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22 July 2014

National Docman Conference 2014 #Docman

National Docman

Conference 2014Docman: 10 years in ScotlandDr. Colin Brown

GP Glasgow, SCIMP



2003-4: Docman for all GP practices in Scotland

• Central funding

• Included training

• Key work for nGMS IT facilitators

• Conversion program for those using other

suppliers e.g. Criffel, EMIS, InPS

• Rapid upgrade of all practices to “paperlite”

• Supported by www.scimp.scot.nhs.uk and

www.microtechsupport.co.uk


Docman makes it easy to customise the several

names that can be given to each document:

The Document Naming sequence is

• Document Type

• Organisation (Location)

• Specialty

All these are configurable: here are the options in

our practice for our local DGH

Naming the documents


Custom names for documentsDoc type Location / care setting


Specialty:


Introducing a standard Folder Name:


47 National Folder Names


• Not customisable

• Useable for our filing clerks

• National agreement on Names 2005

• National standard, so may be mandated

• Software upgrade to user interface to mandate

the user to select and apply a

National Folder Name 2006

Key features of new Folder Names


“The nice thing about standards is that there are so many to choose from” Andrew S Tanenbaum

"Those are my principles, and if you don't like them...

well, I have others." Groucho Marx

The presence of a mandated National Folder Name is independent of any other local custom names for

the document.

Standardisation of this list of names (index) enables its automatic use in other standard contexts

Standards…..


Accident &

Emergency

Include Accident and Emergency letters

ExcludeGP Out of hours contacts Out of hours)

Administration

IncludeGeneral practice administrative paperwork, letters from patients, Benefits agency letters and

requests, Insurance reports and requests. Criminal justice reports

Exclude

Scanned clinical GP notes (Clinical)

Scanned nursing notes (nursing)

Employment medicals (Occupational Health)

Allergy

Include Allergy clinic

ExcludePatch testing (dermatology)

RAST results (Labs)

Breast

Include Breast clinics, breast screening services

ExcludePlastic surgery (Plastics)

Genetic clinics (Genetics)

CardiologyInclude

Cardiology, paediatric cardiology, cardiovascular risk factor clinics, cardiac surgery, thoracic

surgery, ECG, ETT

Exclude Thallium scans (Imaging)

Clinical

Include Scanned clinical GP notes

ExcludeGeneral practice administrative paperwork, letters from patients (Administration)

Scanned nursing notes (nursing)

Complementary

medicine

IncludeHomoeopathy, chiropractic, osteopathy, herbal medicine and any other complementary medication.

Acupuncture except given as part of a physiotherapy programme or at pain clinic

Exclude Acupuncture given as part of a physiotherapy programme or at pain clinic (Pain)

Dental / Max-

Fac

IncludeCommunity dentistry; oral medicine and surgery; orthodontics oral pathology; maxillofacial

surgery

Exclude Plastic surgery (Plastics)

DermatologyInclude

Dermatology, paediatric dermatology, including patch testing and excisions carried out by

dermatologists

Exclude Excision carried out by plastic surgeons (Plastics)

DieteticsInclude General dietetic services as well as diabetic, nephrology and nutritional support services.

Exclude Specialist multidisciplinary obesity services (general medicine)


Update proposed 2014 (sample)

Imaging

Include Clinical radiology, ultrasounds, DEXA and nuclear medicine imaging

ExcludeInterventional radiology (Vascular), EEG (Neurology)

Nuclear medicine laboratory results, e.g. C13 urea, Schilling tests (Labs)

Immediate

Care

Include

Ambulance, other “999”, First Aid or voluntary services

Out of Hours contacts with GP-, CMHT- and Nurse-led services

NHS24 contacts and letters to NHS24

111 contacts

Other national or international variants of these services

ExcludeA&E, Community Nurse-led service contacts (Nursing)

International specialties equivalent to specialties listed here

Infectious

Diseases

Include

Infectious diseases, including HIV and AIDS, including paediatric infectious diseases

Specialist immunisation notifications

Infectious disease and tropical medicine reports

Exclude Pulmonary tuberculosis (Respiratory)

Labs

Include

All biochemistry, haematology, bacteriology and serology results, other Medical physics.

Nuclear medicine laboratory results (C13 urea, Schilling tests). Blood grouping reports.

Exclude

Radiology results, nuclear medicine imaging including bone scans and DEXA (Imaging)

Biopsy and post mortem results (Pathology)

Cervical cytology results (Pathology)

Neurology

IncludeNeurology, neurosurgery, neurophysiology, paediatric neurology, neuromuscular, EEG,

EMG

ExcludeNeuro-psychology (Psychology)

Spinal and head injury rehabilitation (Rehabilitation)


GP Practice only e.g. proposal to rename OOH folder

“Immediate Care” – a new name to expand the scope of the Out of Hours folder to include various other new services from providers of healthcare directly to patients such as NHS24 (now operating both In and Out of Hours) and with urgency ranging from 999 calls to advice by the new 111 services, and services ranging from familiar local ones to those of international travel.

These new services were creating new uncertainties for their best filing destination*, and it was considered that “Immediate Care” would capture both the direct access and speed of these services whatever the service provider or location.This therefore replaces the folder named “Out of Hours”

* - note this addresses only the context of GP Practices

Context of the National Folder nameset


• PSD’s Project development re possible roles in

scanning and archiving of records, as extension

of role with deceased/embarked/untraced and

Armed Forces records.

• Accreditation? for true paperless users after a

managed process for selective back-scanning

• Avoid Print outs? for paperlite practices

• Audit trails: investigate persistence

• GP2PG issues re transfer processes?

• serial transfer is full or incremental?

2006 issues


• started 2007 in Ayrshire and Grampian

• completed Scotland-wide in 2009

• except for 3 practices in Scotland

If receiving practice doesn’t use Docman – who

does the printing? - not the GPs, but

Practitioner Services Dept. do

• non-standard filetypes?

• cross-border traffic for England, Wales and NI.

Deployment issues


Promotional Summary for D2D in 2008

Features Benefits

One-time Indexing Effective indexing due to universal standard

Automatic transfer between sites - immediate access for current “live” clinician

- follows the patient between practices

- practice staff and clinicians love it

- looks like an integrated NHS to the new patient

All Primary Care covered in Index de-duplicates admin work across NHS

so community clerical staff will love it too

Indexing only

- clinical content untouched.

Data Quality 100% copy of original

Compatible with other data types ANY data can be converted to paper and scanned;

most can also be imported directly into Docman.

Scalable to national cover Shareable staff training by national orgs.


• export Docman files for deceased patients?

• QOF 8wks-to-summarise starts when?

• use of eLinks background data transfer service

• has eLinks run?

• clear out the Docman Archive folder?

• opening an archived record

• comments are not transferred

• including SCI Gateway referrals in export

Transfer of documents FAQ 2008


• Hospital specialty letters

• Community letters

• Lab results

• Referral letters

- automatically linked from SCI-Gateway

- imported as .html file (web-format)

• Any other documents: ad-hoc direct scans

• GP system record?

How complete is Docman record? - 1


Addition of GP system record as a document:

How to avoid printing out and re-scanning?

• InPS Vision, EMIS PCS, Ascribe and iSoft had “export

whole record as document” options

• is “the whole record” the Data Protection Summary?

• GPASS work-around used Virtual Print Drivers to create a .pdf of the print output

• deployment of Virtual Print Drivers:- by nGMS IT facilitators

- by GPs per SCIMP website instructions

Complete GP record - 2


• eLinks background automatic transfer system

• transports all NHS claims e.g. ons/offs

• star network topology, not peer-to-peer

• 3 Regional offices of PSD

• operates overnight

• QoS-like Priority scheduling for GP records

• “Docman Transfer” deployment 2009

Automatic transfer


FULL PATIENT RECORDS

We would encourage GP Practices to create a wholly electronic Full Patient Record by adding the GP System Record to Docman before export.

This should be filed in the:

National Filing Folder Name - ClinicalDescription – GP System RecordOrganisation – Exporting Practice Name and Practice Code

This can now be done directly, without printing.

For individual system instructions on how to do this, see:

http://www.scimp.scot.nhs.uk/eRecords_docman.html

Otherwise, GP Practices should print out the GP System Record and

scan into Docman before exporting

Standard Operating Procedures: example


D2D issues


GP2GP solutions

England GP2GP v1.1 Scotland D2D

Transport Spine eLinks

Network topology Peer-to-peer Star to 3 regions of PSD

QA By sender By PSD using MedEx

Initiation Pull by new practice Push from old practice

GP system data HL7 TIF. MDI or JPG

Documents TIF TIF

GP Data: Doc reln. Attachment Inline

Metadata HL7 XML

Destination exceptions By practice By PSD

Cross-border By practice By PSD


Scotland’s GP2GP(S)

England GP2GP v2 Scotland GP2GP(S)

Transport Spine eLinks

Network topology Peer-to-peer Star to 3 regions of PSD

QA By sender By PSD using MedEx

Initiation Pull by new practice Push from old practice

GP system data HL7 HL7

Documents TIF TIF

GP Data: Doc reln. Inline Special document

Metadata HL7 XML

Destination exceptions By practice By PSD

Cross-border By practice By PSD


Naming the Specialties / Care SettingsDocman

name

ISD Specialty name + code other common Specialty names

Endocrine/

Diabetes

A8 Endocrinology & DiabetesA81 Endocrinology

A82 Diabetes

Paediatric Endocrine & Diabetes

Osteoporosis Clinic

ENT C5 Ear, Nose & Throat

(ENT) Paediatric ENT

Gastro-

enterology

A9 Gastroenterology Liver Transplant

General

Medicine

A1 General Medicine ITU Discharge to Physician Care

Specialist Multidisciplinary Obesity

General

Surgery

C1 General Surgery

C11 General Surgery

(excl Vascular)

C3 Anaesthetics

ITU Discharge to Surgeon Care

Minor Surgery

Genetics A3 Clinical Genetics Family History Cancer Care Clinic

Geriatrics AB Geriatric Medicine Geriatric Day Hospital

Specialist Falls Clinic


Note how Docman has shown how multiple

indexes can include Document Type and Care

Setting.

An index of these 2 types of data-about-data, or

“metadata” can be made valid across all Care

Settings,

Now comes The Principle:

Connecting it all up - 1


“An index of Document Type, and an index of

Care Setting, are sufficient to support automatic

transfer of Document Types across all Care

Settings on a national scale”

• approved by Professional Record Standards

Board

• in application for British Standard approval

• other indexes still valid for local use within own

Care Setting.



“To conform to the standard a document management

system would need to hold one entry from each of the lists as an instance of metadata relating to each

individual document in its store.

From that metadata it would then be possible to construct

a standard name in the form:

“Care Setting”:“Document Type”

e.g. if Care Setting = Gynaecology

and Document Type = Discharge Letter

then Name = Gynaecology Discharge Letter.



Maintenance of DocType and Care Setting lists:

each maintained as Snomed subset by

UK Terminology Centre

England RFCs to

https://isd.hscic.gov.uk/rsp-snomed/user/guest/home.jsf

Scotland RFCs via Clinical Document Reference Group



• Admin efficiency saving persists throughout a document’s lifespan in NHS– documents become portable between Care Settings with no

further admin action

– make document indexing a one-time action at document creation: “Index-at-Source”

– use EDT - use Docman Hub

• All suppliers can support interoperability of documents by conforming to The Standard– enables GPSoC support?

– can include documents from Social Care

• Data Quality 100% with digital copies of documents

• Looks like an Integrated NHS to the patient

Benefits


The End

[email protected]

[email protected]

www.scimp.scot.nhs.uk