8. IT INFRASTRUCTURE
8.1 The Scottish Government has recently issued a new e-Health Strategy covering the period 2008-2011. The Strategy outlines how e-Health can support the overall goals for NHSScotland highlighted in Better Health, Better Care. It adopts an incremental and pragmatic approach to developing e-Health solutions.
CHD Developments
8.2 The CHD National Advisory Committee's Data and IT Sub-Group is developing processes to ensure comprehensive and accurate collection and collation of information related to the care of patients with CHD across Scotland. This work also encompasses plans to ensure timely dissemination of the information to key stakeholders at planning, managerial and clinical levels within NHSScotland.
8.3 A culture of data collection and reporting is being developed and strongly encouraged throughout secondary care using information from established databases for cardiac surgery, PCI and the more recently implemented acute coronary syndrome register ( SCI- CHD- ACS). While specific CHD data officers are key to this process, clinicians and other CHD staff have been directly involved in agreeing quarterly reports of data which reflect activity and, more importantly, the quality of care being delivered in each centre. These reports will be available more widely within the next 6 months with plans to post them on the forthcoming "HeartScotland" website. Plans to improve the accuracy and consistency of CHD data recorded using the SMR01 system are being linked to this process. A further project linked to this is being developed with NHSQIS and SIGN to address issues of implementation of guidelines and processes which can regularly assess quality of clinical care.
8.4 A large body of work has been completed with the National Clinical Datasets Development Programme ( NCDDP) hosted by Information Services Division ( ISD), to develop and agree a comprehensive dictionary of data items for patients with CHD. Datasets are now available for heart failure, pacing and electrophysiology, cardiac rehabilitation, core cardiac information and acute coronary syndromes and are currently being developed for chest pain clinics, cardiac catheterisation/angioplasty and cardiac surgery.
8.5 Work is now taking place to develop a high level specification document for an electronic patient record which aligns with the national e-Health agenda. This is a large and extremely important piece of work which aims to build, in a modular fashion, a comprehensive clinical electronic record for patients with CHD managed within secondary care. The system will be developed using a nationally agreed IT platform and will conform strictly to e-Health IT governance. A pilot development for this project is being taken forward in Glasgow for heart failure using local IT infrastructures overseen by the National Advisory Committee's Data and IT Sub-Group.
8.6 A number of benefits have already been identified within the project and include enhanced patient safety and clinical effectiveness, as well as improved service planning and delivery. In order to shape the programme so that it is clinically relevant and appropriate, meaningful clinical engagement will continue to be a key priority.
Stroke Developments
8.7 Several strands of work have been proceeding in the area of stroke e-Health, which have already brought minor improvements in patient care but which promise to yield important benefits over the next five years.
8.8 As in the case of CHD, the NCDDP has developed agreed clinical terms which can be used in clinical information systems. The clinical stroke community has worked with the NCDDP to produce several datasets including those relating to inpatient care, outpatient care, nursing and allied health professionals ( AHPs). This work is an essential step in introducing electronic patient records ( EPR) to stroke services.
8.9 Several stroke MCNs have developed and implemented EPRs to support their stroke services. However, although these local EPR systems work well in the services which developed them, there are significant hurdles to rolling them out across the country, including the fact that they do not currently communicate with each other, or other local IT systems such as labs and radiology. Clinicians and IT developers are working across NHS Boards to take the best ideas from existing systems and build systems which can be rolled out to any stroke service. These systems will be developed using a nationally agreed IT platform and will conform strictly to e-Health IT governance. Over the next five years the roll-out of EPRs across Scotland should bring about real improvements in stroke patient care by:
- allowing clinicians to collect and share information about patients;
- producing legible typed reports for medical notes and communication between hospital and community services;
- prompting clinicians to collect appropriate information;
- providing clinicians with decision support tools (eg systems to predict patients' outcomes or to recommend certain investigations or treatments); and
- capturing data to enable clinicians to monitor the performance of their services.
8.10 The Scottish Government is also rolling out the national Picture Archiving and Communications Systems ( PACS) initiative to all hospitals in Scotland. In the past, patients' X-rays were printed onto expensive film. Digital radiography means that the pictures from plain X-rays and scans are now captured digitally and can be stored on computers. This will allow doctors from across Scotland to see X-rays of their patients, even if these images were taken at another hospital. PACS brings particular benefits for stroke patients, where doctors are very reliant on brain scans to make an accurate diagnosis.
8.11 The system will enable clinicians to get a specialist opinion on the scan very rapidly from another expert working in a different hospital, with obvious clinical benefits.
8.12 Telemedicine in the form of videoconferencing is also being used in stroke medicine to allow patients to receive earlier, and therefore more effective, thrombolysis at their local hospital, even when a local stroke specialist is not available. A stroke specialist in another hospital will be able to check the diagnosis, review the brain scan (using PACS) and recommend the best treatment. The Scottish Centre for Telehealth ( SCT) is working closely with the Stroke MCNs to introduce telemedicine networks throughout Scotland.
ISSUES TO CONSIDER
What further actions should we take to develop the IT infrastructure that is needed to support CHD and stroke services?