Primary Care Division

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INFORMATION MANAGEMENT and DEVELOPMENT within PRIMARY CARE

SCOTTISH GOVERNMENT HEALTH DEPARTMENT

Sheena MacDonald

Senior Medical Adviser SGHD/Associate Medical Director (Primary Care) NHS

Borders

Primary Care Division

How did she get to be there??

• I have absolutely no idea!• Used to be a technophobe• Now just a “normal” user – a mother, a wife, a GP, a

patient• 22 years in GP • Associate Medical Director in Primary Care• Medical Adviser in Primary Care• Pragmatist• ...most importantly a clinician – if its not in the best

interests of the patients why are we doing it?

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INVESTIGATING THE INFORMATION JOURNEY IN PRIMARY CARE

WHAT IS PRIMARY CARE?• General Practices and their systems – GPASS on the

way out EMIS and VISION on the way in• OOH – Taycare on the way out, Adastra in in 11 boards

– not yet confirmed contract to replace Taycare• Community Nursing - MIDAS, EPEX, PMS, GPASS,

EMIS, EDIS, EDISON, PAPER, NONE• Community Hospitals – HOMER, PMS, Paper ???• Dentistry, optometry, mental health, sexual health etc etc

NHS BORDERS 18 SYSTEMS

Primary Care Division

THE FUTURE

• “The Future is here just unequally distributed”• The other “Future” - the demographic challenges – co-

morbidities, epidemic of new diseases, aging population, aging workforce

• The resources - Do more for less• The Quality Agenda – and do it better• If we always do what we’ve always done........ we will

implode!

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Investigating the information journey

• April 2010 scoping exercise

WHAT DO WE HAVE ? ..tell me the story of the journey of a development need

1. E health sponsored CLINICAL PORTFOLIO MANAGEMENT GROUP – overseeing development of In Patient Management System

2. E health sponsored PUBLIC HEALTH PORTFOLIO MANAGEMENT GROUP

3. SCIMP, PCCIU, PTI, ISD, NISG, PSD, SEF, CCLG……. ECS, ePCS

4. E pharmacy

5. Eye-care

6. Dental systems

7. .....and the rest

Primary Care Division

What have we done?• “We’ve punched above our weight”• GPASS • E prescribing• Patient records/summaries• Sci gateway• ECS• ePCS• ePharmacy• Eyecare• Etc etc

Despite no overarching governance/oversight

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WHAT DO WE NEED?

• April 2010 scoping exercise

“the future is here just unequally distributed” “apply the best to the rest”

• Mandate for change – Primary Care National meetings, individual meetings with key stakeholders

• Declaration of Strategic Direction- acknowledge the unique nature of Primary Care within NHS Scotland

• Single point of access/entry with standardised process for raising issues• Detailed work up of requests including technical advice, user in put reality

check• Prioritisation and authorisation• Detailed development, testing, procurement

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OCTOBER 2010 PROGRESS

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Portfolio Management

‘Portfolio Management is a co-ordinated collection of strategic processes and decisions that together enable the most effective balance of organisational change and business as usual’

What this means in practice is:• A portfolio is a collection of projects and systems that are grouped

by a theme.

• The portfolio can then be managed by a board that are interested in further development of these projects/systems.

• Portfolio management is about ensuring systems and projects are:– aligned to the organisation strategy;– contribute to the delivery of policy goals;– effectively use resources; and– have clear and measurable benefit that justifies the investment.

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Portfolio Management in eHealth

The eHealth Programme Board approved the use of Portfolio Management Groups (PMGs) to strengthen governance of existing operational systems within the programme.

The aims of portfolio management in eHealth are to:1. increase the realisation of benefits from existing systems; 2. ensure that changes to existing products are aligned to the

strategic direction of the eHealth Programme; and3. better manage dependencies across the portfolio.

It was agreed that four PMGs would be established:– Clinical– Public Health– Business Systems– Infrastructure

We are now setting a fifth PMG on behalf of Primary Care Directorate.

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Why bother?

Portfolio management should mean:– co-ordinated change across Primary Care Directorate– removal of redundant or duplicated projects– more efficient resource utilisation– improved transparency, accountability and organisational

governance

We will achieve this by ensuring that:– strategic decisions are made based on clear understanding of

cost, risk, impact on operational systems and strategic benefits to be realised;

– all changes are reviewed frequently in terms of progress, cost, risk, priority, benefits and strategic alignment; and

– an improved structure is in place for groups to engage PCD.

Primary Care Division

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"Engine Room"

eHealth StrategyBoard

eHealthProgramme

Board

Primary CareDirectorate

eHealth

Primary CarePMG

SPCFJUDG

HealthBoards

Suppliers(inc. NSS)

Suppliers(inc. NSS)

User Groups

ContractorGroups*

commission

commission

have representation onand feed requirements to

have representation onand report to

Other fundingbodies

Dept of Health

BMC

NSS

feedrequirement

sto

haverepresentationon and feedrequirements

to

have representation onand report to

haverepresentationon and feedrequirements

to

ContractorGroups*

* Initially GPs and nursing and extending topharmacy, optimetry and dentistry once PCPMGis established and scope is increased.

Channel for HPS input to beconsidered - Have representationon Public Health PMG but therewill be cross-over.

JUDG: Joined User Development GroupSPCF: Scottish Primary Care Functionality

BMA

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PCPMG• PCPMG:

– Produce delivery strategy for Primary Care IT– Consider requirements for change and issue commissions– Consider development proposals and make recommendation to eHealth

Programme Board/Primary Care Directorate– Monitor dependencies between the systems and projects within and across

portfolios – Monitor delivery progress

MEMBERSHIP

MD chairPCDISDPSDE healthUsers Group

Primary Care Division

THE ENGINE ROOM

• SPCF:– Channel and prioritise

requests from HBs, SCIMP and suppliers

– Implement commissions raised by PCPMG

– Facilitate specs definition– Provide forum for HBs, SCIMP

and suppliers– Support technical work up,

testing and procurement– monitor delivery of

maintenance and support

JUDG– Prioritise users change

requests– Provide forum for user groups

to discuss specific product issues and National requirements

– Provide guidance on commissioned work

– Provide framework for local support

– Feed requests and input to SPCF

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Development Proposals

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Change Management and Development Proposals

A proposal will need to describe:

– the enhancement or upgrade – the impact on the underlying programme or services

and any dependent projects/programmes/products/services

– the cost of implementing and maintaining– what SMART benefits are to be expected– the timescale for completing– the risks of implementing/ not implementing the

change.– Appropriate user engagement

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Prioritisation PrinciplesTo help prioritise the proposals a set of principles have been developed

by the existing PMG Members.

The Prioritisation Principles are as follows:– Should be linked to the Primary Care or eHealth Strategy– Should be linked to policy objectives and supported by the policy

lead as forming part of a coherent solution– Should have 50% coverage of Scotland or if low volume - high

impact– Should have clear and measurable benefit that justifies the

investment, outlining how and when the benefit will be realised

Proposals will be assessed against these principles and a recommendation made.

All proposals submitted will receive feedback whether approved or not.

Primary Care Division

What will we do first?

WALK BEFORE WE CAN RUN!

Concentrate on GP systems in first instance

Urgent issues

• Confirm engine room including father of SCIMP

• Migration issues

• Docman transfer completion

• Option appraisal for data extraction tool including future of PCCIU and PTI

• Adastra

REAL TIME TEST – Flu vaccination

And then - Community nursing, e pharmacy, dentistry, e care .... The world!

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Questions…

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QUESTIONS FOR YOU

• How can we increase the number of people in the room who feel they can influence the e Health agenda??

• The three main GP systems contracts are held by the NHS Boards – how much can we/ should we do at a national level?

• What are your priorities?• What are our CRAP issues?

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