Clinical Change Leadership Meeting - Minutes

Time/ Date: 13.30 – 16.30 19th January 2011 Location: Beardmore Hotel, Clydebank

Attendees:

Jim Docherty NHS Highland Chris Stewart NHS 24 Neil Kelly (via VC) NHS Dumfries and Galloway Lorna Ramsay NHS National Service Scotland Jim Campbell NHS Ayrshire and Arran Bill Martin NHS Lanarkshire Libby Morris Scottish Government eHealth Directorate Cathy Kelly Scottish Government eHealth Directorate Cliff Barthram NHS Tayside Steve Baguley NHS Grampian Liz Wilson Scottish Government eHealth Directorate Gordon Sim (chair) NHS Borders Andrew Sim NHS Western Isles Bob Milne SCIMP

In attendance Anita Maison Scottish Government eHealth Directorate Sean Brennan Project Manager, NHS Lanarkshire

Apologies Robin Wright NHS Lanarkshire Stella Clark NHS Fife Keith Farrer NHS Orkney Peter Curry NHS Fife Duncan Alcock The State Hospital Robin Lawrenson Scottish Ambulance Service Lynne Prophet NHS Borders Ken Ferguson NHS Ayrshire and Arran Andrew Morris NHS Tayside Jim Unsworth NHS Shetland Nick Sutcliffe Golden Jubilee Hospital Margaret Hastings NHS Greater Glasgow and Clyde Val Baker NHS Lothian Malcolm Gordon NHS Greater Glasgow and Clyde Andrew McElhinney NHS Forth Valley Brian Robson NHS Quality Improvement Scotland

Minutes: Cathy Kelly/Anita Maison Scottish Government eHealth directorate

1. Minutes of last meeting. These were approved as an accurate record of the previous meeting.

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2. Matters arising/Actions from previous meetings

• Lorna Ramsay has arranged a meeting with Peter Curry and Libby Morris to review incident management for national systems. This subgroup will prepare a short options paper for discussion at the March CCLG meeting.

• Jim Ferguson has agreed to provide a Scottish Centre for Telehealth update at the May CCLG meeting.

• Cathy Kelly had visited Ayrshire and Arran to review the JAC ePrescribing system. A summary of her report had been circulated to the group by email in December.

• Cathy Kelly said that clinical eHealth priorities had been incorporated into the eHealth Strategy outcomes paper which was now available for discussion. It was felt that having a single document, which included both clinical and business priorities for eHealth, was preferable to having separate documents.

• Cathy Kelly said no nominations had been received for a new co-chair of CCLG. It was therefore agreed that Jim Docherty would continue to act as co-chair for a further two year term of office.

3. Clinical Portal Presentation Standard

Cathy Kelly informed the group that she had received approval from the eHealth Programme Executive Team for CCLG to develop a clinical portal presentation standard. She had also secured funding for a project manager to support this work. NHS Lanarkshire had agreed to accept the commission and Sean Brennan would act as project manager. It was noted that the proposed timescale for completion of this work was short so that it would be available to the south consortium, who would be implementing clinical portal first.

Sean Brennan introduced himself to the group and discussed his previous involvement with NHS Dumfries and Galloway’s electronic document management project for Mental Health. From experience in Dumfries and Galloway different clinical groups expected the find document types under different folder headings and not all clinicians feel there is a need for a rigid structure. The main lesson learned from this work was that it was important to keeps things as simple as possible. After an iterative process the original 17 folder headings in the existing NHSS document indexing standard were reduced to 10.

Sean then presented a mind map showing the similarities and differences between the NHSS document indexing standard, the clinical portal folder headings previously suggested by a CCLG subgroup and ISD Compound Healthcare Headings.

In the subsequent group discussions the following points were made: • The clinical portal presentation standard should support easy and intuitive document and information retrieval . • The standard should apply to any document management system or clinical portal.

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• Clinicians need to have different methods of filtering information e.g. by date, specialty, document type • Important not to have a rigid structure. Need flexibility so that the same piece of information could potentially be retrieved by searching under different folder headings e.g. a Cardiology outpatient letter may be retrieved by searching under a folder heading of “clinical letters” or by searching under a specialty of “Cardiology”. • Need to keep things simple. • Ability to attach multiple metadata to each piece of information is important. • Need a standardised process to ensure that documents are tagged correctly and consistently across Boards • More difficult to attach multiple metadata to scanned documents therefore these documents are more difficult to retrieve. • Need to add metadata at source, wherever possible, which is best achieved through generation of electronic documents • The document indexing standard should provide the standard for tagging documents with appropriate metadata to support retrieval

Following the discussions Sean told the group he would be gathering information from Boards using clinical portals and document management systems. A small working group would be established with representation from CCLG , eHealth Leads and eHealth Architecture and Design to take things forward. It was agreed that Sean would present a draft clinical portal presentation standard to CCLG at the March meeting.

Action: Sean Brennan to present a draft clinical portal presentation standard at March CCLG meeting

4. Document Indexing Standard It had been noted in the previous discussion that there were dependencies between this standard and development of a clinical portal presentation standard. Libby Morris and Bob Milne requested an update about progress.

Cathy Kelly said NHS Greater Glasgow and Clyde had accepted the commission in October. They were the lead board in a consortium that included NHS Forth Valley, NHS Dumfries and Galloway, NHS Grampian NHS NSS and SCIMP. SGeHD had been in contact with the project team on a few occasions to check on progress and had been assured that stakeholder involvement outside Glasgow had been arranged. The clinical leads from NHS Grampian, Dumfries and Galloway and SCIMP said they had not been contacted about this. Lorna Ramsay said the Glasgow team had spoken with Michael Sibley once on the phone but she was not aware of any other collaborative work.

Cathy Kelly said she would report the lack of stakeholder engagement to Julie Falconer, the Strategic Delivery Manager within SGeHD Programmes, who was monitoring project progress and would ensure matters were escalated if necessary.

Sean Brennan asked if the Glasgow team leading on this commission could be made aware of the plan to develop a clinical portal presentation standard so they were aware of the dependencies between the two.

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Action: Cathy Kelly to notify Julie Falconer about lack of stakeholder engagement and to ensure NHS Greater Glasgow and Clyde project team are aware of the commission to develop a clinical portal presentation standard.

5. Inclusion and exclusion Read codes

Bob Milne reported that SCIMP had obtained funding to build on existing work done by Beena Raschkes in NHS Tayside. They would be comparing these inclusion and exclusion Read codes against those in England and Wales to try and agree a common standard, based on Read v2.0. The exclusion code list appeared to be straight forward however there were still some inclusion codes that required further discussion. It is anticipated this work will be completed in early March 2011. Once the inclusion and exclusion code lists have been finalised it has been agreed that the UK Terminology Group will take over maintenance and governance of the standard for all UK countries.

Bob and Libby offered to present the proposed UK standard for inclusion and exclusion Read codes to CCLG at the March meeting.

CCLG members supported this valuable work and recognised how this would improve the ability to share clinical information in the future. Lorna Ramsay said NSS could offer support with standards templates.

The chair thanked Bob and Libby on behalf of the group and accepted the offer to provide further feedback in March.

Action: Bob Milne/Libby Morris to report on progress of national work to develop standard for inclusion and exclusion Read codes

6. CCLG Objectives 2011

Cathy Kelly presented a paper suggesting four objectives:

• Work with SG eHealth Directorate to define the strategic aims, outcomes and measurement targets for NHSS eHealth Strategy 2011-2015, ensuring that the priorities of the wider clinical community are incorporated.

• Work with the consortium of Boards commissioned by SGeHD, led by NHS Greater Glasgow and Clyde, to review and revise the NHSS Document Indexing Standard.

• Lead the development of a Clinical Portal Presentation standard, with NHS Lanarkshire, as an SGeHD commission.

• Work with SGHD Information Governance lead to develop and publish NHSS Information Sharing protocol.

Bob Milne suggested CCLG should include an objective to review the Good Practice Guidelines for GP Electronic Patient Records, version 4.0. This revised version of the guidance document, developed by the Royal College of General Practitioners Health Informatics Group for Primary Care practitioners, needs to be updated for NHS Scotland to include references to relevant Scottish legislation.

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Members of the group did not feel this was appropriate for CCLG and it was agreed that the expertise and knowledge to undertake this work lay elsewhere.

Libby Morris asked whether this guidance could have wider applicability than Primary Care and could be adopted to support shared records. Lorna Ramsay said that the guidance had been developed by GPs for GPs and that the guidance document was very lengthy. Caldicott Guardians and Information Governance Practitioners had requested that guidance be kept brief and concise. It was also noted that there were other existing sources of similar best practice guidance already in existence in Scotland, such as the NHS Code of Practice on Protecting Patient Confidentiality and Records Management Code of Practice.

It was suggested that CCLG should have an objective for ePrescribing. Cathy Kelly said medicines management was likely to be included as a strategic aim for Boards in the next eHealth strategy therefore the role of CCLG members should be to work with Medical and Nursing Directors in their Boards to develop meaningful outcomes that could be incorporated into Local Delivery Plans. It was agreed that objective 1 should be edited to make reference to the importance of optimisation of medicines management.

Lorna Ramsay suggested there should also be an objective around incident management, since a subgroup of CCLG were developing an options paper to deliver at the next meeting.

It was agreed that, subject to minor editing of the first objective, the objectives should be accepted. Cathy Kelly said she would include these in the business planning tool used by SGeHD, and would record progress towards achievement.

Lorna Ramsay said CCLG should review the objectives regularly since these would need to evolve over time. She suggested review after 6 months since the first three objectives should have been achieved by then. Additional objectives could be added, as required.

Action: Cathy Kelly to revise objectives and send out by email

7. AOCB

7.1 eHealth outcomes discussions paper Cathy Kelly said it was important that clinical leads followed up the morning’ s discussions by meeting with their Medical and Nursing Directors to provide a collective clinical response on the paper to SGeHD.

7.2 ECS

Libby Morris said the pilot of ECS use in NHS Lanarkshire for use in scheduled care and Outpatients had been completed and received positive feedback. The recommendation was that ECS should be used more widely and this recommendation was being discussed at the next ECS Programme Board. She also said that SGPC remained concerned about identity and access management in secondary care and therefore may not support the recommendation.

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Jim Docherty said no one had seen the report yet. Libby said it would be sent to February CPMG and eHealth Programme Board meetings.

CCLG was informed that NHS Tayside now had agreement to populate their electronic discharge system with medication and allergy information from ECS. This would support medicines reconciliation and would reduce the need to transcribe drugs. Cliff Barthram said ECS medications could be imported into the electronic discharge letter after viewing in ECS but currently INPS Vision systems were recording every time the same drug was prescribed, causing duplicate entries. These can be edited and deleted in the electronic discharge document but this problem still needs to be addressed.

It was noted that NHS Greater Glasgow and Clyde had also obtained approval to download medication summary from ECS into their clinical portal. Cathy Kelly suggested other Boards may wish to adopt the same approach and asked whether the processes undertaken by NHS Tayside and Greater Glasgow and Clyde to get approval could be shared with other Boards. Libby suggested this could be discussed at the Clinical Portfolio Management Group, to which the ECS programme reports monthly.

Jim Docherty asked Libby to report back to the next ECS Programme Board that CCLG were pleased with progress being made to move towards wider implementation.

Libby mentioned that any additional information entered by GPs was being truncated at 200 characters. Both Cliff Barthram and Neil Kelly said this had been a problem in their Boards. This would potentially have a significant impact on implementation of the Key Information Summary, where GPs would be more likely to enter free text information. Further investigation was underway.

7.3 GP IT

GP IT migration from GPASS has caused some other recent issues. There was limited ability to test the new systems to identify and address issues before migration. NHS Greater Glasgow and Clyde hold the national GP IT contract but have not providing training or testing facilities.

CCLG agreed that a proper process should be established.

Libby said the previous GPASS user group will change to the Scottish National User Group, which will cover all clinical IT systems used in Primary Care.

7.4 ePCS

Steve Baguley asked for an update about ePCS roll out. Libby said ePCS was live within 12 Boards and asked clinical leads to encourage practices to use this.

It was pointed out that there is no ability for community nursing staff to be able to add information. This should also be considered for implementation of KIS.

Date of next meeting: 9th March 2011 13:30 -16:30 (Lunch from 1300) Location: Conference room 003, Victoria Quay, Edinburgh

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