Dr Hugh Sanderson
Head of Clinical Information Development, South Central SHA

The Hampshire Clinical Repository: Using legacy clinical systems to provide a shared clinical record

The Hampshire Clinical Repository is a shared clinical record which holds extracts of GP and hospital records and which can be accessed via NHSNet. Access is password controlled and users must have the consent of the patient before they open the record.

The system contains GP and hospital information on about 750,000 patients from 110 GP practices and laboratory, radiology, discharge and clinic letters from Winchester, Southampton and Portsmouth Trusts.

The record is used in out of hours settings by GPs, A&E departments and Emergency Medical Assessment Units. In addition, the records are often used by GPs to find the results of laboratory tests during in patient or outpatient visits. An additional function is it's use for the collection of Single Assessment Records jointly between Health and Social Services.

The presentation will describe the data sources, confidentiality and security controls as well as examples of the application, both as a clinical record and as a source of joined up information about the quality of clinical care.

Lynn Woods
Chief Executive, Adastra Software

Lynn co-founded Adastra with software author James Berry in 1994.  He had previously enjoyed a 16-year career in the Royal Air Force, leaving as a Squadron Leader in 1988.  In 1992 Lynn was appointed to manage the SEADOC GP Co-operative based in Folkestone.  As SEADOC expanded to eventually cover a 70-mile strip of the south coast as far west as Brighton it became evident that an operational software capability was needed to manage activity over such a wide area, and thus Adastra came into being.

Integrated Out-of-Hospital Services - Progress Under Radar

Over the last 20 years, out-of-hours primary care services have passed through a dramatic process of evolution.  GP Co-operatives were very successful in demonstrating the merits of collaboration.  That example has been furthered by the integration of community teams, minor injuries and walk-in centres, and now by the introduction of a primary care filter in some A&Es.

Following the transfer of responsibility for OoH care from GP to PCT, there are 90 "operational hub" services managing out-of-hours and urgent care across all of the UK.  These schemes are now embarking on a further surge of development as hub operations are able to concentrate focus and resource to respond to PBC, long term and intermediate care, referrals management, and other sum-of-the-whole imperatives.  At strategic level their potential has yet to be fully recognised, yet their engagement will be central to deployment next year of the GP summary record.  In this presentation we will look at evolution of the operational hub and information flows it will attract, and distribute.

Lt Cdr Mark Trasler MBE RN
Staff Officer Medical Informatics, Fleet Medical Division, Portsmouth

Mark Trasler is the Royal Navy lead for the implementation of electronic clinical records throughout the Defence Medical Services.

Serving in the Royal Navy Medical Branch since joining as a young sailor 36 years ago, Mark has worked in both primary and secondary care and on numerous ships and military deployments all over the world.  A biomedical scientist by background, he has a MSc in Healthcare Information Management and has been employed in clinical informatics (either full or part-time) over the past 15 years with a leading role the policy formulation, development and introduction of many healthcare record and telemedicine initiatives.  He was awarded an MBE in this year's Honours List for services to Defence Healthcare.

DMICP - Clinical Information, Anytime, Anywhere

The Defence Medical Information Capability Programme (DMICP) is a major IS-enabled Business Change programme currently being implemented within the UKs Defence Medical Services worldwide.  Based on the concept of a centralised electronic healthcare record, DMICP will address the numerous capability gaps highlighted as a result of recent operations.  For the first time, the current medical/dental/hospital record will be available wherever it is needed, including at sea and on deployment, and management will have central visibility of clinical activity.  Interfaces with the NHS will help reduce treatment time and with MOD personnel systems to facilitate health protection.  DMICP will be briefly described and the presentation will discuss policy development, business change, clinical template design and benefit realisation.

David Crook
Subset Development Project Manager, SNOMED in Structured Electronic Records Programme, NHS Connecting for Health

David Crook is a director of Medical Mosaic Ltd. David has worked in health informatics for over 17 years focusing on process driven IT implementation in health and social care. In particular David is specialising in how SNOMED CT can be implemented and used to transform and support clinical processes. Currently David is nationally managing subset development (within the NHS Connecting for Health SNOMED in Structured Electronic Records Programme), which is key to ensuring consistency and ease of usage of SNOMED operationally.  David previously has undertaken leading edge work in understanding and testing the analytical capabilities of SNOMED CT including its ability to automatically derive classification data as a feed into Payment by Results (PbR).

Implementing a Clinical Terminology

A clinical terminology is not implemented for its own sake, but to support healthcare processes as part of a package providing a longitudinal patient record. This has both technical and cultural aspects. Understanding and defining the how the terminology fits into the technical infrastructure (user interface, record architecture and messaging) is essential to ensure information is meaningful and interoperable. Equally for any implementation to succeed it needs to be owned by clinicians through establishing and realising the benefits that will accrue from the use of a coded terminology. Understanding, defining and communicating these benefits are therefore essential to successful implementation, as part of the modern electronic record.

Clare Skidmore
Telecare Project Manager, Kent County Council

Clare Skidmore trained in Social Work at York University and subsequently worked in the voluntary sector supporting people with learning difficulies to develop their self-advocacy skills.

Since 2004, Clare has been Telecare Project Manager at Kent County Council, and is now also the Telecare lead for KCC on the Whole System Demonstrator programme. 

Since November 2006 Clare has also worked part-time at the Care Services Improvement Partnership as Programme Manager for the 2007/8 round of the DH Extra Care Housing Fund. 

Clare will be speaking in her Kent County Council capacity.

Telehealth and Telecare: Towards Service Integration and User Empowerment

• A brief history of Telehealth and Telecare in Kent including policy backgroun
• Overall benefits of both - for users and patients, staff and the whole system
• Key challenges and complexities
• Particular challenges relating to data generation and management
• Case studies
• Whole system demonstrator in Kent
• Our vision for the future

Patrick Sachon
Health Programme Manager, Met Office

Pilot of a Direct to Patient Health Forecasting System in Cornwall

Met Office and Medixine with funding from Cornwall Social Care and PCT piloted an automated Health Forecasting Service in Cornwall during winter 2006-07. The pilot involved 9 practices and 447 people with COPD.

The service alerted people with COPD, using automated telephone calls, to periods when there was an elevated risk of illness. The call was interactive and asked patients two evidence based questions. The system relayed their answers to their GP Practice for follow up.

Practices that used the service reduced COPD admission rates by 52% when compared with the previous year. A survey of patients who used the system showed that 89% thought the calls were helpful.

James Jackson
Managing Director, SmartSensor telemed Ltd

A virtual laboratory for health informatics

Terry Burgess
Healthcare Solutions Team, IBM UK Ltd

Terry Burgess works for the IBM Global Services Healthcare team focusing on eHealth. Graduating from Manchester University with a PhD in Psychophysiology, he has worked in a sales and marketing capacity for most of his career in domestic and international companies ranging from market research, medical instrumentation, computer software and hardware. For the last eight years he has worked for the IBM Software Group on Information Management.

Telehealth Perspectives: Delivering on the Promise

In recent years the rise of telemedicine, using mobile technologies for pervasive healthcare, has made remote monitoring for chronic disease management a clinical and commercial reality. Most elderly citizens live with a chronic illness and most of these conditions require monitoring. Benefits to be gained through remote patient monitoring solutions include more effective patient recovery at home, hospital staff relieved of monitoring duties to concentrate on acute medicine, reduced costs, improved patient safety and patient-centric healthcare. The presentation will review market information including some remote patient monitoring systems, interoperability considerations, use examples of IBM’s national and international telehealth assets and will stress the importance of delivering on the promise of the technology through stakeholder alignment, effective delivery and implementation.

Dr Marilyn McGee-Lennon
Senior Research Fellow, University of Glasgow

HECTOR - Evaluation of a PDA based clinical handover system

Aim: To evaluate a handheld computer system being used in practice by emergency care nurses to facilitate clinical handover, patient management and clinical audit.

Method: The evaluation was carried out over a four-week period in the three NHS hospitals using conventional mixed methods, specifically questionnaires and follow-up interviews with the HECT nursing staff users of the handheld computer system.

Results: The handheld computer system has been successfully implemented to support hospital at night teams. In addition it was found that the system was perceived by the team as having significant value in particular to facilitate hospital handover and clinical audit without having unacceptable impact on time or perceived workload. 

Dr Lynsey Woodward
Specialist Registrar in Anaesthetics. Southampton University Hospitals NHS Trust

The use of BEDALERT system for respiratory rate monitoring

In the presentation I will review the importance of measuring respiratory rates in a clinical setting and present two studies that describe the validation of a novel radar-based breathing rate measurement device (BEDALERT) in a manikin and human volunteers.

Prof Gary Smith
Consultant in Critical Care Medicine, Portsmouth Hospitals NHS Trust

Gary Smith is a Consultant in Critical Care Medicine at Portsmouth Hospitals and a Visiting Professor at the University of Bournemouth. He has previously spent one year on the faculty of Yale University. He has served as a council member of the UK Intensive Care Society and has been involved with educational projects focused on “the recognition and management of the deteriorating patient” at the Royal College of Surgeons of England and the Royal College of Physicians of London. He is co-designer of the ALERTâ course, which in over 200 hospitals internationally. Gary currently serves as a member of the Executive Council of the Resuscitation Council (UK) and has been a member of the recent National Institute for Health and Clinical Excellence, National Patient Safety Agency and Department of Health committees, which have focused on “the recognition and response to patient deterioration in hospital”. Gary is currently leading a team of researchers which has developed a hand-held computer-based system for the early recognition of sick or deteriorating patients and is investigating novel, vital signs monitoring devices.

Using technology to identify patient deterioration and facilitate the response to acute illness

Many in-hospital cardiac arrests, unanticipated admissions to Intensive Care Units and hospital deaths are preceded by patient deterioration in the form of simple physiological abnormalities such as low blood pressure, raised breathing rate or reduced peripheral oxygen saturation (SpO2). Despite this, there is often a failure by healthcare staff to measure basic observations of vital signs, a lack of recognition of the importance of worsening vital signs and a delay in responding to deteriorating vital signs.

Dr Mike Bainbridge
Clinical Architect, Technology Office, NHS Connecting for Health

He is currently leads the Clinical Architecture team at NHS Connecting for Health (NHS CFH). This team is delivering innovations in hardware design, clinical interface design and interfaces for the citizen to their own medical record. As a former General Medical Practitioner and medical informatics expert, Mike brings a unique insight to the national programme

Mike previously held the position of chairman of the Primary Health Care Specialist Group of the British Computer Society. He currently sits on the Editorial Board for the Journal of Informatics in Primary Care.

Through his work for the NHS in England, Mike continues to advocate both patient safety and clinical utility and to demonstrate its relevance and use in an international forum.

Collecting data near to the patient: the CfH perspective