Clinical Portal
Catherine KellyeHealth Clinical LeadScottish Government
• Why do we need it?
• What is it?
• What decisions and progress have been made?
• What is happening now?
Why do we need a Clinical Portal?
Key to realising the vision set out in Better Health Better Care to
“..ensure that the right information is available at the right time, in the right place, to enable staff to provide the best possible
care”
SCI-DC
SpecialtySystem
Theatresystem
PACS Lab system
SCI store
EmergencyCare
Summary
PatientManagement
System
GP IT system
PATIENT
What is a Clinical Portal?
• Not single system but range of products and services• Provides “virtual” electronic patient record• Different types of information still held in separate
databases
Info
rmat
ion
Inte
grat
ion
and
Inte
rope
rabi
lityAp
plica
tions
Info
rmat
ion
Acce
ss
Integration Platform
Record Locator Service
PMSGP
SCI Gateway
Labs PACS/RIS Other
ECS SCI Store CHI
A&E
Process Management
PortalFramework
ClinicalDashboard
Management Dashboard
Patient Dashboard
Identity and Access Management(including Single Sign On)
Technology
Launch existing
modules and legacy apps in context
Launch existing
modules and legacy apps in context
Admission Summary
from PAS/PMS/EPR
Admission Summary
from PAS/PMS/EPR
Visit historyVisit history
Discharge history
Discharge history
Radiology reports
Radiology reports
Forward results
Forward results
Pathology reports
Pathology reports
Acknowledge results
Acknowledge results
Alerts from PAS/PMSEPR
Alerts from PAS/PMSEPR
Workflow specific views
Workflow specific views
Local Applications
Local Data
National Data Centre
National Applications
Local Applications
Local Data
National Applications
National Applications
Local Applications
Local Data
National Applications
• Reduced time spent searching for and retrieving clinical information
• More complete and up to date patient record
• Information available to support effective and safe delivery of clinical care
• Reduced adverse drug events due to availability of medication information
• Availability of results may reduce unnecessary duplicate tests
• Reduced reliance on paper based processes
Clinical Portal- benefits
What do we have already?
GG&C Clinical Portal Usage StatisticsResults & Documents Viewed
2009 - 2010
0
20000
40000
60000
80000
100000
120000
140000
160000
W/e
04/
10/0
9W
/e 1
1/10
/09
W/e
18/
10/0
9W
/e 2
5/10
/09
W/e
01/
11/0
9W
/e 0
8/11
/09
W/e
15/
11/0
9W
/e 2
2/11
/09
W/e
29/
11/0
9W
/e 0
6/12
/09
W/e
13/
12/0
9W
/e 2
0/12
/09
W/e
27/
12/0
9W
/e 0
3/01
/10
W/e
10/
01/1
0W
/e 1
7/01
/10
W/e
24/
01/1
0W
/e 3
1/01
/10
W/e
07/
02/1
0W
/e 1
4/02
/10
W/e
21/
02/1
0W
/e 2
8/02
/10
W/e
07/
03/1
0W
/e 1
4/03
/10
W/e
21/
03/1
0W
/e 2
8/03
/10
W/e
04/
04/1
0W
/e 1
1/04
/10
W/e
18/
04/1
0W
/e 2
5/04
/10
W/e
02/
05/1
0W
/e 0
9/05
/10
W/e
16/
05/1
0W
/e 2
3/05
/10
W/e
30/
05/1
0W
/e 0
6/06
/10
W/e
13/
06/1
0W
/e 2
0/06
/10
W/e
27/
06/1
0W
/e 0
4/07
/10
W/e
11/
07/1
0W
/e 1
8/07
/10
W/e
25/
07/1
0W
/e 0
1/08
/10
W/e
08/
08/1
0W
/e 1
5/08
/10
W/e
22/
08/1
0W
/e 2
9/08
/10
W/e
05/
09/1
0W
/e 1
2/09
/10
W/e
19/
09/1
0W
/e 2
6/09
/10
W/e
03/
10/1
0W
/e 1
0/10
/10
Total Results Viewed
Documents Viewed
What decisions and progress have we made?
Clinical Portal Programme Board
• National Integration platform - Ensemble• Non-proliferation• Phased approach to delivery of key information
requirements• Commissioned regional consortia work to
identify portal solutions • Information assurance programme to support
information sharing
Why a common Integration Platform?
Information Access
Identity and Access Management
Integration and Interoperability
Single Sign OneForms
Context sharingRole
Based Access
Audit
Single Window
Information service (Allergies)
Information service(Test results)
Information service(Letters)
Information service (guidelines)
Information service (demographics)
Clinical Information store (eg ECS)
Clinical Information store (eg SCI Store)
Clinical Information store (eg SCI Store) CHIeLibrary
GP systems
SCI Store
etcPMS
choice
.
Integration Platform Process Management
Information service(Record locator)
Record location index
. .
•Minimise duplication of effort•Promote re-use of components•Ease the flow of information between systems and between Health Boards•Simplify national interoperability
Clinical Portal Programme Board
• National Integration platform - Ensemble• Non-proliferation• Phased approach to delivery of key information
requirements• Commissioned regional consortia work to
identify portal solutions • Information assurance programme to support
information sharing
Clinical Portal Programme Board
• National Integration platform - Ensemble• Non-proliferation• Phased approach to delivery of key information
requirements• Commissioned regional consortia work to
identify portal solutions • Information assurance programme to support
information sharing
Agreed information priorities
Discovery work
• NHS Boards in different stages of readiness for implementing a clinical portal
• The data items exist across a wide range of clinical systems within and across the NHS Boards
• Varying levels of access to key data items that are required for inclusion in the portal
• Key challenges– Developing interfaces– Data cleansing– Information Governance arrangements
Clinical Portal Programme Board
• National Integration platform - Ensemble• Non-proliferation• Phased approach to delivery of key information
requirements• Commissioned regional consortia work to
identify portal solutions • Information assurance programme to support
information sharing
West consortium • Dell-Perot commissioned report• Assess current state and identify dependencies• Investigate role of PMS in delivering clinical
portal• Investigate whether Orion could be used in other
Western Boards• Propose solution options and associated
benefits• Make recommendations on way forward
Report findings
• All Boards keen to implement Clinical Portal
• Initial focus on Acute Services
• Strong clinical support
• Best options - Intersystem HealthShare and Orion Portal
• Significant benefits from shared work practices & approaches– Consistent clinical content and structure for presentation of
information – Role Based Access Control (RBAC) + single sign-on
Recommendations• Proof of concept with Intersystems using HealthShare
• Run under WoS Consortium as single Programme Board– Confirm and document functional and technical
requirements– Identify key interfaces and inter-board integration– Review wider architecture (incl. data sources, EDMS
role)– Agree compatible RBAC/IG/ Single sign-on to support
cross Board sharing
North consortium • Understanding of clinical portal readiness and appetite
within the region, and identification of required preparatory work
• Understanding of viability and desirability of building on Clinical Portal solutions already in place within the region
• Assessment of the potential impact of the national PMS and GPIT contracts on the approach to Clinical Portal
• A proposed clinical portal strategy for the region
Summary of Findings• Consensus for adopting a regional clinical portal
• The majority of Health Boards currently do not have all the information priorities available electronically
• Preference for an information focused incremental approach and not getting distracted by the presentation layer
• SCI Store (eventually PMS) and Central Vision (NHS Tayside) are seen as the key sources for a Secondary Care EPR
• Effort should be focused on exploring access to primary care information to support a Primary Care EPR
Primary Care EPR
• Real time information• GPs control what is
shared• Coded information• Opportunities to improve
data quality• Secure method of data
extraction• Supports interoperability
between INPS and EMIS
Primary Care Summary
1 Past Medical History
2 Current Problem List
3 Current Medications
4 Allergies
5 Alerts
Conditions (i.e. diabetes)
Sensory Impairment
Communication Difficulties
Anaesthetic alerts
Mental Health Act
Child Protection Act
Adults with incapacity
Do not resuscitate
Risk Status
IntegrationPlatform
Record Locator Service
Primary Care EPR Secondary Care EPR
PortalFramework
Identity and Access Management(including Single Sign On)
AdminGP
Labs
PACS/RIS
IDL Generator
Letters Generator
CHI
OOH Pharmacy A&E
Positioning the INPS Solution
Vision 360 (clinical server)
MiG
Ensemble
South or West solution?
?
Board choice
Vision 360 Clinical Dashboard (portal server)
Current position• Regional database concept not approved by CPPB
• North consortium to further clarify its proposal and provide evidence of key stakeholder buy-in
• Continue work to assess information governance challenges
• North Consortium to be appraised of West and South Consortia outcomes, to provide opportunities for consideration of alternative /complementary proposals
South consortium
• Developed working prototype using Carefx portal to test key concepts and deliver information priorities
• Aggregated data from multiple Boards from multiple live systems
• Single sign and patient context management
• No central repository containing data copies
• Made use of Ensemble integration engine
• Video of Working Prototype
Sourcing the data
Source Data or Use Interaction
Lothian MPI SCI Store Patient Search, demographics
Portlet
4 Board SCI Stores Results, Reports, Documents
Portlet
Carestream PACS Images Standard AI
TRAKcare Previous encounters Portlet via Ensemble
ECS Meds, Allergies Launch from standard AI
External Links Knowledge Bases, General Info
URL/HTTP
Current position
• Solution assessed by >90 clinicians• Very positive clinical feedback• Approval to develop business case• Implementation if business case approved• Special Health Board assessment of options
Clinical Portal Programme Board
• National Integration platform - Ensemble• Non-proliferation• Phased approach to delivery of key information
requirements• Commissioned regional consortia work to
identify portal solutions • Information assurance programme to support
information sharing
Information Governance concerns
• Unauthorised staff will be able to access clinical information
• Clinical portal will be “free for all”
• Password sharing
• Poor audit and monitoring of access to clinical systems
• Staff not aware of their responsibilities
Role based access
Information Assurance
• Single sign on• User passwords reset• User provisioning - Active directories/EESS• Role based access model • Audit of access e.g. Fairwarning• Consistent sanctions for dealing with
inappropriate access or breaches of confidentiality
• Information governance awareness and training
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