This is my second blog, and having looked back at my first one (26th April 2013), where I was introducing the electronic Casenote, I wanted to reflect on what has changed.
In many ways the message is the same, there is a new Clinical IT system, it will be rolled out across the region, it will mean a change in practice and doing some things differently and, most importantly, it is the next step in the journey towards a fully electronic health record.
To date we have scanned all the Active Mental Health records and we have scanned in almost all of the Acute Casenotes held in DGRI. We are currently working through the Paediatric casenotes and will be starting with the Community Children’s Nursing casenotes in February.
There are 50,800,180 (50 Million +) pieces of paper currently scanned into the eCasenote system and, on a daily basis, we are scanning over five feet of stacked paper from outpatients and inpatients.
But I think it would be fair to say that the electronic casenote was not universally liked, in particular the Consultants in DGRI were very concerned that it didn’t meet their needs.
So what’s changed with PORTAL?
Some form of PORTAL was always the next stage in the road map. In essence, a Clinical PORTAL gathers together information from other hospital systems to present a shared view of information in a single area. This allows all relevant data to be retrieved and easily accessible from any health board premises across the region.
Or, as a Clinician described it, ‘the window/door to the future of IT interactions in clinical practice’ and ‘the one stop for all the clinical information’.
What we have done, is to push a rapid development and deployment of Clinical Portal over the latter half of last year to an Early Adopter group of staff. They have been using it in an unfinished form, to understand its capabilities and make suggestions as to how it needs to work before it is rolled out to the wider audience.
A lot of these clinicians have been the very consultants who initially criticized the electronic casenote, and already their feedback and comments have allowed the system to change in line with clinical requirements. We are heading for 100 users, as the membership of the Early Adopter Program for Clinical PORTAL has been expanded to ensure that representatives of all areas of the service have a voice in its development.
Feedback so far has largely been positive, with most people saying the way it works is very ‘user friendly’. In particular there are several different ways to order the information to make it easier to find what you are looking for, and having several separate systems information on a single screen simultaneously allows for easier understanding of what is happening with the patient.
It’s not all about the patient though.
When looking at the clinical PORTAL, one of the early comments has been on the use of the term ‘Person’ rather than ‘Patient’. This is because another of the reasons for investing in PORTAL technology is that it provides the ability to present a single tool that can be used across Health, Police, Education and Social Services.
This DOES NOT mean that everyone will have access to clinical information, it means that, as well as the health focused Clinical PORTAL, there will be a Social PORTAL, showing social workers their information in one place. Similarly there can be an Education PORTAL and a Police PORTAL giving their view of their information on any person in Dumfries and Galloway.
What it does mean however, is that key information that should be shared, Child Protection, Vulnerable Adults, Lone Worker Risks, Alerts and so on, will have an easy to use integrated mechanism to allow this to happen.
What happens next ?
As mentioned, we have a list of requirements from the Early Adopter Program to be developed before Clinical PORTAL is rolled out. We are expecting a system update in February / March that will address many of these issues and allow rollout more widely after that.
Having the existing electronic casenote documents viewable within Clinical PORTAL is also a key step, and work on this should be finished at around the same time.
We are still investigating the best electronic tablet that can be made available to support this, within Health Board premises at least. And similarly we still haven’t got a working off line solution to make it truly portable.
For any of you who have seen Terminator: Genisys, there is a scene set in hospital where all the clinical staff are wandering about consulting a whole variety of devices to look up all the information they need to effectively treat the patient. That is what we are trying to achieve, before everything goes wrong and gets blown up obviously.
If any of you want to talk to me more about Clinical Portal, eCn or Early Adopters (but not necessarily Terminator: Genisys) please get in touch with me at firstname.lastname@example.org.
Murray Glaister is eHealth Project Lead at NHS Dumfries and Galloway