GP2GP – The way forward
• Tony Callaghan
Magic the
problem away
Final Solution
Computerised
Records
GP2GP
Background – GP2GP in England
• GP2GP has been operational in England since 2006
• Over 5000 practices in England live on system
• About 13,000 electronic transfers completed each
week
• Both EMIS and INPS are accredited suppliers for
GP2GP in England
• System produces HL7 clinical summary and
attachments which are automatically imported at the
new practice, creating a electronic medical record
• In England the system pulls the data from the
previous practice
• If both sending and receiving practices GP2GP
enabled, transfer automatic within minutes of
registration
• GP2GP in England works over the “SPINE” IT
infrastructure which pulls data and sends it to the
requesting practice. The sending practice has no
control over despatch.
• In England, if either party not GP2GP enabled,
record needs to be printed
Benefits
• GP would have early access to full medical record
including medication, medical history, allergies etc
• Automated import/export functionality
• Records could be available within hours of registering
patient
• No need to re key information from paper records,
fewer transcription errors or omissions
• Time saving as record rich source of information
• Completeness of the record
• Reduced admin support
• Improved security
• Driver to improve quality of records
Current Challenges in England
• Limitations on the size of the
attachment files within GP2GP,
currently 5 meg and 99 attachments
• Cross Border transfers
• Returning patients A to B to A
• Limited data on actual true use of
system, we know number of transfers
but no data on imports
• No mechanism for late submissions
• Biggest challenge is that the GP2GP
system in use in England cannot work
over Scotland’s current infrastructure
Scotland’s Approach
• 2006 Docman scanners available at all GP
practices
• “Docman Transfer” was developed, creating a
patient summary with attached scanned images for
electronically transfer between practices within
Scotland
• Standard folder structures agreed for use in
Docman
• 2013, 99.9% of practices are Docman Transfer
enabled, with over 8000 electronic records
transferred each week (includes records to
storage)
Jun-13
Mar-13
Dec-12
Sep-12
Jun-12
Mar-12
Dec-11
Sep-11
Jun-11
Mar-11
Dec-10
Sep-10
Jun-10
Mar-10
Dec-09
Sep-09
Jun-09
Mar-09
Dec-08
Sep-08
Jun-08
Mar-08
Dec-07
Sep-07
Jun-07
Mar-07
Dec-06
DocMan Transfer Figures
140000
120000
100000
80000
To Storage
60000
Printed
Exceptions
40000
Electronic - end to
end
20000
0
Docman Transfer
• Produces clinical summary
• Attaches Docman images
• Standard folder structure agreed for
Docman
• Record available more quickly
• Maintains electronic record format
• Full audit trail and recoverability
• Control with sending practice
• Ability to create new clinical record at
the receiving practice manually from
Problem with this approach
• No ability to export/import the full patient clinical
record.
• Creating a record for Docman Transfer is a manual
process, which is time/resource consuming which
can delay the deduction
• Record can only be transferred within Scotland
• Practices can save data using non standard file
types, which cannot be read by the receiving
practice
• PSD have to print out the clinical record for any
transfer out with Scotland or for practices which are
not Docman Transfer enabled
Docman Transfer System- why
do we continue to use it
•
•
•
•
•
•
It works well
Proven track record
Reliable
Full audit trail
Utilises existing infrastructure
Links into Medex system to identify
patients on CHI and retain records for
long term storage
GP2GP
Docman
Transfer
GP2GP Scotland – the way
forward
we want to
• Deliver full GP2GP functionality, by
building upon what we already have
• minimising risk
• No big infrastructure change
• Transitional approach
• Safety net, retain current processes
• Get the benefits from GP2GP without
adversely disrupting GP Practices or
dismantling their processes
Way Forward for Scotland
Phase 1
• Ability to create, export and import HL7
message
• Link Docman images creating full medical
record
• Automate Docman Transfer production, but
retain manual control of deduction process
• Use existing Docman Transfer infrastructure to
move both HL7 and Docman Images
• Ability to review content before import
Phase 2
• Link into GP2GP in England for cross border
transactions
• Develop pull rather than push process for real
time transfer
Export Process
Enabled Practice
HL7
GP
Clinical
System
Clinical
Summary
eLinks
Checks Manifest,
attachments and
HL7
API
Operator Triggers
Docman Export
Docman
Outputs
Manifest &
attachments
Compress
files
eLinks Transports to
PSD
Import Process
eLink
Transport
Uncompress
Enabled Practice
GP Clinical
System
Staff select
import or not
Docman files +
HL7
Timescales
• March
• Sept
Clarification
• Sept
• Feb
• Feb
• April
• June
Sept 2013 - CCN agreements
Nov - Requirements
Jan 2014 - Development
March - Testing
April – Training (board)
May - Pilots
Dec 2014 - Implementation
Challenges
• Patients returning to original practice,
A to B to A
• Testing( end to end, EMIS PCS
currently accreditation)
• Timescales and aligning supplier
deliverables
(INPS/EMIS/Docman/eLinks/Medex)
• Data Quality
• Frequency of Partners TransactionsINPS
• Cross Border Transfers ( phase 2)
• Moving from push to pull ( phase 2)
Related Issues
• Looking to develop Docman to handle
TR’s
• Working with NHS Boards on
unacceptable file types
• Transfer of correspondence for a
deducted patient
• 7 Practices do not currently use
Docman Transfer
Questions
Will this reduce workload
Would you have the confidence in
the data quality to import records
What do we do with the paper