1. Portfolio/Number/Name:H/T 6 Electronic transmission of lab results to GPs |
2. Programme/Activity: Implementing a national IT system and service in all hospitals to give access from clinical areas to blood, radiology report and pathology test results. The NHSScotland IT Strategy sets out a vision in which patient information is shared electronically between different parts of the local healthcare community to deliver improved patient care. NHSScotland GPs order some 24 million laboratory tests for their patients per annum. Although computers within hospital lab services are used to prepare the results of these tests, for many years the method of reporting back to GPs was only to post the individual pieces of paper back to the relevant GP practice. More recent IT strategy has been to directly link each laboratory computer system to a common electronic database known as SCI Store. A programme of work, now completing, was then undertaken to give GPs and key staff in each GP practice the ability to 'dial in' and look up the patient's test results. This has proven to be useful in situations where immediate access to results are required - no delays through posting and filing - and where results go amiss. 100% of GP practices linked to NHSScotland's telecommunications network now have this facility installed. Note however that the paper flow has not yet been 'switched off' since GPs still need to look at each and every result which comes in and action them as necessary. The next strategic goal, which is the subject of this Technical Note, is to 'push' the electronic results down to the GP practice so that they can be incorporated directly into the patient's existing IT-based record. This is made possible having taken the earlier steps. However before being able to switch off paper there needs in addition to be an on-screen workflow facility for GPs to be able to review and action the test results. In addition to release of time there will be a positive impact on quality due to a number of benefits being realised, for example: - immediate availability of results at point of patient care as soon as lab test complete rather than in days,
- improved access to results - via a terminal rather than wherever the paper happens to be,
- removes transcription errors from phoned results,
- reduces the risk of clinicians missing important patients results,
- clear audit trail provided of whether results have been viewed,
- enhanced security of access compared to paper alternatives,
- ability to view results on screen during a patient consultation supports the opportunity to discuss the results and future treatment options with the patient,
- having the test results assists the practice perform audit,
- ability to manipulate the laboratory results electronically allows graphical display and prepares for inclusion of electronic decision support.
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3. Savings | 3.1 Current target; £m | | 2005-06 | 2006-07 | 2007-08 |
Cash | 0 | 0 | 0 |
Time | 4.0 | 8.0 | 12.0 |
3.2 Efficiencies delivered; £m | | 2005-06 | 2006-07 | 2007-08 |
Cash | 0 | - | - |
Time | 0 | - | - |
4. Accountable Officer for delivery | Kevin Woods, SEHD Chief Executive |
5. Project Manager | Charlie Knox, SEHD Head of Computing & IT Strategy Division |
6. EGDD Portfolio Manager | Rowena Simpson |
7. Description of efficiency and actions to be taken | 7.1 What is the efficiency improvement? How will the efficiency be made? The initiative promotes efficient and effective practice management, for example: - removes the need to sort and file results in the Casenotes
- reduced time to trace and pull together results
- reduced time searching for results, ie. telephoning
The nature of the efficiency is therefore time to be spent on other tasks. |
7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? National programme commissioned by SEHD for NHS National Services Scotland ( NHSNSS) to develop and roll-out the initiative. Key action manager within NHSNSS is Ron Anderson, Head of National IT Programmes. Roll-out project and resource plans agreed and monitored with each NHS Board, under responsibility of Directors of General Medical Services. The partnership working extends to NHSScotland's commercial IT Services supplier, Atos Origin, who maintain the SCI Store IT system and the various GPIT system suppliers. |
8. Associated costs | 8.1 Are there any development or redundancy costs associated with the delivery of this efficiency? This project was embarked upon to secure better access to patient information and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing efficiency. |
9. Measurement | 9.1 What are the inputs that will be measured? Number of test results sent electronically to GP practices. |
9.2 What are the outputs that will be measured? Extensive before-and-after timings have been conducted on paper-based versus electronic test results based on n = 600,000. Although in the hospital setting, the workflow processes and benefits to be gained are the same. Only those savings attributable to secretarial and administration staff have been included as they represent the most reliable contribution. Savings for each administrative staff category have been quantified and converted into w.t.e. The cash equivalent, £293,567, has been derived by applying appropriate salary rates. It is not proposed to devote the significant effort to undertake this level of study in each hospital and GP practice. Instead, a figure has been calculated for savings per test. Based on 600K tests this equates to £0.50 per test. The total number of tests ordered by GPs per annum is known - 24M p.a. - hence when full implementation is achieved over the three year period the annual saving will be £12M. Statistics for these analyses will be taken from extracts from the SCI Store systems are considered to be accurate. |
9.3 What is the baseline for inputs and outputs? The baselines in 2004/05 is 20,000 test results electronically transmitted and incorporated into GP practice IT systems. The total/target is the 24 million lab tests p.a. transmitted to 1041 GP practices. |
10. Quality cross-check | 10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Due to the nature of the service improvement it is not considered that quality checks over time are required. Hence once the software has been designed and tested the data continues to flow into the patient record. What will be monitored however is the 'live time' of the service, as part of routinely collected statistics for contract performance. |
11. Monitoring | 11.1 What are the arrangements for monitoring the delivery of efficiencies? Measurement of progress toward full implementation will be derived from 6 monthly returns from each NHS Board, collated by the NHSNSS project team and submitted to SEHD (Charlie Knox, SEHD Head of Computing & IT Strategy Division). SEHD will apply the necessary conversion to £ equivalent using the formula described above and submit to EG Project Manager. To add to the above, extract analyses on number of test results being transmitted to each GP practice are obtained from SCI Store. Monitoring the reduction of paper flows/filing in GP practices will be undertaken by NHS Board project teams and collated by NHSNSS. |
12. Reporting | 12.1 What are the arrangements for reporting the delivery of efficiencies? Quarterly reporting using existing 'Red-Amber-Green' forms to the eHealth Programme Board |
13. Dependencies | 13.1 Explain if your efficiencies are dependant on legislation or other structural changes being achieved. No legislation or structural changes required. |
14. Use of efficiencies | 14.1 How are the efficiencies released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards for primary care did not assume time efficiencies. Due to the nature of the project there is no time released, but time is more productively applied. |