Rotherham picks Meditech for EPR

1

Is this a planned DCR?

maryhawking@tigers.demon.co.uk

25 Mar 09 21:10

"The Rotherham chief executive added: “This fully integrated electronic patient record will cover the entire patient journey within and beyond the hospital, with links to primary, community, social and mental health care records.” "

Interesting.

As I understand it, Rotherham is very largely TPP in GP and Community - and flagged up the problems of this in 2007.

Has TPP agreed to do the necessary development to allow linked records?

"As part of the development of the EPR, Rotherham plans to offer patients the ability to access their own records online."

That might be interesting... would it allow patients to use the links to records outside the Trust?

Patient Access via PAERS is currently available in EMIS and, I think, IPS: I don't know about TPP.

*What about third party data especially in mental health?**

EHI, please try to get more information for those of us not in Rotherham!

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2

Mary, we'll do our best

jon@e-health-media.com

27 Mar 09 09:57

OK Mary,

 

Will do what we can.

In our defence, we have interviewed the chief exec, were first to announce the procurement was about to complete and broke the news that the contract had been awarded.  

Will see what we can find out on the areas you ask though.

Best regards

Jon Hoeksma

Editor, E-Health Insider

 

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3

Fully integrated vs best of breed

27 Mar 09 11:27

There seems to be a trend emerging that when Acute Trusts are able to procure their own EMR/HIS that they choose a fully integrated system rather than choosing to "integrate" best of breed systems.

I think this is the right thing to do (although some BOB functionality may be lost).

The UK BOB market probably needs more consolidation into larger fully integrated systems.

Maybe Cerner should consider integrating JAC Pharmacy into their Millenium offering and iSOFT/IBA Health should consider integrating Lorenzo with Ascribe Pharmacy?

Just a thought...

 

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4

Interoperability

angus.goudie@GP-A89021.nhs.uk

27 Mar 09 16:21

Will it be able to upload letters etc to the spine. To have any new systems without spine compliance at this stage would seem counterproductive.  Also will it be able to code / transfer data using SNOMEDCT. Lorenzo is designed as a native user of SCT, but Cerner has it as an option only (I believe) , so that users/ modules may well choose not to make use of that functionality.  I haven't heard  where Meditech and McKesson are positioned. 

If we want to get genuine transferable data of dent quality then we really need to beusing the tools that are are agreed as the NHS direction of travel for recording.

 

 

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5

re: Interoperability

27 Mar 09 19:22

Rotherham might be selective about how far they follow "the NHS direction of travel for recording"

CfH's commitment to HL7 Version 3 and SNOMED has contributed to delays in delivery of clinical functionality in NPfIT systems.

Having a field in your database which can accomodate a 64-bit integer is not all there is to implementing SNOMED - far less instantly confer between system interoperability.

Although subsets of SNOMED codes are creeping into some applications [in isolated pockets] they mostly depend on the maintenance of one-to-one maps with other coding systems or classifications. This begs an obvious question - why not use the other coding system or classification?

The NHS Drug, Medicines and Devices dictionary 'dm+d' (an extension of SNOMED but not dependent on it for many implementation purposes) is a little further advanced in its deployment. dm+d is a vital component of the NPfIT Electronic Transfer of Prescription Service - but even this is making slow progress.

SNOMED's (wider) ability to support local recording, decision support and reporting requirements better than existing terminologies / classifications remains signally unproven in the NHS.

Obviously the mapping approach is a start - but we don't know where we're heading! It's not like all the details are worked out. Fundamental ontological and technical / deployment questions remain to be answered.

It's not only a matter of system suppliers getting on the case: but say you're a system supplier and want to get on the case. The complexity of SNOMED is enormously greater than Read Codes. Read Clinical Terms CTV3 (whose complexity defeated all but a couple of GP System suppliers in the 1990's) came with 1.4 MB of pdf documentation. They weren't called subsets but arguably there were just two in CTV3 : Drugs and 'GP'.

SNOMED comes with 5.2 MB of pdf documentation (International Core alone) and now over 140 NHS subsets.

Meanwhile Read Version 2 (still used in 80% of GP Practices) came without documentation and one 'subset' (drugs).  Likewise ICD and OPCS IV "keep it simple, stupid".

As far as between system messaging / interoperability is concerned the picture is even hazier.  The NPfIT Message Implementation Manual comes in a zipped file (depending on which of the seven major versions you download) of between 20 and 50 MB!

"Unless we can formalise the mutual constraints ... HL7 v3 + SNOMED = Chaos.... The documentation is beyond human capacity ... to write or to understand" said Professor Alan Rector in 2006
http://hl7-watch.blogspot.com/2006/11/alan-rector-on-snomed-hl7-and-quality.html

Elsewhere he warns against
 
>>enormous resources [being] spent on over-ambitious plans for semantic interoperability that inevitably fail. In either case, communication will take place by going around rather than via the clinical information systems. In countries where it is mandated, SNOMED and HL7 V3 will become taxes on healthcare, absorbing significant resources while returning no, or in some cases negative, benefits.<< http://www.semantichealth.org/DELIVERABLES/SemanticHEALTH_D6_1.pdf

Three years on, working parties are still trying to "formalise the mutual constraints" - with OpenEHR since thrown into the mix.  Meanwhile the embryonic NHS Logical Health Record Architecture is promised to hold all this and more together.

It's hardly a trivial task. Should Rotherham or anyone else be holding their breath?

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6

Re: Interoperability

27 Mar 09 19:25

Not sure what the previous poster means by uploading letters to the spine. The main services that should ideally be integrated are PDS and Choose & Book (and possibly ETP?).

Re: SNOMED CT. This should certainly be considered among requirements. However, I am less sure it should trump all others. There will be many must-haves in the requirements, which are crucial to meeting the trust's objectives. A system that meets these, but not yet SNOMED, must be preferable to a system that will not enable the trust to meet its objectives but complies with a standard very few live systems currently comply with.

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7

Integrated Best of Breed Systems in UK

31 Mar 09 14:08

CCOW is the primary standard protocol in healthcare to facilitate a process called "Context Management." Context Management is the process of using particular "subjects" of interest (e.g., user, patient, clinical encounter, charge item, etc.) to 'virtually' link disparate applications so that the end-user sees them operate in a unified, cohesive way.

It is possible to have best of breed systems in a multivendor integrated health record. This is by adopting CCOW. Free SDK (software development kit) is available to suppliers to adopt CCOW (an HL7 standard). UK has a number of suppliers that cater to NHS with very good departmental systems (clinical letters/document management systems, pharmacy sytems, Electronic requesting systems, cardiology systems and the list goes on) which support patient flow within the NHS. I personally think this is a much better way of integrating the patient record rather than expecting a single monolithic EPR to perform all tasks. Adoption of CCOW as an NHS strategy will lead to improved patient safety in Clinical IT and also improve productivity in a tax funded health service. Implementation of Best of Breed systems is far easier than a large monolithic system. Future upgrade pathway will be simpler as well. There needs to be a chnge in the Strategic direction of Healthcare IT within NHS

http://www.pacsgroup.org.uk/forum/messages/2/41038.html?

 

Neelam Dugar

Chair of the UK PACS and Teleradiology Group.

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8

Monoliths are good for Stonehenge...

20 Apr 09 13:11

but not so good for healthcare (or IT in general) perhaps!

I fully agree with the previous poster. If for no other reason than the NHS itself if too complex and fragmented to consider a single application.

It is very clear, and has been from the start, that monolithic applications of this complexity are almost certain to fail.

The whole purpose of the SPINE, HL7, ebXML, etc. is to provide an infrastructure that does not need to be monolithic. In that essence it already works quite well as a broker for authentication, authorisation, basic patient information and patient bookings. These are successes that should be celebrated.

The monolithic applications though cannot keep up with the rapid rate of change required by the "business" of the NHS. The requirements are out-of-date before they are signed off and the designs even more so. Let alone the actual implementations.

Regards,

Julian Knight, IT Consultant