portal technology joining up info for carers and patients april 2013

7/28/2019 Portal Technology Joining Up Info for Carers and Patients April 2013

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02 Portal technology - joining up information for carers and patients

About this paper

Last year the Department of Health launched the information strategy, ‘Power of Information:

putting all of us in control of the health and care information we need’, Intellect was invited to:

“prepare a compelling case demonstrating the benefits and value for money of secureonline portals and related solutions for patients, service users, local providers, andcommissioners of health and care services.”1

This paper aims to provide a comprehensive summary for the health and care community on whatportal technology is and can do, and how it can benefit carers, patients and providers.

This paper follows on from Intellect’s initial portal technology overview paper published alongsidethe launch of the Power of Information.2

The challenge to solve

Meeting the demands of the Operating Framework, the Quality, Innovation, Productivity andPrevention (QIPP) programme, and the aims of the Power of Information strategy will require moreintelligent use of information, better integration of care and more effective engagement ofpatients and their carers in the care process.

Portal technology can help a care community make better use of its existing investments in IT to

meet these challenges, rapidly deliver improved efficiency and higher quality care, and betterengage patients in their care.

1 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_134205.pdf 2 http://www.intellectuk.org/component/docman/doc_download/6073-the-case-for-portal-technology

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_134205.pdf


http://www.intellectuk.org/component/docman/doc_download/6073-the-case-for-portal-technology






Portal technology - joining up information for carers and patients 03

Proven and in use: current state of portal technology

Portal technology is not new. Throughout the NHS in England, Wales, Scotland and Northern

Ireland, as well as internationally, portal solutions are used every day, supporting patient care,facilitating workflows, improving clinical safety and healthcare outcomes.

The sophistication and therefore the functionality of a portal can vary widely. At their core portalsprovide a simple common entry point to multiple systems. Portals integrate the information held inunderlying source systems and the workflows managed by these systems. Portals can also improveaccessibility and navigation within source systems. Current portal solutions fall into three broadcategories:

Care based portals focus on a particular care need or condition by bringing together informationrelevant to that need or condition and supporting communication and joint working betweenhealth and care professionals, patients and carers.

Examples include Renal Patient Care – a patient centric portal for renal patients 3 and theEuropean-wide PALANTE project (PAtient Leading and mANaging their healThcare throughEHealth).4

Organisation based portals cover the activities of a single organisation (e.g. an acute or communitytrust, or care organisation). Healthcare professionals and patients within that organisation and theirpartners in care can access information and facilities in the portal.

Examples include Leeds Teaching Hospital5, Northumbria Healthcare NHS Foundation Trust6,Basingstoke7, West Hertfordshire8 and Rikshospitalet hospital in Norway.9

Community based portals cover a geographical health and care community providing access to

multiple systems and pulling together information across various health and care settings.A community portal can provide comprehensive support and a common point of access for allhealth and care professionals, patients and carers within the community.

Examples include South East Scotland10 and the Swedish national portal.11

3 http://www.renalpatientview.org 4 http://www.csamhealth.com/about-us/references 5 http://www.ychi.leeds.ac.uk/eHealthOS/storage/resources/Leeds%20Teaching%20Hospitals%20NHS%20Trus_approved.pdf 6 http://www.orionhealth.com/newsroom/press-releases/orion-health-helps-northumbria-healthcare-nhs-foundation-trust-deliver-an-enhanced-electronic-patient-record 7 http://public.dhe.ibm.com/common/ssi/ecm/en/wsc14289gben/WSC14289GBEN.PDF 8 http://www.westhertshospitals.nhs.uk/newsandmedia/mediareleases/2012/march/innovative_computer_system_launch.asp 9 http://www.csamhealth.com/about-us/references 10 http://www.ehealth.scot.nhs.uk/?page_id=224 also see EHI Interview with Martin Egan http://youtu.be/o543YA53Jbw 11 http://www-935.ibm.com/services/au/gbs/bus/html/healthcare/case/pdf/vpw_the_swedish_national_ehealth_portal.pdf

http://www.renalpatientview.org/


http://www.csamhealth.com/about-us/references


http://www.ychi.leeds.ac.uk/eHealthOS/storage/resources/Leeds%20Teaching%20Hospitals%20NHS%20Trus_approved.pdf



http://www.orionhealth.com/newsroom/press-releases/orion-health-helps-northumbria-healthcare-nhs-foundation-trust-deliver-an-enhanced-electronic-patient-record



http://public.dhe.ibm.com/common/ssi/ecm/en/wsc14289gben/WSC14289GBEN.PDF


http://www.westhertshospitals.nhs.uk/newsandmedia/mediareleases/2012/march/innovative_computer_system_launch.asp




http://www.ehealth.scot.nhs.uk/?page_id=224%20also%20see%20EHI%20Interview%20with%20Martin%20Egan%20http://youtu.be/o543YA53Jbw


http://www-935.ibm.com/services/au/gbs/bus/html/healthcare/case/pdf/vpw_the_swedish_national_ehealth_portal.pdf
















But portals can do much more

In all three above categories portals can offer varying degrees of integration falling in to two main

classes:

View – The portal pulls information together from disparate health and care systems andpresents it in a unified and intuitive view personalised to the needs of an individual or class ofusers.

View and do – As well as integrating information the portal integrates workflows and allows arange of actions or transactions to be initiated and managed in the portal

The majority of current portal deployments fall into the ‘view’ category. But, it is when portalshave ‘view and do’ functionality that the enhanced benefits of portal technology can be harnessed.Allowing online transactions, entering data, correcting data and feedback to underlying systemsdrastically improve patient care, creates a more holistic picture for care professionals and provide

huge business improvements in the form of improved clinical safety, efficiency and data quality.

The diagram below maps the outcomes and business improvements that can be achieved as thefunctionality of portals increases. The diagram also highlights the potential for return oninvestment (ROI) and the relationship between increasing portal scale and use across healtheconomies and an increase in ROI.

There are examples of ‘view and do’ portals in the NHS including Royal Liverpool and BroadgreenHospital12, and internationally at the Oslo University Hospital, Norway13.

See our case study digest at the end of this paper for more details on current portal deployments.

12 http://www.youtube.com/watch?v=hsQYZN5V7ko 13 http://www.csamhealth.com/about-us/references

http://www.youtube.com/watch?v=hsQYZN5V7ko








Benefits

A portal approach provides benefits to users across the care continuum. Below is a matrix of some

of the benefits users in the health care community can expect from using portal technology.


Benefits Patients Careprofessionals

Commissioners CIOs FDs/CEOs

Education andimprovedengagement

Audit/selfservice ability

Accessanywhereanytime

Improveddecisionmaking,co-ordinatedcare and a

positive impacton clinicaloutcomes

Improvedefficiency

Improvedinformation forcommissioningdecisions

Supportevolvinglandscape

Integratedifferent typesof information

Cost saving/ smaller upfrontinvestment

QIPPTarget/CQUINtarget



Patients

Education and improved patient engagement – Patients are able to access up-to-date and

relevant information to help them better understand their condition, the treatments they receiveand those involved in their care. Basic access to test result information, pointers to relevant andtrusted sources of information on a particular condition as well as recording variouscommunications with health care professionals can have a profound impact on care deliveryfrom the perspective of the patient and can help them to be a real part of their health andwellbeing.

Data quality and self-service - The additional functions of a ‘view and do’ portal can provide thepossibility of amending basic personal data e.g. change of address, or booking appointmentsand communicating with carers.

Access anywhere, anytime – Using this style of technology which is similar to other technologies

individuals use in their day-to-day lives, means increased flexibility as users fit it in around theirlifestyles.

Better clinical outcomes – Preliminary research shows that clinical outcomes can be improved byengaging patients through the use of portals by enhancing patient-provider communication,reducing inequity, improving clinical outcomes, and increasing access to care.14

Joined up care – By providing a single source of information for patients a portal can helpindividuals navigate through their pathway, which often span across several fragmented servicesand care settings, providing a smoother and simpler experience for patients and their family.

14 Shaw R and Ferranti J. Patient-Provider Internet Portals-Patient outcomes and use. Comput Inform Nurs. 2011 Jun 21

“RPV is amazing …

I can instantly accessmy data and show it to

my GP if I want to, it's

really reassuring”

Patient


“I am ever so

jealous that my

renal centre is not

on RPV”

Patient

“Thanks to the amazing

NHS, RPV... Bloods done 10.15

this morning. All results posted

on RPV by 3.30 - we are so

lucky in the UK.”

Patient



Care professionals

Improved decision making and coordinated care - Portals provide a platform to support

multi-disciplinary working in a patient-centric way that improves continuity of care throughbetter communication and information sharing. Portals make information available in real timeto support clinical decision making at the point of care and can beunrestricted by geographical or organisational boundaries,according to user needs.

Improved efficiency – With the reduction of duplicate dataentry and far more accessible patient information, healthcare professionals using portal technology today find it ishelping them be more efficient.

Improved patient safety – Through the removal ofduplicate or inaccurate information together with theability for alerts and flagging to be incorporated into thesystem clinicians can have increased confidence in thesystem. Portals also reduce the risk that often results fromfragmented communication between care professionals.


“It’s definitely good for Wales. We

recently had an International Advisory

Group (made up of healthcare expertsfrom around the world) view the portal.

It was great to see enthusiasm from people

outside Wales for what we’re doing. I’m a

proud Welsh woman so anything that shows

Wales off I’m keen to be involved in.”15

Dr. Llewellyn-Jones

“For a three and a half to four

hours clinic I can save 30

minutes of time so I can use

that time to either see more

patients or new patients.”18

Professor Patrick Chu,

Consultant Haematologist

Royal Liverpool andBroadgreen University

Hospitals NHS Trust

Now that I have the clinical

portal, I arrive in the clinic and I

don't see multiple volumes of

case notes and instead of

flicking through all pages in thecase notes I just look at the

screen.”17

Professor Patrick Chu,

consultant haematologist at

Liverpool

15 http://www.wales.nhs.uk/nwis/page/52575

16 http://www.ehi.co.uk/news/acute-care/7251/leeds-releases-portal-open-source-code 17 http://www.youtube.com/watch?v=hsQYZN5V7ko 18 http://www.youtube.com/watch?v=hsQYZN5V7ko

“[The Portal] system has been

invaluable to me as a lone worker,

and means I’m able to keep track of

patients. We no longer rely on ward

staff or carers to inform us about apatient being admitted. The system

has helped improved

communication between multi-

disciplinary team members.”24

Suzanne Goralik, CNS, Gynaecology,

Sherwood Hospital NHS Trust.

“I would welcome other

NHS trusts who are now

exploring the use of clinical

portals to consider building

on this open source effort

and work with the NHS to

progress this opportunity.”16

Dr Tony Shannon, clinical

lead for informatics at Leeds

Teaching Hospital

http://www.wales.nhs.uk/nwis/page/52575


http://www.ehi.co.uk/news/acute-care/7251/leeds-releases-portal-open-source-code












“The portal presents data from

underlying systems which theclinicians are familiar with, in an easy

‘iGoogle’ style format. Training has been

quick and simple and uptake by clinicians

has been astonishing. The proof of

concept exceeded all expectations and we

are now beginning to see those benefits

realised across the trust.21

James Norman, Director of IM&T

at Liverpool


“The appropriate sharing of

information across the region

will allow clinicians both in

the hospital and in the

community, to treat patients

based on shared knowledge.”

John Thornbury, ICT,

Worcestershire22

“I’d say the time difference to create

new data interfaces is as much as 20

times faster than using our previous

tools. We’ve reconfigured the system a

number of times — each time it took a

single day. If we had to do that

programmatically, it would take hundredsor thousands of hours.”

Dave Hextell, Head of Systems

Development, Heart of England Trust23

21 http://www.ehi.co.uk/news/ehi/7546/royal-liverpool-live-with-csc-portal 22 http://www.ehi.co.uk/news/acute-care/7341/worcestershire-goes-live-with-portal

23 http://www.orionhealth.com/special/campaign/heart-of-england-nhs-foundation-trust 24 http://www.orionhealth.com/index.php?option=com_remository&Itemid=130&func=startdown&id=90 25 http://www.orionhealth.com/index.php?option=com_remository&Itemid=130&func=startdown&id=89

“We have several major I.T.

projects planned over the next few

years, including upgrade of our PACS,

a new maternity system andTrust-wide scheduling. [The

solution] continues to evolve as a

product and we are confident that it

will continue to form a pivotal role in

successfully deploying these new

systems.”25

Jason Selby, Software Architect,

University Hospitals of Leicester

NHS Trust

http://www.ehi.co.uk/news/ehi/7546/royal-liverpool-live-with-csc-portal


http://www.ehi.co.uk/news/acute-care/7341/worcestershire-goes-live-with-portal


http://www.orionhealth.com/special/campaign/heart-of-england-nhs-foundation-trust


http://www.orionhealth.com/index.php?option=com_remository&Itemid=130&func=startdown&id=90











Finance directors and CEOs

Cost saving (cash releasing vs efficiency). Portals can provide immediate cash releasing benefits

through a number of mechanisms. This includes increasing the usage of source systems(increasing the return on investment of these systems); reducing reliance on paper notes whichhas a direct impact on storage, transport and staff costs; as well as having a direct impact on‘do not attend’ rates28, test utilisation decreases and more effective medication prescribingpatterns. In addition to these potential cash releasing benefits, efficiency savings linked directlyto the QIPP agenda also release clinician time which can be translated into financial savings.The technology can also help meet other targets including reducing re-admission rates due toimproved integration of information, shortening waiting times as a result of increased efficiencyof patient throughput as well as reducing potential risk of medico-legal liability as information isfully accessible and auditable. These concepts are explored in the benefits evaluation andrealisation section.

Data Quality and self-service - This can decrease administrative costs associated with episodes ofcare and improve accuracy of information on the care community.

QIPP Target/CQUIN target – portal technology does not require a large initial capital investmentcost as it often builds on existing infrastructure. Portal technology also drive various efficiencysavings and reduces duplication and waste within the system, providing a strong tool to helporganisations meet their QIPP and CQUIN targets, while at the same time improving clinical andpatient satisfaction.

Information as an asset – information within care settings is increasingly becoming a valuableasset which increases the more it is shared and utilised. Portal technology enables andencourages sharing information therefore leveraging information as an asset. Wheninformation is viewed and used as an asset its inherent value and its ability to generate value

for providers and commissioners increases.

“There is a clear need for

integrated IT systems in our

hospitals and this portal will

allow us to re-engineer our

clinical processes” Mike Baker, finance director,

Colchester Hospital

University NHS FT26


“The clinical portal is the keystone

in helping to lay solid foundations for the

trusts future. It is creating an effective and

efficient way to reduce costs and

administration, while speeding up and in-

creasing the throughput of patients and

aiding service transformation. Not only has

the portal allowed us to protect our existingIT investments but it has enabled us to align

ourselves with the government’s

interoperability agenda ensuring that our

systems are future proofed.”27

Tony Bell, Chief Executive of Royal

Liverpool University Hospitals NHS

26 http://www.ehi.co.uk/news/acute-care/7570/colchester-plans-%C2%A34.5m-portal

27 http://www.ehi.co.uk/news/ehi/7546/royal-liverpool-live-with-csc-portal 28 Horvath M et al. Impact of health portal enrolment with email reminders on adherence to clinic appointments: a pilotstudy. Journal of Internet Research. 2011, May 26:13 (2):e41

http://www.ehi.co.uk/news/acute-care/7570/colchester-plans-%C2%A34.5m-portal








Building a business case for portals

The benefits are clear and will vary depending on the care community it is being implemented in.

In addition to identifying the benefits that are applicable to the situation there are two furtheraspects that should be considered in order to make the most of portal technology:

1. Benefits evaluation and realisation 2. Dependencies

1. Benefits evaluation and realisation

Before commencing a portal project we strongly recommend that an organisation carries out abusiness value assessment to establish the quantifiable benefits. This can be resourced from withinthe organisation or working with an external partner.

In order to understand the return on investment, organisations must identify relevant metrics orparameters prior to the implementation of a portal and then conduct comparative measurementsbefore, and after implementation. Whilst this will never be an exact science, the ability to usemetrics outlined in the QIPP agenda and other cost/performance improvement programmesprovides the opportunity to demonstrate real ROI from portal technology.

Organisations should consider parameters in the following broad domains:


Cash releasing benefits These benefits are financial as they reduce costsor increase income for organisations.

e.g. reduction in cost for retrieving case notesfrom offsite storage.

Financial but non-cash releasing These benefits result from savings that can bemade in time and efficiency, but where it ismore difficult to have a financial value attached.It is however possible to potentially derivefinancial value from these benefits byre-deploying staff or reconfiguring servicesbased on efficiency savings.

e.g. the amount of clinic clerk time released bynot sourcing case notes and the value inincreasing the amount of time clinicians havefor seeing patients.

Quantifiable benefit These benefits can be quantified in terms of animprovement but cannot easily be translatedinto financial savings. Clinical outcomes couldbe considered in this domain and will result insavings to the health economy.

e.g. reduced emergency attendances/ambulanceconveyances or the value in increasing thepatient throughput in clinics.

Non-quantifiable benefits (non-QB) These benefits provide value to the Trustbut cannot be quantified as they relate to

improvements in people’s views, opinions orfeelings.



After defining these specific parameters in these domains, organisations can conduct baseline datacollection and then implement a continuous evaluation programme after deploying a portal.

A business case can be created using actual costs from the organisation together with expectedpercentage savings (based on reference sites and information available in academic literature). Thecashable saving can be calculated and compared with the installation, training and support costs.

In order to demonstrate the benefits derived from the deployment and use of portals within andacross organisations, key stakeholders must commit to developing and executing an effective andrigorous evaluation. (Note: This applies to any information or technology investment). Thisbusiness case should be revisited periodically to track benefits realisation and evidence to extendthe use of portal across the enterprise and out to partner organisations and patients.

2. Dependencies

There are certain factors that need to be considered when implementing portal technology andalthough not all of them can be solved within a single organisation they are aspects that need

consideration when building a business case.

Information Governance - There will be a need for much discussion on information governance andclinical governance matters. For example, for out-of-area information access there will be a needfor a ‘break-the-glass’ capability, to allow clinicians access to people with whom they do not have alegitimate relationship. However the technology is now there to be able to do this securely andefficiently without the need for information to be moved or stored outside traditional organisationboundaries as a result minimising some of the information governance issues.

In addition patients may want varying levels of access to their circle of care and although thetechnology is available to develop this consideration needs to be taken into account whendeveloping patient facing portals.

Effective information governance is still important, but must not be the ‘tail that wags the dog’.

ID management - There may well be person (patient and service user) identity issues, with some ofthem associated with limited or no access to the Personal Demographics Service (PDS).

There is much emphasis in England (and the UK more widely) on the use of NHS Numbers (andother UK equivalents). Indeed, the “any qualified provider” dictum, and current thinking aboutcommissioner/provider contracts, includes references to the pivotal role of NHS Numbers inensuring that information is joined-up, especially across organisation boundaries.

Intellect makes the point that there is a need for an enhanced interface to the PDS to facilitate thediscovery of NHS Numbers, and more widely that accreditation for access to Spine services must be

made much less cumbersome, time consuming and expensive. Intellect welcomes the work of theSpine Mini Service development and the pre-procurement engagement with the industry on thedevelopment of Spine2 to address this and will continue to work with the team to improve this infuture.




In this instance, organisations may also consider the use of specific technology to aid accuratepatient identification across boundaries. The specific technology that can assist organisations inmanaging patient identity is an electronic master patient index (eMPI).

Data quality – implementing a project like this can initially lead to the exposure of poor data qualityand this must be closely monitored. The information presented in the portal is only as good as thedata available in source systems. Organisations must be prepared to work hard to improve theirdata quality over a set timeframe to enhance end-user experience.

Integration - Legacy systems are not generally designed to put the person at the centre of things,as their primary focus is on the clinicians/clinics/specialties that they support. Therefore, this makesthe design of the portal - the goal of which is to be person-centric - more challenging.

In a large acute trust there can be scores of systems to ‘integrate’, and many may be very old and‘home grown’. This factor gets worse the more organisations involved. However, implementationproject managers and suppliers are now more used to this challenge, and experience shows thatthey can be overcome. A portal provides integration ‘at the screen’, providing a view of

information held in many separate systems. A deeper level of integration links the organisationsapplications and medical devices, automating the routing, customisation and transfer of data. Newservices or organisations can be quickly added.

Some integration engines can serve as an enterprise integration engine, a local integration engineor just as the interface between the Portal and the surrounding applications. Some portal solutionshave the capability to link into existing integration engines deployed by the client. It is critical thatorganisations understand their specific requirements and use cases as this will drive the type ofintegration approach.

Exploiting data - While integration engines provide various techniques to extract data fromunderlying systems in to a portal this process would be much facilitated if underlying systemsexposed API which allow 3rd party application to read and write to them and programmaticallymanage associated transactional services. It is likely to be difficult to get APIs developed on legacysystems that are no longer in active development but it should be possible where this is not thecase. In many situation NHS purchasers may wish to extend contracts for or re-procure existingsystems and they should take such opportunities to insist that in return for extended business thatthe existing system vendors provide, as far as is practical, suitable third party APIs.

Similarly, it is desirable to build portals that allow third parties to deliver apps or portlets thatextend the functionality of the portal and to this end the vendors of portal should be encourage toexpose APIs within the portal both to access portal data and functions, but also potentially as amore convenient and cost-effective way for third parties applications to interact with underlyingsystems.

Record location - Record location will be a key requirement, so that records for people outside thecaring organisation’s normal geographical area can be located and information retrieved, subject toagreed information governance rules. The technology already exists, in use in the US, and is to berolled-out in Southern Scotland. In the US and Scotland this works on the basis of the Integratingthe Health Enterprise (IHE) standard.29

A record locator service further enhances the functionality of a portal by streamlining the queries ofsource systems.

Standards - The industry agrees that standards are a good thing but it must also be noted that theycan be a barrier to both rapid progress and innovation. We would recommend ensuring that portalsolutions should adhere to a minimum set of standards (building on current standards wherever

possible so as not to re-invent the wheel) and this together with opening APIs should be thestarting point.

29 http://www.ehi.co.uk/news/acute-care/7251/leeds-releases-portal-open-source-code







Business change/cultural change - Portal technology has the possibility of revolutionising the way anindividual care setting, team or community do business as usual. Only by making changes to clini-cal practice and procedures generally can the significant benefits be realised. Therefore, it is vital todo business process reengineering (BPR) in concert with the development of the portal.

Standards and data requirements - There is strong demand from clinicians for this type oftechnology so the initial buy-in hurdle is no longer a real issue but they must be engagedthroughout to ensure they understand how best to reengineer what they are doing to fullyutilise the tool in a care setting.

The centre should work with industry to identify standards around portal approaches. A trueportal approach does not replicate data, but provides a view of data that exists in underlyingsystems. This approach satisfies multiple Information Governance considerations and therebyrepresents a more flexible and scalable model. This is important to consider when working acrosshealth and social care boundaries, and in broad geographical areas.

There is a need to define the minimum data items required in various care settings, and the way

that they are presented in the portals. There are good examples of this in Scotland and NorthernIreland:

Scotland: A comprehensive survey of all care professionals in NHS Scotland was conducted inorder to elicit what types of information should be available through portals. This resulted inthe buy-in of clinicians, general support for the idea of using portal technology to makeinformation available to support more efficient healthcare delivery and to improve patientsafety, and a firm basis for developing portals in Scotland.

Northern Ireland: The Evaluation Report on the Electronic Care Record Proof of Concept Project(HSCNI, Version 5, 21 Feb 2011) includes full details of the Minimum Dataset that wasimplemented, from the various ‘connected’ systems, and the User Roles with their access rights,all following an engagement exercise.

Based upon this kind of best practice, identified nationally, local care organisations can avoid thepitfalls of ‘reinventing wheels’, and make an easier start in implementing their own portals,whether wholly within organisations or across organisations.




Appendix 1 - case studies

Care based

Renal Patient Care – a patient centric portal for renal patients30

European-wide PALANTE project (PAtient Leading and mANaging their healThcare throughEHealth).31 The Norwegian component is a pilot to look at giving patients wider access to theirrecords and to help those with long term conditions manage them through access to specialisttools. It will involve 55,000 users spread over SE Norway, 5000 of these users are for the chronicconditions solution. Patients will have secure access and services such as appointment booking,self-test ordering, secure messaging, my medicines, my health account, discharge notes, etc.

Organisational based

Basingstoke32, trust covers a population of around 300,000 patients in Basingstoke, Tadley, Altonand Bordon, as well as surrounding towns and villages in north and mid Hampshire and westBerkshire - portal ‘integrates’ the ‘clinical five’: patient administration system that integrates withother systems and provides sophisticated reporting; a system that manages order communicationsand diagnostic reporting; a system that automates the creation of discharge letters with coding;a scheduling system; and a system for e-prescribing.

Leeds Teaching Hospital33, an open source software pilot developed with the help of an integrationservices provider, connecting five systems: iSoft’s PatientCentre PAS; the trust’s own PatientPathway Manager, which is used in the trust’s oncology department, and information fromapplications provided by Bluespier, Ascribe and EMIS.

Northumbria Healthcare NHS Foundation Trust34, went live with a clinical portal from Orion Health inNov 2011, as the first step towards establishing a full electronic patient record. This will allow

clinicians secure access to patients’ records, based on admissions and attendances, also presentingpathology and radiology reports, PACS images and discharge letters.

Oswestry - a very long standing development (13 years), that started with a clinical auditrequirement, and has been developed to meet the specific needs of the local healthcarecommunity.

Royal Liverpool and Broadgreen Hospital35, after a proof of concept exercise, now rolling outCSC/Harris’ clinical portal, using an interoperability product that provides a single view of data fromdifferent systems - based on the Harris s Fusionfx interoperability platform and is currently drawinginformation from the trust’s core clinical systems, such as the iPM PAS and Sunquest ICE electronicresults reporting and requesting.

West Hertfordshire36 “Making things work better” encompasses overcoming numerous systems,different suppliers, multiple logons and convoluted workflows - results in significant improvementsto clinical efficiency and patient journeys, and ultimate collaboration across health and care in theregion. The West Hertfordshire portal is based on the Harris Provider portal and Fusionfxinteroperability platform.

Worcestershire - Worcestershire Acute Hospitals NHS Trust also went live in Nov 2011 with aclinical portal from Orion Health - the key foundation for creating an integrated electronic patientrecord.

30 http://www.youtube.com/watch?v=hsQYZN5V7ko 31 http://www.youtube.com/watch?v=hsQYZN5V7ko 32 http://public.dhe.ibm.com/common/ssi/ecm/en/wsc14289gben/WSC14289GBEN.PDF 33 http://www.ehi.co.uk/news/acute-care/7414/derby-to-implement-carefx-portal34 http://www.ehi.co.uk/news/ehi/7546/royal-liverpool-live-with-csc-portal 35 http://www.ehi.co.uk/news/acute-care/7341/worcestershire-goes-live-with-portal 36 http://www.orionhealth.com/special/campaign/heart-of-england-nhs-foundation-trust








http://www.ehi.co.uk/news/acute-care/7414/derby-to-implement-carefx-portal










http://www.ehi.co.uk/news/acute-care/7414/derby-to-implement-carefx-portal






Community based

Colchester - lack of integration between trust systems means is cumbersome for clinicians to useand there is still considerable reliance upon paper records and manual re-keying of data - plan is tobuy an off-the-shelf solution - extending to GP practices in due course.

Greater Glasgow and Clyde - has 14.5K active users, providing access to about 200, 000documents per week (results, letters, pre-op assessments, etc), and more recently Theatre Sessionlists - integrates seamlessly with the new Trak implementation at IRH using patient context.

Heart of Birmingham PCT - aggregates information from existing systems across its healthcarecommunity to present a single, integrated care record at the point of care, using Graphnettechnology - allowing GPs and other care givers across Birmingham to gain access to radiology andpathology results, as well as activity around A&E, inpatient and outpatient attendances.

South East Scotland37 - starting with a pilot in an area covering four Health Boards in SE Scotland,and now being rolled-out across these four boards namely, NHS Lothian, NHS Fife, NHS Dumfries

and Galloway and NHS Borders. The solution is based on the Harris Provider portal and Fusionfxinteroperability platform. The solution pulls data from multiple underlying source systems andpresents them in a clinically intuitive unified view, leveraging Master patient index (MPI) and recordlocator service (RLS) technology.

Wales - still at the pilot stage, with national roll-out planned - using Scottish SCI Gateway (alsoused in Scotland, Wales and NI) as part of the integration solution.

Aintree University Hospitals NHS Foundation Trust - following a pilot phase in 2012, plans to morewidely roll out the McKesson Care Portal in 2013 to provide local GPs with real-time access toinformation held by the hospital in its Medway Electronic Patient Record. This will includeinformation on patient admissions and discharges, test requests and status, and wider hospitalnews38.

Colchester Hospital University NHS Foundation Trust - plans to pilot the McKesson Care Portal in2013 to provide a clear, coordinated, view of Medway PAS information that local GPs can use toimprove the patient experience and quality of care 39.

Whittington Health NHS Trust - in 2013 plans to pilot the McKesson Care Portal to provide a view ofMedway PAS information that local GPs can use to improve the continuity of care. The McKessonPatient Portal will also be piloted to provide patients with easy access to heath care informationabout them held by the Trust40.

International examples

Research Community - there are several examples of the research community using portals for

communicating information to patients about health outcomes, provider performance, and chronicdisease and treatment.

Spain - EHR portal links regional level records - has been in place regionally for some time.

Czech Republic - portal for e-Communication functionality for GPs.

EU generally - there is much e-Health activity going on in the EU, under the banner of the i2010Sub Group - part of this activity is about standards.

Oslo University Hospital, Norway41. Oslo University Hospital project has approximately 20,000 userswho are spread across 40 sites. The hospital constitutes about one third of the healthcareprovision in the South-east region of Norway.

37 http://www.ehealth.scot.nhs.uk/?page_id=224 also see EHI Interview with Martin Egan http://youtu.be/o543YA53Jbw 38, 39 & 40 http://www.mckesson.co.uk/ 41 http://www.csamhealth.com/references.aspx




http://www.mckesson.co.uk/


http://www.csamhealth.com/references.aspx







Rikshospitalet the largest cancer hospital in Norway42. Rikshopsitalet is the national hospitalof Norway, with advanced medical research and several specialised healthcare procedures.Rikshospitalet and Radiumhospitalet has merged into one hospital Rikshospitalet -Radiumhospitalet with two main hospitals and several locations. The Hospital had grown by theaccumulation of premises and centres. At the time it had 8,000 users, and was spreadgeographically in multiple hospitals, treatment centres across the city and in addition across anumber of locations within the Oslo county. The Portal solution has been in operation sinceOctober 2006.

Australia - as a component of the proposed national personally controlled electronic health record(PCEHR) system, the aim of conformant portals is to allow independently operated consumer-oriented portals to access the PCEHR System - provider portals link information for direct healthcarepurposes - a host of standards requirements will ensure that ‘the system’ works.

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Thanks to...

The paper was prepared by Intellect’s Healthcare Programme. Intellect wishes to thank all Intellectmembers who contributed to this paper, and particular thanks go to the following people for theirvaluable contributions:

Irfan Hassan, CSAM Dr Lloyd McCann, Harris Healthcare Solutions Mike Spradbery, IBM

42 http://www.csamhealth.com/about-us/references


Ewan Davis, Woodcote Consulting John Heavens, Orion Health

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mailto:[email protected]









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portal technology joining up info for carers and patients april 2013

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