Transcript GP2GP – The way forward

SNUG Conference
GP2GP – What ‘s to come and
how to prepare
• Tony Callaghan 16th September
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 electronic health record and
attachments which are automatically imported at the
new practice, creating a electronic medical record
• 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
• 2015/16 contractual requirement in England to
implement GP2GP
• SPINE 2 Deployed in England - July 2014,
improved band width, transaction speed, etc
Benefits of using GP2GP
•
Improved quality and continuity of care
– Consulting with immediate access to the electronic health record
– Past medical history available and information about medication, allergies,
immunisations and vaccinations
•
Improved safety
– Accuracy of new patient EHR(England)
– Fewer errors, less scope for litigation
•
Clinical time savings
– EHR available during initial consultations
– Less request for duplicate lab tests
•
Administrative time savings
– Summarisation
– Less data entry
– QOF information readily available
How does it work?
Patients register at new
practice
2. Patient demographics
located on Personal Demographic
Service
3. Patient electronic health record
requested
from old practice
Old Practice
Automatically Pulls
Record
4. Patient electronic health record
sent
to new practice
New Practice
What they say about GP2GP
“Everything transfers across in one
quick step and is automatically filed into
the relevant sections of a patient's
record. At first I thought "it can't be as
simple as that? But it really is. I think
it's fantastic!”
Hilary Ellis, Practice Manager, St
James’ Medical Practice, Croydon
“The main advantage of GP2GP will be
improved care for patients as GPs can have
full and detailed medical records available to
them within 24 hrs of a patient registering.
The records are transferred directly between
the practices and remain secure and
confidential at all times.”
Dr John Hampson, Greenmount Practice,
Bury
"The best innovation for medical records since we started using computers for
patient care."
Dr Rakesh Chopra, Cowes Medical Centre, Isle of Wight
Current Challenges in England
• Limitations on the size of the
attachment files within GP2GP,
currently 5 meg and 99
attachments
• Limited data on actual true use of
system, we know number of
transfers but no data on imports
• No mechanism for late
submissions
• Cross Border transfers
• Returning patients A to B to A
• Fixed 2.2
release
• Fixed 2.2
release
• Not fixed
• Not fixed
• Fixed 2.2
release
Other challenges
• Sending GP no control over record,
record pulled
• Limited opportunity to update record
before transfer, late filling
• Wrong patient deducted, new practice
select wrong patient
• Biggest challenge is the difference in
the IT infrastructure between Scotland
and England, systems are not
compatible
Scotland’s Approach
• 2006 Docman scanners available at all GP
practices
• “Docman Transfer” was developed, creating a
patient clinical record summary with attached
scanned images for electronically transfer between
practices within Scotland
• Standard folder structures agreed for use in
Docman
• 100% of practices are Docman Transfer enabled,
with over 8000 electronic records transferred each
week (includes deceased patients, gone away’s
etc stored on Medex)
Docman Transfer Provides
• Patient clinical record summary and attaches
Docman images
• Standard folder structure
• Record available more quickly
• Full audit trail and recoverability
• Control with sending practice
• Secure Transfer process
• Ability to create new clinical record at the receiving
practice manually from the clinical summary
Problem with this approach
• No ability to export/import the full patient clinical
record summary.
• Creating a record for Docman Transfer is a manual
process, which is time/resource consuming which
can delay the export
• Record can only be transferred within Scotland
• Practices can save data using non standard file
types or link records, which cannot be read by the
receiving practice
• PSD have to print out the patient clinical medical
record for any transfer out with Scotland
• System dependant on sending practice completing
transfer
Docman Transfer System- why
do we continue to use it
•
•
•
•
•
•
•
It works well
Proven track record
Reliable
Full audit trail
Secure Transfer process
Utilises existing infrastructure
Links into Medex system to identify
patients on CHI and retain records for
long term storage
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- phase 1
• Docman transfer process will be the trigger
for data extract, not patient deduction
• Data transfer will be in two parts, clinical
summary( HL7) and Docman attachments
extracted at the same time
• EMIS & INPS will develop HL7 message
• Record linkage using patient CHI Number (
HL7 and Docman records)
• Improve the Docman export by simplifying
process ( one button)
• eLinks /Medex Systems will confirm GP2GP
status, and be used as transfer mechanism
• Develop import mechanism
• Software will check if receiving
practice is GP2GP enabled, if not HL7
message not sent
• System matches HL7 with Docman
transfer data, so single message to
receiving practice
• If any failures in the process, support
call notification
• HL7 is the full clinical record
Export Process
Enabled Practice
HL7
GP
Clinical
System
eLinks
Checks
Manifest,
attachments
and HL7
API
Operator Triggers
Docman Export
Clinical
Summary
Docman
Outputs
Manifest &
attachments
MEDEX
Compress files
eLinks Transports to
PSD
Import Process
eLink
Transport
Uncompress
Enabled Practice
GP Clinical
System
Staff select
import
Docman files +
HL7
Challenges
• Difficult to outline Scottish requirements
• EMIS PCS not accredited for GP2GP and
has to be developed from scratch
• Extensive clinical and system testing
required
• Timescales and aligning supplier
deliverables
(INPS/EMIS/Docman/eLinks/Medex)
• Data Quality, will practices import record
• Transfer dependant on sending practice
Roll Out
• Controlled roll out, based on Docman
transfer activity
• Quick wins
• Experience from Docman Export
• Work with NHS Boards to take into
account developments at the
practices
• Implement only when practices ready
Clinical System
No of Exports
EMIS
VISION
VISION
EMIS
VISION
VISION
VISION
VISION
VISION
VISION
VISION
37
35
66
31
26
13
29
25
13
6
50
35
65
10
8
27
15
13
21
64
7
3
18
39
23
8
26
16
26
38
31
28
5
9
37
36
23
13
4
13
15
12
22
30
15
16
47
28
27
20
81
38
GRAMPIAN
EMIS
1246
VISION
741
11
VISION
1011
6
61
EMIS
1506
40
29
50
VISION
1361
34
76
26
88
VISION
1307
52
33
24
38
43
VISION
872
11
57
53
30
38
1
VISION
840
18
23
26
51
57
7
14
VISION
670
8
10
18
30
13
2
30
17
VISION
1071
9
10
14
18
16
11
8
8
28
VISION
685
7
11
9
8
13
2
20
13
21
VISION
598
2
56
LOTHIAN
2
36
67
Timescales
• Sept 2013 - Mar 2014 Requirements
• June 2014 Revised Business Case
Approved
• Aug 2014 - Dec 2014 Development
EMIS/INPS /Docman
• Jan 2015 – Apr 2015 Unit Test
• May 2015 – July 2015 Joint end to end Testing
• Dec 2014 – July 2015 Training
• July 2015 - Oct 2015 Pilots
• Oct 2015 - Mar 2016 Roll Out
How do we get prepared
• Raise awareness within the practice
to GP2GP project and timescales
• Continue to review Data Quality,
structured coding
• Need to increase the frequency of
Docman exports
• Raise the profile of the Docman
Transfer within the practice
• Records filling frequency
How do we get prepared
• Working with NHS Boards on
unacceptable file types ( linked Files)
• Encourage the electronic transfer of
correspondence for a deducted
patient
• Docman transfer service enhanced to
handle TR’s
• Improve Docman transfer support
Way Forward-Phase 2
• Develop linkage with GP2GP in
England/Wales 2016/17
• Assess impact of new GP2GP v2.2
and SPINE 2
• Gateway practice
• Review impact of practices moving to
hosted server
• Link GP2GP transfer to patient
deduction ( pull process)
Questions
Implications on practice workload
both from export and import
Would you have the confidence in
the data quality to import records
and then correct deficiencies
What do we do with the paper