Chasing case notes
Today's healthcare providers are faced with major technological and organisational challenges in managing historical patient information, especially given the increasing demands of an aging society. So consider a health board with over 550,000 patients, supported by 12,000 staff, across 83 GP practices, 17 community day hospitals and three district general hospitals, then the challenge of getting the right information at the right time, to the right person becomes even more complex. This was the case at NHS Lanarkshire.

Due to its size and organizational structure, the health board found that its patient activity and clinical information had become siloed. Information was recorded through multiple IT applications within disparate and proprietary computer systems, many unable to interface with each other. In addition, patient information was (and in some instances still is) being accessed through multiple, separate volumes of paper case notes stored in multiple locations across different hospital sites. This situation, the board knew, had to change and significant progress is now being made in achieving that.

Widening the scope
To bring this disparate patient information together, NHS Lanarkshire opted to deploy Orion Health's clinical portal. This provided a means of securing a single source of patient information across all health agencies, to specifically address the often-complex requirements of patients with long-term conditions (LTCs) (which are prevalent in almost 40% of Scotland's population).

NHS Lanarkshire's clinical portal strategy adopted the findings of a 2009 survey by the Scottish Government. This survey asked clinicians to rank data items in order to prioritise what information was needed to see and treat patients safely.

This data set, which closely matched that of NHS Lanarkshire's own requirements, provided a starting point to allow clinicians to have secure, appropriate online access to relevant patient information in a single, consolidated view.

Sean Brennan, project manager of the clinical portal implementation explains: "We didn't want to focus just on patients with specific long-term conditions such as diabetes or heart failure, but rather deliver something that facilitated the care of any patient regardless of condition. This would then create a portal foundation onto which this very detailed and specific clinical data could be added at a later date. It is not about this initial content but about putting in place a way of sharing simple and ultimately complex clinical data across all agencies and sectors on a common pathway."

The roll out of the clinical portal programme to the whole health board included linking core systems such as a patient management system, GP summary information (through the Emergency Care Summary), laboratory and radiology reports, and access to other clinical applications creating a single electronic view of the patients record.

From this it became apparent to the board that through the use of Orion Health’s clinical portal, it could incrementally develop this electronic patient record without the need to replace existing IT investments.

From frustrations to faster access
The integration technology also provided quicker access to information for GPs at the point of care, as Dr Bruce Thomson explains: "If I need to know anything about my patients that is held in a hospital system, I can now go into the portal and look at tests that aren't necessarily ordered by me, or wouldn't be sent to me. It means I can proactively search for this information if required."

By extending the access to hospital systems, GPs are now presented with a longitudinal view of a patient’s historic and current care. This empowers them with better medical insight and foresight to make informed clinical decisions.

"If a patient who is waiting on test results from the hospital visits me and I don't have the necessary information, what do I do?" says Dr Thomson. "Well, I now have the ability to search for the results in advance of them being sent to me so that my consultation with the patient is as comprehensive as possible, there is no wasted time, and we can plan the next aspect of care that bit farther ahead."

Dr Andrew Smith, consultant physician respiratory medicine at Wishaw General Hospital expresses his frustration of accessing the clinical record before the new technology was deployed: "When a patient attends as an emergency to the accident and emergency department, accessing the previous clinical record of the patient, particularly when you needed notes quickly, meant you relied on a secretary or clerk tracking down the original case record."

The clinical portal now provides medical information that 'follows' the patient to any care setting across NHS Lanarkshire, providing clinicians with the ability to make better, safer, faster more informed decisions.

"Since we've had access to the portal," continues Dr Smith, "it's been absolutely invaluable in that we can immediately access many of the previous clinic letters. This can be really helpful in managing a patient in the early stages of an acute illness."

Engagement, efficiencies and essential safety
According to Dr Chris Mackintosh, GP, and a member of the project board, creating a complete patient history is an essential development for patient safety: "At an individual patient level this portal is absolutely transformative as you don’t have to transfer a physical bundle of paper from one site to another."

For the clinical portal implementation to be successful it demanded a high level of co-operation from clinicians, an important factor to ensure the system would be fit for purpose and meet NHS Lanarkshire's requirements.

"Up until now, clinicians have had to mould their work to do what the IT system allows you to do. What we have now is access to a suite of IT applications irrespective of supplier or system. This allows clinicians to say what they want to happen and the software can be made to work to do just that," affirms Dr Mackintosh.

The sharing of clinical information is not restricted to a single user at a single time, Dr Mackintosh further explains: "This technology is allowing clinicians to discuss patients' conditions within multi-disciplinary team meetings in more detail and in less time. We can now produce a list of patients to be discussed, allowing everyone in the meeting to review the patient's electronic record to support their discussions and facilitate their clinical decision-making."

Looking ahead
For NHS Lanarkshire, the clinical portal is a key starting point for transforming care integration and according to Dr Mackintosh the technology "is an enabler for everything else that is happening."

Barry McAlister, head of systems, concludes by saying the bigger picture is in sight, and outlines how the technology has developed since the clinical portal went live: "Our eCasenotes are now visible via the portal and we are continuing to add other data sources to make the complete record available. The clinical portal is a key part of our overall e-health delivery and is enabling us to bring patient information closer to the point of care in line with our national strategy."

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About Orion Health Ltd
Orion Health is a global, independently owned eHealth software company and is one of the world's leading providers of electronic health records (EHRs) and healthcare integration solutions to healthcare organisations. Worldwide, Orion Health products and solutions are implemented in more than 30 countries, and used by organisations throughout the National Health Service in England and Health and Social Care Northern Ireland, as well as Scotland's NHS Greater Glasgow and Clyde.