Forces (cont’d)
2. Out of Office Hours (OOH) system
mandated
• Started 1997
• GP available from 1600 - 0800 hours
(could be up to 3 GPs present)
• ~30 across the country – some based at
hospitals
• Negotiated by PLO and County
Association
• GPs doctors had to learn how to use a
computer if they wanted to be paid
21-Sep-16
Denis Protti - University of Victoria
20
Driving Factors (cont’d)
3. Peer influence – collegial pressure
– GPs go to see each others computers
4. PLO wrote conversion software to
facilitate the transfer of patient data
from one GP to another
5. Access to the Internet (2-3 times/day)
–
–
–
21-Sep-16
e.g. waiting times for x-rays for all clinics
in Funen County
can see what procedures are done at each
clinic
can decide with patient where they should
go
Denis Protti - University of Victoria
21
Driving Factors (cont’d)
6.
County Support
–
–
–
–
21-Sep-16
Provides GP with a diskette of all their
patients when first starting (been doing since
1992)
Training done by data consultant – visit
practice regularly
Help desk
Practioner coordinator for each specialty
(psychiatry, general surgery, etc.)
• Works 2 hours/month
• Coordinates wishes of GPs to hospitals and
vice-versa
• IT agenda moved forward through them
Denis Protti - University of Victoria
22
Driving Factors (cont’d)
7. Standards set by MedCom
– Contract signed with Counties and
PLO obliging everyone to use them
– Clinicians and vendors involved!
– MedCom tests and certifies vendor
systems
– Steering committee of paying
agencies meets every 3 months to
review compliance data
21-Sep-16
Denis Protti - University of Victoria
23
The Danish GPs are
so automated that
21-Sep-16
Denis Protti - University of Victoria
24
Outline
• The Danish Experience
• The New Zealand Experience
• An American Experience
• The British Experience
• NPfIT – Clinicians Involved?
21-Sep-16
Denis Protti - University of Victoria
25
Percentage of GPs
GP Uptake of I.T. in New Zealand
100
80
60
40
20
0
1994
1997
2000
2003
GP Computer
Use
EDI Network
Subscriptions
Clinical Use
of Internet
Year
21-Sep-16
Denis Protti - University of Victoria
26
New Zealand Facts
• Over 95% of GP offices are using one of
nine Practice Management Systems
– 75% use their systems to electronically send
and receive clinical messages such as
laboratory results, radiology results,
discharge letters, referrals, delivery of agesex registers to their IPA/PHO, etc.
• ~ 50% of GPs now use the Internet on a
regular basis from their offices including communicating with their
patients.
21-Sep-16
Denis Protti - University of Victoria
27
New Zealand Facts (cont’d)
• Specialists use of computers range
from 30-90% depending on their
region. The private specialist use
of a full EMR is limited to 15-20%.
• Like the Danes, GPs increasingly
favor referring patients to
specialists who are able to send
information back to them
electronically.
21-Sep-16
Denis Protti - University of Victoria
28
AGPAL ACCREDITED
2,200 New Zealand sites
1,200 Australian sites
1-800 support across Australasia
21-Sep-16
Denis Protti - University of Victoria
29
New Zealand Facts (cont’d)
• Used by 75% of all healthcare sector
organizations in New Zealand.
– All hospitals, radiology clinics, private
laboratories
– ~1,800 general practices.
– > 600 specialists, physiotherapists, other
allied health workers
• Over 3 million messages a month are
exchanged,
• 95% of the communication in the primary health
care sector.
21-Sep-16
Denis Protti - University of Victoria
30
Driving Forces in New Zealand
• Unlike the Danish success story,
HealthLink received no
government funding to initiate the
service and its growth and success
is based entirely on the market
model of “supply and demand”.
21-Sep-16
Denis Protti - University of Victoria
32
Driving Forces (cont’d)
• The development of IPA’s (Independent
Practitioner Associations) encouraged
the uptake of information technology in
primary care in New Zealand.
– IPAs paid the costs for their member GPs to
access the HealthLink network as part of
their membership services.
• HealthLink facilitated change by
offering an “electronic claiming only”
service for claims submission free of
charge for the first 6 months.
21-Sep-16
Denis Protti - University of Victoria
33
Driving Forces (cont’d)
• The past decade has also seen the
emergence of the new position of
“Practice Manager” within a physician
general practice.
• The Practice Manager has become a
pivotal person to assist with the
installation, management and training
for any physician office system.
• The Practice Manager responsibilities
include financial management, IT and
the human resource function in larger
practices.
21-Sep-16
Denis Protti - University of Victoria
34
HealthLink increasingly used to assist
with chronic disease management
21-Sep-16
Denis Protti - University of Victoria
35
• As a result of these applications of
information technology in primary care:
– Child immunization rates went from 75% to
95%.
– Control of diabetes improved – for patients
with HbA1c higher than 9 pre-enrolment
was 34% and this was reduced to 7% postenrolment
– There was an 80% reduction in wait time for
statins for diabetes patients.
– There was a reduction in acute admissions this was running at 9% per annum. By 2002,
the growth rate was reduced to near 0%.
21-Sep-16
Denis Protti - University of Victoria
36
New Zealand’s critical success factors
• A national health identifier NHI
• Early adoption of HL7
• Development and acceptance of the 1993
Privacy Act and the 1994 Health Information
Privacy Code along with “practical”
implementation of these
• Mandatory electronic claiming for GMS
(government subsidies for GP care)
• Collaboration with private and public
organizations
• Multi-vendor co-operation and
understanding of the business opportunities
21-Sep-16
Denis Protti - University of Victoria
37
NZ critical success factors (cont’d)
• Healthlink’s strategy has always been to
work very closely with primary care
physicians
– to stay close to them and to support them.
• HealthLink is intricately and
comprehensively tied to the GPs
– “like the parmesan in the spaghetti is how
one observer described it”.
21-Sep-16
Denis Protti - University of Victoria
38
An interesting aside
• At one stage the New Zealand Government
spent several millions of dollars on an
alternative product “The Health Intranet of
New Zealand”.
• This failed at the point where they tried to
connect the Intranet to General Practice
computer systems.
– The GPs were very unhappy to let government
representative agents touch their computers – making
the Health Intranet impossible to implement on the
ground.
– The government agents had no understanding of how
General Practice works
21-Sep-16
Denis Protti - University of Victoria
39
NZ critical success factors (cont’d)
• HealthLink employs nurses to act in liaison
roles with General Practice, and so provide
direct contact with the GPs.
• HealthLink provides a help desk that has
become the GP’s first point of contact when
requesting help with their EMRs - like the
Danes.
• HealthLink has also stayed very close to the GP
system providers – again like the Danes.
21-Sep-16
Denis Protti - University of Victoria
40
NZ critical success factors (cont’d)
•
•
•
HealthLink spend a lot of effort on
demonstrator and beta testing sites.
They also work closely with the physician
EMR vendors to debate projects thoroughly at
all stages – before during and after
implementation.
Many of the HealthLink initiatives were a
result of demand of the primary care
physicians
–
21-Sep-16
e.g. discharge summary from hospitals, radiology
test results (DI), orders (still in progress), delivery
of claiming data – i.e. responding to market needs
Denis Protti - University of Victoria
41
The Kiwi docs are getting ready for
21-Sep-16
Denis Protti - University of Victoria
48
Outline
• The Danish Experience
• The New Zealand Experience
• An American Experience
• The British Experience
• NPfIT – Clinicians Involved?
21-Sep-16
Denis Protti - University of Victoria
49
But first
Selected observations from the
American literature
21-Sep-16
Denis Protti - University of Victoria
50
• “Much research has been done in an
attempt to identify the key factors that
predict EPR/EHR implementation
success. Over 150 factors have been
identified, but only two, top
management support and user
involvement are consistently associated
with successful implementations.”
Sittig D
The Importance of Leadership in the Clinical Information
System Implementation Process
November 2001
http://www/informatics-review.com/thoughts/leadership
21-Sep-16
Denis Protti - University of Victoria
51
• “Experience suggests several factors that
may increase acceptance and use of
clinical information systems by
physicians. First, broad physician
involvement in the selection and
implementation of the system from the
outset is essential. Systems with no real
sponsorship from the medical staff are
likely to fail.”
Anderson J
Increasing the Acceptance of Clinical Information Systems
MD Computing; Jan-Feb; 16(1): 62-5; 1999
21-Sep-16
Denis Protti - University of Victoria
52
• “Clinician ‘buy-in’ will require that their
involvement is substantial and real. The
project team must have strong clinician
representation from the outset and
throughout the project, including the
planning, implementation, and postimplementation phases. Clinicians need
to believe that the decisions they make
matter.”
Krall M
Achieving Clinician Use and Acceptance of the Electronic Medical Record
1998
http://www.kaiserpermanente.org/medicine/permjournal/winter98pj/emr.html
21-Sep-16
Denis Protti - University of Victoria
53
• “The need for physician involvement with
clinical information systems has been
advocated since the first installations in the
1960’s. Even though the initial systems were
rather rudimentary, the systems that were
backed by strong physician leadership have
been able to evolve and develop into
sophisticated tools as information technology
has become integrated into all facets of clinical
care.”
Schneider M et al
Physician Involvement in Clinical Systems—A Cost-Effective Investment
HIMSS Proceedings, Session 125
2000
21-Sep-16
Denis Protti - University of Victoria
54
• Whether or not the CPR project leader is
a physician, heavy involvement of
physicians is common to all awardees, as
members of both the CPR project staff
and governing committees. Physicians
with direct roles in the CPR efforts
typically continue to devote at least
some of their time to clinical practice,
which appears to be important to
retaining credibility with the medical
staff.
Metzger JB et al
Lessons Learned from the Davies Program
2000
http://www.cpri-host.org/davies/nuggets.html
21-Sep-16
Denis Protti - University of Victoria
56
One Particularly Relevant
American Experience
• Kaiser Permanente (KP) is a not-for-profit
group model HMO (Health Maintenance
Organization) with headquarters in Oakland,
California.
• The organization is divided into regional
service areas spanning the United States from
Hawaii to the East Coast.
• It has used a centralized organizational model
for their business and information technology
operations since 1997.
• Kaiser has eight million members and 80,000
care-givers across all regions (2/3 in California).
21-Sep-16
Denis Protti - University of Victoria
57
• The Kaiser Permanente Colorado
Region’s CIS implementation began
with 2 medical office pilot sites (80
physicians and 80,000 members) in 1997
and was successfully completed (500
additional physicians and 250,000
additional members) between March
and October, 1998.
• The region has achieved full CIS usage
and has eliminated use of its paper
records for all but archival purposes.
21-Sep-16
Denis Protti - University of Victoria
58
Kaiser’s research findings
• 80 percent of the success of system
implementations the size and
complexity of KP-CIS is attributable to
managing human factors.
• Commitment from, and involvement of
clinicians in the implementation of a
project is of utmost importance.
– Involvement is best achieved by soliciting
active participation from both providers and
staff from project initiation through project
closure and beyond.
•.
21-Sep-16
Denis Protti - University of Victoria
59
The KP approach
• When Kaiser Permanente undertakes
any project, the project leaders develop a
series of Guiding Principles that provide
direction during the entire project to the
project team and to the larger KP
community.
• Once defined and accepted by executive
management, these guiding principles
are communicated throughout Kaiser
Permanente.
21-Sep-16
Denis Protti - University of Victoria
60
The Kaiser CIS guiding principles
1.
2.
3.
4.
5.
6.
21-Sep-16
The leadership and sponsors must be visible,
available, and supportive throughout the project.
The rationale for implementing KP-CIS must be
understood across the Program.
Implementation activities must focus on realistic
timeframes that address system usability at the
point of care. CIS must be based on acceptable
clinical content.
Providers and staff must believe that CIS
enhances their ability to achieve superior clinical
outcomes and improve provider/patient
relationships.
Providers and staff must be continuously
involved in CIS planning, implementation, and
maintenance.
Regions must take the lead in implementing CIS
Denis Protti - University of Victoria
61
Kaiser guiding principles (cont’d)
7.
Providers and staff must acquire the skills to
effectively use CIS. Skills acquisition must
accommodate individual learning styles.
8. Practicing providers and staff members must be
engaged as members of the project team to ensure
credibility with the staff, compatibility with the
local culture and work flow, and clinical utility.
9. Honest, timely, regular, and pertinent
communication to the user community is essential
to adoption.
10. Providers and staff must be prepared to adapt to
the changes that CIS will bring.
11. The appropriate technical and clinical support
structures must be in place to ensure adoption and
continued use of CIS.
21-Sep-16
Denis Protti - University of Victoria
62
Lessons to be learned from Kaiser
• Unwavering executive support
during the CIS implementation
was a major factor in its adoption
by the user community.
– Implementing a CPR produces
extraordinary change in nearly every
facet of operations. Success would be
unlikely without executive
commitment to support of these
changes.
21-Sep-16
Denis Protti - University of Victoria
63
Kaiser lessons (cont’d)
• Identify and appoint physicianadvocates throughout the organization.
– Clinical workflow change is more successful
when physician advocates communicate the
rewards and benefits to the user community.
• It is necessary to develop formal
communications for physicians who are
to use this new CPR to assist them in
understanding how the system will
impact their work.
21-Sep-16
Denis Protti - University of Victoria
65
Kaiser lessons (cont’d)
• Plan for recurrent objection themes from
clinicians.
– A common provider objection is the
perception that they must perform clerical
tasks that take time away from patients.
• Clinician order entry may seem to be
more labor intensive for some primary
care users than for specialists.
– For example, internists may have more
complex patients than pediatricians.
21-Sep-16
Denis Protti - University of Victoria
68
In closing from Kaiser
• Commitment from, and involvement of,
end users (particularly the clinicians) in
the implementation of a project was also
of utmost importance. Involvement is
best achieved by soliciting active
participation from both providers and
staff from project initiation through
project closure and beyond
Wolfe J
Implementing a CPR to Serve Kaiser Permanente’s Eight Million Members
HIMSS Proceedings, session 85
2000
21-Sep-16
Denis Protti - University of Victoria
73
Everything in life is relative
21-Sep-16
Denis Protti - University of Victoria
74
Outline
• The Danish Experience
• The New Zealand Experience
• An American Experience
• The British Experience
• NPfIT – Clinicians Involved?
21-Sep-16
Denis Protti - University of Victoria
75
• Crucially, all of the ERDIP projects
have involved clinicians and had
clinicians on the local project
teams. "We would not have
achieved all we have without the
level of clinician involvement
we've had."
Philip Crouch
ERDIP programme manager
http://www.nhsia.nhs.uk/text/pages/inform/informish6/informp5.asp
2003
21-Sep-16
Denis Protti - University of Victoria
76
• “The Walsall ERDIP project was
managed by a small team with the
support of the NSF groups. This close
involvement of clinicians was important
and any national programme office will
require people with operational
experience. It is also necessary to avoid
turning larger programmes into a project
management industry.”
Walsall Core National Evaluation report
5/11/2002
21-Sep-16
Denis Protti - University of Victoria
77
Key messages for ICRS, derived from the
South Staffordshire experience
• The EHR is still in its early stages of evolution
so that continued learning from formative and
summative evaluation, co-ordinated across
different communities and different suppliers,
will be important.
– Questions of who will be responsible for this and
how it is linked to system supplier performance will
need to be answered.
South Staffordshire Electronic Record
Development and Implementation Project:
Final Evaluation Report
July 2003
21-Sep-16
Denis Protti - University of Victoria
78
• Dr John Pilling stresses not only the
careful preparation necessary for such a
scheme, but also the absolute need for
clinician involvement throughout and
constant liaison, through a committed
project team, between all those
involved. These are lessons that are of
equal validity not just for this PACS
project, but for every IT project in the
healthcare field.
http://www.bjhc.co.uk/issues/v19-7/v19-7editorial.html
21-Sep-16
Denis Protti - University of Victoria
81
• It is not the choice of device but
involvement of clinicians that counts.
• I could go on, but there is no, one
solution that will fit all clinical
scenarios. It is imperative that clinicians
are involved in all these discussions and
that we do not decide what types of
mobile devices will work for them.
Sue Wilson
Head of IM&T (acute services)
Sherwood Forest Hospitals NHS Trust
http://www.e-health-media.com/news/item.cfm?ID=496
Aug 18, 2003
21-Sep-16
Denis Protti - University of Victoria
83
Fear not, we are making progress
21-Sep-16
Denis Protti - University of Victoria
84
Outline
• The Danish Experience
• The New Zealand Experience
• An American Experience
• The British Experience
• NPfIT – Clinicians Involved?
21-Sep-16
Denis Protti - University of Victoria
86
NPfIT’s official position
• Patient, clinician and supplier engagement is
critical to the ultimate success of our solution. We:
– are meeting regularly with SHA chief executives
and four lead CEOs
– are integrating the work of the 28 CIOs with NPfIT
– have a consensus from the Medical Royal Colleges
on a core patient summary or data spine
– have consulted with over 240 clinicians and NHS IT
professionals in producing the initial OBS
– have now got a core group of clinical representatives
working in the Design Authority
• We recognise that two way communication and
involvement is vital.
21-Sep-16
Denis Protti - University of Victoria
87
• Professor Martin Severs from the University of
Portsmouth has joined the National
Programme as Director of Clinical Assurance –
he will take the lead on developing and
ensuring clinician involvement in the National
Programme.
• Professor Severs told the conference that in his
first three weeks in post he had already
reviewed levels of clinician involvement:
– “I found there extensive levels of involvement of
clinicians at all levels of the programme.” He
admitted that this finding had “quite surprised” him.
E-Health Insider
National Programme 'Mobilises' for Delivery
27 Mar 2003
21-Sep-16
Denis Protti - University of Victoria
88
• “The National Programme stresses that clinicians
and other NHS staff have been consulted on
specifications and requirements from the outset.
Most of the input into the OBS for ICRS has come
from clinicians working full time in the NHS, stated
Mr. Granger.”
• “Professor Peter Hutton, head of clinical
engagement with the national programme, added:
In two to three weeks there will be an
announcement on a route in for almost everyone in
the NHS to be involved. From that point on we will
be taking a lot more note of individual user
requirements.”
Granger Confirms Centre to Allocate LSP Contracts
E-Health Insider
August 14, 2003
21-Sep-16
Denis Protti - University of Victoria
89
But … there are other views
• A particular concern is limited engagement
with clinicians so far.
– “Lack of clinician involvement has
been a consistent theme in past
failures.”
– “There is a culture here that means you
just can’t force solutions on clinicians,
they have to be cajoled and
persuaded.”
E-Health Insider
April 2003
21-Sep-16
Denis Protti - University of Victoria
90
• “Despite some early discussions, many
general practitioners and consultants
have not heard of the integrated care
record service or the information spine.
Nick Booth
Sharing patient information electronically throughout the NHS
BMJ, 327:114-115, 19 July 2003
21-Sep-16
Denis Protti - University of Victoria
91
• “News of the National Audit Office’s
involvement in reviewing the national
programme was first reported in
Computer Weekly this week, in a report
which stated that the NAO would
examine arrangements for managing
high-level risks on the NPfIT and
arrangements for gaining the local
commitment of clinicians.”
E-Health Insider
August 22, 2003
21-Sep-16
Denis Protti - University of Victoria
92
• Over many years, NHS informatics
developments have suffered from being underutilised by their potential users…. The position
of informatics should be stressed to empower
decision makers to take steps to harness its
capability, notably through ensuring that
clinical involvement in informatics is enhanced
and integral to day to day working, without
which few health informatics systems will
perform up to their promise.”
BCS Health Informatics Committee & ASSIST
More Radical Steps (2003) Initiatives
August 2003
21-Sep-16
Denis Protti - University of Victoria
93
Questions to be discussed
• Is it important to solicit meaningful
physician input early and often and act
upon it?
• Does finding meaningful ways to
engage physicians require creating an
organizational climate and culture that
respects the heart of medicine?
– Is this the key to maintaining physician
loyalty and involvement?
21-Sep-16
Denis Protti - University of Victoria
94
• Some management teams believe
that ideas should be well fleshed
out and ready for implementation
before discussing them with
physicians.
– When that occurs, do physicians feel
their input is actually sought?
– And if they recommend changes at
that point, will it be difficult for
management to retreat and follow
another course of action?
21-Sep-16
Denis Protti - University of Victoria
95
• How can one best square the need
for centralised/standardised policy
with getting local support and use?
• Does the opinion of national
clinical bodies matter?
21-Sep-16
Denis Protti - University of Victoria
96
Let the discussions begin
21-Sep-16
Denis Protti - University of Victoria
97
ICRS roll out
• Phase 1 by end 2004
• Phase 2 by end 2006
• Phase 3 by end 2008
21-Sep-16
Denis Protti - University of Victoria
98
ICRS phase 1 - 2004
•
•
•
•
Booking of outpatient appointments online
NHS email and access to online knowledge
Electronic laboratory and radiology results
Some clinical communications e.g. GP
referral letters
Providing simple functionality and making
best use of existing systems
21-Sep-16
Denis Protti - University of Victoria
99
ICRS phase 2 - 2006
• Access to a more detailed patient record
including:
> specialist results
> GP prescribing record
> hospital discharge summaries
• Digital imaging
• Computerised referrals and requests
Migrating on to active and interactive
functionality
21-Sep-16
Denis Protti - University of Victoria
100
ICRS phase 3 - 2008
• Working towards full integration of
health and social services including:
>
>
>
>
decision support software
screening
community wide prescribing
computer support for care planning
• Supporting advanced features e.g.
telemedicine
Continuing development and enhancements
21-Sep-16
Denis Protti - University of Victoria
101
Key milestones
• Summer 2003
– Final Output Based Specification to be completed for ICRS
– Short-list of LSP applicants to be finalised
• October 2003
– Initial contracts to be awarded for two LSPs (London and
North East England)
– Contract to be awarded for e-booking service provider
• November 2003
– Early implementation work commences
• December 2003
– Further three contracts to be awarded for remaining LSPs
• April 2004
– National roll out of Phase 1 of ICRS begins in earnest
21-Sep-16
Denis Protti - University of Victoria
102