eHealth in Support of Better Care –
NHS Highland eHealth Strategy
2009 – 2012
(July 2009)
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TABLE OF CONTENTS
1
INTRODUCTION........................................................................................................... 3
2
THE VISION................................................................................................................... 4
3
THE STRATEGIC CONTEXT AND DRIVERS FOR CHANGE ............................ 5
4
THE COMPONENTS OF eHEALTH in NHS HIGHLAND ..................................... 7
5
THE STRUCTURE OF eHEALTH IN NHS HIGHLAND ......................................... 8
6
KEY STRATEGIC PRIORITIES – AN OVERVIEW ................................................ 9
7
SPECIFIC ACTIONS IN SUPPORT OF THE STRATEGY (THE VISION) ....... 12
8
OVERSEEING AND MANAGING THE STRATEGY ............................................ 18
9
CURRENT eHEALTH PROJECTS .......................................................................... 20
10
FINANCIAL OVERVIEW ........................................................................................... 21
Appendix I Table – Prime Specific Actions in Support of the Strategy (The
Vision).................................................................................................................................... 24
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1
INTRODUCTION
This Strategy Document follows on from the previous NHS Highland eHealth
Strategy and is informed and influenced by the Scottish Government/NHS Scotland
eHealth Strategy 2008-2011 and other significant drivers for change.
The document identifies these drivers for change, nationally and specifically for NHS
Highland. The current Strategy is, in effect, a response to these drivers and a
formalisation of how eHealth in NHS Highland will ensure that the organisation meets
its clinical and organisational purpose going forward.
.
The document sets out the overall direction for eHealth over the next three years. It
is implicit in this, due to the rapidly changing nature of the NHS and the eHealth
function, that it will require to be regularly revisited and refreshed. It is proposed that
an annual cycle of strategic review is established and overseen by the eHealth
Steering Group, supported by the GP IM&T Committee, the Information Governance
Committee and the Area Medical Records Committee as appropriate. This cycle of
review will be linked to other Board cycles such as the Local Delivery Plan (LDP).
The document sets out the NHS Highland eHealth agenda in the context of the Better
Health Better Care Action Plan, the Local Delivery Plan, the Final National eHealth
Strategy, NHS Highland Corporate Objectives, Delivering for Remote and Rural
Healthcare and other priority areas, notably and most importantly implementation of
the 18 Weeks Referral to Treatment Standard. Key to the whole strategic direction is
support for the “patient journey” in its entirety.
eHealth encompasses much more than the deployment of computer technology. It
conveys the message of electronics in support of healthcare activity and service
provision and closely related but diverse areas such as Training, Medical Records
and Information Governance. In addition, it stimulates thought and discussion about
the broad range of issues and opportunities that technology offers in the healthcare
setting to both healthcare professionals and patients. It is the use of information,
computers and telecommunications in support of meeting the needs of patients and
the health of citizens and enabling clinical staff to operate more effectively. eHealth
is core to the delivery of clinical services and ensuring that the overall strategic
objectives of NHS Highland are met.
However, eHealth is not only about the technology but about what adoption of
innovative technologies can achieve. The outputs from an effective eHealth Strategy
are improving the outcomes of care, the safety of care and the efficiency with which
care is provided. The technologies cannot deliver these benefits, its use by clinicians
and other staff will allow the benefits to be realised in our hospitals, surgeries and the
home of the patient. Hand in hand with technological change there must be a strong
organisational development function ensuring that staff are fully prepared for different
and better ways of working.
The current structure of eHealth across NHS Highland was established during 2004
and was wholly appropriate and relevant at that time. The NHS and the available
technologies and associated information have changed radically since then. The
current strategy therefore includes proposals for a review of the structure of the NHS
Highland eHealth function to ensure that it remains responsive and effective
therefore remaining wholly capable of meeting the demands upon it.
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THE VISION
The Vision for eHealth for NHS Highland can be simply and succinctly stated, but is
less simple to achieve. The vision, as articulated in our previous eHealth Strategy,
still relates to providing the right information in the right place at the right time using
the right ways, means and safeguards. The priority areas to support and achieve this
can be summarised as follows:

Working towards an electronic patient record;

Providing accurate and timely clinical and management information;

Ensuring the highest level of compliance with information governance
standards;

Enabling the efficient and effective delivery of services;

Enabling and facilitating the re-organisation of services; and

Embracing telehealth.
eHealth is therefore an integral part of achieving the system transformation as set out
in Better Health Better Care and the National eHealth Strategy.
The diagram below shows a patient journey through cancer related services (source:
National eHealth Strategy). The journey is much simplified but demonstrates the
extent of handovers and the multiple ‘silos’ of patient information which can result. If
these ‘silos’ are pieces of paper in cabinets then essential communication becomes
problematic.
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The Vision will offer fast, local and reliable access to patient services through the use
of technologies and the removal of the ‘silos’. That in essence is the strategic
process which this document sets out. In addition progress towards our Vision will
only be achieved by a series of specific actions, these actions are set out in the later
part of this Strategy Document.
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THE STRATEGIC CONTEXT AND DRIVERS FOR CHANGE
The National Health Service in Scotland is undergoing a period of fundamental
change. This change process has a number of explicit drivers which operate
together to determine the strategic direction of the NHS. eHealth fundamentally
underpins and enables these change processes therefore the same drivers influence
the strategic direction of the eHealth function.
The primary drivers for change at the time of writing are listed later in the Delivery
Plan. There will be more of these “drivers” as time progresses emphasising again
the need for a strategy which is revisited and refreshed periodically on a formal basis.
It is important that the eHealth strategic direction is in response to these drivers as
well as being an effective exploitation of the constant developments in technological
capability.
Paradoxically, the drivers of the vision for eHealth are strategically simple; support for
the overall NHS Scotland and NHS Highland goals as set out in the Better Health
Better Care Action Plan. Fundamentally this is about exploiting the power of
electronic information to help ensure that patients get the right care, involving the
right clinicians, at the right time, to deliver the right outcomes. It is about change and
the transformation of traditional and existing processes more than it is about the
enabling technology.
The benefits that eHealth can help bring about are the same as those specified and
sought in Better Health Better Care. Sharing information for the benefit of patients is
a key responsibility of NHS Highland and other bodies to ensure the provision of
service delivery excellence and, on occasion, to help protect vulnerable individuals.
The strategic direction must be seen in the context of the restricted resource
framework within the NHS and the wider Public Sector with the potential for lower
investment and the ever present need to maximise outputs.
These drivers are working together to achieve, through the effective implementation
of eHealth, improved patient safety and overall effectiveness through complete,
accurate and available information.
The key current drivers including the Better Health Better Care Action Plan may be
summarised as:
a)
The Better Health Better Care Action Plan
The Better Health Better Care Action Plan was published by the Scottish
Government in December 2007.
Although eHealth is key to the implementation of each section of the document,
Section 3 includes a specific section on eHealth:
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“High quality information is crucial to the delivery of safe and effective health care.
We will build on our work to put in place a modern and efficient information and
communications system 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. We also
need to ensure that the benefits which information technology brings to patients and
health care professionals, such as improved co-ordination of care are delivered
within a culture which respects, values and keeps secure patients’ data.”
The section on eHealth progresses to give an overview of the then emergent
National eHealth Strategy, (of which more in point c) below).
In addition to the section on eHealth there is a further section on telehealth which is
an integrated part of this NHS Highland eHealth Strategy. In addition to telehealth
similar technologies, most notably video conferencing, are being utilised to maximise
the effectiveness of support services
“Telehealth offers a range of care options remotely via phones, mobiles and
broadband, often involving videoconferencing. Deployed effectively, it can improve
the patient’s experience of care by reducing the need for travel to major cities and
hospitals to receive care and treatment. It has already been used successfully to
provide treatment around conditions such as dermatology, cardiology and
neurology.”
b)
The Local Delivery Plan
The Local Delivery Plan (LDP) is a delivery agreement between the Scottish
Government Health Department and NHS Highland based on key Ministerial targets.
Trajectories towards the HEAT (Health Improvement, Efficiency, Access to Services
and Treatment Appropriate to Individuals) targets and attainment are rigorously
monitored both locally, mainly through the NHS Highland Improvement Committee,
and nationally by detailed and prescribed reporting.
The Cabinet Secretary for Health and Wellbeing has agreed the 2009/2010 HEAT
proposals. The targets for 2009/2010 focus NHS Scotland on working with its
partners to deliver services that will support the Scottish Government longer term
outcomes.
While the NHS Highland eHealth Directorate by its nature has a key role in the
attainment and measurement of many of the targets there are two specific measures
directly related to eHealth and for which the Head of eHealth is accountable:
E7: Electronic Referral Management
E9: CHI Utilisation - Radiology
c)
The National eHealth Strategy 2008-2011
The National eHealth Strategy 2008 – 2011 was issued during 2008. As would be
expected, the National eHealth Strategy has been key in informing aspects of the
NHS Highland eHealth Strategy and associated Delivery Plan.
Fundamental to the NHS in Scotland strategic direction is increasing collaboration
and cooperation between NHS Boards in respect of the eHealth agenda.
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d)
NHS Highland Corporate Objectives
NHS Highland’s primary purpose is to deliver safe and accessible health services
within the context of national policy as outlined in Delivering for Health. The Scottish
Government, through the agreement and delivery of the Local Delivery Plan (LDP)
and associated HEAT targets, assesses performance. Directors, managers and
clinical leaders are responsible for implementation and the NHS Highland Board is
responsible for assuring delivery on behalf of Ministers and the public.
The Corporate Objectives for NHS Highland are set at the level of banner statements
to capture broad themes and build on the corporate objectives of previous years.
e)
Delivering for Remote and Rural Healthcare
Delivering for Remote and Rural Healthcare was published by the Remote and Rural
Steering Group in late 2007. The Report identifies principles which should underpin
a technological approach as:
a. That specialist advice can be provided
videoconference, telephone or e-mail;
from
a
distance
by
b. Travelling to a central point can be obviated by the use of
videoconferencing to a Rural General Hospital (RGH), Community
Hospital, GP Practice or indeed in certain circumstances direct to a
patients home;
c. Digital data can be transferred from remote sites to other points,
enhancing diagnosis. So, for example, blood tests, ECGs, images of all
sorts and sounds can be sent to a central point from a peripheral location.
RGHs could therefore supply a network of Community Hospitals and/or a
Tertiary Centre could likewise supply scarce intellectual resource to the
RGH, Community Hospital and isolated practitioners.
f)
The overall changing environment and priorities such as 18 Weeks
Referral to Treatment (RTT) and Shifting the Balance of Care
There is a process of continuing change contained within other initiatives such as the
National Improvement Programmes. This is leading to the requirement for the ability
to track the patient journey from referral to treatment, in the early stages utilising
legacy systems which were not initially designed to fulfil this function. The emphasis
is a move from patient administration to patient management in the acute care
sector.
This is a challenging agenda with significant NHS Highland and eHealth resource
being allocated.
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THE COMPONENTS OF eHEALTH IN NHS HIGHLAND
The role of eHealth is sometimes considered to be the more technical aspects as this
can be the most visible element. In practice the Directorate of eHealth has a very
broad organisational remit. In the interest of definition and clarity the current key
components of eHealth are listed below.
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Key Components:
Support Services;
System development;
Network Services;
Technical Development;
Telehealth;
Information Services;
Information Governance;
Project/Programme Management;
OD Facilitation;
Health Records Management (Direct Management
Raigmore);
Contractor Services/Support;
Argyll and Bute Community Health Partnership;
Training; and
Primary Care Mentoring.
Medical
Records
The financial position across the NHS in Scotland remains challenging, and this
includes NHS Highland. The strategic direction of the organisation and the eHealth
function may be constrained by the availability of resource. In addition resource
allocation decisions within the NHS unavoidably have an opportunity, as well as a
financial, cost. The current economic climate indicates that public sector allocations
over the next several years will be materially constrained.
The end result of the Vision for eHealth Services across NHS Highland is to pursue
and attain excellence in terms of supporting direct patient care, knowledge and
information and management processes by deploying, maintaining and exploiting a
modern, secure and robust eHealth infrastructure for the organisation.
It should be particularly noted that, although the components of eHealth are identified
as discrete areas above, the whole is much more than the sum of the discrete parts.
The department is directed and managed in a fashion which integrates the key
components into a closely coordinated function.
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THE STRUCTURE OF eHEALTH IN NHS HIGHLAND
The organisational structure for eHealth in NHS Highland was designed and
implemented in 2004 when the function became integrated across the area. Prior to
this each NHS Trust in the area had a discrete eHealth (then more commonly
described as IM&T, Information, etc) function leading to a perceived fragmentation of
purpose and strategic direction.
It should be noted that the eHealth function within the Argyll & Bute Community
Health Partnership (CHP) is managed differently from that in Northern Highland. The
budget is held within the CHP and the Head of eHealth for the CHP reports to the
CHP General Manager, although the Head of eHealth for NHS Highland retains
professional accountability.
Discussions around the management and deployment of services in the Argyll & Bute
CHP area are ongoing as part of the implementation of the current strategy. It should
be noted that the current organisational structure and arrangement around eHealth
mirrors the current model of other support services in the Argyll & Bute CHP area.
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The prime objective is to further integrate the Argyll & Bute and Northern Highland
eHealth functions. In terms of major system implementations; it is planned that these
will be managed and introduced on a pan-Highland basis.
The strategic aim then is to more closely integrate Northern Highland and Argyll &
Bute CHP. Tactically this will be addressed by currently ongoing discussions at a
senior level and within the relevant governance bodies.
The staffing structure of eHealth is being critically reviewed as part of the
implementation of the current strategy. The current structure within Northern
Highland consists of three “legs”.



Implementation
Infrastructure
Information
It is proposed that the structure is revised to remove the post of Head of eHealth
Implementation, which is currently vacant following the appointment of the Head of
eHealth. This will result in a revised structure with the following functions reporting
directly to the Head of eHealth.


Infrastructure and Programme Management
Knowledge and Information (or similar nomenclature)
The revised structure will narrow the span of control and will focus the activity of the
eHealth function in a more effective manner.
The eHealth Department is currently responsible for the operational management of
the Central Medical Records Department within Raigmore Hospital.
These
arrangements are currently under review as part of the overall strategic and structural
process underway.
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KEY STRATEGIC PRIORITIES – AN OVERVIEW
The implementation of a strategy is dependant on the identification and
implementation of specific actions. These actions and timescales will be identified in
a later chapter. These actions are the key building blocks of the strategy
implementation process. Before the specifics are reached it is important to lay out
the key principles which will underpin the strategic direction to be achieved by the
application of these actions.
These key principles are unsurprisingly similar to those introduced in the NHS
Scotland eHealth Strategy. The principles are listed here as they are wholly relevant
and underpin all elements of the future strategic direction across NHS Highland.
a)
Confidentiality Safeguards are an obligation
There is a potential conflict between making patient information readily available and
ensuring that it remains wholly secure. Records within the secondary care sector in
NHS Highland are at present almost wholly held on paper. While there are systems
to protect the security of these records there is also the potential for them to be seen
by inappropriate people and they can be misplaced or lost.
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The implementation of electronic systems can mitigate many of these issues through
strong access control measures and the provision of an audit trail. A robust audit trail
will record what has been accessed, when access has taken place and what the
identified individual has done when accessing. It is of course important that these
audit trails are subject to review on a formal basis. In addition, electronic records
facilitate further efficiencies through access, storage and the minimisation of physical
transportation.
The implementation of electronic systems also introduces new challenges as large
volumes of information are potentially stored in the one place.
NHS Highland has comprehensive systems in place to address the above issues and
support our key duty of patient confidentiality. The continuing development of a
robust Information Governance framework has been formalised and strengthened. In
designing system improvements we consider the following to be key:



b)
Access to information must be based on legitimate reason and the interests of
the patient;
Key stakeholders are the public, patients and healthcare professionals; and
eHealth currently has the support of key stakeholders in this regard and this is
reinforced through the NHS Highland Information Governance Committee and
its reporting arrangements.
Continuing the journey, exploiting what already exists, identifying and
filling gaps.
The journey is a continuing one; much has been achieved in recent times through an
incremental approach to system implementation. In addition there has been work to
build “bridges” between existing systems which originally had no connection (e.g.
Emergency Care Summary which passes information from general practice clinical
systems to the unscheduled care sector).
The strategic direction is not a ‘large complex national IT project’ as has been seen,
with varying success, south of the border. The key to our approach in Scotland and
NHS Highland is greater integration between systems and parts of the areas of
operation (e.g. general practice and secondary care). This is a pragmatic approach
and is to be favoured, in strategic terms, over the alternative “rip and replace”
scenario.
c)
Focus on Benefits, Supported by Technology and Change.
eHealth is about much more than the technology; it is about improving the outcomes
of care, the safety of care and the efficiency with which care is provided. IT systems
can not deliver these benefits alone, but will be used to support clinicians and other
staff deliver patient centred benefits in hospitals, General Practices, the wider
community and patients homes.
The investment and implementation will be focussed on benefits realisation to the
extent that this will be a formal part of any proposed implementation. It is expected
that there will be an increase in resourcing from the centre to support rigorous
change and benefit management although this must be seen in the context of the
current economic climate.
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d)
Virtual, not a single database, Electronic Patient Records (EPRs) in Direct
Care.
Comprehensive patient information available to the clinician at the point of care is a
key objective of the NHS Highland eHealth Strategy. In the absence of this
availability to the clinician it is difficult to envisage the required level of organisational
change focussed on improving patient care.
The historic situation is that much relevant patient information is held but this
information tends to be fragmented and captured and maintained by different
systems. While the General Practice record (now mostly held electronically) is
‘cradle to grave’ the acute sector records are mainly paper and are arguably
fragmented and episodic. This must change.
Theoretically, this could be changed by the implementation of a single national
(Scottish) database that could be used by all clinicians to access the same individual
patient record. However, a single national database is not the intended strategic
direction either nationally or by NHS Highland. The cost and sheer complexity of
setting up such a system would preclude any benefits accruing from implementation
and lead to extended timescales around what is an immediate need.
The vision and intention is the implementation of a clinical portal, developed within
NHS Scotland, to present seamless information to clinicians from a variety of
information systems. This approach has the advantage that it will utilise and
‘defragment’ much of what already exists. This will lead to an early benefit realisation
from the organisational and patient perspectives and will minimise development,
implementation and recurrent costs. A constraining factor which must be addressed
in the acute sector is the current dependence on paper patient records which are of
course by their nature excluded from sourcing by a portal application.
The portal will also allow segmented and secure access to patient information on a
strict ‘need-to-know’ basis and can be potentially deployed across multiple agencies
for specific purposes.
e)
Technology Development, Standardisation and Convergence
There are key themes around the technology and standards which must be achieved
if clinicians are to obtain maximum benefit form the upcoming programme of change:






Focus on ease of use, accessibility;
Convergence on fewer and more re-usable, cost effective IT systems;
Integration between systems, internal to NHS Highland and with partner
agencies (e.g. Highland Council) where appropriate;
Common data standards and terminology across information systems;
Value for Money, with the emphasis on effectiveness; and
Whether a national service or local choice is appropriate will be
considered on a case by case basis.
The increasing dependence on eHealth systems will require additional resilience
(and across NHS Highland increased transmission bandwidths). In addition,
although the approach will focus on maximising what already exists, there is a clear
need to replace several national and local legacy systems which are approaching (or
have exceeded) their useful life.
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f)
Collaborative approach to delivery, drawing on best expertise
Fundamental to the vision of improved eHealth capability is a collaborative approach
between NHS Highland, other NHS Boards, National Services Scotland and the
Scottish Government. There is no single delivery model which will suit each and
every development and initiative. The intention is to draw on skills and abilities which
already exist across the NHS in Scotland in a mutually beneficial way with
collaboration and communication at the forefront of the change process. This is a
prime focus of the National eHealth Leads Group which includes the NHS Highland
Head of eHealth in its membership.
This collaborative approach has already been evidenced through ongoing
developments and procurements such as Patient Management System, MultiDisciplinary Information System (MiDIS) and the clinical portal.
Collaborative working in non-clinical areas is also vital. The delivery of the Financial
Ledger through the Tayside Consortium is an example of this. This arrangement
enabled through eHealth systems not only maximises the current skills framework
but also provides further opportunities for joint working and service redesign, enabled
by eHealth.
NHS Highland is supportive of the new and emerging collaboration between NHS in
Scotland organisations. This may be contrasted with the previous approach where
there was a tendency for each organisation to “go their own way” leading to a degree
of national fragmentation regarding eHealth solutions.
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a)
SPECIFIC ACTIONS IN SUPPORT OF THE STRATEGY (THE VISION)
Working Towards an Electronic Patient Record
Our ultimate aim in eHealth is to move towards an electronic patient record. This will
have benefits from a patient, staff and organisational point of view. There is a huge
amount of clinical data communicated in various forms and sent between primary
and secondary care and back again and also within each of these sectors. Patients
find it difficult to understand why they have to repeat the same information on
numerous occasions, conversely patients also find it difficult to understand why
different information can be held by the same organisation. This does not inspire
patient confidence.
The National Strategy is to build upon what we currently have and to integrate all of
our systems so that they can “talk” to each other so that the patient information can
be extracted and shared. This concept will be fundamental to any bids for eHealth
capital for new projects. A number of key elements to progressing to an electronic
patient record are detailed below.
Implicit in the achievement of the specific actions is the availability of adequate
resource.
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
Universal CHI Usage. Community Health Index (CHI) is the nationally
determined prime patient identifier. This allows data relating to individual
patients to be shared between systems confidently knowing that the data in
each of the systems relates to the exact same patient. This is absolutely
crucial for patient safety and there is a specific target for 2009/2010
regarding CHI usage in radiology, following on from the 2008/2009 target in
respect of laboratories. NHS Highland last reporting period showed CHI
usage in the laboratories at 98%, ahead of target.

Integration of clinical letters into Scottish Care Information (SCI) Store.
Clinical letters are currently produced electronically in secondary care,
printed out and sent to GP Practices where they are digitised by scanning
and stored electronically in the GP system. NHS Highland will make a firm
commitment that clinical letters integration into SCI store will be scoped by
31 March 2010. This will promote increased efficiencies and allow
electronic access to the information without the need to commit to paper.

Integration of electronic reports into SCI store. ECGs and endoscopy
reports are currently produced electronically and the technology is available
to incorporate these reports into SCI store. NHS Highland will undertake to
have both of these reports in SCI store by 30 June 2010. All other reports
produced electronically should, where possible, be stored in SCI store and
work is underway to maximise this utilisation.

Full utilisation of SCI Gateway functionality. SCI Gateway currently has
the functionality to allow electronic communication of referral letters from
primary care to secondary care and this is used extensively within NHS
Highland. SCI gateway also has the functionality to allow communications
electronically from secondary to primary care. This functionality must be
exploited by NHS Highland and will be scoped, in terms of activity and
resource required, by 31 March 2010.

Clinical Portal. There is a strategic drive nationally to provide a portal view
of a patient record, or more correctly, a patient virtual record. If all data
relating to a patient can be identified using the unique CHI number, an
authorised clinician will be able to see that data using a single screen
irrespective of what system the data is actually held in. NHS Highland will
maintain engagement with the national dialogue about portal developments
and will look to implement this at the earliest opportunity.

Electronic communication of laboratory results to General Practices.
NHS Highland will undertake to transmit laboratory results electronically
directly into GP systems using the technology available by 30 June 2010.
The achievement will be largely predicated on safety issues being handled
within the primary care receiving system and technical interface issues
being resolved.

Development of e-forms. Many clinical processes are based on recording
routing information on forms, such as Admission Forms, operation notes or
Multi-Disciplinary Team (MDT) notes. NHS Highland will exploit the
technology available to streamline and digitise these forms and integrate
them with the existing core products of SCI Store and SCI Gateway.
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
Document Scanning. NHS Highland will produce an Evaluation Report on
document scanning. There are potential savings in minimising the need for
off-site storage and retrieval of records in paper format if these were
scanned and held electronically.
This report will be produced by
30 September 2010.

Advice and Guidance.
As stated above there are numerous
communications between the primary and secondary care sectors which
often take the form of formal referral letters. There are increasingly clinical
questions raised in primary care which do not require a formal referral but
do require consideration by an appropriate clinician in secondary care. The
resulting answer provided in response to the question must be appropriately
recorded in the form of an audit trail. A prototype system was developed by
NHS Highland some years ago but this did not progress to implementation.
A strategic review of this system and conclusions on the way forward will be
provided by 31 March 2010.

Anticipatory Care/Long Term Conditions. To support the development of
anticipatory care initiatives which have the objective of providing the most
appropriate intervention to prevent unnecessary hospital admission.
Support the expansion of the cohort of patients for whom the level of
“admission risk” can be identified beyond those who have recently been
admitted. The eHealth Facilitation team is further developing an original
algorithm developed by the Finance Department to identify patients most at
risk of hospital admissions. This is based upon data extracted from GP
clinical systems combined with admissions and outpatient data from the
hospital patient administration system (PAS). The work is referred to as
‘Casefinder’ and is considered to be more accurate than the centrally
produced SPARRA risk listings.
In addition to developing extraction tools, the team is also involved in coordinating an evaluation phase involving 20 Practices across NHS Highland.

b)
MiDIS – Community & Allied Health Professional System, Mental
Health Integrated Care Pathway, secure Inter-agency Data Sharing.
There is a collaborative national development of a community system taking
place; inherent in the functionality is the ability to interface with the MultiAgency Store (MAS) allowing secure sharing of single shared assessment
and other data between health and social work. The Multi-disciplinary
Information System (MiDIS) is the national strategic way forward in respect
of community information systems. NHS Highland is currently awaiting
costs in order that detailed business cases may be prepared.
Providing complete, accurate and timely clinical and management
information
NHS Highland presently has an annual recurring revenue budget of c£550 million.
High quality information is needed to ensure that this funding is utilised in the most
efficient and effective way for the care and health of the population of Highland. This
information must be complete, accurate, timely and available. A number of key
elements and actions will facilitate this as detailed below:
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
Patient Management System (PMS). The new PMS is at an advanced
stage of National procurement with the signing of a contract due to take
place in late 2009.
NHS Highland intends to be one of the second phase of Health Boards
which will implement the new PMS, this is currently planned to commence
in 2012. The implementation will enhance management of the patient
journey and ensure continuing compliance with National Waiting Time
Standards.
The PMS implementation will also provide order
communications functionality (the ability of the clinician to order diagnostic
tests electronically).
There is a need to address the replacement of the current pharmacy system
which is “legacy” in nature. Discussions are currently underway between
eHealth and senior Pharmacy staff in this regard with a view to planning the
approach. The replacement pharmacy system is required at an early stage
and discussions are currently on-going to determine whether a full
procurement is required or whether the work already undertaken nationally
as part of the PMS procurement can be used specifically in respect of
pharmacy.

18 Weeks referral to treatment standard. The 18 weeks Referral to
Treatment Standard is a major undertaking for NHS Highland and other
Health Boards and eHealth will be crucial in facilitating a successful
outcome. Fundamentally, 18 Weeks concentrates on shifting from the
current emphasis on “stages of treatment” to whole pathways of care. The
elements the programme will deliver are joined up treatment through all
stages of the patient pathway, a traceable patient journey(ies) and a
measurement system providing accurate data and information.

Business Objects Universe. A Business Objects Universe has been
established to allow the exploration of referral and other data and this will be
further exploited. The Business Objects Universe will be extended to other
areas where real time integration of data will benefit both patient care and
management decision making.

Medical Staff Revalidation. The General Medical Council (GMC) is
presently introducing revalidation for medical staff. There will be a
requirement for accurate information in respect of medical staff. The
eHealth Department will work closely with senior medical management to
facilitate this process.

Continue General Practice Migration from GPASS. The GPASS practice
clinical system was independently evaluated on a national basis and
deemed not “fit for purpose”. NHS Boards are required to migrate from the
system. NHS Highland is ahead of the national directive and thirty
Practices have been migrated to the Vision clinical system (giving a total of
forty Practices out of sixty eight in Northern Highland). Each migration is a
major business change for the Practice and NHS Highland eHealth have
ensured that appropriate training, support and advice has been made
available.
15
c)

Enhance Emergency Care Summary (ECS). The ECS is operational
nationally. In NHS Highland the ECS dataset is made available to Out of
Hour (OOH) services, A&E and receiving wards at Raigmore Hospital.
Work is continuing to expand the available dataset commencing with
patients who are receiving palliative care.

Information Strategy. A major review of information provision has taken
place across NHS Highland. Information Services Division (ISD) of National
Services Scotland (NSS) has been engaged on a consultancy basis. The
current phase of the project (2009/10) with the objective of producing an
NHS Highland Information Strategy is well advanced and is targeted for
completion by 30 September 2009.
Ensuring High Levels of Information Governance
The nature of modern healthcare involves the rapid transfer of information relating to
patient care between different clinicians, both internally and externally to an
organisation. NHS Highland patients must have confidence that data divulged to a
clinician is held securely and shared only with other clinicians who require the
information as part of the care of that patient. This will entail the continuing
development of robust policies which are practical and known about across the
organisation and are adhered to by staff. This work will be taken forward by the
Information Governance Committee.

Continue to Improve Standards of Information Governance. Much work
has taken place over the last several years to demonstrably improve and
strengthen the standards of information governance across NHS Highland.
This has involved eHealth staff achieving formal qualification, expanding the
membership of the Information Governance Committee, notably to include
patient and staff representation, producing the Information Governance
Improvement Plan and Annual Report and increasing staffing resource.
This work will continue apace over the period covered by the eHealth
Strategy and will lead to increased effectiveness of control over information
obtained and held.

Identity and Access Management (IAMS). Clinical authentication and
authorisation to use systems will be strengthened by the imminent
implementation of the nationally procured Identity and Access Management
System (IAMS). NHS Highland has been subject to preliminary assessment
concerning the readiness of the organisation to implement IAMS and is
targeted to implement in the second half of 2009.

Compliance with CEL 45 (2008) – Mobile Devices Policy. NHS Highland
is implementing the requirements of CEL 45 (2008) by utilising the
nationally procured software solution to encrypt all mobile devices. A plan
will be formulated to deal with USB memory sticks which are currently in
use, and for them to be replaced, where still required, by fully encrypted
versions. Work will continue to lock down USB ports and optical media
readers (i.e. CD drives) which will ensure that NHS Highland data cannot be
copied in any way. The project will also operate across the General
Practice sector.
16
d)
Enabling and Facilitating re-organisation of services
eHealth is a facilitation service and an enabler of service redevelopment and
redesign. While eHealth can facilitate and enable different ways of working this
requires cultural change within the organisation.
An example of this is digital dictation where new technology is to be exploited to
allow new ways of working by clinicians and administrative support staff. In addition
developments such as order communications (the electronic requesting of test
results) will decrease the number of unnecessary or repeat tests performed.
In addition a further benefit to be realised is to maximise the efficiency and
effectiveness of overall service delivery both in direct healthcare and support.
Virtually all of the actions categorised in the above sections (a - c) will enable and
facilitate very different ways of working within NHS Highland with eHealth activity
being the enabler.
e)
Embracing Telehealth
Tele-health may be defined as “information technologies used locally and at a
distance combining health, telecommunication, information technology and health
education to improve the efficiency and quality of healthcare”. In short, the
application of relevant technologies to allow the distance between the patient and the
clinician to be “minimised electronically”.
The application of effective telehealth is particularly relevant and important in an area
such as NHS Highland with a sparse and geographically dispersed population.
Telehealth is, therefore, a vital element in taking specialist care to the patient rather
than the patient travelling to receive care. It is the utilisation of technologies to
provide services in a fundamentally different way and has a material contribution to
make in shifting the balance of care.
In addition to the provision of patient care and assessment at a distance telehealth
can also be successfully utilised in other, perhaps less obvious, ways. Minimising
the requirement for staff to travel to meetings and the provision of remote education
and training are all potential uses of the technology.
Telecare is a service which brings health and social care directly to the service user
while telemedicine involves the use of technology to support the exchange of
information between healthcare professionals, generally for the diagnosis, referral or
management of medical conditions.
Telecare is essentially a multi-agency
programme based around social care and maximising the potential for independent
living. Very often this is achieved by placing devices in the home of the client.
Because of the above factors it has been agreed that this Highland eHealth Strategy
(incorporating telehealth) should be developed independently, but interact closely
with the Telecare Strategy in a complimentary fashion.
In summary, telehealth has the potential to support


Direct Patient Care;
Education and Learning;
17


Management Processes; and
Communication and Meetings.
Telehealth initiatives cannot progress without the presence of a robust technical data
communication infrastructure. The last two years has seen much progress in
achieving almost universal connectivity of NHS Highland locations. Hospitals,
General Practices and the majority of community bases staffed by Nurses, Midwives
and Allied Health Professionals (NMAHPs) now have connectivity although
bandwidth remains a potential issue. In addition, there are now some 120 videoconferencing units deployed, the majority of these centrally managed. Reliability
issues are currently being resolved with the result that a robust VC network will be
available for the implementation of future telehealth initiatives. Implicit in achieving
the degree of reliability and technical robustness is adequately funded and effectively
deployed and available video conferencing support. This support will include central
and remote management of the facilities as well as a formal and controlled booking
process.
Discussion with clinical colleagues has established that the major demand for
telehealth is the provision of video consultation facilities between a central clinician
and a remote patient. This complies with the ethos of Better Health Better Care,
specifically in shifting the balance of care from the acute sector to the locality of the
patient.
The implementation of telehealth projects through the medium of videoconferencing
requires that a technically robust and reliable service is in place. Extensive work will
remain ongoing through the period of this Strategy to enhance the reliance which
may be placed on the technology.
A significant number of telehealth initiatives have and are being run across NHS
Highland, however these have not historically been coordinated and overseen by a
single body. It is intended that a clinically driven Telehealth Sub Group of the
eHealth Steering group be established in order that telehealth initiatives can be
evaluated and translated into projects as appropriate.
Examples of successful clinical telehealth projects to date include:





8
Cancer Multi-Disciplinary meetings
ENT Tele-endoscopy from Raigmore Hospital to The Western Isles
Epilepsy Video Link – New Craigs to The Scottish Epilepsy Centre
Picture Archiving System (PACS) – Digital X-Rays and images
Raigmore Paediatric SCU/Yorkhill – cardiology scanning
management.
and
OVERSEEING AND MANAGING THE STRATEGY
A number of formal bodies have been established to ensure overall governance of
the eHealth Directorate and to focus strategic direction. These governance
arrangements are currently under review as a component of the on-going strategic
review.
18
a)
eHealth Steering Group
The Group’s remit is to oversee the planning, development, delivery and
management of eHealth Services for NHS Highland. Implicit in the implementation of
the current eHealth Strategy is a review of the role and remit of the eHealth
Steering Group.
Strategic projects and initiatives are considered and overseen by the eHealth
Steering Group. The Group is a multi-disciplinary body chaired by the Clinical
Director of eHealth and comprises representatives of each Community Health
Partnership, Raigmore, eHealth, Corporate Services, Nursing Midwifery and Allied
Health Professionals, Pharmacy, Dental, Area Partnership Forum, the Highland
Council and patients.
The current agreed remit and responsibilities of the eHealth Steering Group is as
follows:
Overall Remit




To ensure that NHS Highland continues to operate with an approved
eHealth Strategy within current national guidelines and directives;
To establish and monitor targets and milestones for the implementation of
the eHealth Strategy and ensure that these are met;
To provide the information and reporting forum for the implementation of
the eHealth Strategy through NHS Highland; and
To develop appropriate eHealth links with NHS partners, and relevant
non-NHS bodies (eg. Local Authorities).
Specific Responsibilities




To develop, consider and approve the NHS Highland eHealth Strategy;
To update the Strategy as necessary to reflect current guidance,
directives and changing needs of NHS Highland;
To monitor the implementation of the area eHealth Strategy; and
To report to the Corporate Team and the Highland NHS Board where
appropriate, on eHealth Strategy implementation, together with other
major related issues.
The eHealth Steering Group is chaired by the Clinical Director of eHealth.
The membership of the group in addition consists of
Head of eHealth
Director of Finance
Medical Director (attend as appropriate)
Management representation from each Community Health Partnership and
Raigmore
Clinical Representation from each CHP and Raigmore
One Area Partnership Forum representative
One NMAHP representative
One Pharmacy representative
One Patient representative
One Local Authority representative
19
The membership is subject to periodic review in order to ensure that stakeholders
remain adequately represented.
There are currently three sub-groups that report into the eHealth Steering Group
b)
GP IM&T Committee
Considers and oversees strategic direction and investment in eHealth within the
General Practice sector. Specifically to advise on GP IM&T issues which may arise,
to receive reports on and to monitor progress of active projects within the GP IM&T
sector and to prioritise allocation and use of GP IM&T financial resource (revenue
and capital).
The GP IM&T Committee is chaired by the Clinical Director of South East Highland
CHP.
c)
Area Medical Records Committee
Sets and monitors standards for the management of medical records across NHS
Highland.
The Area Medical Records Committee is chaired by the Clinical Director of eHealth.
d)
Information Governance Committee
Discusses, formulates and monitors the policies around the Information Governance
agenda. This Committee includes patient and staff-side representation.
The Information Governance Committee is chaired by the NHS Highland Head of
eHealth, on an interim basis. This is currently under review as an independent
clinical Chair is more appropriate with support from the eHealth Directorate. The
instigation of a clinical Chair will be formally confirmed by 31 March 2010.
In addition to the explicit local governance structure summarised above the provision
and use of aspects of the eHealth Service is governed by statute, by national policy,
by local policies and by standards of good practice. Continuing compliance with
these and other requirements is reviewed on a cyclical basis by the Internal and
External Audit functions.
9
CURRENT eHEALTH PROJECTS
Fundamental to the strategic direction of the eHealth function is the continuation of
the many initiatives which have been and are already underway. This is in
compliance with the National Strategic aim of avoiding “rip and replace”. The ethos
is to build upon and develop what has already been achieved, this being taken
forward incrementally.
A Strategy is by definition a forward looking document however there requires to be a
robust link with what has already been developed and what is currently in
development.
The Department of eHealth manages a diverse portfolio of projects at any time. The
more major of these projects are almost all capital funded and emerge from the
clinically driven and influenced tactical (annual) and strategic (5 year) capital
allocation and bidding process overseen by the eHealth Steering Group.
20
The project life cycle is complex and ranges from the production of the outline
business case to project management, implementation and ongoing system support.
The range of skills within the eHealth Department allows a project to be managed
through the various phases to completion and to be handed over to allow ongoing
support.
Project management is applied according to the materiality and complexity of a
particular project. The larger projects are managed by a dedicated Project Manager
while smaller projects are managed on a “portfolio” basis with a Projects Manager
overseeing a number at any one time.
Project Boards are normally chaired by a clinician thus ensuring the continuing ethos
of clinically driven project initiatives.
The Programme and Project Management functions within NHS Highland eHealth
were recently reviewed by Audit Scotland resulting in the receipt of a favourable
report.
The eHealth function is currently managing a diverse range of projects which have
positively and demonstrably enhanced patient care and clinical safety across our
area. Fundamentally the capital allocation process is being revised to ensure that
projects are only approved if they are in compliance with the eHealth Strategy.
10
FINANCIAL OVERVIEW
eHealth activity in NHS Highland is funded by both revenue and capital resource.
The implementation of large scale strategic projects such as MiDIS and PMS will
have material financial implications for NHS Highland. The relevant business cases
will be prepared as soon as the relevant costs are available.
In addition, there is a continuing need to invest adequate funding in maintaining and
modernising the infrastructure utilised in the provision of eHealth Services to the
organisation. This ongoing refresh and replacement of infrastructure assets is
particularly important as a situation of under funding can lead to a situation of
“backlog maintenance” where the implementation of innovative projects could be
constrained by a lack of robust underlying technologies.
The next spending review which should be available in the Autumn of 2009 may have
significant implications for overall public sector allocations in 2011/2012 and
onwards. This increases the implementation risks, and highlights the need for an
appropriate budgetary process, flexibility and consideration of an exit strategy.
The figures in the 2011/2012 column below are subject to the outcome of this
spending review.
NHS Highland eHealth revenue funding is as follows:
Northern Highland
Argyll & Bute CHP
NHS Highland Total
2009/2010
£ 000
5,274
1,233
6,507
2010/2011
£ 000
5,274
1,233
6,507
21
2011/2012
£ 000
5,274
1,233
6,507
Note:
In the interest of prudence the 2009/10 figure has been projected “flat” due to the
current public sector financial position.
The figures above exclude incremental drift, pay awards, CHI and ECCI and any
potential central funding identified below, they include GP IM&T funds.
The NHS Highland eHealth Capital Plan is as follows:
Northern Highland
Argyll and Bute CHP
NHS Highland Total
2009/2010
£ 000
1,000
300
1,250
20010/2011
£000
1,500
250
1,750
2011/2012
£ 000
1,900
250
2,150
In addition to the above funding streams a number of new eHealth funds are being
made available from 2009/2010 to help meet the objectives of the National (and
therefore local) eHealth Strategy. Four funding streams are to be allocated to NHS
Boards. It should be noted that the letter does not refer solely to new money as
existing CHI and ECCI central allocations are included.
The Primary Care and Community eHealth Fund (recurrent revenue) is designed
to provide resources to support primary and community care eHealth including GP
IM&T. NHS Highland provide all eHealth assets, maintenance and support to
General Practices across the area. From 2009/2010 National Services Scotland
(NSS) will be charging NHS Boards for the GPASS product which will be offset
against this fund. GP charge details are currently awaited.
The Information and Data Fund (3 Year non-recurrent revenue) will be used to
help support NHS Boards in the following areas:



Information governance issues arising from the gradual replacement of
paper based patient records with electronic records;
Data quality and data cleansing to ensure high quality information is
contained within these records; and
Data migration costs associated with IT system replacement programmes
such as GP IT and Patient Management System.
This fund will be initially allocated over two years with a third year subject to the
outcome of the next spending review.
Change and Benefits Fund (Non-recurrent revenue over two years): This fund
should be used to support various eHealth related change and benefit initiatives.
There are four main elements to this:
Change element
Benefits element
eReferral Element (replacing ECCI)
CHI Element
In addition there will be a national allocation of £20m supported capital over two
years to support NHS Boards in upgrading their core IT infrastructure. Discussions
are yet to take place with eHealth Leads as to how this fund should be distributed.
22
The indicative sums, awaiting final confirmation, in respect of NHS Highland are as
follows:
Fund
Primary and Community
eHealth Fund
Data Fund
Change and Benefit
Fund
Year 1 (09/10)
£
Year 2 (10/11)
£
Year 3 (11/12)
£
501,396
250,698
501,396
501,396
501,396
188,023
488,861
463,791
N/A
It is intended by the Scottish Government that annual planning will work alongside
the eHealth financial strategy to produce increased alignment between Board and
national priorities with consequential improvements in the value of funds invested
from both Board general allocations and from the SGHD eHealth budget.
23
Appendix I Table – Prime Specific Actions in Support of the Strategy (The Vision)
a)
Working Towards and Electronic Patient Record
SPECIFIC ACTION
DESCRIPTION
BENEFIT REALISATION
Universal CHI Usage
Ensuring use of the CHI number Patient safety.
in all clinical communication and Sharing of clinical information.
systems.
Improved data quality.
Integration of Clinical Letters to Integrate clinical letters in order
SCI Store
that there is no requirement to
print out and re digitise.
Integration of electronic reports ECGs and endoscopy reports are
into SCI store
produced
electronically
–
integrate these into SCI store.
Fully utilise SCI Gateway Allow
communications
from
functionality
secondary to primary care via SCI
Gateway (the reverse is fully
operational).
Implement Clinical Portal
Provide a portal view of a patient
record sourced from different
systems using CHI.
Electronic Communication of Transmission of laboratory results
Laboratory Results
in respect of specific patients to
General Practice systems.
Development
Forms
of
Document Scanning
Electronic The recording of routine patient
information on electronic forms.
The production of an evaluation
report of document scanning and
TIMESCALE
Exceed specific CHI usage target
for 2009/10 (Radiology).
Continue to positively promote
CHI usage.
More effective use of clinical time Clinical letters integration into SCI
Faster
transmission
and Store scoped in terms of resource
accessibility of clinical letters.
by 31 March 2010.
Enhanced availability of reports to Endoscopy and ECG Reports
clinicians.
integrated by 30 June 2010
Enhanced clinical communication Achievement
of
electronic
from secondary to primary care.
communication from secondary to
primary care via Gateway by 31
March 2010.
Authorised clinician can see the National development ongoing.
“virtual patient record” on a single Continue to maintain dialogue
screen.
with national developments and
implement.
Reduced paper flow.
Target to achieve by 30 June
Enhanced patient information 2010
(dependent
on
the
flow.
resolution of potential safety
issues
within
the
practice
system).
Enhanced
storage
and Exploratory and scoping work
accessibility
of
patient complete and reported by 31
information.
December 2009.
Evaluation and decision basis for Evaluation report complete by 30
implementing
a
document September 2010.
24
SPECIFIC ACTION
Advice and Guidance System
archive.
DESCRIPTION
scanning solution.
BENEFIT REALISATION
TIMESCALE
The ability for clinicians to The ability to ask clinical Strategic review of previous work
securely communicate between questions where a referral may and a way forward by 31 March
primary and secondary care.
not be needed.
2010.
Note that this was a prototype
system.
Anticipatory Care/Long Term Identify the “admission risk” for a
Conditions
cohort of patients based on data
extracted from
GP clinical
systems.
Reduction
in
inappropriate
referrals.
Minimisation of the requirement This work “Casefinder” is onfor hospital admission and the going.
maximisation of care being taken
to the patient.
Current (June 2009) co-ordination
of an evaluation phase involving
Thereafter
take
targeted
20 General Practices across NHS
preventive action to minimise
Highland.
admission to the hospital sector.
MiDIS – Community and Allied
Health Professional System,
Mental Health Integrated Care
Pathway, secure Inter-Agency
Data Sharing
Further development of the
algorithm to identify patients most
at risk.
The ability to securely share
patient/client
data
between
agencies.
Initially the single
shared assessment (SSA).
Patient/client
data
readily
available to multi-agency team
members.
Enhanced care – no repeat
questions.
The provision of a clinical system Enhanced clinical information in
for use by community staff and community teams.
the mental health sector
25
NHS Highland engaged with
National MiDIS development.
Preparatory
work
includes
membership of the National
Project Board.
b)
Providing complete, accurate and timely Clinical and Management Information
SPECIFIC ACTION
DESCRIPTION
BENEFIT REALISATION
Patient Management System
Implementation,
replacement
for
legacy
Patient
Administration System
18 Weeks Referral to Treatment
Standard
Implementation of the National Enhanced management of the
Patient Management System patient journey and compliance
currently being procured.
with National Waiting Time
Standards.
To monitor and manage whole More effective use of NHS
pathway of care. Initially utilising Highland
resources
and
current systems to measure acceleration of
the patient
patient journey.
journey.
Medical Staff Revalidation
A system to allow compliance Medical
staff
revalidation
with
GMC
revalidation requirements
complete
and
requirements.
accurate.
Continue
General
Practice Implementation of modern clinical Enhanced patient centred clinical
migration from GPASS System systems.
information and management.
Enhance
Emergency
Summary (ECS)
Care Implement nationally determined
dataset enhancement in ECS.
Continue
collaborative
information
work
with
Information Services Division
(ISD) of NSS.
Production of a Draft NHS
Highland Information Strategy
building on work carried out over
the course of the project.
TIMESCALE
Timescale dependent on national
procurement
finalisation.
Expected commencement 2012.
Project live and of the highest
priority.
Scoping
and
requirements
complete by 31 December 2009.
Thirty Practices migrated in
Northern Highland.
Further
progress is dependant on funding
availability.
The availability of additional ECS Phase 1 is complete scoping
(initially
palliative
care) work underway around Palliative
information to the OOH and care dataset.
secondary care sectors sourced
from GP clinical systems.
The adoption of the NHS Draft
Information
Strategy
Highland Information Strategy by complete and available by 30
the NHS Highland Board.
September 2009.
Improved information production
and availability.
26
c)
Ensuring High Levels of Information Governance are Maintained and Enhanced
SPECIFIC ACTION
Continue
Information
Standards
to
DESCRIPTION
BENEFIT REALISATION
Ongoing – continually monitored
by the Information Governance
Committee, Internal and External
Audit and by Quality Improvement
Scotland (QIS).
Access Clinical authentication to systems Access
controls
further Implementation by 31 March 2010
enhanced by Nationally Procured strengthened and system access dependent
on
National
IAMS implementation.
provided on a user profile basis.
Procurement progressing to plan.
Improve Continue
to
increase
the
Governance effectiveness of control over
information obtained and held by
NHS Highland.
Identity
and
Management (IAMS)
TIMESCALE
Assurance that all information is
complete and accurate and held
securely with strict control over
access.
Clinical Portal implementation
support.
Mobile Device Encryption CEL Encryption of all mobile devices, Further enhancement of control Fully
implemented
45 (2008)
“locking out” of unofficial devices. over NHS Highland data.
December 2009.
Includes the General Practice
Sector.
27
by
31
Common Abbreviations and Acronyms in eHealth and the NHS
A&B
Argyll & Bute
CEL
CHI
CHP
Chief Executive Letter
Community Health Index
The unique “citizen number” or patient identifier used in the health sector,
contains the date of birth. Normally allocated when first registering with a GP.
Community Health Partnership.
EDIS
ECG
ECS
EHR
EPR
Emergency Department Information System.
Electro-cardio Graph (electronic trace of heart activity)
Emergency Care Summary
Electronic Health Record
Electronic Patient Records
GMC
GMS
GP
GPASS
General Medical Council
General Medical Services
General Practitioner
General Practice Administration System for Scotland
HB
HEAT
Health Board
Health, Efficiency, Access and Treatment (target based)
IAMS
IG
IM&T
Identity and Access Management System
Information Governance
Information Management and Technology
Term formerly used to describe the function responsible for IT, Medical
Records, Information Services etc. In the Health Sector superseded by
eHealth.
The Information Services Division of National Services Scotland
Information Technology
ISD
IT
LAN
Local Area Network
The “internal” network of an organisation.
MAS
Multi-Agency Store
Secure area where staff from different agencies (mainly health and social
work) can share patient data securely on a need-to-know basis.
Multi-Disciplinary Team
Multi Disciplinary Information System
Community and Mental Health Clinical system. Being developed
collaboratively led by NHS Tayside.
MDT
MiDIS
NHS
NHSH
NHSS
National Health Service
National Health Service Highland
National Health Service Scotland
28
NMAHPs
NSS
Nurses, Midwives and Allied Health Professionals
National Services Scotland
OOH
Out of Hours
PACS
PAS
PMS
PID
Picture Archiving and Communication System (Digital Xray)
Patient Administration System
Patient Management System
Project Initiation Document
RIS
RTT
Radiology Information System
Referral To Treatment
SCI
Scottish Care Information
Umbrella term used for a number of related electronic developments.
SCI Store
Scottish care Information Store
Secure structured repository of patient related care data and information.
SCI Gateway Scottish Care Information Gateway
Secure transmission means for patient related care data between primary and
secondary care.
SLA
Service Level Agreement
Document defining services to be provided by one organisation to another.
SPARRA
Scottish Patients at Risk of Readmission and Admission
SSA
Single Shared Assessment
UPI
USB
Unique Patient Identifier (eg CHI)
Universal Serial Bus
A connection socket on most PCs allows the connection of external devices
e.g. memory sticks. May pose a security risk.
VC
Video Conferencing
WAN
Wide Area Network
29