« Previous | Contents | Next »
Listen
Coronary Heart Disease and Stroke in Scotland
7 Information Technology and the Development and Use of Databases
Strategy Recommendations
Establishment of systems of data collection, storage and management which will support the development and monitoring of CHD and stroke services and meet the Quality Assurance needs of MCNs.
Adoption of nationally agreed datasets with standard definitions.
7.1 The long term vision for Information Management and Technology (IM&T) is to implement electronic integrated patient records which support clinical and social care. This is realistically a 10 year goal. We currently have many stand alone audit databases, patient/client administration systems, and local clinical systems. These were developed individually to address specific tasks, but they make it difficult to maintain a fully accessible record for each patient as they move from one part of the service to another.
7.2 The CHD and Stroke Strategy set a three year target of building a primary care led database of CHD and stroke in Scotland which would meet similar quality standards to the Scottish Cancer Register.
CHD and Stroke Audit
7.3 In the first year of the Strategy, funding was provided to support the roll out of CHD audit tools across Scotland. Resources for the equivalent of 11.5 'G' Grade nurse audit facilitators were made available to NHS Boards operating Catheter Laboratories to improve the quality and completeness of revascularisation and cardiac surgery databases and, in the longer term, to develop quality assurance programmes for broader datasets.
7.4 The Scottish Care Information Programme (SCI) is developing common datasets for various conditions. This is not a straightforward process as customers for the data have different data needs and often seek to record additional, non-core variables. Thought has therefore to be given to the practicality of collecting the data, much of which will be gathered in a hospital setting. Managed Clinical Networks are involved in defining the datasets which must be relevant to clinicians as well as providing useful audit data. Building on the work completed for the SCI Clinical dataset, a minimum dataset for patients with acute coronary syndromes (SCI CHD) has been agreed and Tayside Centre for Clinical Technology has been commissioned to develop a web based data repository. Data collection is being piloted in three NHS Boards to provide information from which to build a full implementation plan across Scotland.
7.5 The new GMS contract for Primary Care provides opportunities for improved information flows. Tayside (HEARTS), Argyll and Clyde, and Greater Glasgow NHS Boards have well developed pilot projects which collect data to describe the patient pathway in CHD and stroke. Work is in train to integrate these datasets to provide a national primary care database.
CASE STUDY
NHS Tayside HEARTS - MCN Tayside has recently entered an exciting time for CHD IT developments with the release of the HEARTS database. HEARTS - MCN is a new, web-based system which offers users many more functions. It has the benefits of links to the national CHI (Community Health Index), it can offer secondary care investigation results per practice, has an enhanced GMS Contract page and now also covers angina. The new system is based on the widely used and stable national SCI-DC (Diabetes) Network system, and offers similar functionality. The system is fully secure and password protected, and has been designed to be used by both primary and secondary care clinicians. When a clinician logs in, the system will automatically recognise whether the clinician works in primary or secondary care and the system functions will be attuned to the particular user. The obvious benefit of the HEARTS - MCN system is the full integration of the patient journey. This means that clinicians can see all the relevant information about their patient collated in the one location and this leads, ultimately, to improved patient care. For example, all the information from primary care systems such as GPASS and from secondary care sources such as Tayside biochemistry results or the most recent ECHO or CCU result is available from one safe, secure, central location. HEARTS - MCN can even display discharge letters for secondary care or allow the users to view the most recent GMS Contract information for their particular practice. Undoubtedly, this integrated approach to the issues surrounding the sharing of information is a definite step in the right direction. It will have a real benefit for patients as the consultant will have access to the data from the GP practice, and the General Practitioner will be able to see the hospital's input. Such a system has great potential and developments will continue in the future under the guidance of the CHD Managed Clinical Network. For further information contact:
mandy.andrew@tpct.scot.nhs.uk |
National CHD and Stroke Strategy Websites
7.6 The Scottish Executive Health Department has established two new web sites for the dissemination of information on the CHD and Stroke Strategy:
7.7 The web sites provide a background to the launch of the Strategy; provide information on the committee structures in place to manage the implementation of the CHD and Stroke Strategy and give details of the various projects supported by Strategy funds.
CASE STUDY
Information Management and Technology Practice Information Services (ISD), part of NHS National Services Scotland, is working towards a national dataset for both CHD and stroke, covering all aspects of the patient's journey of care. Better information will support better patient care and help to plan services for the future. ISD's approach is to work with clinicians, managers, patients and MCNs towards agreement on what should be collected, and they help to provide the tools to gather the data. ISD has produced nationally agreed datasets for CHD hospital patients, including a subset for acute coronary syndromes, and is currently working on a dataset for cardiac rehabilitation. They have achieved agreement on a core dataset to be part of all data collections on CHD patients. The experience they have gained will soon be used in work towards national datasets for stroke patients. ISD staff are supporting the collection of data on CHD and stroke patients. This includes the work of the Scottish Coronary Revascularisation Register, new data on acute coronary syndromes and improving patient data already collected through ISD's existing systems covering all hospital inpatients and day cases. ISD is making good use of the data that they hold to support the Scottish Executive and MCNs. Data are regularly produced and include mortality and incidence of CHD and stroke, numbers of patients treated in hospital and procedures received, GP prescribing, and on the effect of deprivation on mortality and provision of care. Data are made available to clinicians, managers and policy makers through ISD's CHD and stroke section in the Scottish Health Statistics website:
www.isdscotland.org |
« Previous | Contents | Next »