Clinical Portals #1
In this series of short articles we will review the main areas of consideration and concern within the current landscape and approach to Clinical Portals.
It is five years since the Department of Health's NHS informatics strategy moved from 'replace all' to 'connect all', in theory at least. In 2012 'The Power of Information' was not a blueprint but a signposting of this new vision. In 2013 'Safer Wards, Safer Hospitals' set funding against a further set of principles around integrated Digital Care Records.
Over this extended period of uncertainty, Trusts have been dealing with their own approaches to Electronic Patient Records and the Paperless Agenda, given local pressures and legacy system replacement strategies. Latterly, the NHS strategic agenda has moved towards a new model of patient care and care pathways that are difficult to fully support on a single system or platform.
So how can we evaluate Trusts' Clinical Portal 'fit'? One approach is to ask a series of questions about the Trust, it's current infrastructure and the clinical system landscape:
- How do you communicate the right clinical information between healthcare professionals internally and externally and would your plans for core systems replacement, or EPR plans address them fully? In addressing this question, could this be achieved seamlessly in any care setting or between different organisations with which you interact? Is the nature of this access and 'interaction' the same in all cases or would you need to adapt the system(s) to account for users from different organisations or services? One example would be a client-server based EPR and remote access.
- Do your Trusts' plans currently address all aspects of clinical governance and audit of patient related data within each distinct application?
- Do your current/planned systems allow the clinical journey to be reviewed quickly and easily and for information to be shared with other clinicians?
- For each major clinical system (the clinical 5 as a minimum), is there any duplication of functionality?
- Do your existing/planned systems allow a consistent view of patient flow to be seen? If not, is a composite view or extract possible?
- Given the clinical systems baseline, including current or planned EPR implementations, how can your Trust support increased patient centred access or patient involvement?
- From a business perspective, how important are your Trust's external relationships with CCG, community provision and other agencies in dealing with operational issues (for example, length of stay)?
- Does your Trust manage its own Interfacing and Integration engine(s)? To what extent are the systems linked through common HL7 interfaces?
- In reviewing the system's landscape, can the gaps be easily addressed with the current 'expansion' or planned implementations or are some departments still predominately paper based? Is clinical or administrative functionality missing from departmentals? Clinical Portals can address these but the nature and level of them needs to be fully appreciated.
- How would you rate the level of clinical engagement with IT within your Trust? How do Senior Clinicians and other healthcare professionals interact with each other and the existing/planned systems?
- Has your Trust implemented the NHS number requirements?
- Has your Trust undertaken a comprehensive process or service improvement appraisal of each clinical or administrative system and its use to identify any 'non-spend' improvements to flow or processing of information? If not, what are the cost implications?
- Would a comprehensive single sign-on approach to your Trust's current systems provide sufficient cohesion of information?
The balance of answers to these questions would determine whether there is some form of Clinical Portal 'fit' for your Trust. Clinical Portals can be sub-divided into 'read only', 'read/write' and 'read/write/extend', so the nature of your requirements identified in the above questions allows some initial determination of the type of portal technologies that might suit.
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Look out for the next article where we will cover how to develop a Business Case for Clinical Portals.