Emergency Care Summary. Morris L. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Emergency Care Summary
Libby Morris
Chair of ECS Programme Board
General Practitioner Scotland

2. Agenda
• Emergency Care Summary
• Dataset
• System Overview
• Usage
• Palliative Care Summary
• Evaluations and Clinical Feedback
• Future Direction and Challenges

3. Overview
• Patient Safety is key driver
• Read only record extracted twice daily from
GP Practice Systems
• Integration with Out of Hours and
Emergency (A+E) Departments
• One national store for all of Scotland
• Explicit Consent to view ECS record

4. Agreed Dataset
• Patient demographics (address, telephone, CHI
number)
• Allergies and Adverse Reactions to medications
• Medication history
- Repeat prescriptions in past 12 months
- Acute prescriptions in past 30 days
• Consent Flag
• Patient opt out status

5. System Overview
PRACTICE NHS
GP OOH 24
consultation clinician ECS summary
ECS update
request & A&E
display
ECS
System Ambulance
1. During consultation
Practice Admin. Who saw
Staff who2. Due to prescription
for
practice? Patient contact
3. Other TBD…

6. Usage
• Pilot in 2004, National Rollout in 2006
• Over 5.4 Million Patient Records extracted
• 1600 patients have „opted out‟ of practices
connected
• Represents 0.03% of all patients
• Over 4.7 million accesses and increasing trend in
use
• 2.1 million accesses in 2009

7. Total Accesses to ECS

8. 2009 Dumfries and Galloway

9. Palliative Care Summary (ePCS)
• Moving from paper based forms to shared electronic
information
• National rollout across Scotland
• Integration with patient pathway at critical stage
• Contains significant and sensitive information
• Resuscitation Status
• Preferred Place of Care and Patient Wishes
• Diagnosis and Current Treatment
• Carer Details and Advice for OOH

10. New Developments - SAS
• ECS use to be piloted by Scottish Ambulance
Service (SAS)
• Rollout to Paramedic “in-cab” systems
• Fully integrated with clinical reporting
• Consent will be given by patients
• Pilot underway….
• National rollout following pilot
• Focus on clinical benefit
• Performance review

11. EHR Impact Evaluation
• Formal evaluation carried out by EHR Impact
Programme
• Focus on Social and Economic benefits
• Extensive review of all stages of ECS project
• Quality, risk reduction and efficiency savings
• Not cash saving!
• Benefits can be expressed in financial terms
• Initial findings presented at WoHIT Conference in Nov
2008
• Final report published Dec 2009

12. 7.000.000
6.000.000
5.000.000
4.000.000
₤
3.000.000
2.000.000
1.000.000
0
2002 2003 2004 2005 2006 2007 2008 2009 2010
Present value of total annual costs Present value of annual benefits

13. Clinicians Views
• Improves patient care by making decisions safer
• Many people have no idea what medication they are
taking
• Especially in an emergency when they are ill and confused
• At least 50% of details given by patients is wrong or
has something missing when checked against ECS
• Local evaluations have found that:
• Clinical decisions can be more timely, accurate and
patient centred
• Pharmacists are using ECS as the key tool for medicines
reconciliation

14. Clinicians Quotes
• “One of the best tools we have got for improving patient
safety”
• “ECS has been a godsend, I can‟t imagine how we
managed without it”
• “It can take ages if we need to phone GP surgery”
• “ECS information can help the most vulnerable patients,
especially those who are admitted over the weekend who
have no one to bring in their meds”
• “Before ECS we often had to „work blind‟ with no
information at all”

15. Lessons Learned…
• Incremental approach works for Scotland
• Careful consideration of patient groups and
clinical need
• Evidence emerging of clinical benefits
• Integration is more than just technology
• Must build ECS into main clinical system
• Keep it simple….

16. Questions?
• Jonathan Cameron (jcameron2@nhs.net)
• Programme Manager
• Dr Libby Morris (libby.morris@nhs.net)
• National Clinical Lead