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Changing Clinical SoftwareChanging Clinical Software

Dr Colin BrownDr Colin BrownGeneral PractitionerGeneral Practitioner

SCIMP Director eRecordsSCIMP Director eRecords

SCIMP Conference SCIMP Conference Dunblane 2007Dunblane 2007

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Why are we doing this?Why are we doing this? Where are we starting from? Where are we starting from? Where are we going?Where are we going? How do we get there?How do we get there?

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Clinical System ChangesClinical System Changes Versions Versions referenced:referenced:

Ascribe Ascribe to Vision 3to Vision 3 EMIS PCS EMIS PCS to Vision 3to Vision 3

from GPASS 5x, Vision 3, EMIS LVfrom GPASS 5x, Vision 3, EMIS LV GPASS 5xGPASS 5x to EMIS PCS, GPass Clinical/2007, to EMIS PCS, GPass Clinical/2007,

Vision 3 Vision 3 from Torex HMCfrom Torex HMCiSoft Synergy from Meditel, PremiereiSoft Synergy from Meditel, Premiere

SystmOneSystmOne from EMIS LV, Vision 3from EMIS LV, Vision 3 Vision 3Vision 3 to GPASS 4xto GPASS 4x

from GPASS 4x, 5x, Seetec, Microtest, from GPASS 4x, 5x, Seetec, Microtest, EMIS LV, VAMP Medical EMIS LV, VAMP Medical

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WHY?WHY?GP systems are specialist engineered GP systems are specialist engineered

products with these unique functions:products with these unique functions: constructing a life-long record constructing a life-long record audit trail of all usersaudit trail of all users unconstrained scale and contentunconstrained scale and content structured to support computer processingstructured to support computer processing securitysecurity usable in front of patients in their 10 mins usable in front of patients in their 10 mins by any users in Primary Care Teamby any users in Primary Care Team

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Overall PlanOverall Plan

Pre-migration practice development statusPre-migration practice development status

- data quality issues- data quality issues

Data migration issuesData migration issues

Data freeze periodData freeze period

Go Live DayGo Live Day

New-system learning and design issuesNew-system learning and design issues

3rd-party issues 3rd-party issues

General and specific Lessons LearnedGeneral and specific Lessons Learned

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Practice development statusPractice development status SoftwareSoftware Hardware and systemHardware and system

- local, or remote Managed Technical Service- local, or remote Managed Technical Service- use of old system?- use of old system?- continuing use after GoLive? concurrent?- continuing use after GoLive? concurrent?

Business processesBusiness processes TrainingTraining

- what are the training needs?- what are the training needs?- IT training - IT training - Specific new-system training- Specific new-system training

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Data quality Data quality pre-migration pre-migration

Codes – standard?Codes – standard? - Read versions 2 and 3, SNOMed- Read versions 2 and 3, SNOMed

FreetextFreetext Drug dictionaryDrug dictionary data – another data – another

migration?migration?Issues - “OP”, ADRs, BAN/RINN, custom Issues - “OP”, ADRs, BAN/RINN, custom drug items, old scriptsdrug items, old scripts

Metadata: Metadata: “data about data” “data about data” e.g. Non-standard system admin data e.g. Non-standard system admin data PrioritiesPriorities Recalls Recalls ReviewsReviews

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Pre-migration PlanningPre-migration Planning: : phone a friend phone a friend ask the audienceask the audience

1 - access the UG1 - access the UG2 - the patients - involve them2 - the patients - involve them3 - check with occasional team users 3 - check with occasional team users

split the optionssplit the optionsHB support staff?HB support staff?

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Data MigrationData Migration

Extraction of data from old database Extraction of data from old database Conversion of the extracted data to new databaseConversion of the extracted data to new database

format, and of old to new data types.format, and of old to new data types.Quality Assurance.Quality Assurance.

Conversion accuracy? Conversion accuracy? Coded and Uncoded data Coded and Uncoded data InPS - 2 utilities provided InPS - 2 utilities provided EMIS - these functions built in to the main EMIS - these functions built in to the main

softwaresoftware

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Data FreezeData FreezeDatafreeze? =Datafreeze? =

when your old data has gone for conversion, when your old data has gone for conversion, and your new system isn’t working yet to and your new system isn’t working yet to use the converted datause the converted data

BUT - your old system is still working… So…..BUT - your old system is still working… So…..

Computer Downtime - Is there any need for Computer Downtime - Is there any need for this?this?

NO ………….. (mostly) NO ………….. (mostly)

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Go Live DayGo Live DayHints and Tips from Supplier Hints and Tips from Supplier

Business Continuity Plan – as if Business Continuity Plan – as if paperless paperless

No routine surgeries, clinicsNo routine surgeries, clinics Print-offs for the datafreeze periodPrint-offs for the datafreeze period Hardware and system configuration Hardware and system configuration

on siteon site

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Data Melt = copying back data from Data Melt = copying back data from the freeze. the freeze.

You've got to do this? - not You've got to do this? - not necessarily so…necessarily so…

Clinical value is max. if sooner not Clinical value is max. if sooner not later.later.

A technological fix?A technological fix?

Post-GoLive datafreeze updatePost-GoLive datafreeze update

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New System Learning 1New System Learning 1

Function re-modelling Function re-modelling - Predict the functions to be changed…. to Predict the functions to be changed…. to

anticipate how your new system will work anticipate how your new system will work differently and re-model your business differently and re-model your business processesprocesses

- Original s/w method of delivering a Original s/w method of delivering a function may not be the only wayfunction may not be the only way

- Version-specific not brand-namesVersion-specific not brand-names

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New System Learning 2 New System Learning 2

Design issuesDesign issues e.g. e.g. on-the-fly coding on-the-fly coding Keyboard use Keyboard use Appointments Appointments Better Display > Data Quality issuesBetter Display > Data Quality issues

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3rd Party Issues3rd Party IssuesDocmanDocmanLabeltraceLabeltraceSCI Gateway SCI Gateway (2nd Opinion)(2nd Opinion)

SCI StoreSCI Store (web access)(web access)

Managed ServerManaged Server

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General Lessons LearnedGeneral Lessons Learned

Clinical - specific benefitsClinical - specific benefits Detailed Pros/Cons – per userDetailed Pros/Cons – per user

Practice Management - similar challenges?Practice Management - similar challenges? Summarising for training status Summarising for training status Lloyd George to A4Lloyd George to A4 Going paperlight Going paperlight Changing premisesChanging premises Changing partnersChanging partners Changing or new jobChanging or new job

Combine some of these?Combine some of these?

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DO - LISTDO - LIST #1 - for Suppliers #1 - for Suppliers online connectivity on Go Live Dayonline connectivity on Go Live Day √√ share the Drug Dix / coding migrationsshare the Drug Dix / coding migrations √√ improve handling of non-coded dataimprove handling of non-coded data implement post-GoLive datafreeze updateimplement post-GoLive datafreeze update consider appointments migrationsconsider appointments migrations customise migration advice for “donor” systemcustomise migration advice for “donor” system custom-configure the initial setup of new custom-configure the initial setup of new

systemsystem guarantee access to archive data + audit trailsguarantee access to archive data + audit trails

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DO - LISTDO - LIST #2 - for NHS Board IT Depts #2 - for NHS Board IT Depts Original s/w + h/w: keep liveOriginal s/w + h/w: keep live √√ Prescription mapping: pharmacist supportPrescription mapping: pharmacist support

√√ Share local expertise in new processesShare local expertise in new processes

√√ Test install /configure s/w on hardware Test install /configure s/w on hardware

platform platform beforebefore Go-Live. Go-Live. Archive data + audit trails: contract with Archive data + audit trails: contract with

suppliers to retain legibilitysuppliers to retain legibility custom data quality fixes pre-migration: custom data quality fixes pre-migration:

support GMS IT Facilitatorssupport GMS IT Facilitators

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DO - LISTDO - LIST #3 - for #3 - for UsersUsers custom benefit lists for each usercustom benefit lists for each user prepareprepare engage your local friendly new-engage your local friendly new-

system user to check out your test system user to check out your test data.data.

engage your patientsengage your patients access all UG supportaccess all UG support

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DO - LISTDO - LIST #4 - for #4 - for Scottish NHSScottish NHS

Share lessons from GP2GP project Share lessons from GP2GP project

on migrating data between systems on a on migrating data between systems on a per-patient basisper-patient basis

Develop GP2GP v2Develop GP2GP v2

A standard intermediate data format for A standard intermediate data format for migrations?migrations?

Connect to….. Connect to…..

Connecting for HealthConnecting for Health

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DON'TDON'T ( (= specific "errors of = specific "errors of commission“)commission“)

SuppliersSuppliers Change the GoLiveDayChange the GoLiveDay Use non-standard pseudo-Read codesUse non-standard pseudo-Read codes Health BoardsHealth Boards

Strip kit needed for original s/w to run Strip kit needed for original s/w to run UsersUsers

Leave it all to the leaderLeave it all to the leaderGo on Holiday!Go on Holiday!

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THE ENDTHE END

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www.visioneer.pbwiki.comwww.visioneer.pbwiki.com

colin.brown99@nhs.netcolin.brown99@nhs.net